Exploring Community Pharmacist Collaborative Networks to Enable Integrated Care

Background: Community pharmacists are essential to patient care and often the most accessible primary care providers, particularly amid global shortages of physicians and nurse practitioners. They address health inquiries, conduct screening, ensure prescription safety, and may hold limited prescribing authority. While pharmacist roles in team-based care are well described for inpatient settings, we know far less how community pharmacists collaborate; they are not physically co-located or in traditional team structures with other professionals.

 

This knowledge gap may hinder community pharmacists’ incorporation into integrated care models. Understanding how community pharmacists engage in interprofessional care is necessary to strengthen system-wide collaboration.

 

Approach: We employed an egocentric qualitative social network analysis to explore collaborative networks of community pharmacists. Eligible participants had worked at least one year in community pharmacy practice in British Columbia, Canada. We collected ego network data using a two-stage participant-aided concentric circle technique for network visualization. In the first stage, participants named individuals they considered members of their collaborative network to support patient care. In the second stage, participants placed the names within a concentric circle diagram.

Participants were informed they were at the center of the diagram (“ego”) and positioned their network member names (“alters”) in the rings according to the relative strength of their relationship, with one being closest and four most distant. Participant rationale for alter placement was elicited through semi-structured interview questions asking them to describe collaboration with network members. Interview transcripts were systematically coded and analyzed iteratively throughout data collection.

 

 

Results: Thirty community pharmacist participants described collaborative networks of varying sizes and configurations. Reported network membership was as low as 4 and as high as 12 alters (mean, 9). Overall, prescribing professionals were the most prevalent network members in the networks, especially family physicians (25, 83%). Non-prescribing nurses were part of 20 (67%) networks. Other health professionals (e.g. dietitians, physiotherapists, occupational therapists) were identified less frequently.

 

 Physicians, patients and family, and other pharmacists were consistently situated as the closest network collaborators. Community pharmacists established network relationships by various means, such as sharing the care of specific patients or frequent interactions with network members working near the community pharmacy itself. In rural communities, pharmacists were more likely to have met network members in social settings.

 

Network collaboration was facilitated when members could efficiently communicate and exchange patient information and develop care plans. Community pharmacists faced ongoing system-factors negatively impacting network relationships and collaboration including workforce instability and increasing collaborator workload and out-of-office periods.

 

Implications: This study characterizes community pharmacist networks and examines how they establish and maintain relationships for collaborative patient care. The findings offer valuable insights into the information flow and relationship-building required to integrate pharmacists into broader care models. They also identify system-level barriers that impede collaboration, pointing to policy changes necessary to support pharmacists in navigating structural challenges and coordinating care across settings.

 

These insights have international relevance, where similar system constraints limit the essential role of community pharmacists in delivering integrated, person-centred care alongside other network members and teams.