Telepharmacological Consultation for Polypharmacy Management in Primary Care: A Qualitative Study of General Practitioners' Experiences With Cross-Sectoral Coordination

Abstract

The telepharmacological outpatient clinic (TPOC) is a hospital service in which clinical pharmacologists and clinical pharmacists review a patient's full medication regimen and hospital record, then discuss it with the referring general practitioner (GP) by video conference. Seven GPs in the Region of Southern Denmark who had used or been introduced to the service were interviewed to explore how it was used and what prevented wider use. Interviews were semi-structured and analysed thematically. GPs described practices organised around single diagnoses, with no separate pathway for patients who are difficult because they are complex. This was the setting the service entered. Four themes were identified. Whether the service was used depended on integration into existing clinical software. Its value reached past the referred patient, as GPs applied what they had learned to patients never referred. GPs described a coordination gap for patients attending several outpatient clinics, where no clinician held an overview of the whole treatment. They wanted the intensity of the service matched to the complexity of the case. GPs who wanted to refer more often pointed to awareness and time pressure, not to doubts about the service. Uptake appears to depend on workflow integration.