Physicians, pharmacists, nurses describe why triadic prescription review stalls in Pakistan

Prescription review is supposed to be a team effort, but in Pakistani hospitals it rarely involves all three key professions at once. A qualitative study published in BMC Health Services Research finds that collaboration among physicians, pharmacists, and nurses during medication review remains fragmented and mostly two-way, with true triadic collaboration—concurrent, synchronous interaction and joint decision-making among all three professions—described as absent or non-routine in most settings.

Researchers conducted face-to-face, semi-structured interviews with 45 healthcare professionals: 15 physicians, 15 pharmacists, and 15 nurses drawn from public and private hospitals primarily in Rawalpindi and Islamabad, with linked participants from Karachi and Lahore. Recruitment ran from January to March 2026 using purposive sampling, and interviews averaged just 10 to 15 minutes. The team transcribed the conversations verbatim and analyzed them through inductive thematic analysis following Braun and Clarke’s framework, allowing themes to emerge from the data rather than testing pre-set hypotheses.

The interviews revealed a striking pattern: while participants acknowledged that interprofessional collaboration (IPC) was valuable, day-to-day practice was predominantly dyadic—physician with nurse, or physician with pharmacist—and episodic, triggered by specific problems rather than embedded systematically in prescription review. Participants described triadic interaction as non-routine in their settings, and the study set out to characterize current collaborative practices, identify barriers and benefits, and propose context-specific enhancement strategies.

The barriers participants described were structural as much as interpersonal. Professional hierarchy and physician dominance loomed large, and policy deficiencies compounded the problem: participants said current rules confine pharmacists largely to administrative and supply roles, keeping them out of the clinical loop where medication errors could be caught. Communication gaps between professions and severe workload constraints further eroded any opportunity for structured joint review.

The workload figures cited by participants were extreme. One physician reported managing 600 patients within 24 hours, a burden that leaves little room for the deliberate, multi-professional discussion that safe prescription review demands. The study characterizes Pakistan’s healthcare system as marked by fragmented care, high patient loads, and underdefined professional roles, conditions in which the participants said systematic collaboration struggled to take hold.

Despite these obstacles, participants consistently believed that IPC would improve patient safety, therapeutic outcomes, cost-effectiveness, and operational efficiency. The authors are careful to flag, however, that these perceived benefits reflect participant beliefs rather than objectively measured outcomes—no patient-level data on error rates or costs were collected in this qualitative design.

Current facilitators of collaboration were notably scarce. Only a minority of participants reported factors that enabled collaborative practice, such as the presence of dedicated clinical pharmacists in their institutions or supportive department heads who encouraged cross-professional input. The study notes that these enabling conditions were limited across the hospitals surveyed.

To close the gap, participants proposed a set of context-specific strategies: mandatory interprofessional education, integrated health information technology, structured communication channels, policy reforms that define collaborative roles across professions, and deliberate cultivation of mutual respect among physicians, pharmacists, and nurses.

The study’s conclusions translate into distinct calls for different actors. Participants recommended that policymakers mandate pharmacists’ clinical involvement and expand hospital pharmacy positions. Hospital administrators, they suggested, should implement structured interprofessional forums and invest in shared electronic health records. Academic institutions, meanwhile, were urged to integrate interprofessional education into curricula to build mutual respect and role clarity.

For a health system characterized by fragmented care, high patient loads, and underdefined professional roles, the study offers a candid diagnosis: medication safety in Pakistan currently rests on dyadic, problem-triggered exchanges rather than systematic triadic review, and the participants argue that the policy action and institutional investment they describe is needed to change that.

Subject of Research: Barriers and facilitators to triadic interprofessional collaboration in prescription review among physicians, pharmacists, and nurses in Pakistan

Article Title: Barriers and facilitators to triadic interprofessional collaboration in prescription review: A qualitative study of physicians, pharmacists, and nurses in Pakistan

Article References: Salar, H., Jamil, E., Khan, M. E., Abubakar, M., Tahir, H., Saleem, A., Ghazanfar, W., Ajmal, L., Safdar, S., Ansari, A., Hasnain, F., Ahmad, A., Ali, D., Azeem, M. W., Hamza, A., Yasin, T., Nawaz, A., Khan, M. U., & Ullah, M. (2026). Barriers and facilitators to triadic interprofessional collaboration in prescription review: A qualitative study of physicians, pharmacists, and nurses in Pakistan. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15728-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15728-z

Keywords: Barriers, facilitators, triadic, interprofessional, collaboration, prescription, review, qualitative, physicians, pharmacists, nurses, Pakistan