Medical and pharmacy students’ attitudes towards physician-pharmacist collaboration in Kuwait

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Keywords

Students, Pharmacy, Medical, Education, Interprofessional Relations, Communication Barriers, Attitude of Health Personnel, Surveys and Questionnaires, Kuwait

Abstract

Objective: To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait.

Methods: A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p<0.05.

Results: The response rate was 82.4%. Respondents had overall positive attitudes towards physician-pharmacist collaboration. Pharmacy students expressed significantly more positive attitudes than medical students (p< 0.001). Medical students rated the three most significant barriers to collaboration to be: pharmacists’ separation from patient care areas (n=100, 70.0%), lack of pharmacists’ access to patients’ medical record (n=90, 63.0%) and physicians assuming total responsibility for clinical decision-making (n=87, 60.8%). Pharmacy students’ top three perceived barriers were: lack of pharmacists’ access to patients’ medical record (n=80, 84.2%), organizational obstacles (n=79, 83.2%), and pharmacists’ separation from patient care areas (n=77, 81.1%). Lack of interprofessional education was rated the fourth-largest barrier by both medical (n=79, 55.2%) and pharmacy (n=76, 80.0%) students.

Conclusions: Medical and pharmacy students in Kuwait advocate physician-pharmacist collaborative practice, but both groups identified substantial barriers to implementation. Efforts are needed to enhance undergraduate/postgraduate training in interprofessional collaboration, and to overcome barriers to physician-pharmacist collaboration to advance a team approach to patient care.

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References

1. Hepler CD. The future of pharmacy: pharmaceutical care. Am Pharm. 1990;NS30(10):23-29.

2. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.

3. Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc (2003). 2005;45(5):566-572.

4. Nace DK, Grundy P, Nielsen M. Patient-centered primary care collaborative (PCPCC). The patient-centered medical home: integrating comprehensive medication management to optimize patient outcomes resource guide, 2nd ed. Washington, DC: PCPCC; 2012.

5. American Society of Hospital Pharmacists. ASHP statement on pharmaceutical care. Am J Hosp Pharm. 1993;50:1720-1723.

6. Al-Taweel D, Awad A, Johnson BJ. Pharmacists’ contributions to the delivery of pharmaceutical care to patients with type 2 diabetes in Kuwait. Int J Diabetes Dev Ctries. 2014;34(2):108-115. doi: 10.1007/s13410-013-0169-4

7. Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ. Pharmaceutical care: past, present and future. Curr Pharm Des. 2004;10(31):3931-3946. doi: 10.2174/1381612043382521

8. Martin-Calero MJ, Machuca M, Murillo MD, Cansino J, Gastelurrutia MA, Faus MJ. Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des. 2004;10(31):3969-3985. doi: 10.2174/1381612043382549

9. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, Bates DW. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267-270. doi: 10.1001/jama.282.3.267

10. Kuo GM, Buckley TE, Fitzsimmons DS, Steinbauer JR. Collaborative drug therapy management services and reimbursement in a family medicine clinic. Am J Health Syst Pharm. 2004;61(4):343-354.

11. Carter BL, Ardery G, Dawson JD, James PA, Bergus GR, Doucette WR, Chrischilles EA, Franciscus CL, Xu Y. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med. 2009;169(21):1996-2002. doi: 10.1001/archinternmed.2009.358

12. Hammad EA, Yasein N, Tahaineh L, Albsoul-Younes AM. A randomized controlled trial to assess pharmacist- physician collaborative practice in the management of metabolic syndrome in a university medical clinic in Jordan. J Manag Care Pharm. 2011;17(4):295-303. doi: 10.18553/jmcp.2011.17.4.295

13. Tallian KB, Hirsch JD, Kuo GM, Chang CA, Gilmer T, Messinger M, Chan P, Daniels CE, Lee KC. Development of a pharmacist-psychiatrist collaborative medication therapy management clinic. J Am Pharm Assoc (2003). 2012;52(6):e252-e258. doi: 10.1331/JAPhA.2012.11215

14. Hirsch JD, Steers N, Adler DS, Kuo GM, Morello CM, Lang M, Singh RF, Wood Y, Kaplan RM, Mangione CM.Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244-1254. doi: 10.1016/j.clinthera.2014.06.030

15. Gattis WA, Hasselblad V, Whellan DJ, O'Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Arch Intern Med. 1999;159(16):1939-1945. doi: 10.1001/archinte.159.16.1939

16. Cranor CW, Bunting BA, Christensen DB. The Asheville project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173-184. doi: 10.1331/108658003321480713

17. Katoue MG, Awad AI, Schwinghammer TL, Kombian SB. Pharmaceutical care education in Kuwait: pharmacy students' perspectives. Pharm Pract (Granada). 2014;12(3):411. doi: 10.4321/s1886-36552014000300002

18. Awad A, Al-Ebrahim S, Abahussain E. Pharmaceutical care services in hospitals of Kuwait. J Pharm Pharm Sci. 2006;9(2):149-157.

19. Katoue MG, Awad AI, Schwinghammer TL, Kombian SB. Pharmaceutical care in Kuwait: hospital pharmacists' perspectives. Int J Clin Pharm. 2014;36(6):1170-1178. doi: 10.1007/s11096-014-0013-z

20. Matowe L, Al-Kandery AS, Bihzad SM. Pharmacy in Kuwait. Am J Health Syst Pharm. 2003;60(15):1591-1592.

21. Kheir N, Al Saad D, Al-Naimi S. Pharmaceutical care in the Arabic-speaking Middle East: literature review and country informant feedback. Avicenna. 2013;2. doi: 10.5339/avi.2013.2

22. Van Winkle LJ, Fjortoft N, Hojat M. Validation of an instrument to measure pharmacy and medical students' attitudes toward physician-pharmacist collaboration. Am J Pharm Educ. 2011;75(9):178. doi: 10.5688/ajpe759178

23. Hojat M, Spandorfer J, Isenberg GA, Vergare MJ, Fassihi R, Gonnella JS. Psychometrics of the scale of attitudes toward physician–pharmacist collaboration: A study with medical students. Med Teach. 2012;34(12):e833-e837. doi: 10.3109/0142159X.2012.714877

24. Hojat M, Gonnella JS. An instrument for measuring pharmacist and physician attitudes towards collaboration: preliminary psychometric data. J Interprof Care. 2011;25(1):66-72. doi: 10.3109/13561820.2010.483368

25. Seselja-Perisin A, Mestrovic A, Klinar I, Modun D. Health care professionals' and students' attitude toward collaboration between pharmacists and physicians in Croatia. Int J Clin Pharm. 2016;38(1):16-19. doi: 10.1007/s11096-015-0215-z

26. Garber JS, Madigan EA, Click ER, Fitzpatrick JJ. Attitudes towards collaboration and servant leadership among nurses, physicians and residents. J Interprof Care. 2009;23(4):331-340. doi: 10.1080/13561820902886253

27. Hansson A, Arvemo T, Marklund B, Gedda B, Mattsson B. Working together--primary care doctors' and nurses' attitudes to collaboration. Scand J Public Health. 2010;38(1):78-85. doi: 10.1177/1403494809347405

28. Al-Wazaify M, Matowe L, Albsoul-Younes A, Al-Omran OA. Pharmacy education in Jordan, Saudi Arabia, and Kuwait. Am J Pharm Educ. 2006;70(1):18.

29. Matowe L, Abahussain EA, Al-Saffar N, Bihzad SM, Al-Foraih A, Al-Kandery AA. Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait. Med Princ Pract. 2006;15(3):185-189. doi: 10.1159/000092179

30. The World Health Organization, 2010. Framework for action on interprofessional education and collaborative practice. Available from: http://www.who.int/hrh/nursing_midwifery/en/ (accessed 15 April, 2016).

31. Zargarzadeh AH, Jacob S, Klotz RS, Khasawneh FT. Clinical pharmacists and basic scientists: do patients and physicians need this collaboration? Int J Clin Pharm. 2011;33(6):886-894. doi: 10.1007/s11096-011-9562-6

32. Gallagher RM, Gallagher HC. Improving the working relationship between doctors and pharmacists: is inter-professional education the answer? Adv Health Sci Educ Theory Pract. 2012;17(2):247-257. doi: 10.1007/s10459-010-9260-5

33. Aston SJ, Rheault W, Arenson C, Tappert SK, Stoecker J, Orzoff J, Galitski H, Mackintosh S. Interprofessional education: a review and analysis of programs from three academic health centers. Acad Med. 2012;87(7):949-955. doi: 10.1097/ACM.0b013e3182583374

34. Cameron A, Rennie S, DiProspero L, Langlois S, Wagner S, Potvin M, Dematteo D, LeBlanc V, Reeves S. An introduction to teamwork: findings from an evaluation of an interprofessional education experience for 1000 first-year health science students. J Allied Health. 2009;38(4):220-226.

35. Anderson ES, Lennox A. The Leicester Model of Interprofessional education: developing, delivering and learning from student voices for 10 years. J Interprof Care. 2009;23(6):557-573. doi: 10.3109/13561820903051451

36. Keller ME, Kelling SE, Cornelius DC, Oni HA, Bright DR. Enhancing practice efficiency and patient care by sharing electronic health records. Perspect Health Inf Manag. 2015;12:1b.