Chapter 4 Who do pharmacists work with? General methodology and
4.1. Methodology
As discussed in chapter 2, there has been a significant drive across healthcare sectors to integrate HCPs in interprofessional teams in order to provide more efficient and holistic patient care (Department of Health, 2010; World Health Organisation, 2010). Pharmacists represent the third largest health professional workforce in the UK (General Pharmaceutical Council, 2018d) and in recent years there has been a desire to further utilise their skills and knowledge resulting in an expansion of the pharmacist role (Royal Pharmaceutical Society, 2015). Despite the expansion of the role, there is a concern that in the main the profession continues to practice in silos (Ray, 1998; Department of Health, 2010; Royal Pharmaceutical Society and Royal College of General Practitioners, 2011; Primary Care Workforce Commission, 2015). Given the paucity of literature examining interprofessional engagements that pharmacists undertake in practice this concern may be perceived rather than real. It is therefore important to understand the nature and extent of interprofessional practice as well as any facilitators and barriers to such practice in order to further advance and support pharmacists’ interprofessional working. This chapter therefore discusses the general methodological approach and sets out the general methods used to identify the frequency and nature of interprofessional interactions pharmacists undertake in pursuit of their professional practice (see section 4.2 and beyond). Whilst this chapter details the general mixed methods approach used throughout the studies presented in Chapters 5 and 6, the specific nuances and practicalities in conducting the questionnaires and interviews in the community and hospital settings are further described within the relevant chapter.
4.1.1. Methodology development
When conducting research it is important that the research question guides the methodological approach (Corbin and Strauss, 2008). The researcher identifies themself as a pragmatist (see section 4.1.2 for more details) and therefore priority was given to gathering meaningful and relevant data which was applicable to answering the research question through whichever methodological approach was most relevant (Johnson and Onwuegbuzie, 2004). As the aim of this study was to determine and explore the interprofessional interactions (IPIs) taking place between pharmacists and other HCPs, a mixed methods approach was best suited to obtain useful data for this complex topic. A mixed methods approach refers to one which collects and analyses both quantitative and qualitative data to address the aim of the study (Tashakkori and Teddlie, 2010). This approach was chosen for this study in order to utilise the varying strengths of the two (often
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opposing) research methods and reduce the limitations and restrictions of undertaking a qualitative or quantitative approach alone (Johnson and Onwuegbuzie, 2004).This mixed methods study was conducted in a sequential manner – questionnaire followed by semi-structured interviews. This allowed the data to be collected iteratively, and findings from the quantitative questionnaire were used to inform the qualitative interviews. This allows for a more focused and in-depth exploration of the subject (Driscoll et al., 2007). The two-step approach commenced with a self-complete questionnaire that was administered to large numbers of pharmacists to determine precise, numerical, generalisable data related to respondents’ reported frequency of interaction with healthcare team members (HCTMs – comprising of HCPs and other staff within the healthcare team). This was then supplemented by qualitative, face-to-face, semi-structured interviews with pharmacists to explore these complex interactions in more detail, including how and why interprofessional interactions occur, thus giving context and meaning to the quantitative data. Using a sequential method helped to better select interview participants who could provide further information related to particular areas of interest identified through questionnaires. This approach also helped to make findings representative of the pharmacist population (Creswell and Creswell, 2017) and meant that data could be triangulated (Babbie, 2015b). The study was conducted in Wales in the two largest pharmacy practice settings, namely community and hospital pharmacy (see chapters 5 and 6 respectively)(General Pharmaceutical Council, 2018b). Figure 4.1 provides a general overview of the study design and methods used.
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Figure 4.1. Study design overview for mixed method exploration of pharmacists’ interprofessional interactions in practice
STEP 1
Literature search conducted identifying research gaps relating to the understanding and exploration of the interprofessional interactions undertaken by pharmacists in professional practice
STEP 2
Questionnaire used to determine the frequency of interactions between pharmacists and other HCTMs in the two largest pharmacy practice areas - community and hospital pharmacy
STEP 3
Interviews conducted to further explore pharmacists’ interprofessional interactions in the community and hospital pharmacy practice environments
Questionnaire sent to all 716
community pharmacies in
Wales
Questionnaire sent to all
hospital pharmacists in
Wales (approximately 520 across 19 hospitals)
Quantitative data analysed using SPSS descriptive analysis, with data comparisons made using chi- squared. Qualitative comments analysed using inductive thematic analysis
Interviews conducted with
community pharmacists
from a range of pharmacies across Wales
Interviews conducted with
hospital pharmacists
across four Welsh health boards
Deductive thematic analysis was used to ascertain predetermined interaction factors such as frequency and method. Inductive thematic analysis was used to determine common themes across the data
Questionnaire data helped inform interview schedule development Purposive sampling used to achieve participation of a cross section of pharmacists in Wales Purposive, snowball sampling used to achieve representation from a range of pharmacists in Wales
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4.1.2. Epistemological and ontological view
Reflexivity is the notion of being sensitive to the ways the research has been conducted as well as the researcher’s own assumptions and experience that may impact on the research process (Mays and Pope, 2000). Although the generic qualitative research approach relies less on any particular philosophical underpinnings, having an awareness and recognition for my own ontology (whether there is an objective reality) and epistemological views (how this reality is perceived) is crucial and is shared here for clarity (Caelli et al., 2003).
My own view is that of a pragmatist. This is a philosophy of science which focuses on the empirical problems at hand, taking each in turn, resulting in a somewhat flexible social ontology (Frankel Pratt, 2016). The pragmatist view is contradictory to the way ontology is generally defined, with many researchers categorising themselves as based on their belief as to whether there is an objective reality. Bauer and Brighi (2002) believe that pragmatism looks “beyond the epistemological stalemate opposing positivism and post-positivism, pragmatism invokes a methodological pluralism and disciplinary tolerance [and] encourages a multi-perspectival style of inquiry that privileges practice and benefits from the complementarity, rather than opposition”. Frankel Pratt (2016) also argues that the pragmatist stance is considered as both an epistemological and ontological view as it dissolves the specificity and rigidity across the two opposing ontological views, promoting flexibility and the belief that embracing and utilising these views can help foster valuable and tailored research. This means that, as a pragmatist, my focus is much more on the outcomes of research and the use of the most applicable method to achieve these (Johnson and Onwuegbuzie, 2004), thus prompting the application of mixed methods which could fulfill the aims of determining and exploring the interactions taking place between pharmacists and other HCTMs.
4.1.3. Reflection on previous experience in the area
Although social researchers aim to be objective when undertaking studies, this can be a challenge, particularly as it is not only the researcher’s philosophical views but their own past experiences that can also have an impact on the research (Babbie, 2015b). Therefore, it is important to acknowledge my own experience and recognise how this might impact the study (Caelli et al., 2003).
As these studies focus on community and hospital pharmacists and their experiences, as a practising pharmacist with experience in both environments I too have perceptions of the
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interactions taking place within these areas. Therefore, whilst consciously aiming to remain objective and impartial, my subconscious preconceptions may have unintended impact on the generation of questions and the development of inductive themes within the data. In contrast, my experience may also have a positive impact on the research, as my understanding of the area may allow more in-depth determination of themes. My role as a pharmacist may also put the participants at ease when undertaking the interviews as I may be viewed as a peer rather than simply a probing researcher. I therefore ensured that I introduced myself and my professional background before conducting each interview.