Safety of care
Communicating with pharmacists: Optimizing drug therapy
Originally published February 2014 / Revised June 2016
Effective communication with a pharmacist can often go a long way to prevent prescribing missteps and, at the same time, optimize patients' drug therapy. There is no one-size-fits-all formula for physicians to work and communicate effectively with pharmacists, as circumstances will dictate the most appropriate approach.
The number of prescriptions filled by Canadian pharmacies has risen 5% annually since 2007. In 2010, about 483 million prescriptions were dispensed.1
The extent, frequency, and methods of working and communicating will vary depending on the characteristics of both the doctor's practice and the pharmacies. Any number of factors can come into play, such as location or the patient population being served. In a rural setting with only 1 or 2 pharmacies in the entire community, communication will likely differ from an urban centre. If a physician and pharmacist develop specific knowledge on a condition, such as diabetes, the two professionals may communicate more frequently and extensively as a result.
Pharmacists' roles and responsibilities
Physicians will be aware that pharmacists are independent health professionals governed by a provincial or territorial regulatory authority (College). As self-regulated professionals, pharmacists must meet the standards of care of their profession. Those standards, for instance, generally state that pharmacists are responsible for assessing each prescription before they can dispense a medication. As a result, there may be times when pharmacists require additional information from physicians to fulfill their professional obligations. For example, if pharmacists are having difficulty accurately reading a prescription or have concerns about a drug dosage, they must contact the physician to verify the information before the medication is dispensed.
Communicating with pharmacists and medical assistance in dying
Medical assistance in dying (MAID) has been legal in Québec since December 10, 2015, and federal legislation now authorizes MAID across Canada in accordance with eligibility criteria and safeguards. Physicians participating in MAID may be required to work with pharmacists to obtain the drugs to be administered to their patients as part of this process. In doing so, physicians are required to clearly communicate to the pharmacist when a prescription is intended for MAID.
Physicians should also be aware of, and comply with, any legislation or regulatory guidelines related to the dispensing and disposition of drugs to be used for MAID.
In all provinces and territories, pharmacists' work and responsibilities are expanding. Physicians should consider how these new responsibilities affect how the two professions work and communicate. Depending on the jurisdiction, pharmacists' additional authority can include prescribing for minor ailments; renewing medications; changing dosages, formulations, and regimens; making therapeutic substitutions; providing emergency prescriptions; administering injections; etc. In some provinces and territories, pharmacists have the authority to carry out activities independently, while others require physician notification, consultation, or approval. Physicians will want to know when pharmacists can act independently, and when they require physician involvement. Doctors wanting more information on the scopes of practice of pharmacists in their jurisdiction should contact their College or medical association.
From a medico-legal perspective, as both physicians and pharmacists are independent providers, each owes a separate duty to the patient for care that falls within their individual scopes of practice. This means physicians will generally not be held liable for the actions of a pharmacist. For example, if a physician writes a clear and appropriate prescription for a patient, but the pharmacist dispenses the prescription incorrectly and the patient is harmed, the courts and Colleges would generally hold the pharmacist responsible.
Of course, physicians may be held liable if their actions result in patients being harmed. For example, in some jurisdictions where pharmacists have the authority to independently change prescriptions, pharmacists are generally also required to notify the prescribing doctor. The physician is then responsible for reviewing the alteration. In this situation, the physician could be held liable if he or she is notified of a change which should give rise to concern, but fails to take any action to protect the patient.
Patients benefit from good communication practices
Respectful, open, cooperative, and timely communication can optimize patient care. For example, when pharmacists call to discuss a patient's prescription, physicians will want to respond by listening to the concerns and cooperating to resolve the issue. The result is that patients will receive appropriate medication and information. If pharmacists are calling frequently to verify a prescription, there may be an underlying problem that requires attention. A physician may wish to invest additional time when writing prescriptions to ensure they are clear and have adequate information.
Numerous studies have confirmed that enhanced communication and collaborative working relationships between physicians and pharmacists foster better patient care. In some cases, better communication has resulted in patients' increased adherence to drug therapy.2 In others, it has been shown to provide individuals suffering from chronic conditions with greater support so they can improve how they manage their drug therapy.
While physicians cannot reasonably be expected to establish a close collaborative relationship with all community pharmacists, this may be achieved in some circumstances. A physician with a number of HIV patients may work closely with a pharmacist with expertise for this condition. The two professionals may collaborate closely to provide information to patients. The pharmacist is well positioned to reinforce what the physician has already advised, and may provide counselling on how to take the medication, when to take it, what interactions to watch for, and any dietary concerns.
Exchanging routine and critical information
Physicians should consider establishing processes and procedures to minimize the risk of miscommunication with pharmacists. To ensure clarity and legibility, physicians could consider generating computer printed prescriptions or printing in block letters when using pen and paper. Technology, such as e-prescribing, can be effective in some settings.
Using appropriate wording on a prescription, such as once a day or every day instead of qd, and giving pharmacists adequate information, such as why a patient's medication is being changed, may eliminate the need for pharmacists to contact a physician later.
Putting the physician's College number on all controlled prescriptions gives pharmacists the information they need to ensure these medications are being dispensed safely.
Determining how communication from pharmacists will be processed and having office staff follow established procedures allows critical and routine requests for information to be responded to appropriately and efficiently. Having a timely and efficient system for reviewing pharmacists' requests for medication refills, for example, ensures appropriate and safe dispensing.
Physicians should be aware, however, that any communication channel, old or new, can break down. For instance, when faxing a prescription to a pharmacy, information can inadvertently be cut off. Documenting communications with pharmacists provides a record of the information that was exchanged, facilitates any future investigations and treatments, and is valuable if there are questions about the care.
Taking the next step
Through effective communications and working relationships with pharmacists, physicians have the opportunity to improve their patients' medication treatment and protect them from adverse events. After determining the communication approaches that will best suit their practice, physicians should become aware of what activities are within pharmacists' scopes of practice, make a conscious effort to consistently use good communication practices, and establish processes and procedure for exchanging routine and critical information.
- "Pharmaceutical sales increased during recession," Canadian Medical Association Journal (2010), Vol. 182, no. 8, p. E341
- Laubscher, T., Evans, C., Blackburn, D., Taylor, J., Mckay, S., "Collaboration between family physicians and community pharmacists to enhance adherence to chronic medications," Canadian Family Physician (2009), Vol. 55, December, p. 69-75