http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2014; 28(6): 579–581 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.917405
SHORT REPORT
Can inter-faculty relationships improve future collaboration between physicians and community pharmacists in Poland? Anna Piecuch, Paulina Pawłowicz, Małgorzata Kozłowska-Wojciechowska, Sebastian Waniewski and Magdalena Makarewicz-Wujec Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
Abstract
Keywords
Pharmaceutical care requires interprofessional collaboration between pharmacists and physicians. The aim of this paper is to determine the nature of inter-faculty relationships between medical and pharmacy students and its possible influence on the attitudes of medical students towards pharmacists and pharmaceutical care. The study was conducted using anonymous questionnaire administered to all medical students at the Medical University of Warsaw, Poland. The study involved 404 medical students (265 women and 139 men). Fifty-four percent of students reported that they maintained relationships with pharmacy students. Students had mixed views about the nature of the interprofessional relationship between physicians and pharmacists. Only 22% (n ¼ 87) of the students had heard about pharmaceutical care. However, a number expressed interest in this form of collaboration in their future professional career. Students also claimed that they did not consider themselves prepared for the future collaboration with pharmacists in providing pharmaceutical care services, but they would like to participate in relevant interprofessional workshops with pharmacy students. The results from this study suggest that social relationships between medical and pharmacy students may have some effect on how pharmacists and their role is perceived and also on medical students’ attitudes towards pharmaceutical care.
Interprofessional collaboration, interprofessional relations, medical students, pharmacy students, surveys History Received 5 September 2013 Revised 20 March 2014 Accepted 19 April 2014 Published online 12 May 2014
Introduction
Methods
In 1988, World Health Organization (WHO) drew attention to the need for commencing collaboration between physicians and pharmacists in order to increase pharmacists’ influence on pharmacotherapy and to enhance their advisory role (WHO, 1988). It was suggested that this purpose could be achieved through the delivery of shared pharmaceutical care. Interprofessional education is increasingly seen as an important factor that may enhance collaboration between pharmacists and physicians (Barr, Freeth, Hammick, Koppel, & Reeves, 2006). The aim of this paper is to collect opinions of medical students on the professional role of pharmacists as well as to examine medical students’ attitudes towards pharmaceutical care. Secondary objective is to determine the association between attitudes of medical students and the nature of their relationships with pharmacy students. The majority of existing surveys used for measuring doctors’ attitudes towards pharmacists are unusable for researching students. Due to the fact that pharmaceutical care is very uncommon and clinical functions of Polish pharmacists are very limited, the existing tool to measure students’ attitudes towards collaboration (Van Winkle, Fjortoft, & Hojat, 2011) does not reflect our reality, putting too much emphasis on the clinical aspects of the pharmacist’s work.
The study was conducted during the spring semester 2011–2012 using a self-administered anonymous questionnaire directed to all medical students from the 1st and the 2nd Faculty of Medicine, Medical University of Warsaw, Poland. Data collection and analysis The questionnaire consisted of three closed-ended questions describing relationships between the participants and pharmacy students; the other seven questions regarded medical students’ views on the role of a pharmacist in pharmacotherapy process and their attitudes towards pharmaceutical care and interprofessional collaboration. The questionnaire was pre-tested for repeatability using a convenience sample of seven students. Answers obtained in the pre-test were not included to the study. Analysis Statistical analysis involved Spearman’s rank correlation coefficient and 2 test. The level of significance was set at p50.05. Statistical analysis was carried out using STATISTICA 9.1 (StatSoft, Cracow, Poland).
Results Correspondence: Anna Piecuch, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland. E-mail: [email protected]
The study involved 404 students (20% of all 2020 invited subjects), including 265 women and 139 men. Two hundred and eighty-six respondents (71%) were from the 1st Faculty of Medicine and 118 (29%) were from the 2nd Faculty of Medicine.
580
A. Piecuch et al.
Two hundred and eighteen study participants reported having interprofessional relationships with pharmacy students. Over 84% of these participants had engaged in common recreational meeting (mainly social gatherings), 17% in community service, while 15% in scientific and educational meetings (Table I). Half the students met each other less frequently than once a month (50%), nearly 24% met at least once a month and over 26% met at least once a week. Fifty-eight per cent of participants recognized pharmacist as healthcare professional who both completes the prescription and also proactively advises patients on the use of over-the-counter medicines. Only 29% felt that a pharmacist proactively participates in pharmacotherapy process both with prescription and non-prescription medicines. Medical students who claimed to have scientific relationships with pharmacy students more often indicated a proactive role for pharmacists ( 2 Yates’ corrected ¼ 11.54, df ¼ 1, p ¼ 0.0007, tetrachoric ¼ 0.4636). In addition, according to 43% of study participants, physicians and pharmacists do not collaborate; 31% of students offered the opposite opinion. Only 22% of medical students were familiar to the term of pharmaceutical care. This concept was more prevalent in medical students who reported having more frequent relationships with pharmacy students ( 2 ¼ 20.99, df ¼ 2, p50.0001, contingency coefficient ¼ 0.2964), students who reported having scientific relationships ( 2 Yates’ corrected ¼ 15.23, df ¼ 1, p ¼ 0.0001, tetrachoric ¼ 0.4893) and students who participated in community services together with pharmacy students ( 2 Yates’ corrected ¼ 10.00, df ¼ 1, p ¼ 0.0016, tetrachoric ¼ 0.4019).
J Interprof Care, 2014; 28(6): 579–581
The Polish legal definition of ‘‘pharmaceutical care’’ has been quoted to the study participants. Students were asked for their opinion on how pharmacists can support the pharmacotherapy process. Students claimed that they do not consider themselves prepared for the future collaboration with pharmacists (73%). Only 4% felt prepared for such collaboration, and the remaining 23% did not express an opinion. However, most medical students expressed interest in this form of collaboration in their future professional career (72%). Only 11% were not interested in collaboration with pharmacists. More interest in future collaboration was expressed by students who regarded pharmacists as healthcare colleagues ( 2 Yates’ corrected ¼ 41.22, df ¼ 1, p50.0001, tetrachoric ¼ 0.6398) and by students who participated in social gatherings ( 2 Yates’ corrected ¼ 7.13, df ¼ 1, p ¼ 0.0076, tetrachoric ¼ 0.4096). Furthermore, most students declared their willingness to participate in workshops on pharmaceutical care together with pharmacy students (64%), however, 18% of students are not interested in such workshops.
Discussion The results of this study suggest that medical students have a range of perceptions about pharmacists, how their role in the treatment process is understood and also a range of attitudes towards pharmaceutical care. Participation in interprofessional meetings, as well as direct relationships between pharmacists and physicians appear to be important factors that create favourable conditions for interprofessional collaboration through the interchange of opinions and information (Kowalska & Kempa, 1998).
Table I. Survey responses from participating medical students. Statement
Number of responses
Percent share
33 21 15 5 38 14 22 4 3 184 9 30 174 54 35 8 14
15% 10% 7% 2% 17% 6% 10% 2% 1% 84% 4% 14% 80% 25% 16% 4% 6%
42 233
10% 58%
118
29%
11
3%
323
80%
166 42 58
41% 10% 14%
14
3%
a
Social interactions between medical students and pharmacy students (n ¼ 218). Scientific and educational meetings Shared university classes/elective courses Scientific and training conferences Membership of scientific student associations Community service Student government Student organizations The ‘‘Teddy Bear Hospital’’ project Charity campaigns Leisure activities Athletic competitions Common interests (e.g. student choir, theatre) Social gatherings Other Living in the same hall of residence/lodgings Partner is a pharmacy student Other (not specified) Professional role of a pharmacist (n¼404). Pharmacist is a clerk and his/her work consists in dispensing of medications without question. Pharmacist is a health care professional who dispenses prescribed medications without question, but also proactively advises patients on the over-the-counter medicines. Pharmacist is a health care professional who proactively participates in treatment with prescription and non-prescription medicines. Not sure. How should a pharmacist collaborate with a physician to support the pharmacotherapy process? (n ¼ 404).a A pharmacist should educate patients on medications they are receiving (including potential adverse effects and drug interactions). A pharmacist should review the use of medicines by patients to identify and solve drug-related problems. A pharmacist should monitor appropriate clinical parameters to assess the effectiveness of treatment. A pharmacist should work together with a patient to determine feasible therapeutic goals, such as specific clinical or laboratory values (e.g. blood pressure). Not sure. a
Answers do not sum up to 100%, as multiple answers were possible.
DOI: 10.3109/13561820.2014.917405
Pharmaceutical care is not common in pharmacy practice in Poland, and therefore it is not widely known (TNS OBOP, 2011). While there is a social demand to reinforce the advisory function of pharmacists, their participation in patient care is however very limited. The relationship between physicians and pharmacists in Poland is often regarded as separate and asymmetrical, with physicians occupying the dominant position (Iskierski & Zimmermann, 2006). The study indicated that the medical students are open to an increase of pharmacist engagement in patient education, but are not enthusiastic about admitting pharmacists to clinical tasks. The findings from this study can allow us to design more effective interprofessional workshops and activities aimed at increasing medical students’ awareness of areas where a pharmacist can, or even should be more engaged. Most research has focused on the attitudes of students towards collaboration and interprofessional education (Barr et al., 2006). We were interested whether social contacts had any effects on those attitudes, and how they may have affected the nature of such relationships – both of which can be seen as areas for further research. The results from this work should be interpreted within the context of the study’s limitations. For example, the use of an unvalidated study instrument may have resulted in measurement error. In addition, non-response bias may have occurred due to the poor response rate. Finally, while the study sought to understand views about pharmacists and pharmaceutical care, it did not include pharmacy students.
Impact of interfaculty relations on future collaboration
581
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of this paper.
References Barr, H., Freeth, D., Hammick, M., Koppel, I., & Reeves, S. (2006). The evidence base and recommendations for interprofessional education in health and social care. Journal of Interprofessional Care, 20, 75–78. Iskierski, J., & Zimmermann, A. (2006). Społeczna rola zawodu aptekarza w oczach własnych i pacjento´w [Social role of the pharmaceutical profession in the eyes of pharmacists and the patients]. Farmacja Polska, 62, 210–217. Kowalska, M., & Kempa, M.E. (1998). Pro´ba oceny przygotowania absolwento´w Wydziału Lekarskiego S´l. A.M. do wspo´łpracy z farmaceutami w zakresie farmakoterapii [An attempt to evaluation of SMA Medical Faculty graduates preparedness to cooperation with pharmacists on pharmacotherapy]. Farmacja Polska, 54, 74–77. TNS OBOP (2011, January 25). Opieka farmaceutyczna – nieznana nowos´c´ [Pharmaceutical Care – unknown novelty]. Retrieved from http://obop-arch.tnsglobal.pl/biuro_prasowe/informacje_prasowe/ 2011/stycze#6639. Van Winkle, L., Fjortoft, N., & Hojat, M. (2011). Validation of an instrument to measure pharmacy and medical students’ attitudes toward physician-pharmacist collaboration. American Journal of Pharmaceutical Education, 75, Article 178: 1–6. WHO. (1988). The role of the pharmacist in the health care system. Report of a WHO Consultative Group. New Delhi, India: WHO.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SHORT REPORT
Can inter-faculty relationships improve future collaboration between physicians and community pharmacists in Poland? Anna Piecuch, Paulina Pawłowicz, Małgorzata Kozłowska-Wojciechowska, Sebastian Waniewski and Magdalena Makarewicz-Wujec Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
Abstract
Keywords
Pharmaceutical care requires interprofessional collaboration between pharmacists and physicians. The aim of this paper is to determine the nature of inter-faculty relationships between medical and pharmacy students and its possible influence on the attitudes of medical students towards pharmacists and pharmaceutical care. The study was conducted using anonymous questionnaire administered to all medical students at the Medical University of Warsaw, Poland. The study involved 404 medical students (265 women and 139 men). Fifty-four percent of students reported that they maintained relationships with pharmacy students. Students had mixed views about the nature of the interprofessional relationship between physicians and pharmacists. Only 22% (n ¼ 87) of the students had heard about pharmaceutical care. However, a number expressed interest in this form of collaboration in their future professional career. Students also claimed that they did not consider themselves prepared for the future collaboration with pharmacists in providing pharmaceutical care services, but they would like to participate in relevant interprofessional workshops with pharmacy students. The results from this study suggest that social relationships between medical and pharmacy students may have some effect on how pharmacists and their role is perceived and also on medical students’ attitudes towards pharmaceutical care.
Interprofessional collaboration, interprofessional relations, medical students, pharmacy students, surveys History Received 5 September 2013 Revised 20 March 2014 Accepted 19 April 2014 Published online 12 May 2014
Introduction
Methods
In 1988, World Health Organization (WHO) drew attention to the need for commencing collaboration between physicians and pharmacists in order to increase pharmacists’ influence on pharmacotherapy and to enhance their advisory role (WHO, 1988). It was suggested that this purpose could be achieved through the delivery of shared pharmaceutical care. Interprofessional education is increasingly seen as an important factor that may enhance collaboration between pharmacists and physicians (Barr, Freeth, Hammick, Koppel, & Reeves, 2006). The aim of this paper is to collect opinions of medical students on the professional role of pharmacists as well as to examine medical students’ attitudes towards pharmaceutical care. Secondary objective is to determine the association between attitudes of medical students and the nature of their relationships with pharmacy students. The majority of existing surveys used for measuring doctors’ attitudes towards pharmacists are unusable for researching students. Due to the fact that pharmaceutical care is very uncommon and clinical functions of Polish pharmacists are very limited, the existing tool to measure students’ attitudes towards collaboration (Van Winkle, Fjortoft, & Hojat, 2011) does not reflect our reality, putting too much emphasis on the clinical aspects of the pharmacist’s work.
The study was conducted during the spring semester 2011–2012 using a self-administered anonymous questionnaire directed to all medical students from the 1st and the 2nd Faculty of Medicine, Medical University of Warsaw, Poland. Data collection and analysis The questionnaire consisted of three closed-ended questions describing relationships between the participants and pharmacy students; the other seven questions regarded medical students’ views on the role of a pharmacist in pharmacotherapy process and their attitudes towards pharmaceutical care and interprofessional collaboration. The questionnaire was pre-tested for repeatability using a convenience sample of seven students. Answers obtained in the pre-test were not included to the study. Analysis Statistical analysis involved Spearman’s rank correlation coefficient and 2 test. The level of significance was set at p50.05. Statistical analysis was carried out using STATISTICA 9.1 (StatSoft, Cracow, Poland).
Results Correspondence: Anna Piecuch, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland. E-mail: [email protected]
The study involved 404 students (20% of all 2020 invited subjects), including 265 women and 139 men. Two hundred and eighty-six respondents (71%) were from the 1st Faculty of Medicine and 118 (29%) were from the 2nd Faculty of Medicine.
580
A. Piecuch et al.
Two hundred and eighteen study participants reported having interprofessional relationships with pharmacy students. Over 84% of these participants had engaged in common recreational meeting (mainly social gatherings), 17% in community service, while 15% in scientific and educational meetings (Table I). Half the students met each other less frequently than once a month (50%), nearly 24% met at least once a month and over 26% met at least once a week. Fifty-eight per cent of participants recognized pharmacist as healthcare professional who both completes the prescription and also proactively advises patients on the use of over-the-counter medicines. Only 29% felt that a pharmacist proactively participates in pharmacotherapy process both with prescription and non-prescription medicines. Medical students who claimed to have scientific relationships with pharmacy students more often indicated a proactive role for pharmacists ( 2 Yates’ corrected ¼ 11.54, df ¼ 1, p ¼ 0.0007, tetrachoric ¼ 0.4636). In addition, according to 43% of study participants, physicians and pharmacists do not collaborate; 31% of students offered the opposite opinion. Only 22% of medical students were familiar to the term of pharmaceutical care. This concept was more prevalent in medical students who reported having more frequent relationships with pharmacy students ( 2 ¼ 20.99, df ¼ 2, p50.0001, contingency coefficient ¼ 0.2964), students who reported having scientific relationships ( 2 Yates’ corrected ¼ 15.23, df ¼ 1, p ¼ 0.0001, tetrachoric ¼ 0.4893) and students who participated in community services together with pharmacy students ( 2 Yates’ corrected ¼ 10.00, df ¼ 1, p ¼ 0.0016, tetrachoric ¼ 0.4019).
J Interprof Care, 2014; 28(6): 579–581
The Polish legal definition of ‘‘pharmaceutical care’’ has been quoted to the study participants. Students were asked for their opinion on how pharmacists can support the pharmacotherapy process. Students claimed that they do not consider themselves prepared for the future collaboration with pharmacists (73%). Only 4% felt prepared for such collaboration, and the remaining 23% did not express an opinion. However, most medical students expressed interest in this form of collaboration in their future professional career (72%). Only 11% were not interested in collaboration with pharmacists. More interest in future collaboration was expressed by students who regarded pharmacists as healthcare colleagues ( 2 Yates’ corrected ¼ 41.22, df ¼ 1, p50.0001, tetrachoric ¼ 0.6398) and by students who participated in social gatherings ( 2 Yates’ corrected ¼ 7.13, df ¼ 1, p ¼ 0.0076, tetrachoric ¼ 0.4096). Furthermore, most students declared their willingness to participate in workshops on pharmaceutical care together with pharmacy students (64%), however, 18% of students are not interested in such workshops.
Discussion The results of this study suggest that medical students have a range of perceptions about pharmacists, how their role in the treatment process is understood and also a range of attitudes towards pharmaceutical care. Participation in interprofessional meetings, as well as direct relationships between pharmacists and physicians appear to be important factors that create favourable conditions for interprofessional collaboration through the interchange of opinions and information (Kowalska & Kempa, 1998).
Table I. Survey responses from participating medical students. Statement
Number of responses
Percent share
33 21 15 5 38 14 22 4 3 184 9 30 174 54 35 8 14
15% 10% 7% 2% 17% 6% 10% 2% 1% 84% 4% 14% 80% 25% 16% 4% 6%
42 233
10% 58%
118
29%
11
3%
323
80%
166 42 58
41% 10% 14%
14
3%
a
Social interactions between medical students and pharmacy students (n ¼ 218). Scientific and educational meetings Shared university classes/elective courses Scientific and training conferences Membership of scientific student associations Community service Student government Student organizations The ‘‘Teddy Bear Hospital’’ project Charity campaigns Leisure activities Athletic competitions Common interests (e.g. student choir, theatre) Social gatherings Other Living in the same hall of residence/lodgings Partner is a pharmacy student Other (not specified) Professional role of a pharmacist (n¼404). Pharmacist is a clerk and his/her work consists in dispensing of medications without question. Pharmacist is a health care professional who dispenses prescribed medications without question, but also proactively advises patients on the over-the-counter medicines. Pharmacist is a health care professional who proactively participates in treatment with prescription and non-prescription medicines. Not sure. How should a pharmacist collaborate with a physician to support the pharmacotherapy process? (n ¼ 404).a A pharmacist should educate patients on medications they are receiving (including potential adverse effects and drug interactions). A pharmacist should review the use of medicines by patients to identify and solve drug-related problems. A pharmacist should monitor appropriate clinical parameters to assess the effectiveness of treatment. A pharmacist should work together with a patient to determine feasible therapeutic goals, such as specific clinical or laboratory values (e.g. blood pressure). Not sure. a
Answers do not sum up to 100%, as multiple answers were possible.
DOI: 10.3109/13561820.2014.917405
Pharmaceutical care is not common in pharmacy practice in Poland, and therefore it is not widely known (TNS OBOP, 2011). While there is a social demand to reinforce the advisory function of pharmacists, their participation in patient care is however very limited. The relationship between physicians and pharmacists in Poland is often regarded as separate and asymmetrical, with physicians occupying the dominant position (Iskierski & Zimmermann, 2006). The study indicated that the medical students are open to an increase of pharmacist engagement in patient education, but are not enthusiastic about admitting pharmacists to clinical tasks. The findings from this study can allow us to design more effective interprofessional workshops and activities aimed at increasing medical students’ awareness of areas where a pharmacist can, or even should be more engaged. Most research has focused on the attitudes of students towards collaboration and interprofessional education (Barr et al., 2006). We were interested whether social contacts had any effects on those attitudes, and how they may have affected the nature of such relationships – both of which can be seen as areas for further research. The results from this work should be interpreted within the context of the study’s limitations. For example, the use of an unvalidated study instrument may have resulted in measurement error. In addition, non-response bias may have occurred due to the poor response rate. Finally, while the study sought to understand views about pharmacists and pharmaceutical care, it did not include pharmacy students.
Impact of interfaculty relations on future collaboration
581
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of this paper.
References Barr, H., Freeth, D., Hammick, M., Koppel, I., & Reeves, S. (2006). The evidence base and recommendations for interprofessional education in health and social care. Journal of Interprofessional Care, 20, 75–78. Iskierski, J., & Zimmermann, A. (2006). Społeczna rola zawodu aptekarza w oczach własnych i pacjento´w [Social role of the pharmaceutical profession in the eyes of pharmacists and the patients]. Farmacja Polska, 62, 210–217. Kowalska, M., & Kempa, M.E. (1998). Pro´ba oceny przygotowania absolwento´w Wydziału Lekarskiego S´l. A.M. do wspo´łpracy z farmaceutami w zakresie farmakoterapii [An attempt to evaluation of SMA Medical Faculty graduates preparedness to cooperation with pharmacists on pharmacotherapy]. Farmacja Polska, 54, 74–77. TNS OBOP (2011, January 25). Opieka farmaceutyczna – nieznana nowos´c´ [Pharmaceutical Care – unknown novelty]. Retrieved from http://obop-arch.tnsglobal.pl/biuro_prasowe/informacje_prasowe/ 2011/stycze#6639. Van Winkle, L., Fjortoft, N., & Hojat, M. (2011). Validation of an instrument to measure pharmacy and medical students’ attitudes toward physician-pharmacist collaboration. American Journal of Pharmaceutical Education, 75, Article 178: 1–6. WHO. (1988). The role of the pharmacist in the health care system. Report of a WHO Consultative Group. New Delhi, India: WHO.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
