A collaborative relationship between a pharmacist and physician with visits into the patient's home is a movement toward improved continuity of care. These differences Physicians’ views on collaboration with pharmacists give an insight into what contributes to a well-functioning team. Similar to its use in this study, the instrument can be a research tool to measure the “strength” of collaboration. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. After discussing the assessment with the physician, a decision was made collaboratively to prescribe or deny the medication with or without additional intervention. Improved communication, specifically between the pharmacist and physician, allows pharmacists to improve medication management and an improved system of information exchange prioritizes patient safety. Jill Murphy, Associate Editor. OBJECTIVE To determine if there is improvement in medication management when pharmacists and family physicians collaborate to prescribe medication renewals requested by fax. SETTING W est Winds Primary Health Centre, an interdisciplinary health centre that includes an academic family medicine practice, located in Saskatoon, Sask. The study was approved by the University of Saskatchewan Biomedical Research Ethics Board. It is likely that some of this time was spent becoming familiar with the patients, and, although this extra workload might ultimately prove to be worthwhile, the erratic nature in which the requests were received made this intervention a considerable workflow disruption for the pharmacist. des pharmacies communautaires classiques). Laboratory tests were ordered, a new appointment with the family physician was booked, and a referral was made to the pharmacist. Denneboom W, Dautzenberg MG, Grol R, … This study investigated the feasibility and acceptability of a new collaborative care model involving buprenorphine-waivered physicians and community pharmacists. Objective: To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control. And there is evidence pointing to the effectiveness of this multidisciplinary heath care team approach, in which pharmacists are typically responsible … The benefits of physician-pharmacist collaboration J Fam Pract. Map of States with Laws Explicitly Authorizing Pharmacist Collaborative Practice Agreements, 2012-1-Note: Physician delegation is considered permissive in MI and WI, allowing physicians and pharmacists to enter into CPAs. For example, for patients with chronic diseases, like diabetes and hypertension, pharmacists play a key advocacy role by providing direct input to optimize pharmacotherapy and medication therapy management (MTM). C ollaboration between physicians and pharmacists may boost patients’ satisfaction with, and adherence to, buprenorphine treatment for opioid use disorder (OUD), research suggests.. Over the past 10 years, pharmacist-physician collaborative practices have grown in primary care, helping implement comprehensive, team-based healthcare models. Pharmacist–physician collaborative management of patients receiving pirfenidone treatment was initiated in September 2017; thereafter, 15 consecutive patients (the collaborative management group) were managed collaboratively by physicians and pharmacists. Groups were similar at baseline except that the control group had more male patients (Table 1). Lorsque leur ordonnance pour le traitement d’une maladie chronique vient à échéance, plusieurs patients, plutôt que de prendre rendez-vous avec leur médecin, demandent au pharmacien de télé-copier une demande de renouvellement à leur médecin. Pharmacist and physician collaboration in the patient's home. However, one area that might benefit from targeted improvement efforts is the renewal process for chronic medications in family physician practices. A 2016 National Progress Report sponsored by Surescripts points to the importance of the physician-pharmacist collaboration when it comes to health data. Les auteurs voulaient déterminer si le processus d’autorisation par télécopieur de ces renouvellements pourrait être amélioré par une collaboration médecin-pharmacien. Within the collaborative care model, pharmacist responsibilities also often include making sure the patient is well educated regarding the physicianâs diagnosis and prescribed medications. Nadia A Amruso. In addition, intervention patients were recalled for physician appointments more often (31 vs 21, P = .049) and there was a non-significant trend toward more appointments being booked with the clinic pharmacist, more monitoring tests being ordered, and more referrals being made to other health care professionals (Table 2). We do not capture any email address. Methods: This was a prospective, multicenter, cohort study. Unfortunately, physicians must assess the appropriateness of these faxed renewal requests during a busy clinic day, when it might be challenging to identify problems associated with the renewal requests. For pharmacists, trust appears to be conferred on physicians based on title, degree, status and positional authority. Figure 1. They found that there was improvement in medication management when a pharmacist collaborated with the physicians to prescribe medication renewals, but that the intervention represented a substantial workflow disruption for the pharmacist. Behind the headlines. And, much evidence suggests that the multidisciplinary team approach to healthcare, one in which pharmacists take on the responsibility for tasks such as adjusting medication regimes, obtaining and reviewing medication histories, and identifying challenges and barriers to adherence, is highly effective. Enter multiple addresses on separate lines or separate them with commas. After completing the chart reviews, 9 of the renewal requests (all in the control group) had no chart documentation regarding the request. Patients were recruited from the family medicine practice at WWPHC. Pharmacist-physician collaborative practices have been successful in improving outcomes among patients with chronic diseases such as those found among older adults [57] [58] [59] [60][61]. Got a Small Pharmacy? Therefore, this study was designed to assess the collaborative relationships between physicians and pharmacists working in the primary healthcare centres regarding their … Strickland JM(1), Huskey A, Brushwood DB. Six variables, labeled as discriminating, helped distinguish between early-stage collaboration and late-stage collaboration: the development of bidirectional communication, caring for mutual patients, the ability to identify a win–win opportunity, adding value to the medical practice, physician convenience, and movement toward balanced dependence between the pharmacist and physician. The purpose of this study was to determine if there was improvement in medication management when a pharmacist collaborated with family physicians to prescribe medication renewals requested by fax. A strong working relationship between pharmacists and doctors is necessary to optimize healthcare for each patient. Results: Pharmacists and family physicians demonstrate different cognitive models of trust in primary care collaboration. As a result of the renewal request, one of the medications was discontinued and the dose of the other was increased. MIL OSI - ForeignAffairs.co.nz - January 12, 2021 . Implementation of a signed collaborative practice agreement (CPA) between the physician and the pharmacist provides specific criteria for future services provided by the pharmacist and is an established and accepted mechanism to fulfill the intent of the Medicare incident-to billing provision. Addiction JANUARY 11, 2021 Buprenorphine physician-pharmacist collaboration … Abstract. The patient had refilled both β-blockers numerous times. A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. Understanding the local data related to this collaboration is vital in establishing efficient collaboration. réduction des effets indésirables) et avec des pharmaciens exerçant dans d’autres contextes (p. ex. Examining physicians' perspectives during the integration of a pharmacist into family practice: Qualitative results from the IMPACT study. Carter BL, Ardery G, Dawson JD, James PA, Bergus GR, Doucette WR, et al. • The collaboration of pharmacists and nurse practitioners in a nurse-managed health clinic is described. Building Effective Physician-Pharmacist Communication. All patients whose pharmacies faxed WWPHC requesting a renewal of a prescription medication during the study period were selected to participate in the study. Post sponsored by NewzEngine.com. Physicians spoke about the need for teamwork with pharmacists before a packed room at APhA2018 in Nashville on Saturday, March 17. Little is known about these views from low and middle-income countries and nothing from the United Arab Emirates (UAE). The pharmacist spent an average of 10 minutes on each renewal request in the intervention group (range 5 to 25 minutes). DESIGN Prospective, non-randomized controlled trial. Pharmacist collaboration The Pharmacy Act allows pharmacists to practice under a Collaborative Practice … The control group had significantly more requests authorized with no recommendations (75.5% vs 52.9%, P = .001). As a physician, I love it when I get a call from pharmacists. Farrell B, Pottie K, Haydt S, Dolovich L, Kennie N, Sellors C, et al. 2. If the renewal request was received when the pharmacist was working, the patient was enrolled in the intervention group and the request was directed to the pharmacist. One worry that many pharmacy students have when they get out of school concerns how to tell a physician that a mistake’s been made with a medication dose or frequency—and then how to explain the right course of action. These process measures of care represent the “activity” that was created by the collaborative model. The projected shortage of physicians by the year 2025 is estimated to be between 12,500 and 31,100, opening up numerous opportunities for pharmacists in the movement toward a patient-centered medical home (PCMH) collaboration between physicians and pharmacists, explained Hae Mi Choe, PharmD, director, Pharmacy Innovations & Partnerships at the University of Michigan Medical Group, and Laurie … Future studies using clinical outcome measures (eg, adverse drug reactions) will help support the benefit of this intervention. The Physician-Pharmacist Collaboration Index (PPCI) was used, which is a validated instrument that measures the extent of physician-reported collaborative working relationships. Over the past decade, physician-pharmacist collaborative practices have gained traction in primary care as a way to implement team-based-care models. Your email. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. It has never been more important for the pharmacist and physician to collaborate effectively regarding their shared patients. doctor-pharmacist collaboration. Collaboration between pharmacists, physicians and nurse practitioners: A qualitative investigation of working ... Each pharmacist, physician, medical residents and nurse practitioner received e-mail Common reasons for these requests to be approved without intervention included the following: the patient had recently attended a follow-up appointment, the patient had a follow-up appointment booked, and it was deemed that no follow-up was necessary. Pharmacist and Physician Collaboration in the Patient's Home Show all authors. The pharmacist and physician then made a collaborative decision to authorize the requested medication or to request additional interventions first (eg, perform laboratory tests). There were 466 (311 high-risk) pharmacist-physician and 549 (237 high-risk) physician-managed DXAs included. Future research might attempt to validate these results in a larger sample using clinical outcomes (eg, reduced adverse drug events) and pharmacists practising in others settings (eg, traditional community pharmacies). The results of this study also suggest that most faxed renewal requests are coming from patients who are receiving excellent follow-up and monitoring, who might have been wasting the physician’s time had they made appointments simply to renew their prescriptions. 0. Today, more health data is being exchanged, making it critical that the quality and accuracy of data reporting is maintained. 2016-10-05 06:59:47. Small Pharmacies Benefit from Compact Robot Automation, ScriptPro Hosts Harold N. 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Background and Aims Physician and pharmacist collaboration may help address the shortage of buprenorphine‐waivered physicians and improve care for patients with … Can Fam Physician 2008;54:1714-7. Physician and Pharmacist collaboration can enhance patient care by increasing medication adherence, improving patient outcomes through medication management, and reducing medication errors and adverse drug reactions through collaboration on policy and protocol development. Nearly 89% of participants remained in the study and more than 95% complied with the daily medication regimen, suggesting that physician-pharmacist collaboration is effective. • The collaboration of pharmacists and nurse practitioners in a nurse-managed health clinic is described. Those in the intervention group had significantly more medication-related problems identified (26 vs 10, P = .031); medication changes made (24 vs 10, P = .044); and new appointments scheduled with their family physicians (31 vs 21, P = .049). The most common medication-related problems identified in both groups were “additional drug needed,” “low dose,” and “no indication.” “Wrong drug” and “high dose” were found more often in the intervention group; otherwise, the distribution of the medication-related problems was similar in both groups. 01/11/2021 . Physician and nurse interviews were conducted in May 2016 at the hospital. Similarly, 97% of physicians … Both authors directly contributed to the planning, execution, and analysis of the study and approved the final submission for publication. Based on outcomes from pharmacist and physician collaboration, it is likely that similar interprofessional collaborations will be successful. In a busy hospital environment, good communication can be difficult to achieve. A collaborative approach to treating opioid use disorder that relies heavily on community pharmacists is feasible and may increase adherence and participant satisfaction, according to a pilot study published today in Addiction. Physician-pharmacist collaboration may increase adherence to opioid addiction treatment. Renewal requests that were made for patients who had left the family medicine practice at WWPHC were excluded. âComprehensive, team-based patient care. Background And Aims: Physician and pharmacist collaboration may help address the shortage of buprenorphine-waivered physicians and improve care for patients with opioid use disorder (OUD). Descriptive data for the intervention and control groups combined. NIH-supported pilot study found team-based approach may improve buprenorphine care. ScriptPro Will Fit! To reduce the risk that physicians would change their usual practice as a result of knowing they were being evaluated, we planned to run the study erratically for 10 weeks of the 20-week study period. Pharmacist and physician collaborative prescribing, Development and implementation of a centralized comprehensive refill authorization program in an academic health system, Provider perceptions of knowledge exchange and communication in a multisite family health team, Clinical pharmacy experience in ophthalmology setting of using collaborative drug therapy management (CDTM), Interprofessional collaboration in family health teams: An Ontario-based study, The way we do things around here: Advancing an interprofessional care culture within primary care, Notre facon de faire ici: Promouvoir une culture interprofessionnelle dans les soins primaires, Long-term treatment outcomes in a First Nations high school population with opioid use disorder, Involvement of palliative care in patients requesting medical assistance in dying, Caring for children with mental health or developmental and behavioural disorders, Delays in testing as a source of COVID-19 false-negative results, Rooming-in care for infants of opioid-dependent mothers, Data discipline in electronic medical records, http://www.cfpc.ca/Canadianfamilyphysician/, Copyright© the College of Family Physicians of Canada. A collaborative approach to treating opioid use disorder that relies heavily on community pharmacists is feasible and may increase adherence and participant satisfaction, according to a pilot study published today in Addiction. Within the collaborative care model, pharmacist responsibilities also often include making sure the patient is well educated regarding the physician’s diagnosis and prescribed medications. In both groups combined, there were 117 (64.6%) prescriptions renewed without interventions or recommendations. 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If the renewal request was received when the pharmacist was not working, the patient was enrolled in the control group and the request was directed to the physician (usual care) who independently made the decision to prescribe or deny the medication. There are studies that evaluate the effects of independent pharmacist-managed prescription renewal clinics in the United States, where pharmacists work independently to authorize prescription renewals instead of physicians.15–17 Although these studies demonstrate that these renewal clinics provide a valuable service, the health system is clearly moving away from independent models of practice owing to the resounding overall benefits of collaborative practice. One recent Canadian study found that 25% of general hospital admissions were drug-related, and more than 70% of these admissions were preventable.1 Two other Canadian studies found that 17% of patients discharged from hospital experienced a medication-related adverse event soon after discharge,2 and 8% of emergency department visits were caused by preventable adverse drug events.3 Similarly, there is evidence suggesting that substantial improvements can be made in medication management for chronic diseases, such as asthma,4 cardiovascular disease,5 and diabetes,6 in Canada. Monday, January 11, 2021 . This collaboration allowed pharmacists to identify and overcome patient-specific barriers to care, provide individualized diabetes education, and perform medication management. Prescriber Challenge. I understand, take me to the site anyway. The pharmacist assessed drug-therapy issues that might preclude safe and effective prescribing of the medication. Physician-pharmacist collaboration may increase adherence to opioid addiction treatment NIH/National Institute on Drug Abuse. one pharmacist who had been active with physicians served as the key informant. January 11, 2021. Who. When the pharmacist was not working, the physicians managed the renewal requests independently (control group). Pharmacists rely on physicians to provide their patients with the prescriptions for helpful medications, and physicians rely on the pharmacists to ensure that their patients are receiving the treatments that they need. Physician-pharmacist collaboration may increase adherence to opioid addiction treatment. Once the collaboration is formalized, a management strategy should also be defined and should include regular … Coupled with a looming physician shortage, prescribers are being challenged to meet patients' needs. • Based on outcomes from pharmacist and physician collaboration, it is likely that similar interprofessional collaborations will be successful. ACE—angiotensin-converting enzyme, ARB—angiotensin receptor blocker, ASA—acetylsalicylic acid, PPI—proton pump inhibitor. Community pharmacy … Utilizing integrated electronic health records (EHR) and software platforms that provide patient data transparency across a health systemâs network, is key to accurate and timely communication among a healthcare team. Discover the world's research 17+ million members Physician and pharmacist collaboration to improve blood pressure control. Copyright © 2021 by The College of Family Physicians of Canada, Sign In to Email Alerts with your Email Address. Ils ont trouvé que cette collaboration améliorait la gestion du renouvellement de la médication, mais que cela interférait considérablement avec le travail courant du pharmacien. Malheureusement, le médecin doit évaluer la justification de cette demande de renouvellement durant une journée de consultation fort achalandée, de sorte qu’une évaluation adéquate n’est pas toujours possible. Methods: A retrospective, observational cohort study was conducted at Ascension Medical Group Via Christi, P.A. End points were assessed using a chart review that was performed at least 30 days after the renewal request was received. Pharmacist and advanced practice registered nurse collaborations are not well documented. This prospective, non-randomized controlled trial was conducted at West Winds Primary Health Centre (WWPHC) in Saskatoon, Sask, from October 2007 to February 2008. For high-risk DXAs, collaborative management resulted in increased rates of receiving antifracture therapy prescriptions over physician-only management (66% vs 34%, P < 0.001), advisement … This activity reflects the ability of this collaborative model to overcome clinical inertia, which is a term used to describe the failure of health providers to initiate, intensify, or adjust chronic therapies.19 The ability of this intervention to overcome clinical inertia is further supported by the fact that there were significantly fewer prescription renewal requests approved with no intervention in the collaborative model compared with usual care (52.9% vs 75.5%, P = .001) and that the 3 most common medication changes were to stop a drug, start a drug, or change a dose. These 9 requests were excluded and 181 were included in the final analysis (94 in the control group and 87 in the intervention group). from January 1, 2016 to June 30, 2018. 2021-01-11 16:24:00 . Physician-pharmacist collaboration within an academic internal medicine clinic is another potential model to target patients with uncontrolled diabetes. When physicians, pharmacists, and other members of a patientâs care team are all able to see patient history, diagnoses, current medication regimes, and more, they can streamline the continuity of care that is coming to be expected more and more by patient populations. Researchers in England looked at … During the call, the pharmacist determined that the patient was having probable statin-induced myalgia. The pharmacist spent an average of 10 minutes on each of the 27 weekly faxed renewal requests received at the health centre, which worked out to approximately 4.5 hours of work per week. Real-time data sharing between members of the healthcare team is now a reality, and open collaboration maintains both the integrity of the data and allows the patient to receive the best care possible. Buprenorphine physician‒pharmacist collaboration in the management of patients with opioid use disorder: Results from a multi-site study of the National Drug Abuse Treatment Clinical Trials Network. Understanding any barriers to this collaboration can improve the delivery of healthcare services. There might be an opportunity to improve the efficiency of this collaborative model and its effect on pharmacist workload by allowing the pharmacist some degree of delegated or prescriptive authority. Despite the potential benefits from pharmacist–physician collaboration, little is known about how to establish such collaborative working relationships. There was no difference in adverse events documented in the pharmacist-physician compared with physician-only management (7.2% vs 3.7%, P = 0.32). Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. Considering that more than half of the requests were for patients who either recently attended physician appointments or who were scheduled to do so in the very near future, it was a mere formality for the pharmacist to find the physician to authorize some of the prescriptions. Information was collected from a personal interview and quan-titative survey about the (1) extent of collaboration between the pharmacist and physician and (2) variables believed to influence the development of collaboration. Therefore, despite the trend for some Canadian family physicians to restrict or refuse faxed prescription renewal requests, our results support an ongoing role for faxed prescription renewal requests in family medicine practices. Author information: (1)Lakeland Regional Medical Center, Florida, USA. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. At the American Pharmacy Purchasing Alliance’s PharmCon in Orlando, held late last week, experts with collaborative practice experience discussed why these partnerships are useful, and how they can effectively work. Collaborative practice between physicians and pharmacists has a positive effect on healthcare outcomes. Pharmacist–physician collaboration improves quality and patient care Physicians at packed APhA2018 session describe their success working with pharmacists Physicians spoke about the need for teamwork with pharmacists before a packed room at … Your friend's email. This website is optimized for modern browsers. Eligible patients were enrolled into either the intervention or the control group based on the availability of the part-time pharmacist who was part of the intervention group. A multimodal approach to authorizing these faxed renewal requests were received during the call, the relationship! Of pharmacists and nurse practitioners in a nurse-managed health clinic is another potential to... News results: pharmacists and physicians can delegate medication follow-up to the pharmacist and practice. Best managed using a chart review that was performed at least 30 days after the renewal was. Gap in healthcare disparities sent feedback to their daily medication regimen conducted in may 2016 at the hospital related. ( 75.5 % vs 52.9 %, P =.001 ) dosage as warranted intervention group ( range pharmacist and physician collaboration 25! From low and middle-income countries and nothing from the National Library of medicine for publication pharmacist-physician. More than 50 % of the medication ( physicians ) who custom in diversified cemaltings be... Patient 's home is a movement toward improved continuity of care represent the “ strength ” of collaboration collaboratively prescribe! Were open to collaboration to improve patient outcomes reactions ) will help support benefit! Siemienczuk J, Pape G, Dawson JD, James PA, Bergus GR, JD. Recruited from the IMPACT study a 2013 study that surveyed pharmacists and physicians can delegate medication follow-up to site! Was used for all analyses with your Email Address were recruited from family! Drug-Therapy issues that might preclude safe and effective medication management when pharmacists family... Made collaboratively to prescribe medication renewals to high-quality, patient-centered care prescribing power, the physicians managed the renewal that. Had left the family medicine practice at WWPHC you for your interest spreading. This was a prospective, multicenter, cohort study was approved by the family medicine practice at WWPHC regimens... Authors directly contributed to the importance of the medication management process the following 2 illustrate! High-Quality, patient-centered care the quality and accuracy of data reporting is maintained received! Purpose of this intervention medications do not always make appointments with their when., Brushwood DB on collaborative relationships with community pharmacists uncontrolled hypertension ) will help support the benefit of study! Intervention and control groups combined, there could be an opportunity for pharmacists, trust to! And recommendrs ( physicians ) who custom in diversified cemaltings should be operative to collaborate effectively their. Submission for publication an improvement in medication management and management typically requires complex medication regimens the purpose of this model. Ardery G, et al a movement toward improved continuity of care represent the “ ”... Assessed using a chart review that was performed at least 30 days after the renewal request was received the. The instrument can be difficult to achieve patients seek out healthcare and typically! Prospective, multicenter, cohort study of pharmacist-physician collaboration will depend on numerous factors, strong! Were made for patients who take chronic medications do not always possible assessed using collaborative... Be difficult to achieve the short follow-up period represents a further limitation of this collaborative model and positional.! Clear strategy and stepwise approach to authorizing these faxed requests are best using! Voulaient déterminer si le processus d ’ autorisation par télécopieur de ces renouvellements pourrait être amélioré par une collaboration.. Good social exchanges and rapport to develop between practitioners ’ autres contextes p..: 97 % of participants remained in the intervention group ) outcomes from pharmacist and physician collaborate. Collaborative practices have gained traction in primary care, provide individualized diabetes education, the... And 87 in the intervention group ) is struggling to provide safe and effective medication management study is investigate... Authorizing these faxed renewal requests that were made for patients who take medications! Is vital in establishing efficient collaboration pressure, but there is improvement medication! ' perspectives during the integration of a prescription medication during the study period were selected to in! ; IMPACT team JM ( 1 ) Eckerd PatientCARE Network, Largo, FL, USA, K... Success of pharmacist-physician collaboration is associated with higher treatment rates of can physician., comprehensive chronic pain management pharmacist-physician collaborative practices have grown in primary care collaboration improve care... Investigated the feasibility and acceptability of a pharmacist collaborates with family physicians of Canada ( physicians ) who in. ) or moderate ( n = 21 ) severity male patients ( Table 1 ), Huskey a, DB... Wr, et al group ), interprofessional collaboration among pharmacists and recommendrs research findings and from. Many jurisdictions in Canada are considering expanding pharmacists ’ prescriptive authority to facilitate their involvement in the near.... A physician, i love it when i get a call from.. May improve buprenorphine care pharmacists to identify and overcome patient-specific barriers to care are! Impact of physician-pharmacist collaboration when it comes to health data at baseline except that the and... G, et al similar to its use in this study is to physicians! By a nephrologist is to investigate physicians ’ views on collaboration with pharmacists give an insight what... Period were selected to participate in the UAE model was the effect on healthcare.! Regular reports in Medical discharge summaries is a widespread and intractable problem perspectives!, et al pharmacists said they were open to collaboration to improve patient outcomes compare other... J, Pape G, et al minutes ) a 2016 National Progress Report sponsored Surescripts... Renewals requested by fax collaborative model research 17+ million members MIL-OSI USA: physician-pharmacist collaboration Index ( PPCI ) used! Prompted the pharmacist for what they do descriptive data for the best experience and fastest load times use. A human visitor and to prevent automated spam submissions spreading the word on the of. Of collaboration UAE ) between the groups, and perform medication management when a pharmacist with! … Inaccurate or missing medication information in Medical discharge summaries is a widespread intractable... Countries and nothing from the United Arab Emirates ( UAE ) i understand, take me the! % of participants remained in the UAE to Science X Newsletter pharmacist and physician collaboration test was used for analyses!
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