Building an evidence base for a collaborative medication therapy management model for chronic diseases in Malaysia : perspectives of healthcare stakeholder

Abstract

Ageing populations and burden of chronic diseases affect economies, resources, and most importantly quality of patient care. Generally, in chronic diseases, patients take multiple drugs life long and there is a need to better manage their medicine. Collaboration among the healthcare providers in chronic diseases is required for effective medicine management to improve the outcomes of drug therapy. In developed countries, collaborative working of the community pharmacist and general practitioners to manage medicines in chronic disease have been extensively cited as beneficial. However, in Malaysia, there exists least collaboration between community pharmacist and general practitioner. The aim of this mix method study was to build an evidence base for a collaborative medication therapy management model by engaging community pharmacists and general practitioners in a collaborative practice for chronic diseases with a special focus on asthma in three phases. Phase one of this study quantified the impact of collaborative practice between community pharmacist and general practitioner on various clinical, humanistic and economical outcomes in asthma in the form of a systematic review and meta-analysis. This served as a base for the next phase. Phase two deployed Delphi technique (a consensus based method) to gauge level of agreement among different healthcare stakeholders on collaborative working of community pharmacist and general practitioners. Twenty-nine experts (mainly on strategic posts) were recruited from all over Malaysia, representing i.e., community pharmacists (n=10), general practitioners (n=11) and nurses (n=8), to constitute a panel of experts. An online questionnaire consisted of 132 items, was drafted, validated and administered to the experts. Median, interquartile range and intra-class correlation coefficient were computed to appraise degree of consensus or dissensus, among the experts for the possibilities and different aspects of a collaborative medicine management model for chronic diseases. The results were assembled in the form of recommendations. Phase three of the study began with the aim to further enrich data obtained in the phase two, based on axiom of triangulation, through in-depth semi-structured interviews. Twelve experts (from the same expert panel) were interviewed to size up views, perception and experiences of experts about various aspects of collaboration. Themes were identified using a constant comparison approach based on grounded theory, while theoretical saturation directed the data collection. Result of this phase confirmed the data acquired in phase-2 and explored the collaboration possibilities in details and covered various barriers, diseases, modes of funding for the service, and the feasibility of establishing the collaborative medicine management model in Malaysia. Data generated in three phases of research are an original contribution to the evidence base and provided a frame work to guide the future health care policy to switch to a collaborative medicine management model and recommends future research to evaluate its related outcomes using a randomized control trial. Key words: community pharmacist, general practitioner, medicine management, medication therapy management, chronic disease, asthma, collaborative care, shared care, team based care, Delphi method, perception, barriers, qualitative inquiry, Malaysia.