PharmaJournal Interview with Dr Otmar Kloiber about “Collaborative Practice”


18 September 2013

1.     Why is the development of collaborative practice so important?

In today’s world of evolving healthcare systems, the delivery of effective, high-quality patient care is increasingly complex. In most cases care is already provided by teams or by different health professionals and health workers consecutively. We are convinced that a collaborative, team-based approach to care, particularly when dealing with complicated cases, can lead to better results. This does not necessarily mean a change in roles and functions, but it does mean a strong effort to commonly focus on the person’s need. Interprofessional collaborative practice (ICP), which has the potential to manage across the continuum of care and encompass prevention, treatment, rehabilitation and palliation, is the way to address the challenges that healthcare systems face today. Collaborative practice models bring together all healthcare professionals as a team for “person-centered” care.

2.     Why did WHPA decide to publish a statement about “collaborative practice” in May 2013?

The World Health Professions Alliance was formed in 1999 and brings together the global organizations representing five disciplines in healthcare: the International Council of Nurses (ICN), International Pharmaceutical Federation (FIP), World Dental Federation (FDI), World Medical Association (WMA), and World Confederation of Physical Therapists (WCPT). As an Alliance, we speak for more than 26 million healthcare professionals worldwide and work to facilitate collaboration among the health professions and major stakeholders in health, such as governments, international organizations and the UN, particularly the World Health Organization. 

We believe that WHPA has already set a standard of excellence of ICP at the global level. We have done this through our joint advocacy for educational, legislative, and health systems changes that bring about and strengthen interprofessional partnerships. The release of the WHPA Statement in May 2013, during the week of the 66th World Health Assembly, was meant as a call to action to governments attending the Assembly to create enabling policy environments for ICP. But creating policies is only the first step. The next step needs to be action both to improve the delivery of services and to empower persons, be they patients or just persons seeking advice to participate in their healthcare by making informed decisions, enhancing their role in prevention and adhering to appropriate treatment and rehabilitative care.

3.     What are the key messages of the statement?

An overarching key message of the statement is that collaborative practice is the way to go if modern health systems are to meet the global health challenges. Without effective teamwork among various healthcare professionals involved in the delivery of services, along with good communication and coordination of care, patients may experience duplication, gaps and discontinuity in health services and, ultimately, poor health outcomes.

Another message we want to communicate is that governments play a key role in facilitating interprofessional collaborative practice in terms of policies and organization of health systems, including adequate funding, health professionals’ education and regulation.

Health professionals associations should be actively involved and contribute to the discussions and development of ICP policies, governance structures and funding models.

We also believe that evidence is important and we would like to see more research and evaluation to demonstrate the benefits of collaborative care in different contexts and resource environments.

However, the most important message is that the ICP is the means to an end, not the ultimate goal in and of itself. ICP ensures that the role of individual professions is appreciated in the delivery of the highest possible standard of quality care that benefits a patient. And the patient is also viewed as a valuable member of the team.

4.     What impact do you expect in terms of implementation at the level of daily practices?

Interprofessional collaboration is not a new concept, and despite the attention it has been getting recently at the policy and health systems level, there is little evidence that the concept is reaching the ward level everywhere.  The WHPA Statement of Collaborative Practice is a call to action to all healthcare workers to get our act together and work towards overcoming barriers to success, whether they are individual factors, inter- and intraprofessional challenges or systemic barriers. Amid these challenges it is important not to lose sight of the fact that the focus of ICP is the persons we serve. No matter what the challenges are, all healthcare professionals should maintain a person-centered focus of care and understand and respect each other’s skills and competencies in reaching a common goal.

Change will take time, but steps need to be taken in the right direction now to make sure it happens. WHPA believes that education is key in ensuring that ICP is a part of daily practice.

The concept of interprofessional education dates back to the 1960s and was reinforced by the World Health Organization in 1988 through two reports, Continuing Education for Physicians and Learning Together to Work Together for Health. WHPA is committed to joint advocacy at the global and national levels through our member associations. But the action has to take place in countries, and the medical profession needs to assume a leading role. We also need the support of the academic community to provide interprofessional education where this enables teamwork and collaborative practice skills. In addition, it is important to develop best practice models that are possible to replicate in different country settings and resource environments.

5.     Could you quantify in terms of savings or cost containment, the benefits of such collaborations among healthcare providers?

Our primary concern is the health of the person as individual patients or as communities or populations. We are concerned about the careful and responsible use of resources. We work hard to save lives, to alleviate suffering, to comfort the dying, to prevent disease and to maintain the well being of our fellow human beings, and the cost of saving a life is not easy to express in monetary terms.

6.     More specifically, how could physicians and pharmacists work better together?

In collaborative teamwork, the active involvement and participation of every team member with complementary skills is paramount. Team members bring broad and diverse knowledge as well as training and appreciation of the full spectrum of health and healthcare delivery from prevention to treatment and rehabilitation. Physicians are prepared to take the lead in patient care, but we fully respect the importance, competence and role of all our partners.

A seamless cooperation of pharmacists and physicians in both ambulatory settings and in hospitals can help to better provide patients the optimal medication and application of the medicine. It can strengthen the adherence to therapy and can help to avoid medication errors and increase pharmacovigilance. Physicians’ and pharmacists’ teamwork can help tackle one of the biggest challenges in modern medicine: Microbial resistance. The education and knowledge of pharmacists are far too valuable to leave to vending functions.

7.     Do you know examples of successful collaborative practice between these two professions?

There are a few studies that indicate that a successful physician-pharmacist collaboration can indeed lead to better health outcomes. For example, research conducted in the US that evaluated a program aimed at improving the care of patients with poorly controlled Type 2 diabetes, indicated that physician-pharmacist collaboration can significantly improve the health of patients, as evidenced by improved readings of glycemic and lipid control tests (Ramser et al. Physician-Pharmacist Collaboration in the Management of patients with Diabetes Resistant to Usual Care. Diabetes Scpectrum Volume 21, Number 3, 2008).  

A report in the Archives of Internal Medicine indicated that when physicians and pharmacists collaborated to select the best options of treatments and give advice on lifestyle and dietary improvements, they were able to lower the blood pressure readings of 75 per cent of ambulatory care patients within an acceptable range vs. only 50 per cent where care was provided only by a physician.

There was another research report published in the Annals of Pharamacotherapy in 2010, which reported on the nine-year sustained cost-containment impact of a Swiss Pilot project in Fribourg, where six trained community pharmacists moderated the prescribing practices of 24 general practitioners. For the nine-year period, there was a 42 per cent decrease in drug costs in the target group as compared to the control group, representing a US$ 225,000 savings per general practitioner in 2007. The results were explained by better compliance with the clinical protocols of care, more reliance on generic medicines, and interdisciplinary continuing education on the rational use of drugs.

These studies indicate that there is plenty of room for innovation in terms of different methods of healthcare delivery, and that collaborative practice is also a diverse, open-ended concept, amenable to adaption to different contexts.

8.     In Switzerland, many physicians are allowed to directly sell medicines to their patients and thus are competitors of pharmacists. Do you think that it is possible in these conditions to develop an interdisciplinary collaboration?

Every healthcare system reflects the values, history and culture of the country where it operates. Combining the prescribing and dispensing of medicines by physicians is justified by some on the grounds that the practice improves access to medicines in areas where pharmacies are sparse. This may not be intended to trigger competition between the professions. In regions where there is no team, there quite obviously will be no teamwork and physicians have to fulfill multiple roles. Some of this may be changed by the use of health telematics, but distance will remain and in the end all health care is local.

In terms of interdisciplinary collaboration, I would like to stress again that interprofessional collaboration’s goal is the best possible quality person-centered care, and healthcare professionals should always find ways to use their skills and expertise to the benefit of their patients, irrespective of financial incentives and the organization of healthcare delivery systems.

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