Pharmacist-Doctors Relationship in Saudi Arabia

Introduction

Several studies have highlighted the role of inter-professional relationships in improving patient outcomes (Alhawassi et al., 2017; Isetts et al., 2016; Rathbone, Mansoor, Krass, Hamrosi, & Aslani, 2016). They suggest that interprofessional collaboration improves information sharing and quality checks. This paper discusses pharmacist-doctor relationships in Saudi Arabia and their effects on patient safety. The aim and objectives appear below.

Aim

• Find out the impact of pharmacist-doctor relationships on patients’ perception of medication safety
• Investigate the effects of collaboration between pharmacists and doctors on medical error reporting in Saudi Arabian healthcare facilities. In this analysis, issues relating to the frequency and accuracy of reporting medication errors will be explored
• Highlight the role of collaboration between Saudi pharmacists and doctors in the prevention of medication errors by establishing whether it helps patients to have a broader understanding of their medication plan
• Examine the importance of collaboration between pharmacists and doctors in the analysis of medication errors in Saudi Arabia, relative to the different stages of medication error analysis
• Identify factors that influence the relationship between pharmacists and doctors in the Saudi Arabian health sector by evaluating the extent that both parties could collaborate without interfering with each other’s professional integrity

Objectives

• To investigate whether improved pharmacist-doctor relationships in Saudi Arabian healthcare facilities can improve commitment to patient safety by reducing the opportunity for medication errors to occur
• To find out whether pharmacist-doctor relationships in Saudi Arabia will contribute towards the improvement of self-efficacy for both sets of professionals when promoting patient safety
• To examine if improved collaboration between pharmacists and doctors in the Saudi Arabian healthcare sector will enhance patient satisfaction levels
• To estimate the extent that collaboration between pharmacists and doctors would improve the quality of healthcare services in Saudi Arabia, with regards to the timeliness of delivering pharmaceutical services, effectiveness of providing quality care, and equitable medication advice
• To determine the role of collaboration between pharmacists and doctors in helping patients to manage their medication plans

Patient Safety and Its Effects

Patient safety is one of the world’s major public health concerns (Alhawassi et al., 2017; Isetts et al., 2016; Rathbone et al., 2016). It is defined as “the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum” (World Health Organization, 2019, p. 1). The lack of patient safety portends human and financial costs on affected communities because it has led to more than 2.6 million deaths and has cost families up to $42 billion in healthcare costs annually (World Health Organization, 2019).

Causes of Patient Safety

Wagner et al. (2018) also suggest that patient safety issues are linked to poor working relationships among healthcare service providers. Several internal and external organizational factors influence such relationships. For example, the presence of a poor organizational culture could impede efforts to create organisational synergy in healthcare institutions (Wagner et al., 2018). Similarly, the lack of an effective communication strategy between different levels of health workers could affect how well they address patient safety issues to prevent the possibility of adverse drug events or medication errors (Wagner et al., 2018). In part, the importance of understanding the relationship between pharmacists and doctors explains the need to address the occurrence of medication errors because some of them occur through miscommunication or poor collaboration between different levels of health workers (Alhawassi et al., 2017; Isetts et al., 2016; Rathbone et al., 2016).

Inter-Professional Relationships in Saudi Arabia

One of the challenges that affect the relationship between doctors and pharmacists in Saudi Arabia is the high rate of staff turnover. Al-Jedai, Qaisi, and Al-Meman (2016) claim it causes instability in Saudi health institutions. This concern makes it difficult to build long-lasting collaborative relationships within the kingdom or to improve health outcomes and patient safety standards. In a study that investigated the effects of stress and working conditions among pharmacists in Saudi Arabia, Alosaimi et al. (2018) claim work-related stressors affect the quality of relationships between pharmacists and other healthcare service professionals. The cross-sectional study also points out that work-related stressors contribute to high staff turnover, which further undermines the possibility of developing long-term relationships among healthcare service professionals (Alosaimi et al., 2018).

In a different (qualitative study) authored by Alhomoud, Almahasnah, and Alhomoud (2018) aimed at investigating the over-the-counter sale of prescription medicine, it was established that doctors are not often involved in prescribing or selling medicine, thereby undermining patient safety. The failure to involve doctors as part of the drug administration chain is also linked to adverse patient outcomes in Saudi Arabia because the above-mentioned Saudi-based study suggested that antibiotics are often sold in the kingdom without a prescription (Alhomoud et al., 2018).

Perceptions about Inter-Professional Collaboration

In a qualitative study aimed at assessing inter-professional collaborative frameworks for general practitioners in the health care sector, Löffler et al. (2017) claim that mutual trust and appreciation are important tenets of developing inter-professional relationships in the healthcare setting. Relative to this assertion, Löffler et al. (2017) posit that pharmacists often prefer a structured and straightforward communication style. In a different study that investigated the nature of collaboration between pharmacists and physicians, it was established that physicians respected pharmacists because of their immense knowledge of drug information and clinically defined roles which made it easier for other healthcare service professionals to collaborate with them (Alipour, Peiravian, & Mehralian, 2018). However, the study also showed that the expectations of physicians towards collaborating with their counterparts in the pharmacy department did not match the real experience on the ground (Alipour et al., 2018). Therefore, there was room for pharmacists to improve their relationship skills when interacting with their colleagues.

Albassam, Alshammari, Ouda, Koshy and Awad (2018) also explored the relationship between physicians and pharmacists in a Kuwait-based study, which sought to investigate their perceptions towards pharmacogenetics. Both sets of professionals held positive views about the discipline (Albassam et al., 2018). The same study shows that pharmacists and physicians can collaborate at an inter-professional level and advance the discipline’s (pharmacy) standards.

Relationship between Doctors and Pharmacists

The relationship between doctors and pharmacists varies across different countries and cultures (Tsao et al. 2016). However, in most cases, physicians and pharmacists rarely collaborate (Tsao et al., 2016). Some researchers argue that the lack of collaboration between both professionals should be discouraged because their relationship is instrumental in training younger healthcare professionals in information sharing (Albassam et al., 2018). To support this finding, countries that encourage collaboration between doctors and pharmacists often report low incidences of medication errors (Isetts et al., 2016).

Threats to Patients’ Lives

According to Alhawassi et al. (2017), poor patient assessment and diagnosis by medical professionals pose a threat to patients’ lives. Several factors catalyse such threats. One of them is poor communication among healthcare professionals when making referrals or discharging patients from medical facilities (Ng et al., 2017). Misdiagnosis is also associated with the problem because it causes the administration of wrong drugs that may inflict harm on patients (Singh, Schiff, Graber, Onakpoya, & Thompson, 2016). The failure of healthcare staff to collaborate also poses a threat to patient’s lives because it makes them unable to detect the deterioration of a patient’s health on time, thereby causing a delay in accessing the right medication or treatment (Bosch et al., 2018).

Importance of Collaboration among Healthcare Service Providers, Pharmacists and other Medical Staff

Rathbone et al. (2016) say that collaboration among healthcare staff should be promoted to improve patient outcomes. Particularly, the collaboration between pharmacists and other medical staff should be encouraged to improve adherence to medication plans (Rathbone et al., 2016). However, effective collaboration between pharmacists and other medical staff can only occur if each healthcare team understands the scope of practice and training methods of their colleagues (Ng et al., 2017). Therefore, collaboration should be fostered between pharmacists and other medical staff with a proper understanding and respect for the expertise of each professional group.

Summary

As highlighted above, this literature review shows that few studies have investigated inter-professional collaboration between pharmacists and doctors. The ones that do are based in western countries. Therefore, the literature is silent about the relationship between pharmacists and doctors in Saudi Arabia and the larger Middle East region. Consequently, there is a need to undertake further research about the collaboration between both professional groups.

References

1. Albassam, A., Alshammari, S., Ouda, G., Koshy, S., & Awad, A. (2018). Knowledge, perceptions and confidence of physicians and pharmacists towards pharmacogenetics practice in Kuwait. PloS One, 13(9), 1-10.
2. Alhawassi, T. M., Abuelizz, H. A., Almetwazi, M., Mahmoud, M. A., Alghamdi, A.,
3. Alruthia, Y. S., … Pitts, P. J. (2017). Advancing pharmaceuticals and patient safety in Saudi Arabia: A 2030 vision initiative. Saudi Pharmaceutical Journal, 26(1), 71-74. doi:10.1016/j.jsps.2017.10.011
4. Alhomoud, F., Almahasnah, R., & Alhomoud, F. K. (2018). “You could lose when you misuse” – Factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: A qualitative study. BMC Health Services Research, 18(1), 915. doi:10.1186/s12913-018-3753-y
5. Alipour, F., Peiravian, F., & Mehralian, G. (2018). Perceptions, experiences and expectations of physicians regarding the role of pharmacists in low-income and middle-income countries: The case of Tehran hospital settings. BMJ Open, 8(2), 1-10.
6. Al-Jedai, A., Qaisi, S., & Al-Meman, A. (2016). Pharmacy practice and the health care system in Saudi Arabia. The Canadian Journal of Hospital Pharmacy, 69(3), 231-237.
7. Alosaimi, F. D., Alawad, H. S., Alamri, A. K., Saeed, A. I., Aljuaydi, K. A., Alotaibi, A. S.,… Alfaris, E. A. (2018). Patterns and determinants of stress among consultant physicians working in Saudi Arabia. Advances in Medical Education and Practice, 9(1), 165-174. doi:10.2147/AMEP.S155113
8. Bosch, X., Sanclemente-Ansó, C., Escoda, O., Monclús, E., Franco-Vanegas, J., Moreno, P., … López-Soto, A. (2018). Time to diagnosis and associated costs of an outpatient vs inpatient setting in the diagnosis of lymphoma: A retrospective study of a large cohort of major lymphoma subtypes in Spain. BMC Cancer, 18(1), 276.
9. Isetts, B. J., Buffington, D. E., Carter, B. L., Smith, M., Polgreen, L. A., & James, P. A. (2016). Evaluation of pharmacists’ work in a physician-pharmacist collaborative model for the management of hypertension. Pharmacotherapy, 36(4), 374-384. doi:10.1002/phar.1727
10. Löffler, C., Koudmani, C., Böhmer, F., Paschka, S. D., Höck, J., Drewelow, E., …Altiner, A. (2017). Perceptions of interprofessional collaboration of general practitioners and community pharmacists – A qualitative study. BMC Health Services Research, 17(1), 224. doi:10.1186/s12913-017-2157-8
11. Ng, G., Pun, J., So, E., Chiu, W., Leung, A., Stone, Y. H., … Chan, E. A. (2017). Speak-up culture in an intensive care unit in Hong Kong: A cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. BMJ Open, 7(8), 1-10. doi:10.1136/bmjopen-2016-015721
12. Rathbone, A. P., Mansoor, S. M., Krass, I., Hamrosi, K., & Aslani, P. (2016). A qualitative study to conceptualise a model of interprofessional collaboration between pharmacists and general practitioners to support patients’ adherence to medication. BMJ Open, 6(3), 1-10.
13. Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2016). The global burden of diagnostic errors in primary care. BMJ Quality & Safety, 26(6), 484-494. doi:10.1136/bmjqs-2016-005401
14. Tsao, N. W., Khakban, A., Gastonguay, L., Zafari, Z., Lynd, L. D., & Marra, C. A. (2016). Opinions and preferences of British Columbia pharmacists and physicians on medication management services. Canadian Pharmacists Journal, 150(1), 42-51.
15. Wagner, A., Hammer, A., Manser, T., Martus, P., Sturm, H., & Rieger, M. A. (2018). Do occupational and patient safety culture in hospitals share predictors in the field of psychosocial working conditions? Findings from a cross-sectional study in German university hospitals. International Journal of Environmental Research and Public Health, 15(10), 2131.
16. World Health Organization. (2019). Patient safety. Web.