Derek Jorgenson

Practice Change Challenges and Priorities: A National Survey of Practising Pharmacists

Background: Vision and action plans have been created to address the future of pharmacy and help pharmacists progress into expanded roles in order to provide more patient-centred care. To assess the thoughts and perceptions of pharmacists in these new roles, a survey was conducted among practising pharmacists in Canada. Methods: A Web-based survey, developed as part of the Canadian Pharmacists Associations Moving Forward initiative, was open to all practising pharmacists in September and October of 2007. This survey educated pharmacists on potential future roles and sought to gain feedback on the human resource challenges and priorities that might result from the proposed practice changes. Results: From the 1003 respondents, it was found that the majority of pharmacist time is spent on dispensing duties. However, over 60% of pharmacists felt that it was time to begin taking on new responsibilities and over 70% of pharmacists want to be performing expanded clinical duties within 5 years. Discussion: It is encouraging to see that most pharmacists are open to new expanded clinical roles in the near future. Despite the challenges identified, such as the need for additional training, increases in workload and stress and expected poor physician acceptance, it was felt that changes would result in improved patient health outcomes and better personal job satisfaction. Conclusion: Pharmacists have responded positively to the proposed vision for the future of pharmacy and are eager to move away from the traditional dispensing role to an expanded clinical role that more fully utilizes their unique skills and knowledge.

Integrating pharmacists into primary care teams: barriers and facilitators

This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada.

Guidelines for pharmacists integrating into primary care teams.

Health systems are moving toward a more interprofessional approach to primary care. This team-based paradigm has had a significant impact on the role of pharmacists within primary health care systems. Within the past decade, nondispensing clinical pharmacists have been integrated into many Primary Care Trusts in the United Kingdom,1,2 primary care teams in North America3-5 and similar practice settings around the world.6,7 Pharmacists bring value to these teams by improving medication use through individual patient assessments and population-based interventions, providing education and drug information to other team members and implementing system-level practice enhancements.3 Pharmacists commonly encounter barriers to integrating into these primary care teams. For example, many experience a lack of role clarity, and other team members’ expectations regarding the pharmacists’ responsibilities are frequently unclear.4,8-11 In addition, patients often do not understand the role of the pharmacist in this setting.9,10,12 Pharmacists are also typically unfamiliar with the roles of other team members,13 creating difficulties in collaborating successfully.14-16 During the early stages, pharmacists often depend on other team members to assist in their integration, creating additional work for nurses and physicians.17 Other frequently reported barriers include physician resistance, lack of pharmacist assertiveness, inadequate pharmacist support, lack of space and inadequate pharmacist training.9-11,13,14,17-21 Many of these barriers to pharmacist integration can be minimized or avoided if pharmacists are prepared. Unfortunately, recent evidence suggests that pharmacists often continue to make the same mistakes and struggle to integrate into these teams, despite the fact that these barriers are well documented in the literature.22 The purpose of these guidelines is to provide recommendations that will assist pharmacists to successfully integrate into existing primary care teams.

Eligibility requirements for community pharmacy medication review services in Canada

Background A medication review is defined as a structured, critical examination of a patient’s medications with the objectives of reaching an agreement with the patient about his or her treatment and optimizing the impact of medications on the patient’s health.1 Most provinces in Canada have recently implemented government-sponsored programs to compensate community pharmacies for providing medication reviews to patients who meet predefined eligibility requirements. Ontario was the first province to remunerate community pharmacies for a standardized medication review program in 2007 called MedsCheck. Since 2007, similar programs have appeared in other provinces. The remuneration provided to pharmacies ranges from

Proposing a Redefinition of Pharmaceutical Care

52.50 to

Part 1: Barriers to the advancement of the pharmacy profession

150 per review, with some programs offering

Evaluation of a Community Pharmacy-Based Screening Questionnaire to Identify Patients at Risk for Drug Therapy Problems.

15 to

Pharmacist educators in family medicine residency programs: A qualitative analysis

35 for follow-up services. While the operational details and terminology of each program differ to some degree, all of these programs share the common goal of having a pharmacist meet with patients to provide education about the medications they are taking, to provide the patients (and pharmacy) with a current best possible medication history, to identify and address drug therapy problems and to elucidate and monitor patients’ progress toward the goals of their drug therapy. The provincial funding available for these programs is limited, and pharmacist time continues to be at a premium. Consequently, each province has limited access to these services by developing strict eligibility criteria. The presumed goal of the criteria is to ensure that these new programs improve patient outcomes and use public resources responsibly, by providing the service to patients who will benefit the most. This article is intended to provide an overview of the eligibility criteria for provincially funded medication review programs across Canada.

Interprofessional student-run primary health care clinics: Educational experiences for pharmacy students.

In many clinical practice settings, individual pharmaceutical care practitioners have thousands of patients who may receive their service. However, the pharmaceutical care approach provides virtually no guidance regarding how patients should be identified or prioritized by practicing pharmacists. We believe that pharmacists need to be “officially” accountable to specific patient groups at high risk for drug- or disease-induced morbidity within their practice. Consequently, the current definition of pharmaceutical care and its associated care processes need to be modified to ensure the activities of pharmacists are being focused on high-priority patients on a consistent basis.

Integrating a brief pharmacist intervention into practice: Osteoporosis pharmacotherapy assessment.

This is the first of 5 short papers reporting the results of a survey of pharmacy leaders and professionals from a broad range of practice settings and geographic locations across Canada. Ninety-six individuals who were invited to attend the Pharmacy Thought Leadership Summit on June 23-24, 2016, in Calgary, Alberta, were also invited to complete a survey prior to the summit. The goal of the summit was to reach agreement on priorities and actions that the Canadian Pharmacists Association (CPhA) can take forward with partner organizations to achieve an optimal future for pharmacy practice—a future that reflects the aspirations of pharmacy professionals and the health care needs of Canadians. Additional details on the survey methodology have been published previously. Of the summit participants invited to complete the survey, 65 responded, for a response rate of 68%. Participants were asked to rate their level of agreement regarding barriers that affect the advancement of the pharmacy profession. The barriers were broken down into system, workplace, educational and individual barriers. The top 3 responses for each barrier group are presented in Table 1. Participants had an opportunity to provide additional comments in this section of the questionnaire, which helped to provide context to the quantitative results in Table 1.