Barriers to General Practitioner Participation in a Clinical Trial Initiated by Pharmacists

Abstract

Objective: The purpose of this study was to determine general practitioners' (GPs) reasons for not entering patients into a randomized trial that compared outpatient anticoagulation management by community pharmacists with that of physicians. Methods: An anonymous survey was mailed to all GPs who were invited to participate in the anticoagulation study ( n = 118). Results: Completed surveys were received from 78/110 (71%) of GPs who had declined to participate in the anticoagulation study. Of those who had consented to participate, 8/8 completed surveys were received. The top-ranked reasons for not entering patients were “pharmacist should accept legal liability” (40%), “concern about other health care professionals taking over physician responsibilities” (33%), and “concern about responsibility for my patients” (29%). Other frequently cited barriers included concern about pharmacists' ability to manage warfarin patients, general issues related to control over patient care decisions, and lack of time. The top-ranked reason for agreeing to participate was the belief that “research advances the profession” (87%). Shortly after this survey, a statement published by the College of Physicians and Surgeons of BC reinforced physicians' concern about legal liability and recommended that physicians avoid referring patients to community pharmacy—based anticoagulation programs. Conclusion: Pharmacists who plan to conduct research in the community setting should thoroughly investigate potential barriers to GP involvement in patient recruitment, because of the difficulty in anticipating the most crucial issues. Local physicians may not support pharmacy-based anticoagulation programs, whether or not they are implemented as part of a clinical trial.