Doctors’ and nurses’ perceptions of a ward-based pharmacist in rural northern Sweden
Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden
Maria Sjo¨lander 0 1
Maria Gustafsson 0 1
Gisselle Gallego 0 1
0 School of Medicine, The University of Notre Dame Australia , 160 Oxford Street, Darlinghurst, NSW 2010 , Australia
1 Department of Pharmacology and Clinical Neuroscience, Umea ̊ University , 90187 Umea ̊ , Sweden
Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a wardbased pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.
Clinical pharmacy; Doctors perceptions; Nurses perceptions; Rural health care; Sweden
Impacts on practice
To successfully implement clinical pharmacy services in
hospital wards, roles, clinical competence and
responsibilities should be clearly described and specified.
When implementing clinical pharmacy services in a
hospital, it is important to focus on collaborative
working relationships between doctors, nurses and
To be able to integrate clinical pharmacists into health
care teams, it is important that other health care
professionals understand their required skills and
competence, as well as having clearly defined
expectations of the service they provide.
The role of pharmacists has experienced significant
changes in recent decades. In a hospital setting, pharmacy
services have changed from traditional dispensing roles
to become patient-centred services . Studies have
demonstrated that the provision of clinical pharmacy
services (CPSs) can contribute to a significant reduction
in adverse drug events (ADEs),  length of stay and
readmissions to hospital [3, 4]. However, as described by
Makowsky et al.  even though clinical pharmacists
have the potential to improve medication safety in
hospital settings, they are still an underutilised resource.
While in countries such as the United States,  the
United Kingdom  and Australia  ward-based
pharmacists are commonplace, until recently very few
Swedish clinical pharmacists worked in hospitals
providing CPSs. The degree of implementation of CPSs in
hospitals in Sweden has varied. In 2009, after positive
results from a trial exploring the effectiveness of
interventions carried out by ward-based pharmacists in
reducing morbidity and the usage of hospital care for
elderly patients, CPSs were implemented in some
hospitals in the south of Sweden .
In Va¨sterbotten County, one of five counties situated in
Norrland, the most northerly region of Sweden, CPSs have
been provided on a number of wards at two regional hospitals
since 2003. In 2014 a request was made for this service to be
implemented on the medical ward of a rural hospital in the
region. The clinical pharmacy service included medication
reconciliation, medication review, and participation in ward
rounds. Before the implementation, a study was designed to
investigate if medication reviews conducted by a clinical
pharmacist as part of a ward team can reduce drug-related
problems (DRPs) among people admitted to the medical
ward at a rural hospital. However, since this involved a
change in current practice, it was important to understand the
factors that may have an impact on the implementation of the
CPSs . Makowsky et al.  described how the
integration of pharmacists into core health care teams appears to
assist better team decision-making around drug therapy,
positive patient outcomes, improving patient safety and
improving continuity of care. Research in primary care
settings in the United States,  Canada  and the United
Kingdom  has highlighted the importance of
understanding primary care practitioners’ expectations and
perceptions of pharmacy services. This is important in order to
develop collaborative relationships. However, to date
limited research has been conducted in Sweden to understand
the working relationships and perceptions and expectations
of doctors and nurses prior to the introduction of a CPS on a
Aim of the study
This study aimed to explore doctors’ and nurses’
perceptions and expectations of having a ward-based pharmacist
The study was approved by the Regional Ethical Review
Board in Umea˚ (registration number 2014/322-31O¨ ).
Written consent was obtained from all study participants.
All transcripts were de-identified and all data were kept
This study adhered to the consolidated criteria for reporting
qualitative research (COREQ) .
Setting and context
This study took place on the general medical ward of a
hospital in rural northern Sweden. The ward has 18 beds
and different categories of patients are admitted to this
ward. However, most patients are older and have multiple
comorbidities. The region is sparsely populated, with a
population density of fewer than five people per square
kilometre . It is situated in the middle of the
Va¨sterbotten County, which has a catchment area covering
55,186 km2 (about the size of Denmark) and is populated
by about 259,239 inhabitants. Of these, the majority live in
or near the city of Umea˚, which has a university hospital.
However, around 70,000 people live outside the urban
areas. The most distant point in the county is about 300 km
from the hospital and due to its geographical location it is
also the base for the ambulance helicopter .
Before the interviews were conducted on the medical
ward, no clinical pharmacist had provided patient care
services at this hospital. However, since 2015,
prescriptionists (‘‘receptarie’’ in Swedish) have been in charge of
delivering drugs to the hospital once a week from a nearby
regional hospital (128 km away). The prescriptionists’
main tasks involved checking inventory, ordering and
unpacking drugs and interacting with the nurses about
Purposive sampling  was used to identify doctors and
nurses working on the ward where the clinical pharmacy
service was due to be implemented. All doctors and nurses
on the ward were invited to participate. The clinical nurse
manager in charge of the ward scheduled all the interviews.
Days and times were chosen to best suit the workload and
staffing of the ward.
All interviewees were given information about the study
and were informed that participation was voluntary. An
interview schedule was developed with a list of topics to be
discussed during the interviews. Topics included: the role of
pharmacists, prior experience of working with pharmacists
and the perceptions and expectations of having a pharmacist
on the ward (see Appendix 1). There are no formal
requirements to be able to work as a clinical pharmacist in Sweden,
both pharmacist (‘‘apotekare’’) and prescriptionist
(‘‘receptarie’’) can work as clinical pharmacist. However pharmacist
(‘‘apotekare’’) are more likely to have this role. The term used
during the interviews was pharmacist (‘‘apotekare’’).
Semi-structured interviews were conducted between April
and May 2015 at the hospital by the first author (MS). Due
to the confidential nature of the information revealed by the
respondents, there was an emphasis on reassuring each
respondent that anonymity was guaranteed. All participants
signed a consent form. Interviews were digitally recorded
with the permission of the interviewees, transcribed
verbatim and translated into English. Background data (age,
gender, years working at the hospital and years in their
current role) were also collected on all participants.
Data collection involved several stages. First, author MS read
and reread the transcripts. At this stage, descriptive codes were
applied to the data. Subsequently, based on the first order
codes, a coding framework was developed to organise the
interview data. Codes were compared and discussed by
authors MS & GG until a consensus on a coding framework
was reached. Coding and consensus meetings were performed
iteratively for the first four interviews. At a later stage, the
codes were grouped into themes. Through consensus
meetings, the most relevant themes were identified.
In total, 18 people were invited, and all agreed to
participate. An equal number of medical doctors and nurses were
interviewed. Sixty-seven percent were females and
onethird were 50 years or older. Table 1 describes the
characteristics of the study participants. Two broad themes
were identified: (1) Role specification with two subthemes:
(a) traditional roles versus patient-centred care and
(b) working relationships; and (2) Expected outcomes with
four subthemes: (a) impact on patient care, (b) drug
knowledge, (c) workload and (d) ‘‘I think this feels just
Traditional roles vs patient-centred care
Even though the term pharmacist (‘‘apotekare’’) was used
during the interviews most participants were not able to
differentiate between pharmacists (‘‘apotekare’’) and
prescriptionists (’’receptarie’’). Participants described the
pharmacist role in different ways. Some had limited
experience or a vague idea of what pharmacists can or are
allowed to do on a ward. Others—mainly
nurses—described traditional roles such as inventory and drug
distribution, as illustrated by this quote: ‘‘… to keep the drugs or
the store room for drugs in order and make sure we don’t
run out of drugs, that they are ordered on time. Yes.
Unpack them when they arrive maybe.’’ (Nurse 8).
Some participants expect ward-based clinical
pharmacists to educate staff and share their ‘‘drug knowledge’’.
One participant noted: ‘‘There are lots of medications that
we are not very familiar with. Or we have heard of or seen
about them at some point, but we know nothing more about
the treatment. Perhaps they will be able to help us,
someone to ask…’’ (Doctor 9)
Views on the patient care role of the pharmacist also
varied. Some participants described how they did not
expect the pharmacist to have direct contact with patients:
‘‘I imagine that they might not be very much directly
together with the patient.’’ (Doctor 1) Others questioned
whether they can have access to the patients’ medical
records: ‘‘… access to medical records and so. I don’t
know, when it comes to authorisation, what access they
have.’’ (Nurse 1) Conversely, some (mainly doctors)
described how the pharmacist may have a role in patient
education as evidenced by these quotes:
I hope that there is time and space for that person to
also meet with patients and discuss [with them] what
they have understood about their medications and
how they actually take [them]. (Doctor 7)
They have a greater opportunity to work with the
patient to go through their medicines and like make
sure that they understand what it’s about and so on.
Familiarity or previous experience working with a
pharmacist demonstrated a better understanding of their role.
Some participants (mainly doctors) were able to describe
how decisions are made in a ‘‘consultative manner’’ and
described very specific tasks: ‘‘Look through the patients’
total drug treatment, give advice and views on it and also
participate when we want to change, prescribe or
discontinue medications, and be a support and give advice in
connection with that.’’ (Doctor 3)
One of the doctors interviewed raised the issue about the
clinical relevance of the pharmacists’ recommendations.
This was based on the doctors’ experience with
pharmacists in an out-patient pharmacy using a web-based
interaction program which identifies all drug interactions. This
doctor described how he receives phone calls from
outpatient pharmacists asking about interactions which he
considered had no clinical relevance: ‘‘… they [pharmacists]
called all the time and asked: ‘Should they really have a
beta blocker and an ACE inhibitor? They don’t go
together.’ But that is how heart failure should be treated, so…
Well it could be like that, that you get stuck in those kinds
of things…’’ (Doctor 1)
However, another doctor who had previously worked
with pharmacists in a different hospital mentioned: ‘‘… but
my experience of pharmacists was that they could give
some more information but that it was not categorical, not
that they said ‘No you can’t do that’, but more like
counselling. My experience was good.’’ (Doctor 4)
Impact on patient care
The majority of participants took a positive view of the
implementation of the new CPS. Some mentioned it would
be ‘‘exciting and interesting’’ and ‘‘nice to meet new people
with a completely different focus’’. (Doctor 5) Another
participant mentioned: ‘‘It is fun to get a new professional
group in health care. I think we need more competence
specifically about medicines.’’ (Nurse 2)
I don’t think that there will be any obstacles or
conflicts, absolutely not. I am sure we will find some
good solution and that they will enjoy it here and that
there will be some benefits. (Doctor 9)
Some of the participants mentioned that they hope that
patient outcomes and quality of care will improve as
illustrated by this quote: ‘‘I think that the greatest
[expectation] is that you can get the right medicines to the right
patients. So I think that would be a very good advantage
[sic] both for the patient and also for the treatment in
general. We might get the right treatment from the start.’’
Some of the participants expected that their knowledge
about drugs would improve while working with the
pharmacist. This is exemplified by a doctor who explained:
‘‘[Apart from increased patient safety] I should take the
opportunity to learn a little myself too.’’ (Doctor 6) Some
also mentioned that patients’ knowledge could improve if
the pharmacist works with them.
[The clinical pharmacist] will probably bring
increased knowledge among those of us who
participate in the rounds, simply. Not only doctors, but also
other groups of staff. (Doctor 3)
However, some doctors (mainly experienced doctors)
were concerned that having a pharmacist may mean losing
knowledge or junior doctors not gaining competence on
drugs. ‘‘If this in some way takes the training [to talk to
patients about drugs] away from the junior doctors, it will
not be good either. Then you will rely on having another
category that will manage that.’’ (Doctor 8)
Participants also voiced different views on how they
believe having pharmacists as part of the ward team might
impact on their workload. Some of the senior doctors were
concerned that ward rounds or hospital discharge might
take longer, at least to begin with.
… probably it will mean that the rounds will take a
little longer as a result of another aspect that must be
considered, additional viewpoints. (Doctor 3)
Junior doctors believed that having a ward pharmacist
would not have an impact on the workload. ‘‘It might
perhaps take longer to do the round if you are going to
discuss more, but that’s not really workload. It’s good, you
might not have to check things up and might not have to
keep on wondering, but you could maybe solve more
things.’’ (Doctor 1)
Many nurses expected a positive effect on their
workload since they anticipated that the pharmacist would do
some of their tasks (i.e. ordering drugs, checking expiry
dates, keeping the store room for drugs in order). One
participant mentioned: ‘‘[Pharmacists] can hopefully order
drugs. That is something that we [nurses] do today… the
kind of things that take time for us that we actually don’t
have to do. So if it’s possible to shift that to another
category, then that’s incredibly good.’’ (Nurse 1)
‘‘I think this feels just unnecessary’’: negative views
While most attitudes were positive, one participant expected
no positive outcomes at all and felt that this new service was
just unnecessary and that the money should be spent on
something else. On the question of whether this person
thought that a clinical pharmacist could contribute
something, the answer was: ‘‘No, no. I must say, I think this feels
just unnecessary. I don’t know… we are too small a ward for
this to be needed. I think that the money should be spent on
something else within the county council.’’ (Nurse 4)
A second nurse mentioned that nurses will be fired and
pharmacists employed instead. ‘‘It has been discussed
before that it should be a pharmacist that should manage
the storage room for drugs. As I said then, as long as it’s
not a disadvantage; that is, that it’s seen as meaning that we
can take away a nurse because we have a pharmacist to do
this. I don’t want that.’’ (Nurse 9)
This study explored doctors’ and nurses’ perceptions and
expectations of having a ward-based pharmacist providing
CPSs in a rural hospital in northern Sweden. Study results
found that unfamiliarity with pharmacists, their clinical
skills and unfulfilled expectations about reduced workload
might be barriers to a successful implementation of the
clinical pharmacy service. On the other hand, participants’
mostly positive attitudes are likely to be a facilitator. To
date, studies have explored the perceptions of doctors and
nurses using cross-sectional surveys [18–20]. Most
qualitative studies have explored the perceptions of physicians
in primary care settings. Lauffenburger et al.  and
McGrath et al.  explored the perceptions of primary
care practitioners in the USA, and Hughes and McCann
explored these perceptions in Ireland . Makowsky
explored collaboration between pharmacists, physicians
and nurse practitioners on a Canadian hospital ward .
However no qualitative studies have been carried out in
hospital settings in Sweden. This study provided the
opportunity to explore doctors’ and nurses’ perceptions and
expectations of having a ward-based clinical pharmacist
before the service was implemented.
The results showed that participants were uncertain about
the ward-based clinical pharmacist role and unclear about
their clinical skills and competencies. As practitioners begin
working together, each may have role expectations about the
other that are based on past experiences, stereotypes, and
educational backgrounds . For CPSs to be successfully
implemented on this ward it is important to raise
professional awareness and recognition . Besides role
specification , trustworthiness  is a factor considered to
affect the extent to which health professionals collaborate
and are willing to delegate and share responsibilities.
Indeed, uncertainty about the clinical pharmacists’
competence, and concerns about their ability to distinguish
between clinically relevant or irrelevant questions, were
described in the present study. If useful recommendations
are made consistently over time and the pharmacist is able to
demonstrate their competence, physicians’ trust may
develop. Gaining trust is important, but can only be gained
from high-quality clinical recommendations that improve
patient outcomes . Hence this highlights the importance
of clinical pharmacists having appropriate training and
clinical experience in direct patient care. In Sweden, there
are no formal requirements for a pharmacist to work as a
ward-based clinical pharmacist except for a Bachelor or
Master of Science degree in Pharmacy. There are no
residency training programmes for pharmacy graduates who
want to work in the hospital sector. However, to ensure that
pharmacists are prepared, trained and have the necessary
experience in direct patient care, enhanced training in
clinical pharmacy is desirable, and postgraduate education
is offered in Sweden. A standardised set of pharmaceutical
services is being offered to patients and prescribers (see
Table 2), as the majority of Swedish clinical pharmacists
work in a similar way to one another .
Table 2 Clinical pharmacy services provided in the ward
DRP drug related problem
Doctors expressed worries about losing competence
regarding knowledge of medicines. This is consistent with
previous research concluding that being threatened and
fears of dilution of professional identities are barriers that
could also hinder collaborative working relationships
(CWRs) [22, 30]. Further, one nurse voiced her concern
about losing her job and being replaced. The CWR
conceptual model described by McDonough  describes
how individual, context and exchange characteristics
influence the level of collaboration among health care
professionals. This study allowed us to understand the
‘‘context’’ which appears to see the pharmacist role in
distribution, drug-focused (information about medicines,
side effects) and not towards patient-centred roles (patient
education). Despite the reservations and barriers previously
described, participants also conveyed positive attitudes,
and thought it would be ‘‘exciting’’ and ‘‘interesting’’ to
work together with clinical pharmacists. This is
encouraging, as old habits and difficulties adapting to new things
have been mentioned as barriers in earlier studies .
Some of the relevant factors identified in this study are
potentially modifiable and have informed the introduction
of the CPSs in this hospital ward. For instance, since the
lack of understanding of the pharmacist role was a potential
barrier, a talk was given to the ward staff (nurses and
doctors) explaining in detail what the CPS encompassed.
Strengths and limitations of the study
One of the limitations of this study is that things may have
been ‘‘lost in translation’’ as the interviews were conducted
in Swedish and then translated into English. There may
also be cultural nuances that are not captured by doing the
data analysis in English. Doctors and nurses who
participated in the study may not be the same as the ones that will
be around once the CPSs are rolled out due to staff
A strength of this study was the participation of both
doctors and nurses from the ward. Hence all viewpoints
were explored. It was also a unique opportunity to find a
hospital where no pharmacy services are available and drug
supply is provided by a regional hospital. It is important to
note that while the hospital has not had CPSs implemented,
The results showed that the participants’ expectations of
the clinical pharmacist role were unclear. Unfamiliarity
with pharmacists, their clinical skills and unfulfilled
expectations about reduced workload might be a barrier to
a successful implementation of the CPS. On the other hand,
participants’ mostly positive attitudes are likely to be a
Acknowledgements The investigators would like to thank the
participants who agreed to be interviewed.
Funding Gisselle Gallego was supported by Carl Wilhelm Scheele,
Visiting Professor from the Swedish Research Council. The funding
body did not influence the data collection, analysis, writing of the
manuscript, or the decision to submit for publication.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://creative
commons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appropriate
credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
1. Kaboli PJ , Hoth AB , McClimon BJ , Schnipper JL . Clinical pharmacists and inpatient medical care: a systematic review . Arch Intern Med . 2006 ; 166 : 955 - 64 .
2. Bergkvist A , Midlov P , Hoglund P , Larsson L , Bondesson A , Eriksson T. Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management . Eur J Clin Pharmacol . 2009 ; 65 : 1037 - 46 .
3. Bosma L , Jansman FG , Franken AM , Harting JW , Van den Bemt PM . Evaluation of pharmacist clinical interventions in a Dutch hospital setting . Pharm World Sci . 2008 ; 30 : 31 - 8 .
4. Graabaek T , Kjeldsen LJ . Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review . Basic Clin Pharmacol Toxicol . 2013 ; 112 : 359 - 73 .
5. Makowsky MJ , Koshman SL , Midodzi WK , Tsuyuki RT . Capturing outcomes of clinical activities performed by a rounding pharmacist practicing in a team environment: the COLLABORATE study [NCT00351676] . Med Care . 2009 ; 47 : 642 - 50 .
6. Matsoso MP . Future vision and challenges for hospital pharmacy . Am J Health Syst Pharm . 2009 ; 66 : S9 - 12 .
7. McLeod M , Ahmed Z , Barber N , Franklin BD . A national survey of inpatient medication systems in English NHS hospitals . BMC Health Serv Res . 2014 ; 14 : 93 .
8. Moles RJ , Stehlik P. Pharmacy practice in Australia . Can J Hosp Pharm . 2015 ; 68 : 418 - 26 .
9. Gillespie U , Alassaad A , Henrohn D , Garmo H , HammarlundUdenaes M , Toss H , et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial . Arch Intern Med . 2009 ; 169 : 894 - 900 .
10. Baker R , Camosso-Stefinovic J , Gillies C , Shaw EJ , Cheater F , Flottorp S et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes . Cochrane Database Syst Rev . 2010 ; 17 ( 3 ):CD005470. doi:10.1002/14651858.CD005470.pub2.
11. Makowsky MJ , Schindel TJ , Rosenthal M , Campbell K , Tsuyuki RT , Madill HM . Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting . J Interprof Care . 2009 ; 23 : 169 - 84 .
12. Hammond RW , Schwartz AH , Campbell MJ , Remington TL , Chuck S , Blair MM , et al. Collaborative drug therapy management by pharmacists-2003 . Pharmacotherapy. 2003 ; 23 : 1210 .
13. Dolovich L , Pottie K , Kaczorowski J , Farrell B , Austin Z , Rodriguez C , et al. Integrating family medicine and pharmacy to advance primary care therapeutics . Clin Pharmacol Ther . 2008 ; 83 : 913 .
14. Bradley F , Elvey R , Ashcroft DM , Hassell K , Kendall J , Sibbald B , et al. The challenge of integrating community pharmacists into the primary health care team: a case study of local pharmaceutical services LPS pilots and interprofessional collaboration . J Interprof Care . 2008 ; 22 : 387 - 98 .
15. Tong A , Sainsbury P , Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32- item checklist for interviews and focus groups . Int J Qual Health Care . 2007 ; 19 : 349 - 57 .
16. Vesterbacka J , Eriksson A. A rural ambulance helicopter system in northern Sweden . Air Med J . 2001 ; 20 : 28 - 31 .
17. Patton MQ . Qualitative research and evaluation methods . 3rd ed. Newbury Park: Sage Publications; 2002 . ISBN 9781412972123.
18. Lustig A , Sokol R , Peled R , David T. Nurses ' evaluation of pharmacists' services-a hospital survey . Pharm World Sci . 2005 ; 27 : 290 - 5 .
19. Gillespie U , Mo¨rlin C , Hammarlund-Udenaes M , Hedstro¨m M. Percived value of ward-based pharmacists from the perspective of physician and nurses . Int J Clin Pharm . 2012 ; 34 : 127 - 35 .
20. Franklin A , Panyin AB , Vincent B , Isaac K , Stephen C. Medication safety activities of hospital pharmacists in Ghana: experiences and expectations of doctors and nurses . Int J Pharm Pharm Sci . 2014 ; 6 : 525 - 9 .
21. Lauffenburger JC , Vu MB , Burkhart JI , Weinberger M , Roth MT . Design of a medication therapy management program for medicare beneficiaries: qualitative findings from patients and physicians . Am J Geriatr Pharmacother . 2012 ; 10 : 129 - 38 .
22. McGrath SH , Snyder ME , Duen˜as GG , Pringle JL , Smith RB , McGivney MS . Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis . J Am Pharm Assoc . 2010 ; 50 : 67 - 71 .
23. Hughes CM , McCann S. Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment . Br J Gen Pract . 2003 ; 53 : 600 - 6 .
24. King N , Ross A. Professional identities and interprofessional relations: evaluation of collaborative community schemes . Soc Work Health Care . 2003 ; 38 : 51 - 72 .
25. McDonough R , Doucette W. Developing collaborative working relationships between pharmacists and physicians . J Am Pharm Assoc . 2001 ; 41 : 682 - 92 .
26. Zillich AJ , McDonough RP , Carter BL , Doucette WR . Influential characteristics of physician/pharmacist collaborative relationships . Ann Pharmacother . 2004 ; 38 : 764 - 70 .
27. Doucette WR , Nevins J , McDonough RP . Factors affecting collaborative care between pharmacists and physicians . Res Social Adm Pharm . 2005 ; 1 : 565 - 78 .
28. Snyder ME , Zillich AJ , Primack BA , Rice KR , Somma McGivney MA , Pringle JL , et al. Exploring successful community pharmacist-physician collaborative working relationships using mixed methods . Res Social Adm Pharm . 2010 ; 6 : 307 - 23 .
29. Gillespie U , Alassaad A , Hammarlund-Udenaes M , Mo¨rlin C , Henrohn D , Bertilsson M , et al. Effects of pharmacists' interventions on appropriateness of prescribing and evaluation of the instruments' (MAI , STOPP and STARTs') ability to predict hospitalization-analyses from a randomized controlled trial . PLoS ONE . 2013 ; 8 : e62401 .
30. McPherson K , Headrick L , Moss F. Working and learning together: good quality care depends on it, but how can we achieve it? Qual Health Care . 2001 ; 10 : ii46 - 53 .