P-15: Playing Telephone: Understanding the state of medication decision making
Mercer Kathryn, Burns Catherine, Guirguis Lisa, Abidi Samina, Boersema Jonathan, Chabot Christian, Chin Jesse, Dogba Joyce, Guénette Line, Légaré France, McKinnon Annette, Waked Khrystine*, Grindrod Kelly
University of Waterloo
Objectives: To study how electronic health information is shared across patients, family physicians, nurse practitioners, and pharmacies, including the types of information typically exchanged, tools that support interprofessional shared medication decision-making and best practices related to the use of Electronic Health Records (EHRs) for decision making.
Approach: We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants collected data using an ethnographic approach including workflow observations, recordings of clinicians talking aloud while prescribing or dispensing medications, and (where possible) recordings of patient interactions clinicians related to medication therapy. We also completed semi-structured interviews with clinicians to inquire about healthcare provider experiences with medication decision making and EHRs. For data analysis, all audio recordings were transcribed, translated into English as required, and thematically coded.
Results: We collected data at 19 pharmacies and 8 medical clinics and identified five main themes. First, the Current State of Computer Systems can support or constrain the ability of clinicians to collaborate. Second, Different Communication Expectations mean healthcare providers (primary care, pharmacy) have a limited understanding of the others' contexts around managing medication, leading to frustration in general. Third, when collaborating, clinicians focus on Task Oriented Communication (e.g., errors, fax renewals) rather than decision oriented communication (e.g., choosing the best medication). Fourth, clinicians express that they value Shared Decision Making but in practice focus on informing patients and describing options with minimal patient input, with limited awareness of the contradiction. Fifth, there is a Desire and Need for EHRs which are complete and accurate for making informed decisions.
Conclusion: Collaboration between community pharmacists and primary care providers is generally task-based with little opportunity for interdisciplinary shared decision making. EHRs are a potential tool to help clinicians share information. However, to improve the quality of collaboration, more attention will need to be paid to the environmental contexts within which community pharmacists and primary care providers manage medications.