Alicia Ault

April 09, 2015

Physicians and pharmacists are natural teammates but they need to invest time in developing and nurturing their relationships to leverage each other's skills to deliver high-quality, efficient, patient-centered care.

This was the message delivered at the American Pharmacists Association (APhA) 2015 Annual Meeting in San Diego by Reid Blackwelder, MD, and Brian Cross, PharmD, from East Tennessee State University in Johnson City.

Fractured communication, historic perceptions that the responsibilities of physicians and pharmacists belong in different silos, and problems sharing health information have all impeded team-based care, said Dr Blackwelder.

This fragmentation has led to poor outcomes and a lack of patient-centered care, he told Medscape Medical News.

Although physicians are responsible for medication reconciliation, pharmacists might have a better idea of what the patient is actually taking, said Dr Blackwelder. The physician only knows what the patient reports, whereas the pharmacist knows what prescriptions are filled, and if the patient is getting prescriptions from multiple doctors.

Complementary Roles

"You have to recognize that some team members have unique education, skills, and training," Dr Blackwelder said. "We need to make sure that the right people are doing the right job in the right place."

The fastest way for pharmacists and physicians to collaborate is to get to know each other and to "assume good intent," he explained.

"The time you spend creating a face-to-face connection, or connection over the phone, inevitably saves you time down the road," he told Medscape Medical News.

For example, if a pharmacist picks up the phone to speak with a physician, instead of being irked, the physician should "assume this is to help your patient do better," he noted.

And if pharmacists understand the doctor's viewpoint, they will likely feel more comfortable approaching the physician with requests.

At East Tennessee State University, pharmacists are "embedded" in the residency program, said Dr Blackwelder.

Embedded Pharmacists

For patients attending the warfarin clinic, pharmacists conduct medication reconciliation and manage the therapy. "I now have someone in my office who can do that and is better trained," Dr Blackwelder said.

Pharmacists are also involved in the transition of care. An office-based team — comprised of third-year family medicine residents, a clinical pharmacy faculty member, a social worker, an attending physician, and sometimes a pharmacy resident — evaluates each patient within a week of discharge. The physician comes in at the end of the visit, reviews the care plan, and talks with the patient.

It's efficient, readmissions have dropped, and the patients love it, Dr Blackwelder reported.

 
The time you spend creating a face-to-face connection, or connection over the phone, inevitably saves you time down the road.
 

The team-building idea has to be seeded early in the education process. East Tennessee brings together first-year medical, pharmacy, nursing, and psychology students for a communications course that teaches them how to collaborate when interviewing patients and generating reports. In addition, interprofessional groups of students are brought together periodically for problem-solving sessions.

Then when they become residents, they're asking to work with the pharmacist or to get one on board, Dr Blackwelder said.

During the presentation, Dr Blackwelder challenged members of the audience to identify the relationships they need to establish and the tools they need to get there, and to figure out the one thing they can do personally to build a stronger relationship.

The presentation "far exceeded our expectations" by sending a variety of messages about the importance of coordinated, team-based care, said Anne Burns, RPh, vice president of professional affairs at the APhA.

The idea of team-building is likely not new to many of the meeting attendees, but the presentation provided some practical tips, Burns told Medscape Medical News.

The strongest of these is that "relationships will really drive these care models," she said. Letting pharmacists know that the relationships don't just happen on their own, but require an effort, is "an important message," she said.

"Assume the best intent," is a key message, because "sometimes we just don't appreciate the perspectives of those we're working with," she added.

Dr Blackwelder and Dr Cross have disclosed no relevant financial relationships.

American Pharmacists Association (APhA) 2015 Annual Meeting: Presented March 28, 2015.

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