Strengthening Primary Care Collaboration for Dyslipidemia Management: Perspectives of Private-Sector General Practitioners and Community Pharmacists

ABSTRACT

Despite various interventions, dyslipidemia remains a pressing public health issue in Malaysia. In managing dyslipidemia, general practitioners (GPs) and community pharmacists (CPs) in the private sector often operate in silos compared to their counterparts in the public sector. This results in fragmented care and a lack of continuity in managing patients with dyslipidemia. Interprofessional collaboration between GPs and CPs has the potential to improve dyslipidemia outcomes but remains underutilized. Therefore, this study aimed to (1) examine the current involvement of GPs and CPs in dyslipidemia management, (2) explore their perceptions of interprofessional collaboration, and (3) identify barriers hampering collaborative care in the private sector. A qualitative study with focus group discussions was conducted with purposively selected participants (n=12), consisting of either GPs or CPs currently practicing in Malaysia. The sessions were held online via the Microsoft Teams platform, which were recorded and transcribed verbatim. Four main themes emerged regarding involvement: patient screening, treatment initiation, secondary prevention, and medication management. In terms of perceptions, participants highlighted the benefits such as the improved treatment effectiveness and enhanced patient engagement. Suggested effective strategies included the need for a standardized documentation system and timely referral mechanisms. However, several significant barriers were identified, which include independent management structures, absence of formal communication channels, business rivalry, mutual distrust, and inadequate regulatory support. Despite these challenges, collaboration was perceived as beneficial under the conditions of this study, though it was constrained by structural and systemic barriers.

INTRODUCTION

Dyslipidemia can be defined as a metabolic derangement of lipids, leading to a persistent elevation in plasma cholesterol, triglyceride (TG), or both, involving abnormal levels of related lipoprotein species [1,2]. For over the past 30 years, dyslipidemia has posed a global burden, affecting millions of people [3]. It ranked 15th globally in causing death in 1990, 11th in 2007, and 8th in 2019 [3]. This remains a significant challenge for healthcare systems in controlling dyslipidemia. One reason for this challenge may be the asymptomatic nature of dyslipidemia, which results in patients being unaware of its presence. Additionally, dyslipidemia can potentially increase the risk of premature atherosclerotic cardiovascular disease and other cardiovascular diseases (CVDs), such as stroke, coronary artery disease, and peripheral artery disease [4].

In terms of management, general practitioners (GPs) and community pharmacists (CPs) in private sector are considered the first-line professionals responsible for managing dyslipidemia. However, these professions usually work independently, unlike in the public sector, where collaboration between doctors and pharmacists is widely practiced when treating patients. A specific study conducted by Ismail et al. revealed that less than 50% of the collaboration between GPs and CPs was limited to CVD risk screenings, counseling, or the distribution of educational materials related to CVD management [5]. Therefore, a collaborative care approach, also known as interprofessional collaboration, is highly recommended to ensure better dyslipidemia management, which should be performed by GPs and CPs in a timely and effective manner to prevent the development of CVD, type 2 diabetes mellitus, and various other complications that may diminish quality of life and longevity [6].

According to the World Health Organization, collaborative care or interprofessional collaboration within healthcare settings can be defined as a process in which two or more professionals learn about, from, and with each other, allowing effective collaboration and improving health outcomes [7]. This study focuses on the collaboration between GPs and CPs in managing dyslipidemia despite their differing roles in the private sector. The collaboration among GPs and CPs can be understood as a collective process of communication and decision-making aiming at addressing the health and disease-related needs of patients while respecting the expertise and characteristics of each professional [8]. This statement explains the relationship between healthcare professionals who provide care to improve patients’ health. Another study revealed that healthcare professionals should actively engage with patients to ensure the effective management of various types of lipid disorders [9].

The ACC/AHA guidelines state that the determination regarding the management of an individual patient should be a collaborative effort involving both healthcare professionals and patients [9]. Collaboration and shared responsibilities among healthcare providers yield positive outcomes in drug therapy quality, help prevent adverse drug-related incidents, and offer economic efficiency by reducing the frequency of patient visits to GPs [8]. Effective communication forms a vital basis for establishing trust across professions, as the extent of collaboration can vary significantly based on several factors, including shared values, interpersonal relationships, role definitions, and trust [8]. As reported by Hewko and colleagues in 2021, patient outcomes are greatly enhanced when communication and collaboration among health professionals work efficiently [10]. However, in the Malaysian private healthcare setting, collaboration between GPs and CPs remains limited and is often conducted in an informal or fragmented manner, resulting in gaps in communication, continuity of care, and coordinated dyslipidemia management. Additionally, despite the positive outcomes, limited studies have explored the readiness, perceptions, or barriers encountered by these professionals in implementing collaborative care. Therefore, thi study specifically aims to explore the current involvement, perceptions, and barriers faced by GPs and CPs in promoting collaborative care in the Malaysia context.

METHOD  

Study Design and Procedure

A qualitative study through focus group discussions (FGDs) was conducted from March 2024 to May 2024. The focus group discussions were held via the online platform, Microsoft Teams, involving two GPs and two CPs in each session. The purposive sampling method was utilized to recruit participants who met the inclusion criteria. Participants, who were GPs and CPs, were approached via phone calls, text messages, or emails to clinics and pharmacies within Malaysia. Those who agreed to participate were shortlisted, screened based on eligibility criteria, and invited to participate. The timing of the FGDs was set based on the availability of all participants. Furthermore, participants were required to complete consent forms and confidentiality agreements before the FGDs began. This ensured that they were well-informed about the study’s purpose and the requirement for the session to be recorded, as well as maintaining the confidentiality of the information gathered throughout the study. Three focus group discussions, each with four participants, were conducted online via Microsoft Teams, comprising two GPs and two CPs per session.

Study population, sampling and sample size

Participants who fulfilled the following criteria were included: 1) Registered GPs and CPs in Malaysia, and 2) had been working for at least two years in private clinics (for GPs) and community pharmacies (for CPs). These inclusion criteria were set to ensure that the participants had sufficient experience and exposure in the particular setting. GPs or CPs who worked part-timer were excluded from the study. Participants were recruited using purposive sampling. Potential participants were identified through professional networks and direct contact with private clinics and community pharmacies in Malaysia. A total of 20 healthcare professionals were approached, consisting of 10 GPs and 10 CPs, of whom 12 (6 GPs and 6 CPs) agreed to participate in the study. The remaining individuals either declined participation or did not respond to the invitation.

The sample size was determined based on a study conducted by Hennick et al. (2019), which suggested that four groups are needed to reach data saturation [11]. Each focus group involved two GPs and two CPs; therefore, a total of 16 participants were required for this study, consisting of eight GPs and eight CPs. However, data saturation was achieved during the third session of the focus group discussion, leading to the cessation of data collection. Data saturation was achieved after three FGDs (n = 12), consistent with qualitative research standards.

Study Instrument

The study instrument utilized semi-structured interview questions adapted from previous studies discussing collaborative care among GPs and CPs [5,12,13]. The focus group guide comprises both open-ended and semi-structured questions organized into three main sections: (1) two questions capturing healthcare professionals’ background and current involvement; (2) five questions exploring perceptions of collaborative care among healthcare professionals in dyslipidemia management; and (3) two questions examining barriers to the success of collaborative care in the prevention and management of dyslipidemia. Prior to finalization, the focus group questions underwent expert review by a panel consisting of four professionals: two academic pharmacists, one general practitioner (GP), and one community pharmacist (CP) to ensure the clarity and relevance of the questions.

Data Analysis

No.*	Gender	Race	Workplace	Years of working experience	Agreement on the importance of collaborative care in dyslipidemia management
GP 1	Male	Malay	Clinic chain	10	Agree
GP 2	Female	Malay	Clinic chain	2	Agree
GP 3	Male	Malay	Clinic chain	13	Agree
GP 4	Female	Malay	Clinic chain	10	Agree
GP 5	Female	Malay	Independent	7	Agree
GP 6	Male	Indian	Independent	5	Agree
CP 1	Female	Malay	Pharmacy chain	10	Agree
CP 2	Female	Malay	Pharmacy chain	14	Agree
CP 3	Female	Chinese	Pharmacy chain	4	Agree
CP 4	Male	Malay	Independent	6	Agree
CP 5	Male	Chinese	Pharmacy chain	4	Agree
CP 6	Male	Malay	Pharmacy chain	2	Agree

*GP: general practitioner, CP: community pharmacist

Data analysis was carried out using thematic analysis. All focus group discussions were audio-recorded and transcribed verbatim. The initial coding process involved identifying meaningful statements and assigning codes to relevant segments of the transcripts.The assigned codes were then independently reviewed against the initial transcripts. The coded data underwent thematic analysis, where the codings were compared and organized into broader themes and subthemes related to the barriers, benefits, strategies, experiences, and effective interventions associated with collaborative care in dyslipidemia management. Any discrepancies in coding or theme interpretation were discussed between the researchers until consensus was achieved. No qualitative data analysis software was used; coding and thematic organization were performed manually using Microsoft Spreadsheet.

Trustworthiness

To ensure methodological rigor and trustworthiness, several measures were undertaken throughout the study. Credibility was enhanced through repeated readings of the transcripts and continuous discussions among the research team during theme development to ensure that the findings accurately reflected participants’ perspectives. Dependability was supported by maintaining detailed records of the coding process, theme refinement, and analytical decisions throughout the study. Confirmability was strengthened through independent review of codes and themes by multiple researchers, followed by consensus discussions to minimize potential researcher bias.

Ethics approval

The study was approved by the Research Committee of UiTM, Selangor, with reference number REC (PH)/UG/101/2024 (MC).

RESULT

The sociodemographic characteristics of the 12 participants are shown in Table I.

The GPs who participated in this study were evenly balanced between males and females. Most of them were Malays, working in clinic chains, and had significant experience as GPs, with over five years in practice. Similarly, the CPs also had an equal number of males and females, most of whom were Malays and primarily working in the pharmacy chains, having served for more than four years. All participants agreed on the importance of collaborative care between GPs and CPs for dyslipidemia management.

Several themes and subthemes were derived from the transcripts, as shown in Table II.

Category	Themes	Subthemes
Involvement of GPs and CPs in dyslipidemia management	1. Screening 2. Initiating dyslipidemia treatment 3. Preventing dyslipidemia complications 4. Medication management
Perception toward collaborative care approach in dyslipidemia management	1. Importance of collaborative care	1. Effectiveness of treatment 2. Enhancing patient care
	2. Effective strategies toward collaborative care	1. Standardized documentation system 2. Patient referrals
Barriers to conducting collaborative care effectively in dyslipidemia management	1. Lack of formal engagements and communications 2. Management independency 3. Business rivalry 4. Distrust culture between GPs and CPs 5. Lack of supportive laws and regulations

Theme	Examples of quotations from participants	Participant
Theme 1: Screening	“Normally, for patients aged 40 years and above, we will do a medical checkup. Therefore, we will observe the result specifically, the fasting lipid profile.”	GP 4
	“As CP, I can only do screening. If the result shows high levels of total cholesterol, we will refer them to the doctors. Otherwise, if the results show that they are okay, we just advise on lifestyle and diet.”	CP 2
	“I am also involved in Corporate Social Responsibility (CSR) projects or in collaboration with the government to conduct random screenings and pre-checkups for Asnaf, poor and underprivileged people, as well as for government staff.”	CP 1
Theme 2: Initiating dyslipidemia treatment	“If they had a problem with their fasting lipid profile, we would immediately start the appropriate treatments.”	GP 4
	“Here, in a private clinic, we as GPs act as doctors, pharmacists, phlebotomists, counsellors, and everything in one.”	GP 5
Theme 3: Preventing dyslipidemia complications	“Thus far, I’m mostly not encountering hyperlipidemia issues, but it’s more for secondary prevention since 70-80% of patients have already had complications. Some patients come to my pharmacy after missing their appointment in KK, then they go to private clinics to see whether or not they need antidyslipidemic agents at that level, especially statins.”	CP 4
Theme 4: Medication management	“In community pharmacy, when I handle dyslipidemia cases, my role is more important in highlighting patients’ medication adherence.”	CP 3
	“Thus far, there are a few doctors who refer to me regarding the need for or indications of the use of antidyslipidemic agents, as well as the need for any patients to start antidyslipidemic agents based on their indications.”	CP 4
	“My role in handling dyslipidemia patients is, of course, to provide medications based on prescriptions and the goals of medication.”	CP 5

Involvement of GPs and CPs in dyslipidemia management

Most GPs were found to be involved in initiating dyslipidemia treatment. Moreover, the majority of CP participants reported offering dyslipidemia screening through simple lipid tests. The CPs emphasized that screening is essential, as it allows them to provide counseling and education to patients. One participant also mentioned her active involvement in community programmes or collaborations with the government regarding screening. This statement is supported by the following narrative in Table III.

Perception of the importance and effectiveness of the collaborative care approach in dyslipidemia management

In terms of perceptions of collaborative care, the majority of participants indicated that implementing collaborative care is important. They suggested that this collaboration could enhance dyslipidemia management by fostering effective teamwork among healthcare professionals, thereby supporting the workload of GPs and benefiting from diverse professional opinions.  Most participants highlighted the need for a standardized documentation system. The following narratives are shown in Table IV.

Barriers to implementing collaborative care

Barriers to implementing collaborative care are detailed in Table V.

DISCUSSION

Theme	Subtheme	Examples of quotations from participants	Participant
Theme 1: Importance of collaborative care	Subtheme 1: Effectiveness of the treatment	“I think the collaborative care is highly important so that dyslipidemia management can be better.”   “It is important… when we have collaboration, we can see different opinions from different professionals.”	CP 2     CP 5
	Subtheme 2: Enhancing patient care	“For me, collaboration is important. When patients may be reluctant to see the doctors, CPs can engage with them and provide reassurance to have a detailed check-up and consultation with doctors.”	GP 5
Theme 2: Effective strategies for collaborative care	Subtheme 1: Standardized Documentation System	“Here, we give patients a book where we write down their medications for documentation. Any feedback or simple blood tests done at the pharmacy, I tell the patient to write it down. It doesn’t matter if it’s from a doctor or a pharmacist; whatever they try, they can write it in there.”	GP 4
		“If there’s a proper book, there will be information on where the patient got the medication, what kind of medication they took, and if there were any interventions from the CP regarding the medication they took. However, there needs to be an improvement: to standardize it across all clinics and pharmacies in Malaysia so that the book is used comprehensively.”	CP 4
		“I think having an Electronic Medical Record (EMR) system would be helpful to ensure that patient information is transferred across healthcare service centers. We need standardized documentation when CPs refer patients to GPs. This documentation should provide enough information for the doctors to understand the patient’s condition better.”	CP 5
	Subtheme 2: Patient Referrals	“We can schedule an appointment for the patient in advance. Based on my experiences, if we don’t give the appointment in advance, the patient will disappear from the radar. Therefore, we schedule an appointment, and after getting the medication from the pharmacy, they come back. At the same time, we can also check their compliance.”	GP 4

In general, all GPs and CPs have positive perceptions of this collaboration, as they believe it will significantly improve the delivery of patient care and health outcomes. This finding is consistent with a study conducted by Kaur et al. in 2018, which revealed that the camaraderie between medical family therapists and pharmacists, facilitated by timely communication, could prevent the worsening of patients’ symptoms improve health outcomes [14].

Current involvement of GPs and CPs in dyslipidemia management In this study, both GPs and CPs were actively involved in screening patients for dyslipidemia. Abnormal cholesterol levels can usually be detected in a clinical laboratory or a physician’s office. However, blood cholesterol tests, also known as point-of-care testing (POCT), are currently available and easily accessible in community pharmacies. Based on previous discussions, screening appears to be primarily performed by CPs rather than GPs. This may due to the patient’s preferences for screening by CPs. A study reported that patients often feel reluctant to visit GPs to determine their blood cholesterol levels, especially when they have no CVD symptoms [15]. This reluctance may stem from poor awareness of asymptomatic nature of dyslipidemia [15]. A study conducted by Krass et al. (2023) revealed that the majority of respondents believed that CPs effectively communicated screening results, carried out the service professionally, and expressed strong support for the continued availability of such screening services in community pharmacies [16]. Understanding patients’ screening history and risk factors allows GPs and CPs to provide more personalized education and counseling to improve overall health literacy [17].

Theme	Examples of quotations from participants	Participant
Theme 1: Lack of formal engagements and communications	“For us CPs, the challenge is getting the doctor’s contact number. Therefore, without their personal contact number, it’s difficult to communicate and collaborate.”	CP 2
	“Communication between GPs and CPs truly needs to be significantly improved.”	CP 4
	“The biggest challenge is communication.”	CP 6
	“There’s no formal way of communication. I also rarely communicate with pharmacists.”	CP 5
	“However, there isn’t a good mechanism for the pharmacy to inform the clinic about the patients’ updates.”	GP 3
	“We cannot deny that sometimes there’s miscommunication and conflicts between GPs and CPs.”	CP 5
Theme 2: Management Independence	“The most challenging aspect is the difference in management. In the private sector, their management and administration are independent.”	GP 4
Theme 3: Business Rivalry	“The main challenge is business rivalry, which is the competition in terms of business because everyone struggles in business.”	CP 1
	“In the business aspect, money is everything. That’s why if we let someone else handle it, we will lose money. So now, it’s a question of whether we need to prioritize the customer or our business. If our business fails, we won’t have the opportunity to treat patients anymore.”	CP 6
	“At the end of the day, both sides are afraid that this collaboration will affect their business.”	GP 5
Theme 4: Distrust culture between GPs and CPs	“From the CPs’ perspective, they think that the GPs may not send the patients back. They perceive that the patient is coming only for the first-time consultation. In addition, GPs side may think that the CPs would not ask the patients to refer back to them. This ongoing issue shapes a culture where both sides do not trust each other, hindering continuous care.”	CP 5
Theme 5: Lack of supportive law and regulations	“I hope we have more collaboration. In addition, I think in Malaysia, the lack of collaboration occurs because of the law and policymakers. Overseas, they have agreements between GPs and CPs. We should have a comprehensive understanding of our roles and a point of agreement that benefit both parties, especially as we are all trying to survive in the current economy.”	CP 1
	“I think it’s time for the government to establish some sort of collaboration agreement or a good platform for it. In my 10 years in this business, there has been a substantial gap between GPs and CPs. Unless I know the doctor personally, communication is limited. For me, sudden or random collaboration and communication with doctors just doesn’t happen. Because we don’t have a good database, it’s difficult for doctors and pharmacists to access patients’ data.”	CP 1
	“It seems that policymakers in Malaysia have made the pharmacist field smaller because many areas have been taken over by doctors.”	GP 1

GPs are responsible for initiating appropriate dyslipidemia treatment based on the patient’s condition. They are known as medical experts in clinical settings, using their knowledge to provide advice, prescribe medications, and implement standardized care plans when treating patients [18]. However, in this study, one GP expressed frustration about having to cover other job responsibilities while fulfilling her role as a doctor, highlighting the complexity and breadth of responsibilities managed in the private sector. Thus, collaborative care may reduce the burden on GPs by sharing responsibilities, leveraging their expertise in medication management, and increase accessibility for residents in the community [19]. This sentiment was supported by one of the CPs, who emphasized his role in secondary prevention of CVD when encountering dyslipidemia patients. In this context, CPs can review patients’ medication regimens, monitoring medication adherence, and identify and resolve any drug-related problems to ensure that patients with established dyslipidemia receive optimal pharmacotherapy [5,20].

As medication experts, CPs play a crucial role in ensuring medication adherence among patients with dyslipidemia. Encouraging patients to adhere to antidyslipidemic agents is vital for the effective management of dyslipidemia and the prevention of CVD complications. While promoting medication adherence, CPs also serve as valuable resources for medication knowledge regarding antidyslipidemic agents [21]. This reflects the trust and reliance that healthcare professionals, particularly GPs, place on CPs’ expertise in providing guidance on the appropriate use of antidyslipidemic agents based on patients’ specific needs and indications. Moreover, some CPs prioritize their role as medication suppliers based on prescriptions and the goals of the medication, ensuring continuity of supply to meet local needs [22].

Perception of the importance of the collaborative care approach in dyslipidemia management

All GPs and CPs shared positive insights into the benefits of interprofessional collaboration for effectively manage dyslipidemia. This study revealed that most participants agreed that having a standardized documentation system is the most effective strategy for managing dyslipidemia. Some participants suggested providing a book for each patient for documentation purposes, which could help trace the treatments received by patients across various healthcare settings. The book could be filled by GPs, CPs, or the patients themselves, recording essential medical information, including medical conditions, prescribed medications, and any interventions received from other healthcare providers. This concept is akin to the “pink book” or pregnancy check-up book given to pregnant mothers to document and record essential medical information related to their pregnancy journey, allowing for periodic health checks once pregnancy is confirmed [23]. This “pink book” is widely utilized and standardized under the Malaysian Ministry of Health.

Furthermore, some participants explained the importance of having an electronic medical record (EMR) system to ensure that all necessary patient information is transferred across healthcare service centers, whether in the public or private sector. This standardized documentation system has already been implemented in Australia, operating under a shared public‒private model within the Medicare system [24]. This system, called My Health Record, is a national electronic health record system that aims to provide a secure, digital platform for storing and sharing patient health information across the healthcare system [25]. In contrast, Malaysia does not yet have a fully standardized and interoperable EMR system, which is primarily implemented in the public sector and not in the private sector. Therefore, it is imperative for Malaysia to advance in establishing this standardized documentation system. Having sufficient information enables healthcare professionals to understand patients’ conditions better, allowing them to provide personalized and optimal treatment.

In addition to EMR, another effective strategy is to ensure timely referral to patients, which can prevent missed appointments. GPs can schedule follow-up appointments during the initial patient visit, anticipating that the patient will comply with the next scheduled appointment. In private clinics, medications are typically supplied for a maximum of one month, even when the actual treatment requires up to three months. According to the 5th edition of the Clinical Practice Guidelines for Dyslipidemia, follow-up appointments are necessary to monitor patients’ lipid profiles one to three months after initiating treatment or changing the dose of statins [26]. During thefollow-up appointment, GPs will assess the effectiveness and safety of the prescribed drug therapy after evaluating the current dyslipidemia status. This ensures that patients receive appropriate and optimized treatment while understanding the importance of regular follow-up visits. In a study, Ismail et al. highlighted that regular follow-up is a crucial element of patient-centered care that should be integrated into dyslipidemia managementdyslipidemia. Patients with occasional follow-ups have been shown to achieve better outcomes [27].

Barriers to collaborative care in dyslipidemia management

The main concern raised by both parties is a lack of communication between GPs and CPs, which results in a monodisciplinary culture in private healthcare settings. In primary healthcare, GPs and CPs often do not work in close proximity to each other. Their interactions are limited to phone calls or messages, which occur only if both professions have each other’s contact information [12]. This situation arises because there is no formal mechanism to facilitate efficient communication between them. Studies have shown that the lack of a shared formal documentation systems and reliable communication channels can lead to issues such as redundant documentation, incomplete information, limited mutual accessibility, and inadequate communication [28–31].

The findings of this study align with previous studies conducted in Malaysia and other countries, which reported that although healthcare professionals generally demonstrate positive perceptions toward interprofessional collaboration, practical implementation remains limited due to communication barriers, unclear professional boundaries, and independent healthcare practice structures. A qualitative study in Malaysia by Mubarak et al. similarly highlighted that collaboration between GPs and CPs in chronic disease management is often hindered by fragmented primary care systems, lack of standardized collaborative protocols, and concerns regarding professional autonomy [32]. In addition, studies from other settings have reported that limited interaction between GPs and CPs contributes to reduced mutual understanding and trust between the two professions [33]. These similarities suggest that challenges in collaborative dyslipidemia management are not unique to Malaysia but are commonly observed across healthcare systems where primary care services operate independently.

Following the issue of a lack of communication, management independence subsequently arises. This independence allows GPs and CPs to operate in silos when treating patients without being micromanaged by other professionals. It creates significant gaps in conducting interprofessional collaboration efficiently. Mario et al. highlighted that the differences in management structures between privately owned pharmacies and publicly funded or managed primary care clinics contribute to a lack of trust and interest in collaborations from GPs [34]. Conflicts between these two parties often arise when personal interests to protect their businesses come into play. The findings showed that GPs perceived CPs’ financial incentives from selling medications as a source of conflict, which increase the degree of mistrust and diminishes respect for collaborative patient care [34]. In regard to business, both parties often prioritize their own business interests to remain competitive. This aligns with the findings of this study, where participants acknowledged the existence of business rivalry and the struggle for survival in their respective markets. This self-interest has fostered a culture of mutual distrust between GPs and CPs, which hinders continuous care for patients. However, this negative perception was primarily reported by healthcare professionals who lack experience in conducting interprofessional collaboration. These particular insights may also stem from past negative experiences encountered by both GPs and CPs in their interactions with other professionals [34].

Most participants highlighted the lack of supportive laws and regulations. The healthcare system operates within a complex socio-legal framework, marked by various policymakers, multiple governance levels, and the critical nature of policy interdependence. The complexity of this policy landscape may influence interprofessional collaboration, affecting healthcare professionals’ ability to practice effectively in healthcare settings [35]. Interprofessional collaboration between GPs and CPs in Malaysia faces significant barriers, primarily due to the absence of supportive laws and regulations. All participants agreed that the government, as a policymaker, needs to take decisive action to foster a systematic platform for collaboration. one approach the government could adopt is to establish a systemic platform and a comprehensive database that are accessible to both GPs and CPs in the private sector, accompanied by a formal agreement outlining the scope of this collaboration. A study conducted by Alghamdi et al. (2023) revealed that the involvement of policymakers in this collaboration significantly facilitates better patient outcomes [36]. This study also highlighted that such collaboration might provide financial and policy support for healthcare settings to enhance interprofessional collaboration among GPs, CPs and other medical staff across healthcare settings [34]. Therefore, thoughtful policymaking in these areas is essential to enable collaborative, team-based primary care.

From a practical perspective, future collaborative care initiatives may benefit from the development of standardized referral systems, shared care protocols, interprofessional training programs, and digital health platforms that facilitate communication between GPs and CPs. Such approaches may help strengthen trust, improve role clarity, and support more coordinated dyslipidemia management in Malaysian primary care.

Study limitations and strengths

Several limitations were observed in this study. As this study employed focus group discussions with a relatively small and purposively selected sample, the findings may not be generalizable to all healthcare professionals or settings. The perspectives captured reflect the views of those who agreed to participate and may not represent the broader population. In addition, participants may have moderated their responses due to the group setting, providing socially acceptable views rather than their true opinions, especially when discussing interprofessional collaboration or sensitive barriers.

Despite these limitations, the study has several noteworthy strengths. First, it provides timely and in-depth insights into the dynamics of interprofessional collaboration between GPs and CPs in the management of dyslipidemia within the private healthcare sector, an area that remains underexplored in the current literature, particularly in the Malaysian context. The attainment of data saturation across focus groups enhances the trustworthiness of the findings. The use of qualitative methodology allowed for rich, nuanced exploration of professional attitudes, perceived barriers, and practical experiences, contributing depth and context that may be overlooked in quantitative methods.

Importantly, the study aligns with current healthcare priorities that emphasize integrated, patient-centered care, and its findings have practical implications for strengthening collaborative care models in real-world primary care settings. The research was conducted with strict adherence to ethical standards, and transparency in the methodological approach enhances its credibility and reproducibility. These strengths underscore the study’s value as a foundational piece for informing future policy, practice, and research aimed at optimizing interprofessional collaboration in chronic disease management.

CONCLUSION

In conclusion, this study demonstrated that both GPs and CPs generally viewed collaborative care in dyslipidemia management positively and perceived that such collaboration may enhance patient care and support continuity of care. The findings indicated that both professions were involved in dyslipidemia management, particularly in screening, medication management, and patient counseling, with CPs being more actively engaged in screening-related activities. Participants also highlighted the importance of standardized documentation systems and improved communication mechanisms to facilitate collaborative care. However, several barriers were identified, including limited communication, independent management structures, business-related concerns, mutual distrust, and insufficient regulatory support. Overall, the findings underscore the need for structured policies, standardized communication systems, and regulatory support to enhance interprofessional collaboration in private-sector dyslipidemia care. Future studies may further explore practical strategies and policy approaches to strengthen collaborative dyslipidemia management in primary care.

ACKNOWLEDGEMENT

The authors express their sincere gratitude to all research team members who contributed directly to the study, particularly in the coordination, data collection, transcription, and analysis processes. The authors would also like to thank Universiti Teknologi MARA for the institutional support provided throughout the conduct of this research. Special appreciation is extended to all general practitioners and community pharmacists who willingly participated in the focus group discussions and generously shared their time, experiences, and valuable insights, which greatly contributed to the successful completion of this study.

CONFLICT OF INTEREST

The authors have no conflict of interest to report.

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