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dc.contributor.authorMercer, Kathryn
dc.contributor.authorBurns, Catherine
dc.contributor.authorGuirguis, Lisa
dc.contributor.authorChin, Jessie
dc.contributor.authorDogba, Maman Joyce
dc.contributor.authorDolovich, Lisa
dc.contributor.authorGuénette, Line
dc.contributor.authorJenkins, Laurie
dc.contributor.authorLégaré, France
dc.contributor.authorMcKinnon, Annette
dc.contributor.authorMcMurray, Josephine
dc.contributor.authorWaked, Khrystine
dc.contributor.authorGrindrod, Kelly 18:43:21 (GMT) 18:43:21 (GMT)
dc.description©Kathryn Mercer, Catherine Burns, Lisa Guirguis, Jessie Chin, Maman Joyce Dogba, Lisa Dolovich, Line Guénette, Laurie Jenkins, France Légaré, Annette McKinnon, Josephine McMurray, Khrystine Waked, Kelly A Grindrod. Originally published in JMIR Human Factors (, 25.09.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.en
dc.description.abstractBackground: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.en
dc.rightsAttribution 4.0 International*
dc.subjectshared decision-makingen
dc.subjectelectronic health recordsen
dc.subjectinterprofessional collaborationen
dc.subjectmedication managementen
dc.titlePhysician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Studyen
dcterms.bibliographicCitationMercer K, Burns C, Guirguis L, Chin J, Dogba MJ, Dolovich L, Guénette L, Jenkins L, Légaré F, McKinnon A, McMurray J, Waked K, Grindrod KA Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study JMIR Hum Factors 2018;5(3):e24en
uws.contributor.affiliation1Faculty of Engineeringen
uws.contributor.affiliation1Faculty of Scienceen
uws.contributor.affiliation1Waterloo Libraryen
uws.contributor.affiliation2School of Pharmacyen
uws.contributor.affiliation2Systems Design Engineeringen
uws.contributor.affiliation2Waterloo Libraryen

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