University of Montreal, Quebec, Canada.
Res Social Adm Pharm. 2011 Sep;7(3):233-45. doi: 10.1016/j.sapharm.2010.05.003. Epub 2010 Jul 23.
Collaborative practices allow physicians and pharmacists to comanage pharmacotherapy to maximize the benefits of medication regimens. The Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia (TEAM) study compared the efficacy of a physician-pharmacist collaborative primary care (PPCC) intervention, where pharmacists requested laboratory tests and adjusted medication dosage, to the usual care (UC) for patients under treatment with lipid-lowering medication.
In a qualitative study nested within the TEAM study, the perceptions of physicians, pharmacists, and patients regarding the PPCC model, interprofessional collaboration, and the clinicians' willingness to implement the model in their practice were explored.
In the area of Montreal (Quebec, Canada), TEAM study participants assigned to the PPCC group were invited to participate. Individual semistructured interviews with physicians (n=7) and 2 six-member focus groups with pharmacists (n=12) and patients (n=12) were analyzed using a phenomenological approach.
The vast majority of participants reported PPCC was more structured and systematic than the UC they had received previously, wherein physicians prescribe and adjust pharmacotherapy and pharmacists provide the counseling and dispense medications. Many patients felt they received better follow-up and reported being reassured and well informed, making them more inclined to care for themselves better. These feelings were attributed largely to the pharmacists' accessibility and ability to communicate with them easily. Given the physician shortage, physicians perceived interprofessional collaboration as almost inevitable. They considered PPCC to be safe and effective. However, obstacles were also identified. Physicians were concerned that it might alter their special relationship with patients and threaten their overall medical follow-up. Pharmacists felt enthusiastic about their new role, but found PPCC time consuming and thought it might not be applicable to all the patients.
PPCC model was highly appreciated by patients, and clinicians saw it as beneficial to patients. However, several obstacles still have to be overcome before the model can be implemented in the current health care context.
合作实践使医生和药剂师能够共同管理药物治疗，最大限度地提高药物治疗方案的效益。评价血脂异常患者门诊初级保健管理方案的试验（TEAM）研究比较了一种医生-药剂师合作初级保健（PPCC）干预的效果，其中药剂师要求进行实验室检查并调整药物剂量，与接受降脂药物治疗的患者的常规护理（UC）相比。
在 TEAM 研究中的一项定性研究中，探讨了医生、药剂师和患者对 PPCC 模式、跨专业合作以及临床医生在实践中实施该模式的意愿的看法。
在蒙特利尔（加拿大魁北克省）地区，邀请 TEAM 研究参与者分配到 PPCC 组参加。对 7 名医生（n=7）和 12 名药剂师（n=12）和 12 名患者（n=12）的 2 个六名成员焦点小组进行了半结构化访谈，使用现象学方法进行了分析。
绝大多数参与者报告说，PPCC 比他们以前接受的 UC 更具结构性和系统性，在这种模式中，医生开处方并调整药物治疗，而药剂师提供咨询和分发药物。许多患者觉得他们得到了更好的随访，并报告说感到安心和知情，这使他们更倾向于更好地照顾自己。这些感觉主要归因于药剂师的可及性和与他们轻松沟通的能力。由于医生短缺，医生认为跨专业合作几乎是不可避免的。他们认为 PPCC 安全有效。然而，也发现了一些障碍。医生担心这可能会改变他们与患者的特殊关系，并威胁到他们的整体医疗随访。药剂师对他们的新角色感到热情，但发现 PPCC 耗时且认为它可能不适用于所有患者。
PPCC 模式深受患者欢迎，临床医生认为对患者有益。然而，在当前的医疗保健环境下实施该模式之前，仍需克服一些障碍。
