PCB 513- PHARMACISTS’ RELATIONSHIP WITH OTHER HEALTH PROFESSIONALS

Learning objectives
At the end of this topic, you will be able to:
• understand the major roles of the pharmacist in healthcare system
• understand the benefits of collaborative relationship between the pharmacists and other
health professionals
• understand the barriers/obstacles to interprofessional collaboration between
pharmacists and health professionals
• describe how pharmacists can develop and/or improve working relationship with other
health professionals
Introduction
• Pharmacists are educated and trained health professionals charged by appropriate authorities
with the management of the distribution of medicines to consumers and efforts to ensure their safe
and efficacious use
• They play an important role in improving access to health care and are be part of any
comprehensive health system.
• The joint International Pharmaceutical Federation (FIP)/World Health Organisation guidelines on
Good Pharmacy Practice (GPP) categorise the roles of pharmacists in health system into four viz:
Role 1: Prepare, obtain, store, secure, distribute, administer, dispense and dispose of medical
products. Functions under this role includes:
i. preparation of extemporaneous medicine preparations and medical products
ii. obtaining, storing and securing medicine preparations and medical products
iii. distributing medicine preparations and medical products
iv. administering medicines, vaccines and other injectable medications
v. dispensing of medical products
vi. disposal of medicine preparations and medical products
Roles of pharmacists in health system cont’d
Role 2: Provide effective medication therapy management. Functions under this role include the
following:
i. assessing patient health status and needs
ii. managing patient medication therapy
iii. monitoring patient progress and outcomes
iv. providing information about medicines and health-related issues

Role 3: Maintain and improve professional performance

Function:
v. plan and implement continuing professional development strategies to improve current and future
performance

Role 4: Contribute to improve effectiveness of the healthcare system and public health
Functions:
vi. disseminate evaluated information about medicines and various aspects of self-care
vii. engage in preventive care activities and services
Roles of pharmacists in health system cont’d
iii. comply with national professional obligations, guidelines and legislations
iv. advocate and support national policies that promote improved health outcomes

A core requirement of GPP is that the welfare of patients and improvement of outcomes be the
pharmacists’ primary concern in all health settings. To effectively perform their functions,
pharmacists need to forge collaborative relationship with other health professionals (doctors,
nurses etc.)

Collaborative care is defined as a ‘‘joint communicating and decision-making process with the
goal of satisfying the patient’s wellness and illness needs while respecting the unique abilities
of each professional’’
 Benefits of collaborative relationship between pharmacists & other health professionals

Benefits of pharmacists’ collaboration with other health professional, especially collaboration with
physicians include:
• improvement in patient care e.g., reduction in heart failure event, better BP control, improved
blood glucose control in type 2 diabetes, reduction in cholesterol etc.
• enhanced patient safety and reduced workload
• accurate and complete history taking
• improved detection of prescribing errors and improved drug safety through drug level monitoring
• improvement in cost-effectiveness of prescribing

Despite evidence of the benefits of collaborative relationship between pharmacists and

physicians, forging such collaboration has been difficult.
Q. What are the barriers/obstacles to collaborative relationship between pharmacists and
physicians/other health professionals?
Obstacles to interprofessional relationship among health professionals

• Lack of communication or communication breakdown

• Lack of trust in another professionals’ competence
• Misconception of role and responsibilities of other members in the health team
• Perceived status and power differentials from the hierarchical structure within the
professions
• Professional-imposed boundaries
• Practice site distance from one another
Model for developing collaborative working relationship between pharmacists & other health professionals

• While the concept of collaborative working relationship (CWR) is relatively new in pharmacy
profession, literature is rife with CWR between nurses and physicians.

• To help pharmacists build CWR, especially with physicians, a staged approach based on
models of interpersonal relationships, business relationships and collaborative care has been
developed (McDonough & Doucette, 2001)
Figure 1: Staged approach to developing pharmacist-physician collaborative working relationship
• The progressive shading shows increasing collaboration among pharmacists and physician and
indicates greater motivation to maintain relationship

• Stage 0: exchange is minimal and interaction in discrete in nature e.g., phoning to refill prescription,
reporting ADR, discussion of problem detected at the point of dispensing.

• Stage 1: efforts to establish a relationship is unilateral, mostly by the pharmacist e.g., pharmacists
develop a service and ask physicians to make referrals. At this stage, only the pharmacist sees the
need for the relationship.

With progression through the stages, the efforts to maintain the relationship becomes bilateral.
At Stage 4, all parties are committed to maintaining the relationship, there is increased communication,
mutual trust and respect.
Characteristics that influence development of pharmacists-physicians CWR

1. Individual/participant characteristics: these include knowledge, attitudes, beliefs,

professional experience

2. Context characteristics: these proximity of practice, volume of exchange among

professionals, practice feature, system relationship

3. Exchange characteristics: these include attraction, power and justice, openness, direction
of communication, norm development, performance assessment, conflict and resolution.
Reading resources
McDonough, R. & Doucette, W. (2001). Developing collaborative working relationship between
pharmacists and physicians. Journal of American Pharmaceutical Association, 41(5):682-692.

Makowsky, M., Rosenthal, M., Campbell, K. (2009). Collaboration between pharmacists, physicians
and nurse practitioners: A qualitative investigation of working relationships in the inpatient medical
setting. Journal of Interprofessional Care, DOI: 10.1080/13561820802602552.