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Research article
Professional Roles of General Practitioners, Community Pharmacists and Specialist Providers in Collaborative Medication Deprescribing - A Qualitative Study
Navina Gerlach
Philipps-Universitat Marburg
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2236-9637
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimization and deprescribing efforts. Although specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimization. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimization is neglected. Our qualitative study therefore aims to explore GPs’, community pharmacists’ and specialist providers’ role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimization approaches.
Method: Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional collaboration. We conducted conventional content analysis and conceptualized emerging themes using the Theoretical Domains Framework.
Results: 26 GPs, four community pharmacists and three community specialists took part in the study. The main themes corresponded to the four domains ´Social/professional role and identity` (1), ´Social influences’ (2), ´Reinforcement` (3) and ´Environmental context and resources’ (4) which were further described by beliefs statements, that is inductively developed key messages. For (1), GPs emerged as central medication managers while pharmacists and specialists were assigned confined or subordinated tasks in deprescribing. Social influences (2) encompassed patients’ trust in GPs as a support, while specialists and pharmacists were believed to threaten GPs’ role and deprescribing attempts. Reinforcements (3) negatively affected GPs’ and pharmacists’ effort in medication optimization by social reprimand and lacking reward. Environmental context (4) impeded deprescribing efforts by deficient reimbursement and resources as well as fragmentation of care, while informational and gate-keeping resources remained underutilized.
Conclusion: Understanding stakeholders’ role perceptions on collaborative deprescribing is a prerequisite for joint approaches to medication management. We found that clear definition and dissemination of roles and responsibilities are premise for avoiding intergroup conflicts. Role performance and collaboration must further be supported by structural factors like adequate reimbursement, resources and a transparent continuity of care.
Keywords
General practice, Polypharmacy, Deprescriptions, Intersectoral collaboration, Multimorbidity, Medication therapy management, Medication optimization, Qualitative research
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CURRENT STATUS: Published
Version 2
Posted 14 Aug, 2020
Published
On 04 Sep, 2020
Published
On 04 Sep, 2020
No community comments so far
Editorial decision: Accept
On 27 Aug, 2020
Review #1 received
Received 24 Aug, 2020
Editor assigned
On 12 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Reviewer #1 agreed
On 12 Aug, 2020
Submission checks complete
On 11 Aug, 2020
Editor invited
On 11 Aug, 2020
No comments provided
Editorial decision: Major revision
On 15 May, 2020
Review #2 received
Received 15 May, 2020
Review #1 received
Received 04 May, 2020
Reviewer #2 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 14 Apr, 2020
Editor assigned
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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This preprint is under consideration at BMC Family Practice. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Professional Roles of General Practitioners, Community Pharmacists and Specialist Providers in Collaborative Medication Deprescribing - A Qualitative Study
Navina Gerlach
Philipps-Universitat Marburg
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2236-9637
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 14 Aug, 2020
Published
On 04 Sep, 2020
Published
On 04 Sep, 2020
No community comments so far
Editorial decision: Accept
On 27 Aug, 2020
Review #1 received
Received 24 Aug, 2020
Editor assigned
On 12 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Reviewer #1 agreed
On 12 Aug, 2020
Submission checks complete
On 11 Aug, 2020
Editor invited
On 11 Aug, 2020
No comments provided
Editorial decision: Major revision
On 15 May, 2020
Review #2 received
Received 15 May, 2020
Review #1 received
Received 04 May, 2020
Reviewer #2 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 14 Apr, 2020
Editor assigned
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimization and deprescribing efforts. Although specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimization. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimization is neglected. Our qualitative study therefore aims to explore GPs’, community pharmacists’ and specialist providers’ role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimization approaches.
Method: Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional collaboration. We conducted conventional content analysis and conceptualized emerging themes using the Theoretical Domains Framework.
Results: 26 GPs, four community pharmacists and three community specialists took part in the study. The main themes corresponded to the four domains ´Social/professional role and identity` (1), ´Social influences’ (2), ´Reinforcement` (3) and ´Environmental context and resources’ (4) which were further described by beliefs statements, that is inductively developed key messages. For (1), GPs emerged as central medication managers while pharmacists and specialists were assigned confined or subordinated tasks in deprescribing. Social influences (2) encompassed patients’ trust in GPs as a support, while specialists and pharmacists were believed to threaten GPs’ role and deprescribing attempts. Reinforcements (3) negatively affected GPs’ and pharmacists’ effort in medication optimization by social reprimand and lacking reward. Environmental context (4) impeded deprescribing efforts by deficient reimbursement and resources as well as fragmentation of care, while informational and gate-keeping resources remained underutilized.
Conclusion: Understanding stakeholders’ role perceptions on collaborative deprescribing is a prerequisite for joint approaches to medication management. We found that clear definition and dissemination of roles and responsibilities are premise for avoiding intergroup conflicts. Role performance and collaboration must further be supported by structural factors like adequate reimbursement, resources and a transparent continuity of care.
Figure 1