The results of the study provide evidence for the validity of the ATCI-P in measuring attitudes towards collaboration and illustrate the relationship between the frequency of interprofessional collaboration and ‘interactional’, ‘practitioner’ and ‘environmental determinants’. The structural model (Figure
2) describing these relations was modified and tested on a validation sample, and displayed adequate fit statistics. ‘Interactional determinants’ and an ‘environmental determinant’ were shown to influence collaboration directly, while ‘practitioner determinants’ was found to indirectly influence collaboration. ‘Interactional determinants’ was found to be the strongest predictor of pharmacist collaboration with GPs, and was in turn strongly influenced by ‘practitioner determinants’.
PCA of the ATCI-P indicated that items making up the variable ‘trust’ belong to ‘practitioner determinants’ rather than ‘interactional determinants’ as initially hypothesised (Figure
3). This may be because trust is linked to the individual rather than their interaction; that is, these items entail the pharmacist’s assessment of the GP, rather than an assessment of their interactions. It may be argued that a positive assessment of a practitioner is in fact a prerequisite for strong interactions. In contrast ‘recognition of roles’ was found to belong to ‘interactional determinants’ rather than ‘practitioner determinants’. This may be because perceptions on role affect how practitioners interact with one another.
Regarding the ‘environmental determinants’, only ‘physician contact during training’ was found to be a predictor of collaboration. The item asks pharmacists whether during their pre-registration training they rarely, occasionally or frequently had contact with GPs (if training was carried out in community pharmacy) or medical officers (if training was carried out in hospital pharmacy). Those pharmacists who had frequent contact with GPs and/or medical officers during their pre-registration training were more likely to have higher levels of collaboration with their GP counterpart in their current practice. This may suggest that exposure to collaboration during the final year of pharmacist training equips pharmacists with the skills and confidence for future collaboration.
When ‘proximity to GP’s office’ was modelled as a predictor of collaboration using Sample 1 data, those pharmacists working in closer proximity to their GP counterparts were found to have higher levels of collaboration than isolated practitioners. This may be because being geographically closer to one another provides more opportunity to develop rapport and positive relationships as a result of increased interaction. However when ‘proximity to GP’s office’ was modelled and tested on the validation sample (Sample 2), the impact of this variable was not replicated. As this variable has been identified as important in previous studies
[15, 27], and significantly impacted on collaboration when modelled using Sample 1 data, it should not be disregarded but may be worth investigating in future research.
This study has several important implications for practice and highlights possible strategies for improving interprofessional collaboration between pharmacists and GPs. Policy makers may wish to consider strategies for fostering good communication, trust and respect between GPs and pharmacists. One strategy may be to restructure primary health care services so that GPs and pharmacists are collocated. This would make them more accessible to one another and thereby increase opportunities for interprofessional collaboration. For pharmacist collaboration with GPs to be successful there must also be a willingness from both parties to work together. This may be nurtured by creating educational opportunities that allow pharmacists more interaction with their medical colleagues in their formative years to build confidence and encourage teamwork. It would also allow GPs to recognise and appreciate that pharmacists have an important contribution to make to medication safety and effectiveness.
Several limitations to the study should be noted: firstly, the response rate of 40% was only modest however the size of the sample was adequate for the analysis. Secondly, the items that make up the instruments are reflective of current primary care practice and may require refinement if changes to practice occur in the future. This, however, is not a shortcoming of the theoretical model proposed, but rather a qualification that the specific items employed in the model must align with current practice. It should also be noted that the ATCI-P and model have been developed for community pharmacists practicing in Australia. Validity testing of the ATCI-P and model for other settings e.g. ambulatory and tertiary settings; for other practitioners e.g. GPs or hospital pharmacists; and in other countries may yield different results and requires further research. Finally, as pharmacists have different interactions with different GPs it was necessary to ask the respondents to think of only one GP when completing the questionnaire. Respondents were asked to ‘think of the GP with whom you have most dealings’. Therefore, the results may be biased towards reflecting the relationship of more actively collaborating pharmacist and GP pairs than that of the average population.