Tags

Type your tag names separated by a space and hit enter

Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study.
JMIR Hum Factors. 2018 Sep 25; 5(3):e24.JH

Abstract

BACKGROUND

Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care.

OBJECTIVE

The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs.

METHODS

This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data.

RESULTS

We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation.

CONCLUSIONS

We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.

Authors+Show Affiliations

School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada. Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada.Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States.Faculty of Medicine, Université Laval, Ville de Québec, QC, Canada.Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.Population Health and Optimal Health Practices, CHU de Québec Research Centre, Université Laval, Ville de Québec, QC, Canada. Faculté de pharmacie, Université Laval, Ville de Québec, QC, Canada.Healthcare Navigators, Toronto, ON, Canada.Faculty of Medicine, Université Laval, Ville de Québec, QC, Canada.Patient Partner, Toronto, ON, Canada.Lazaridis School of Business and Economics, Wilfrid Laurier University, Waterloo, ON, Canada.School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30274959

Citation

Mercer, Kathryn, et al. "Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study." JMIR Human Factors, vol. 5, no. 3, 2018, pp. e24.
Mercer K, Burns C, Guirguis L, et al. Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR human factors. 2018;5(3):e24.
Mercer, K., Burns, C., Guirguis, L., Chin, J., Dogba, M. J., Dolovich, L., Guénette, L., Jenkins, L., Légaré, F., McKinnon, A., McMurray, J., Waked, K., & Grindrod, K. A. (2018). Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR Human Factors, 5(3), e24. https://doi.org/10.2196/humanfactors.9891
Mercer K, et al. Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR human factors. 2018 Sep 25;5(3):e24. PubMed PMID: 30274959.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. AU - Mercer,Kathryn, AU - Burns,Catherine, AU - Guirguis,Lisa, AU - Chin,Jessie, AU - Dogba,Maman Joyce, AU - Dolovich,Lisa, AU - Guénette,Line, AU - Jenkins,Laurie, AU - Légaré,France, AU - McKinnon,Annette, AU - McMurray,Josephine, AU - Waked,Khrystine, AU - Grindrod,Kelly A, Y1 - 2018/09/25/ PY - 2018/01/19/received PY - 2018/06/24/accepted PY - 2018/04/23/revised PY - 2018/10/3/entrez PY - 2018/10/3/pubmed PY - 2018/10/3/medline KW - collaboration KW - electronic health records KW - interprofessional collaboration KW - medication management KW - shared decision-making SP - e24 EP - e24 JF - JMIR human factors VL - 5 IS - 3 N2 - BACKGROUND: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. OBJECTIVE: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. METHODS: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. RESULTS: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. CONCLUSIONS: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach. SN - 2292-9495 UR - https://www.unboundmedicine.com/medline/citation/30274959/Physician_and_Pharmacist_Medication_Decision_Making_in_the_Time_of_Electronic_Health_Records:_Mixed_Methods_Study_ L2 - https://humanfactors.jmir.org/2018/3/e24/ DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.