Improving Pharmacist-Physician Collaboration

Operational barriers and lack of shareable patient-specific documentation are systemic obstacles to eective collaboration between pharmacists and physicians. However, there are some simple steps that go a long way in improving collaboration between pharmacists and physicians. “I believe there often is a disconnect between the patient care that pharmacists and physicians provide, especially in the community pharmacy setting,” said Michelle Jeon, PharmD, who is an assistant professor in the department of pharmacy practice at the University of Health Sciences and Pharmacy in St Louis, Missouri.

In an email to Drug Topics®, Jeon said pharmacies have crucial patient information that most physicians don’t have direct access to, such as medication out-of-pocket costs and refill histories. Pharmacies may serve as a central repository for medications prescribed by several dierent prescribers, and pharmacists can identify potential drug interactions and duplications in therapy. However, Jeon said pharmacists often don’t have access to diagnoses and patient information, such as weight, in order to ensure optimized patient-specific medication doses.

Jeon and her colleagues have been investigating how pharmacists can improve collaboration with physicians and overcome systemic barriers. Collaborative drug therapy management (CDTM) is permitted between a physician and pharmacist in Missouri. This allows pharmacists to modify, initiate, or discontinue noncontrolled medication therapies under a written protocol. However, Jeon’s team surveyed 103 community pharmacists and 23 outpatient physicians and found that pharmacists identified operational barriers of time and reimbursement. Physicians reported concern with clinical risks, including potential disconnect between providers and inadequate pharmacist training.

Jeon said physicians need a better understanding of the clinical role of pharmacists working in the community setting. “Most pharmacies conduct adherence calls on a regular basis, providing an opportunity to uncover barriers to optimal medication habits and educate patients about their medications,” Jeon said.“If physicians tapped into these pharmacist-led services through referrals or shared documentation, patient outcomes and overall care could drastically improve.”

Brian Caswell, RPh, the 2019-2020 president of the National Community Pharmacists Association and owner of Wolkar Drug in Baxter Springs, Kansas, said that pharmacists can find it difficult to track down a physician with questions and vice versa. “If I leave a message with an oce, these questions can be so technical that the message can get lost in translation before it gets to the doctor,” Caswell said.

He would like to see pharmacists and physicians set up recurring group conversations to discuss common issues, such as prior authorizations and how to streamline processes. Caswell said the coronavirus disease 2019 (COVID-19) pandemic has compounded some issues.“Pharmacists and physicians are so busy, especially right now. In my view, time is the biggest barrier to collaboration,” Caswell said.

"There are reimbursement hurdles. On the pharmacy end, there are state and federal rules on the prescription order. You can’t assume anything,” Cliord Young, RPh, CGP, president of the California Pharmacists Association, said. “It is more complex than it appears and should be. You can go into a phone queue from hell to get a clarification.”

According to Young, the very high costs of some newer agents has added even more complexity. “Most pharmacists need to know the restraints the physician is under. The payment to physicians is a challenge, just like it is to the pharmacists. If the physicians understood that we are really the patient advocate, that would help,” Young said. “It is about relationships.”