Using a conflict conceptual framework to describe challenges to coordinated patient care from the physicians' and pharmacists' perspective

Abstract

Background In an effort to increase cost-effectiveness of health care and reduce overall costs, patient-centered medical homes have been proposed to spur fundamental changes in the way primary care is delivered. One of the chief principles that describe a patient-centered medical home is that care is organized across all elements of the broader health care system, including community pharmacies. Objectives To identify and describe challenges to a physician-pharmacist approach to coordinating patient care. Methods A descriptive, exploratory, non-experimental study was conducted in Wisconsin (U.S. State) from June–December, 2011. Data were collected through two rounds of face-to-face interviews with physicians and community pharmacists. The first round involved one-on-one interviews with pharmacists and physicians. The second round brought pharmacist-physician dyads together in an open-ended interview exploring issues raised in the first round. Content analysis was guided by a conflict management conceptual framework using NVivo 10 qualitative software. Results A total of four major themes emerged from the conflict analysis of interviews that illustrate challenges to coordinated patient care: Scarce resources, technology design and usability, insurance constraints, and laws and policy governing patient care. The study findings indicate that both groups of healthcare professionals work within an environment of conflict and have to negotiate the challenges and strains that exist in the current healthcare system. Their need to work together, or interdependence, is primarily challenged by scarce resources and external interference. Conclusions Bringing physicians and pharmacists together for a face-to-face interaction successfully stimulated conversation about opportunities in which each profession could help the other to provide optimal care for their patients. This interaction appeared to dispel assumptions and build trust. Results of this project may provide pharmacists with the confidence to reach out to their physician colleagues to improve efficiencies and overall patient care.

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