McCullough Megan B, Solomon Jeffrey L, Petrakis Beth Ann, Park Angela M, Ourth Heather, Morreale Anthony P, Rose Adam J
Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA
Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA.
Ann Pharmacother. 2015 Feb;49(2):189-95. doi: 10.1177/1060028014561473. Epub 2014 Nov 26.
Clinical pharmacists (CPs) with a scope of practice operate as direct care providers and health care team members. Research often focuses on one role or the other; little is understood about the dynamic relationship between roles in practice settings.
To identify the challenges CPs face in balancing dual roles as direct care providers and health care team members and the implications for CP effectiveness and quality of care.
Pharmacists were interviewed with a primary purpose of informing an implementation effort. Besides the implementation, there were emergent themes regarding the challenges posed for CPs in negotiating dual roles. This study is, therefore, a secondary analysis of semistructured interviews and direct observation of 48 CPs, addressing this phenomenon. Interview data were entered into NVivo 10 and systematically analyzed using an emergent thematic coding strategy.
Pharmacists describe role ambiguity, where they perform as direct providers or team members simultaneously or in quick succession. They note the existence of a "transaction cost," where switching causes loss of momentum or disruption of work flow. Additionally, pharmacists feel that fellow providers lack an understanding of what they do and that CP contributions are not evaluated accurately by other health professionals.
It is a challenge for CPs to balance the distinct roles of serving as collaborators and primary providers. Frequent role switching is not conducive to optimal work efficiency or patient care. Our findings suggest concrete steps that medical centers can take to improve both CP worklife and quality of patient care.
具有执业范围的临床药师作为直接护理提供者和医疗团队成员开展工作。研究通常聚焦于其中一个角色；对于实践环境中角色之间的动态关系了解甚少。
确定临床药师在平衡作为直接护理提供者和医疗团队成员的双重角色时所面临的挑战，以及对临床药师效能和护理质量的影响。
对药师进行访谈，主要目的是为一项实施工作提供信息。除了实施工作外，还出现了一些关于临床药师在协调双重角色时所面临挑战的新主题。因此，本研究是对48名临床药师的半结构化访谈和直接观察的二次分析，以探讨这一现象。访谈数据录入NVivo 10，并使用新出现的主题编码策略进行系统分析。
药师描述了角色模糊的情况，即他们同时或相继迅速担任直接提供者或团队成员的角色。他们指出存在“交易成本”，即角色转换会导致动力丧失或工作流程中断。此外，药师觉得其他提供者不了解他们的工作内容，其他医疗专业人员没有准确评估临床药师的贡献。
临床药师要平衡作为合作者和主要提供者的不同角色是一项挑战。频繁的角色转换不利于实现最佳工作效率或患者护理。我们的研究结果提出了医疗中心可以采取的具体措施，以改善临床药师的工作生活和患者护理质量。
