OBJECTIVE To ascertain the opinions of family physicians about medication adherence in patients .... list the top 5 reasons they believed were responsible for.
Research Web exclusive
Collaboration between family physicians and community pharmacists to enhance adherence to chronic medications Opinions of Saskatchewan family physicians Tessa Laubscher
MB ChB CCFP FCFP
Charity Evans Dave Blackburn
PhD
Jeff Taylor
PhD
Shari McKay
MA
ABSTRACT
OBJECTIVE To ascertain the opinions of family physicians about medication adherence in patients with chronic diseases and the role of community pharmacists in improving adherence to chronic medications, as well as their opinions on increased collaboration with pharmacists to enhance medication adherence. DESIGN A self-administered postal survey of 19 questions, with opinions collected by ordinal (5-point Likert scale) and open responses. SETTING Saskatchewan. PARTICIPANTS Two hundred and eighty-six family physicians working in Saskatchewan in January 2008. MAIN OUTCOME MEASURES Descriptive statistics of physicians’ opinions on the following: medication adherence in patients with chronic diseases; their current interaction with community pharmacists; and potential collaborative strategies to promote medication adherence. RESULTS The response rate was 39.4%. Approximately 75% of the physicians acknowledged that nonadherence to chronic medications was a problem among their patients. Medication costs and side effects were identified as the 2 most common reasons for medication nonadherence. Only one-quarter of physicians communicated regularly with community pharmacists about adherence issues; most of these physicians were rural physicians. Most physicians agreed that increased collaboration with pharmacists would improve adherence, although support for potential interactions with pharmacists varied. Concerns were expressed about time required by physicians and financial reimbursement. Physicians in practice for less than 10 years and those practising in rural areas were more willing to share clinical information and communicate with pharmacists to promote medication adherence. CONCLUSION Saskatchewan family physicians appreciate the importance of medication nonadherence but currently seldom interact with community pharmacists on this issue. They believe that pharmacists have a role in supporting patients with medication editor’s key points adherence and indicate a willingness to work more • The purpose of this study was to obtain family collaboratively with them to promote adherence. For physicians’ opinions on medication adherence of this type of collaboration to be effective, it appears patients with chronic diseases. It aimed to deterthat increased adherence-related communication mine if physicians and community pharmacists between the 2 health care providers and additional interacted in order to facilitate medication adherhealth care funding are required. •
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This article has been peer reviewed. Can Fam Physician 2009;55:e69-75
ence, collecting physicians’ opinions as to whether such collaboration might be appropriate. Saskatchewan family physicians believed that community pharmacists had a role in supporting patients with medication adherence; however, they seldom communicated with pharmacists about this issue. Physicians reported a willingness to work more collaboratively with community pharmacists to promote medication adherence.
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Collaboration entre les médecins de famille et les pharmaciens communautaires pour accroître la fidélité à l’égard des médicaments utilisés pour le traitement des maladies chroniques Opinion des médecins de famille de la Saskatchewan Tessa Laubscher
MB ChB CCFP FCFP
Charity Evans Dave Blackburn
PhD
Jeff Taylor
PhD
Shari McKay
MA
Résumé
OBJECTIF Vérifier l’opinion de médecins de famille sur la fidélité des malades chroniques à leur médication, sur le rôle des pharmaciens communautaires dans l’amélioration de la fidélité aux médicaments utilisés pour le traitement des maladies chroniques et sur la possibilité qu’une collaboration accrue avec les pharmaciens puisse puisse favoriser cette fidélité.
TYPE D’ÉTUDE Enquête postale auto-administrée comportant 12 questions, les opinions étant recueillies sous forme de réponses ouvertes ou chiffrées (échelle de Likert à 5 points).
CONTEXTE Saskatchewan. PARTICIPANTS Un total de 281 médecins de famille exerçant en Saskatchewan en janvier 2008. PRINCIPAUX PARAMÈTRES ÉTUDIÉS Statistiques descriptives de l’opinion des médecins sur la fidélité des malades chroniques à leur médication, sur leur interaction courante avec les pharmaciens communautaires et sur les stratégies de collaboration susceptibles de favoriser la fidélité aux médicaments prescrits. RÉSULTATS Le taux de réponse était de 39,4 %. Environ 75 % des médecins reconnaissaient que la fidélité aux médicaments utilisés pour le traitement des maladies chroniques était problématique chez leurs patients. Les 2 causes les plus fréquentes de non fidélité étaient le coût des médicaments et les effets indésirables. Seulement un quart des médecins communiquaient régulièrement avec des pharmaciens communautaires au sujet de problèmes de non-fidélité au traitement. La plupart des médecins estimaient qu’une meilleure collaboration avec les pharmaciens communautaires améliorerait la fidélité, quoique l’appui à l’égard d’éventuelles interactions avec les pharmaciens était variable. Les inquiétudes concernaient le temps exigé des médecins et le remboursement financier. Ceux qui avaient moins de 10 ans de pratique et ceux qui exerçaient en milieu rural étaient plus disposés à Points de repère du rédacteur partager les informations cliniques et à communiquer • Cette étude voulait connaître l’opinion de médecins avec les pharmaciens pour favoriser la fidélité. CONCLUSION Les médecins de la Saskatchewan sont conscients des problèmes de non-fidélité aux médicaments prescrits, mais en réalité, ils interagissent rarement avec les pharmaciens communautaires à ce sujet. Ils croient que les pharmaciens ont un rôle à jouer pour favoriser la fidélité des patients et se montrent disposés à collaborer davantage avec eux dans ce but. Pour que ce type de collaboration soit efficace, une meilleure communication médecinspharmaciens et un financement additionnel de la part des services de santé paraîtraient nécessaires.
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Cet article a fait l’objet d’une révision par des pairs. Can Fam Physician 2009;55:e69-75 e70
de famille sur la fidélité à la médication chez les malades chroniques. Elle cherchait à déterminer si les médecins et les pharmaciens communautaires travaillaient de concert pour favoriser la fidélité au traitement pharmacologique, en demandant aux médecins si ce type de collaboration leur semblait approprié. Les médecins de la Saskatchewan estimaient que les pharmaciens communautaires pouvait participer à la promotion de la fidélité des patients à leur médication; toutefois, ils communiquaient rarement avec les pharmaciens à ce sujet. Les médecins se disaient prêts à collaborer davantage avec les pharmaciens communautaires pour favoriser la fidélité à la médication.
Canadian Family Physician • Le Médecin de famille canadien Vol 55: december • décembre 2009
Collaboration between family physicians and community pharmacists
T
he World Health Organization defines adherence as “the extent to which a person’s behaviour— taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.” 1 Nonadherence to medications is a considerable barrier to the successful management of chronic diseases, such as diabetes, hypertension, coronary artery disease, osteoporosis, and asthma,1-5 and is responsible for suboptimal clinical outcomes, decreased quality of life, and increased expense to the health care system.1,6-10 Numerous patient-related factors influence medication adherence, including individual patient perceptions and beliefs, knowledge about the disease and role of medications, and the complexity and cost of treatment regimens.2-5,11,12 It has been suggested that enhancing medication adherence through cost-effective interventions would likely have a greater effect on the health of patients with chronic diseases than any improvement in specific medical therapies.1,13 Therefore, health care providers should be encouraged to work collaboratively for the purpose of improving medication adherence.14 Many studies have demonstrated improved adherence to chronic medications with pharmacist-led interventions2-4,15-17 or with physicians and pharmacists collaborating in formal teams.18-20 However, the extent of family physician–community pharmacist collaborations to improve medication adherence in real-world settings is unknown, and there are no published studies looking at the opinions of these health care providers in regard to working together to enhance medication adherence. The purpose of this study was to obtain the opinions of family physicians or general practitioners regarding medication adherence in patients with chronic diseases. In addition, we aimed to determine if physicians and community pharmacists currently interact to facilitate medication adherence, and to solicit opinions from physicians as to whether such collaboration might be appropriate. This study is part of a research program looking at establishing a novel model of practice to enhance medication adherence in typical community pharmacy settings.
Methods The study was conducted in early 2008, with purposive sampling of all family physicians or general practitioners working in family practice or primary care clinics in the province of Saskatchewan. A current list of names and addresses of family physicians or general practitioners licensed in the province was obtained from the College of Physicians and Surgeons of Saskatchewan. Physicians working primarily in hospital settings (eg, emergency, palliative care, critical care) or administration were
Research
excluded. A questionnaire, with a cover letter and stamped return envelope, was sent to each of the 747 physicians, with a second mailing 6 weeks later to all nonrespondents. The study collection period closed 12 weeks after the initial mailing. A sample size calculation was not required given that the entire physician population was surveyed. The questionnaire was designed with input from all research team members because an existing survey capturing the 3 study objectives (ie, physician opinions regarding medication adherence, physician opinions regarding the potential role of pharmacists in medication adherence, and the current level of collaboration with community pharmacists regarding medication adherence) could not be found. Demographic information included the type and location of medical practice, number of years in practice, and accessibility of community pharmacies. The questionnaire was revised after pilot-testing by 7 family physicians in the Department of Academic Medicine at the University of Saskatchewan in Saskatoon. The final questionnaire contained 19 questions. Opinions were collected using 5-point Likert scales and open responses. Research ethics board approval was obtained from the University of Saskatchewan. Descriptive statistics were calculated for all questions. Analysis was carried out using χ2 and ANOVA (analysis of variance) tests, as appropriate. All statistical analyses were performed using SPSS, version 15.0 for Windows.
RESULTS A total of 747 questionnaires were initially mailed, and 307 questionnaires were returned. Thirteen questionnaires could not be delivered to the intended recipients and 8 physicians stated that the questionnaire was not applicable to them, resulting in 286 of the 726 questionnaires (a response rate of 39.4%) available for analysis. The demographics of the respondents are reported in Table 1. Most physicians either partially (171 of 285 [60.0%]) or strongly (50 of 285 [17.5%]) agreed that nonadherence to chronic medications was a problem for their patients. Most physicians (247 of 284) either usually (54.6%) or always (32.4%) assessed for adherence in their patients. However, the process used to evaluate adherence was not determined. Physicians were asked to rank from a list the top 5 reasons they believed were responsible for medication nonadherence in their patients. Medication cost was ranked number 1 most often (39.6% of respondents); medication side effects (actual or perceived) was the next most commonly identified reason for nonadherence (Table 2). Almost all respondents (276 of 284 [97.2%]) believed that community pharmacists had a role in promoting
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Collaboration between family physicians and community pharmacists
Table 1. Demographics of respondents: N = 286.* Demographics
Table 2. Total number of times respondents ranked a reason for patients’ nonadherence to medication as a “top 5” reason
N (%)
Location of practice,† N = 286 •
Rural (population
