A drug-related problem (DRP) is defined as any undesirable event experienced by a patient that involves, or is suspected of involving drug therapy and potentially or actually interferes with the desired health outcome. DRPs due to medication errors are common, including medication discrepancies (MD) between recorded treatment plans across different medical locations. The unintentional MD may be a potential risk of medication errors that pose a significant threat to patient health and even endanger their lives[3, 4]. According to the World Health Organization (WHO), medication errors are a leading cause of avoidable harm within healthcare, and organizational adverse events occur in about one in every ten hospitalizations. As the aging trend intensifies, older patients with chronic diseases are challenged by the complexities of poly-medicine. Polypharmacy is reported as a heightened risk factor for DRPs occurrence. Midlov's study of elderly patients on multiple medications, showed on average, two medication errors in every care transition. Recent studies have shown that over one-third of patients (35.9%) experience medical advice errors. Because of incomplete data sources and inadequate communication, 85% of patients' errors are due to medication history (e.g., not including aspirin on the preadmission medication list), as almost half are omitted. 67% of hospitalized patients had at least one error in their prescription drug history at the time of admission, and 20%-87% of patients had medication discrepancies at the time of discharge. Unresolved drug differences may lead to a significant increase in harmful DRPs.
The solution to DRP is closely related to clinical pharmacist-physician (CPP) communication. Intentional communication and collaboration between CPPs can support patients with complex medication decisions and promote better health outcomes[12, 13]. Gerardo's research showed that 90% of physicians agreed that pharmacists' recommendations are clinically helpful, and pharmacists have increased their knowledge of medications they prescribe. Physicians have emphasized the value of clinical pharmacist communication, team care, and medication management. A qualitative survey in Ireland found that effective communication and interprofessional trust are essential to successful collaboration between pharmacists and other health professionals. Lucian et al. proposed that intentional interactive communication between CPPs helps lower the rate of adverse drug events caused by prescribing errors. Medication reconciliation (MR) is a pharmaceutical service dedicated to reducing DRP. In this process, clinical pharmacists need to inform physicians of the types of DRP and possible adverse results and understand the basis of prescribing this drug from physicians. Effective communication can influence a consensus on medication decision-making. However, there is no standardized and effective communication plan between pharmacists and physicians on DRP, and the communication effect lacks evidentiary support[10, 16–19].
However, many DRPs are often the result of inadequate communication across healthcare providers in various departments. Due to the lack of clinical information about patients, the independent and parallel working systems of medical staff, and the imbalance of authority or professional boundary friction when delivering patient care, clinical pharmacists often lack effective communication with physicians. Communication methods are mainly non-face-to-face (such as by fax or telephone), and medical communication is mostly incomplete and fragmented. In the process of MR, clinical pharmacists usually report only an MD list to the physician without further detailed discussions. Case noted studies in the USA found drug related-problems frequently occurred through poor communication between primary and secondary care about medication changes. Although many researchers have recognized the impact of communication between CPPs on patients' medication decisions, they have not paid attention to communication details (such as communication time, communication frequency) that affect the final medication decisions and patients' health outcomes[13, 15].
Theories for understanding CPP communication
Poly-medicine patients are typically faced with complex medication decisions and require collaboration between physicians and pharmacists to support decision-making. There is a lack of information on pharmacists-physician communication and the communication factors that affect the use of medicines.
Traditional shared decision-making models are limited to the patient-physician dyad, yet care is increasingly planned and delivered through interprofessional teams. France et al. proposed a model linking multiple professionals for an interprofessional approach to shared decision making (IP-SDM) in primary care. They argued that such a model could further improve the quality of care by fostering continuity in the decision-making process within the multiple components of the healthcare system. Six key assumptions underlying the IP-SDM model include 1) Equipoise, which refers to a situation where a decision point with more than one option exists and for which potential benefits and harms should be weighed; 2) Exchange of information about the options relevant to the patient's health condition; 3) Values clarification by individuals involved in the decision-making process; 4) Feasibility of the options during the decision-making process; 5) Achieving consensus among all of the healthcare providers. 6) Evaluating the implementation of fidelity and health outcomes[24, 26]. Obviously, IP-SDM can make a difference in the decision-making of poly-medication in the treatment of patients, which can guide care providers to cooperate intentionally, share knowledge and decision-making.
Furthermore, Relational Coordination (RC) Theory provides us with concrete dimensions to understand the possible influencing factors in the process of cooperation and communication between CPPs. Relational Coordination is an organizational performance theory used across industries, including healthcare, that describes the management of interdependence between people and tasks[27, 28]. Cramm et al.'s study indicated that the delivery of chronic illness care was positively correlated with RC. RC has seven dimensions, four of which measure the frequency, timeliness, accuracy, and problem-solving nature of communication. Three dimensions measure the degree of shared goals, shared knowledge, and mutual respectability for assessing the quality of the underlying relationships. These dimensions of communication based on RC theory are suit for understanding CPP communication.
To sum up, three research questions were put forward: (1) what is the current mode of the communication between CPPs? (2) Is the communication between CPPs effective in reducing the occurrence of DRPs? (3) What are the communication factors between CPPs affecting the occurrence of DRPs? This study aimed to use semi-structured interviews to explore the current communication mode between CPPs based on the IP-SDM model and RC theory and conduct randomized controlled trials (RCT) to explore their effects on reducing DRPs. A cross sectional study is designed to explore the impact of communication on the occurrence of DRPs.