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General practitioner–pharmacist collaboration in Germany: an explanatory model

International Journal of Clinical Pharmacy volume 41, pages 939–949 (2019)Cite this article

Abstract

Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner’s perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as ‘Communication and Collaboration’ and ‘Pharmacist medication management’. The significant demographic predictors of collaboration were age, population of the surgery’s location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.

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Acknowledgements

We would like to thank all participating practitioners.

Funding

None.

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany

    Anna Dähne & Christoph A. Ritter

  2. Pain Management and Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia

    Daniel Costa

  3. School of Pharmacy, The University of Sydney, Sydney, NSW, Australia

    Ines Krass

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  1. Anna Dähne
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  2. Daniel Costa
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  4. Christoph A. Ritter
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Correspondence to Anna Dähne.

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Appendices

Appendix 1

Frequency of Interprofessional Collaboration Instrument for general practitioners (FICI-GP)

  1. 1.

    The pharmacist and I openly communicated with each other.

  2. 2.

    The pharmacist informed me of new products/services that are available/that they provide.

  3. 3.

    I contacted the pharmacist for specific drug information.

  4. 4.

    I contacted the pharmacist for specific patient information.

  5. 5.

    The pharmacist contacted me to clarify scripts.

  6. 6.

    The pharmacist contacted me to discuss dosage adjustments.

  7. 7.

    The pharmacist contacted me to recommend an alternative medication (e.g., due to an adverse reaction, contraindication etc.).

  8. 8.

    I adjusted patient medication after the pharmacist’s recommendation.

  9. 9.

    I shared patient information with the pharmacist.

  10. 10.

    I involved the pharmacist in decisions regarding medication management.

Attitudes Toward Collaboration Instrument for general practitioners (ATCI-GP)

  1. 1.

    The professional communication between myself and the pharmacist is open and honest.

  2. 2.

    The pharmacist is open to working together with me on patients’ medication management.

  3. 3.

    The pharmacist delivers high quality healthcare to patients.

  4. 4.

    The pharmacist has time to discuss with me matters relating to patients’ medication regimens.

  5. 5.

    The pharmacist meets the professional expectations I have of him/her.

  6. 6.

    I can trust the pharmacist’s professional decisions.

  7. 7.

    The pharmacist actively addresses patients’ medical concerns.

  8. 8.

    Discussions with the pharmacist help me provide better patient care.

  9. 9.

    The pharmacist and I have mutual respect for one another on a professional level.

  10. 10.

    The pharmacist and I share common goals and objectives when caring for the patient.

  11. 11.

    My role and the pharmacist’s role in patient care are clear.

  12. 12.

    I have confidence in the pharmacist’s expertise in medicines and therapeutics.

  13. 13.

    The pharmacist has a role in assuring medication safety (for example, to identify drug interactions, adverse reactions, contraindications etc.).

  14. 14.

    The pharmacist has a role in assuring medication effectiveness (for example, to ensure the patient receives the optimal drug at the optimal dose etc.).

  15. 15.

    My working together with the pharmacist benefits the patient.

Note: In answering both the FICI-GP and ATCI-GP items, respondents were asked to ‘think of the pharmacist with whom you have most dealings and no financial relationship.’ In answering the FICI-GP items, respondents were asked to ‘estimate the number of times following has occurred in the last 3 months’ on a four-point response scale, where 1 = ‘nil’, 2 = ‘1–2 times’, 3 = ‘3–4 times’, 4 = ‘more than 4 times’. In answering the ATCI-GP items, respondents were asked to ‘indicate the extent to which you agree or disagree with the following statements’ on a five-point response scale, where 1 = ‘strongly disagree’, 2 = ‘disagree’, 3 = ‘neither agree nor disagree’, 4 = ‘agree’ and 5 = ‘strongly agree’.

Appendix 2

See Table 6.

Table 6 Estimates from path analysis
Full size table

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Dähne, A., Costa, D., Krass, I. et al. General practitioner–pharmacist collaboration in Germany: an explanatory model. Int J Clin Pharm 41, 939–949 (2019). https://doi.org/10.1007/s11096-019-00851-1

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Keywords

  • Attitude
  • General practitioners
  • Germany
  • Pharmacists
  • Statistical factor analysis
  • Surveys and questionnaires