Examining physicians' perspectives during the integration of a pharmacist into family practice: Qualitative results from the IMPACT study

Rationale: Physicians may have concerns about medical-legal issues, scope of practice, continuity of care, workload, and satisfaction as other health disciplines integrate into primary care. This study involved a qualitative evaluation of physicians’ perspectives as 7 pharmacists integrated into 7 physician-led family practices in the Ontario IMPACT (Integrating family Medicine and Pharmacy to Advance primary Care Therapeutics) project. Pharmacists provided medication assessments, drug information, and academic detailing, and developed office system enhancements to optimize drug therapy. Objective: To examine the perspectives of family physicians (e.g., challenges, barriers, successes) 12 months into the process of integrating a pharmacist. Study Design and Methods: Qualitative design using key informant interviews (n = 14) at the 12th month of the integration process. A diverse sample of participating family physicians was purposively selected based on age, sex, and degree of support. Physicians who were felt by integrating pharmacists to be unsupportive were oversampled. Interviews were 20 minutes, audiotaped and transcribed. Four researchers with varied backgrounds used immersion and crystallization to identify codes, and iterative grounded theory to determine key process and content themes. Results: Challenges included finding time to make contact and learn about the pharmacist’s role and skills. Insufficient space was seen as the main structural challenge. Facilitating factors in the development of the interprofessional relationships were mutual respect of time, practical skills, and boundaries. Appreciations included having a colleague to provide current, reliable drug information, fresh perspectives, time-saving measures, and feeling increased confidence in prescribing. Practice-level benefits included group education, medication-related protocols, and liaison with community pharmacy and pharmaceutical representatives. Physicians’ initial concerns (e.g., medical legal implications, loss of continuity of care, and scope of practice) decreased markedly as they began to understand and appreciate the role of the pharmacist. Conclusions: Family physicians found the integration process both challenging and rewarding. Initial concerns abated with time and experience. As pharmacist involvement in primary care increases across the country, the experiences and perspectives of family physicians are important to consider and appreciate. I enjoyed finding out how physicians and pharmacists learned to work together in this project. The qualitative interviewing approach helped us to learn a great deal about their experiences. Barbara Farrell