Communicating health information in primary care: a multidisciplinary exploration of patient, pharmacist, and physician decision-making

Abstract

Research has yet to clearly define how health care professionals’ (HCPs) use and sharing of information influences how health decisions are made, both independently and collaboratively. Similarly, the manner in which patients use, interact with, and find health information is not fully, and how external influencers impact patient decision-making about health. The overall goal of this thesis is to examine how and what information is being shared among patients, pharmacists, and physicians and how this information is used in decision making. Using a variety of methodologies, this research examined five areas of communication and decision-making: 1) How patients, pharmacists, and physicians currently make decisions as a healthcare team; how this information influences shared decision-making about patients’ medications and health; and how this process can be improved through the use of electronic health records (EHRs); 2) How information is communicated among HCPs and between HCPs and patients; 3) What information patients seek out, collect and communicate to their HCPs; 4) How relationships influence professional collaboration and communication in healthcare; and 5) The scope of existing knowledge around including the reason for use on a prescription and how that influences the ways in which pharmacists make decisions. This thesis consists of four papers that describe two studies. Three of the papers use data from a qualitative examination of ethnographic observations and structured or semi-structured interview methods to examine: 1) patients’ medication decision-making with their pharmacists and physicians; 2) pharmacist and physician medication decision-making; and 3) how relationships between pharmacists and physicians influence collaboration. The final paper is a scoping review of the literature that characterizes the current body of research on how including the reason for use on a prescription impacts pharmacist decision making. The first study examines how patients make decisions with their health care team, how information influences decision-making and how the process can be improved through EHRs. It revealed that different people play different roles when it comes to helping patients make decisions. The first of three papers emerging from the first study determined that while EHRs can support decision-making, more research is needed to further clarify perceptions of role and how to develop EHRs that are adaptive to varying user information needs. The second paper focuses on physician-pharmacists medication decision-making and examined how physician and pharmacist relationships influence collaboration and communication. It concluded that there is limited communication and collaboration between physicians and pharmacists around managing medications. Further, this research saw an emerging result about how relationships influence how and when collaboration and communication occur, resulting in the third paper which examined the relationships more closely. The fourth paper emerged from the need to better understand the current scope of research about including reason for use on a prescription that is sent to a pharmacist--an emerging area of interest from the original study. Taken together, the chapters provide an emerging picture of how and what information is and should be communicated in healthcare and the factors that influence how information is shared. The findings reveal important common elements that have yet to be fully explored when it comes to information sharing, and these ultimately influence decision-making in health. The findings describe a complex environment of differing information needs among pharmacists, physicians, and patients and emphasize the importance of understanding specific knowledge that must be communicated. Future research should be designed to accommodate a robust multidisciplinary approach that allows us to examine how sharing and communicating health information changes as the influence of technology and the number of stakeholders involved in care increases. Future research should focus on helping HCPs develop multidisciplinary strategies for collaboration and information sharing, based on a shared understanding of each other’s roles, priorities, and values.