Community pharmacist attitudes towards collaboration with general practitioners: development and validation of a measure and a model

Background: Community Pharmacists and General Practitioners (GPs) are increasingly being encouraged to adopt more collaborative approaches to health care delivery as collaboration in primary care has been shown to be effective in improving patient outcomes. However, little is known about pharmacist attitudes towards collaborating with their GP counterparts and variables that influence this interprofessional collaboration. This study aims to develop and validate 1) an instrument to measure pharmacist attitudes towards collaboration with GPs and 2) a model that illustrates how pharmacist attitudes (and other variables) influence collaborative behaviour with GPs. Methods: A questionnaire containing the newly developed "Attitudes Towards Collaboration Instrument for Pharmacists" (ATCI-P) and a previously validated behavioural measure "Frequency of Interprofessional Collaboration Instrument for Pharmacists" (FICI-P) was administered to a sample of 1215 Australian pharmacists. The ATCI-P was developed based on existing literature and qualitative interviews with GPs and community pharmacists. Principal Component Analysis was used to assess the structure of the ATCI-P and the Cronbach's alpha coefficient was used to assess the internal consistency of the instrument. Structural equation modelling was used to determine how pharmacist attitudes (as measured by the ATCI-P) and other variables, influence collaborative behaviour (as measured by the FICI-P). Results: Four hundred and ninety-two surveys were completed and returned for a response rate of 40%. Principal Component Analysis revealed the ATCI-P consisted of two factors: 'interactional determinants' and 'practitioner determinants', both with good internal consistency (Cronbach's alpha = .90 and .93 respectively). The model demonstrated adequate fit (X-2/df = 1.89, CFI = .955, RMSEA = .062, 90% CI [.049 - .074]) and illustrated that 'interactional determinants' was the strongest predictor of collaboration and was in turn influenced by 'practitioner determinants'. The extent of the pharmacist's contact with physicians during their pre-registration training was also found to be a significant predictor of collaboration (B = .23, SE = .43, p <. 001). Conclusions: The results of the study provide evidence for the validity of the ATCI-P in measuring pharmacist attitudes towards collaboration with GPs and support a model of collaboration, from the pharmacist's perspective, in which collaborative behaviour is influenced directly by 'interactional' and ` environmental determinants', and indirectly by ` practitioner determinants'.