Status: This project is in progress

This applied health research question seeks to better understand the roles and responsibilities of pharmacists who practice as members of family health teams, an interdisciplinary environment that fosters the delivery of comprehensive patient-centred primary healthcare.

Project lead

AHRQ capturing activities by family health team pharmacists impact patient careSimone Dahrouge, Director and Scientist, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute

Co-investigators

Ulrika Gillespie, Postdoctoral Fellow, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute

Lisa Dolovich, Professor and Research Director, Department of Family Medicine, McMaster University; Scientist and Associate Director, Centre for Evaluation of Medicines, St. Joseph’s Healthcare Hamilton; Associate Professor, Departments of CE&B and Medicine, McMaster University

Submitter: Angie Heydon, Executive Director, Association of Family Health Teams of Ontario

Introduction

Ontario’s pharmacists have been integral members of hospital-based healthcare teams for more than 25 years, but they have not been members of primary care practices until more recently.

Known as Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics, the IMPACT program was a large-scale Ontario-based demonstration project that aimed to improve patient outcomes by optimizing drug therapy through a community practice model that integrated pharmacists into family practices. IMPACT ran from 2004 to 2006, during which the program integrated seven pharmacists from both hospital or community pharmacy  into primary care practices across the province.

When Ontario family health teams began to recruit pharmacists in 2006, no systematic method was in place to guide role development of the now more than 150 pharmacists who are part of these collaborative primary care practices.

Pharmacist practice in family health teams varies considerably. Some pharmacists are more patient focused and assess medication-related needs through one-on-one patient consultation, while others engage in medication management services more at the individual practice level. One reason for this heterogeneity in practice may be the lack of models or standards of care specific to pharmacists on primary healthcare teams.

Program of studies

Not much is known about how family health team pharmacists practice, so this study is being conducted to help better understand their roles and responsibilities in this practice setting.

The first stage of the investigation was an interview study to capture the range of activities performed by family health team pharmacists. The second stage used a web-based survey of family health team pharmacists in Ontario to quantify the activities revealed from the interviews. In the third stage, study researchers will evaluate the impact of pharmacist activities on patient care using health administrative data housed at the Institute for Clinical Evaluative Sciences.

Stage 1 of the study is complete and the results from stage 2 are being analyzed. Stage 3 will be conducted over 2015.

Study 1: Pharmacist interviews

Objectives
1. To identify relevant activities performed by family health team pharmacists
2. To describe the components of each activity and their goals
3. To identify the areas of patient outcomes that pharmacists expect are affected by their practice activities

Methods
Research participants were selected and recruited from the group of some 120 pharmacists in the Ontario Family Health Team Pharmacist Network. Semi-structured telephone interviews were conducted in which participants were asked to list and describe activities they perform and the impact they believe these activities have on patient care.

Results
When data from 10 interviews had been coded saturation of responses had occurred. The resulting code list contained five main categories and 20 subcategories of pharmacist activities, which were used to develop the web-based survey for stage 2 of the project.

Study 2: Web-based pharmacist survey

Objectives

  1. To determine the main characteristics and the extent of practice of pharmacists on family health teams across the province
  2. To map in which family health teams the activities identified in study 1 are being performed by pharmacists and to what extent
  3. To determine the patient outcomes that pharmacists expect are affected by their activities and to what degree they are affected

Methods
An e-mail recruitment letter was sent to all individuals in Ontario identified as family health team pharmacists. Participants were asked to provide demographic information, their intensity of work (hours per week at family health team), educational level, years since graduation, and years of experience as a family health team pharmacist.

Activities identified in the interview study were listed and the respondents were asked to state which ones they perform and how frequently. Participants were asked for consent to link data collected in the pharmacist survey to health administrative data housed at the Institute for Clinical Evaluative Sciences.

Preliminary results
The response rate was 45% (70 respondents out of 155). The answers to closed-ended questions are being analyzed descriptively; open-ended questions will be analyzed using content analysis.

Possible implications
By gathering this information and applying it to data from health administrative databases it will be possible to make comparisons between family health teams with different degrees of pharmacist contribution, performing different types of activities, on various patient outcomes and process measures.

Study 3: Linking data from the pharmacist survey to ICES data

Objectives

  1. To determine, for each family health team in Ontario, the level of pharmacist collaboration
  2. To determine pharmacist activities and the extent to which they are performed in each family health team
  3. To determine appropriate outcomes and process measures that pharmacist activities have an impact on
  4. To compare groups of family health teams with different types and extent of pharmacist contribution using data on chosen outcomes and process measures

For more information, please contact Susan Dimitry, AHRQ administrator.

Presentations

2015 Canadian Pharmacists Conference • Ottawa, ON • May 28–31, 2015

  • Capturing activities performed by pharmacists in family health teams (oral, abstract as PDF)
    Gillespie U, Dahrouge S, Dolovich L

Canadian Association for Health Services and Policy Research Conference • Montréal, QC • May 25–28, 2015

  • Capturing activities performed by pharmacists in family health teams (poster)
    Gillespie U, Dolovich L, Dahrouge S