The University of Alberta partnered with the Alberta College of Family Physicians’ Collaborative Mentorship Network for Chronic Pain and Addiction (CMN) to conduct a study that compares the mental models of pharmacists and family physicians that prescribe chronic opioid therapy and opioid agonist therapy (OAT) to patients.
Physicians and pharmacists both work for the best interest of a patient, but not sharing the same mental model can create inaccuracies, difficulty coordinating decisions, and knowledge gaps that lead to misunderstandings. This lack of clarity or awareness is better addressed when family physicians and pharmacists connect to understand their respective roles and builds trust as a team to manage a patient’s care.
Dr. Lee Green and his team from the University of Alberta use Cognitive Task Analysis (CTA) to study mental models (how people think) to understand the systematic differences existing between pharmacists and family physicians when managing their patients that have been prescribed chronic opioid therapy and OAT. The study’s results inform on ways these clinicians can work better together.
The study found that pharmacists and family physicians do not share the same mental model of chronic opioid therapy or OAT, and these models can differ even within the same profession.
For example, findings show that mental models among pharmacists may differ due to the contextual setting in which they work (e.g., chronic pain clinic, community pharmacy working closely with opioid dependency clinic, independent or “big-chain” pharmacy), and mental models among family physicians may differ based on their past experiences working with patients and pharmacists, as well as by when they were trained and the guidelines learned at that time.
The study also finds that family physicians do not have a full understanding of the pharmacist’s role, beyond tracking adherence and errors. Interestingly, both pharmacists and physicians have a need for “just in time” information, and both face challenges in gathering information from each other about a patient. The reasons for this breakdown of communication were noted as follows:
- a lack of timely access to one due to different working hours
- a reliance on asynchronous communication (e.g., fax)
- a lack of consistency in guidelines (each follow separate professional guidance documents).
So, what does this mean and how does this affect patient care?
When doctors and pharmacists are providing shared care to a patient but hold different mental models there is a risk that important information is not shared accurately and there could be problems in coordinating treatment decisions. Better understanding the other groups’ mental models is key to resolving those issues and improving team functioning and care coordination. Without a shared mental model in the management of chronic opioid therapy or OAT, there could be misunderstandings of roles and responsibilities, as well as missed opportunities for potential collaborations.
How can we make a change?
This lack of role clarity, potential, or awareness could be addressed by providing opportunities for prescribers and pharmacists to connect, understand what’s involved in their respective roles, build trust, and learn how each may be a key resource or team member in managing patient’s care.
Furthermore, sharing personal and professional experiences, expertise, and resources in managing chronic opioid therapy and/or OAT, may also address the varying degrees to which family physicians and pharmacists felt comfortable managing opioid therapies and the patients receiving these therapies.
Even though the study has not been published yet, some helpful tips have been identified from its summary of findings. The study recommends the following:
- Access to timely information and consistent guidelines that are evidence-based and trustworthy.
- Improved infrastructure for information and management co-opioid continuity through collaboration between the profession’s provincial colleges.
- A need for shared tools that are accessible to family physicians and pharmacists when managing chronic opioid therapy and/or OAT.
How would understanding different mental models used by professionals benefit your practice? What kinds of things can you do to ensure you are on the same page with other professions when providing care to patients with chronic pain and substance use care needs?
