Enhancing evidence-based decision making through primary care provider–pharmacist collaboration and patient simulation training

Abstract

Background

Traditionally, physicians’ and pharmacists’ roles have been distinct. However, an aging population, increasing prevalence of chronic conditions, the growth of value-based care payments, and forecasted shortfalls in primary care providers (PCPs) are forcing a rethinking of this paradigm. Creating opportunities for collaboration between PCPs and pharmacists presents an opportunity to address these challenges. This study explores the impact of this collaboration on evidence-based decision making at Village Medical and Walgreens.

Methods

Online simulated cases of patients with diabetes were randomly assigned to PCPs alone or PCP-pharmacist dyad pairs. The patient simulations were administered in 3 seasons in 2023, and participants completed the cases by making care decisions and receiving real-time feedback on improvement opportunities. Care decisions were scored against evidence-based guidelines. In the first season, PCPs completed cases alone to establish a practice baseline. For the next 2 seasons, 40 PCPs were each paired with a pharmacist and asked to complete their next 2 seasons of patient simulations together. Care decisions made by the dyad pairs were compared with 40 Village Medical matched PCPs completing the cases on their own.

Results

In the baseline season, we found no difference in the treatment domain between the predyad and control PCPs (64.0% vs. 63.2%, respectively). By the final season, treatment scores improved for both groups (up to 72.9% for the dyads and up to 68.9% for control), a difference-in-difference improvement of +3.2% for the dyads (P = 0.497). Stopping sulfonylureas and prescribing sodium-glucose cotransporter-2 inhibitors showed noteworthy difference-in-difference improvements among the dyads: +16.2% (P = 0.501) and +23.1% (P = 0.296), respectively.

Conclusion

This proof-of-concept study provides evidence that PCP-pharmacist collaboration can improve care decisions, especially in polypharmacy management, medication deprescribing, and evidence-based integration of new medications. The results support continued efforts to enhance collaboration between pharmacists and primary care to improve care quality.