Nese Yuksel

Prescribing by pharmacists in Alberta.

PURPOSE The evolution of prescribing by pharmacists in Alberta is described. SUMMARY The prescribing model for pharmacists registered with the Alberta College of Pharmacists is defined by three categories of prescribing a Schedule 1 drug, a drug available only by prescription in Alberta. Pharmacists are not authorized to prescribe narcotics and controlled drugs (i.e., opium and its derivatives, barbiturates, and benzodiazepines) that are federally regulated. The first two categories of prescribing, adapting a prescription and prescribing in an emergency, legitimize existing practices that were not previously recognized in legislation. When adapting a prescription, the pharmacist modifies an existing prescription either to meet the unique needs of the patient or to extend therapy on an incidental basis when the patient is unable to contact the original prescriber. Emergency prescribing enables pharmacists to prescribe in unique situations when patients are unable to access other health services. Additional prescribing, the third category, provides pharmacists who successfully complete an application process the ability to independently prescribe--a privilege that is not authorized in any other jurisdiction in North America. By April 1, 2007, over 2800 pharmacists who were registered on the clinical registry had completed the orientation program necessary for prescribing to adapt a prescription or for an emergency encounter, and by September 1, 2007, over 3300 had completed the program. Fifteen pharmacists were granted additional prescribing privileges after completing a pilot program. CONCLUSION Collaborative efforts among health care professionals, regulatory health authorities, and patients led to the development of the current prescribing model for pharmacists practicing in Alberta. The model includes provisions for adapting a prescription, prescribing in an emergency, and additional prescribing by pharmacists who obtain authorization.

The North American Menopause Society recommendations for clinical care of midlife women

In celebration of the 25th anniversary of The North American Menopause Society (NAMS), the Society has compiled a set of key points and clinical recommendations for the care of midlife women. NAMS has always been a premier source of information about menopause for both healthcare providers and midli

Factors influencing pharmacists’ adoption of prescribing: qualitative application of the diffusion of innovations theory

BackgroundIn 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists’ adoption of prescribing using a model for the Diffusion of Innovations in healthcare services.MethodsPharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations.ResultsThirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists’ adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists’ decisions to apply for independent prescribing privileges.ConclusionsDiffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists’ adoption of prescribing. The characteristics of the prescribing model itself which legitimized prior practices, the model of practice in a pharmacy setting, and relationships with physicians were prominent influences on pharmacists’ prescribing behaviours.

Underuse of inhaled corticosteroids in adults with asthma.

Despite strong evidence that inhaled corticosteroids are beneficial in treating asthma, a number of small studies suggest a use rate of only 34–56%. The primary objective of this study was to determine patterns of prescribing inhaled corticosteroids for high‐risk patients with asthma. Secondary objectives were to assess patterns of practice with respect to other agents prescribed before and at hospital discharge, and to determine if an emergency room asthma care map at one of the study hospitals was being followed. We retrospectively reviewed charts of 1022 patients with an acute attack of asthma treated in the emergency rooms of the Royal Alexandra Hospital and University of Alberta Hospital from January 1, 1996, to March 31, 1997. A forward stepwise logistic regression analysis was performed with the dependent variable defined as whether or not the patient was using an inhaled or oral corticosteroid during the index visit, and the independent variable being all major demographic variables. Inhaled corticosteroids were prescribed for 460 patients (52.0%) at the index visit. Overall, anti‐inflammatory drugs were prescribed for 548 patients (62.1%). An asthma care map was followed for 107 (16.8%) patients treated at the Royal Alexandra Hospital at the index visit. Logistic regression analysis showed that women and patients with more than one emergency room visit most likely were to be using inhaled or inhaled plus oral corticosteroids at the index visit. Documentation of drug therapy at discharge was poor for 42% of patients; therefore, analysis of practice patterns in this group was not attempted. This study shows that inhaled corticosteroids were prescribed for only about one‐half of patients with an acute asthma attack. Given this low use by high‐risk patients, the need for programs designed to improve asthma therapy is evident.

Practice patterns with hormone therapy after surgical menopause.

OBJECTIVES To describe practice patterns with hormone therapy (HT) in women after a surgical menopause and to describe their experience of hot flashes and other menopausal symptoms. METHODS This was a cross-sectional chart-review with telephone follow up interview of women between the ages of 20 and 50 years who had a hysterectomy and bilateral salpingo-oophorectomy (BSO) before menopause at an academic teaching facility in Edmonton, Canada between December 1, 2006 and November 30, 2007. RESULTS Seventy women were interviewed. Mean respondents age at surgery was 44.3 (±5.2) years and mean time since surgery was 10.2 (±3.8) months. Twenty-eight women (40%) were started on HT after surgical menopause; 23 (33%) were still taking HT at the time of the interview. Estrogen therapy (ET) was the only HT prescribed in all instances, with over half the women on transdermal estrogen at time of the interview and 70% on ET doses equivalent to 0.625mg conjugated estrogens. Women not taking HT were more likely to experience daily hot flashes (74% vs 30%, p=0.006) and to classify them as moderate or severe intensity (57% vs 47%, p=0.033). Night sweats and difficulty sleeping were reported equally in both groups. CONCLUSIONS Over 2/3rd of women were not on HT after a surgical menopause and many of these women were still having daily hot flashes. Targeted patient education prior to surgery or at discharge may help improve the management of menopausal symptoms and long term health consequences in women after a surgical menopause.

How have pharmacists in different practice settings integrated prescribing privileges into practice in Alberta? A qualitative exploration

Since 2007, pharmacists in Alberta have had authority to adapt existing prescriptions and independently prescribe medications after a peer review process. This study aimed to explore and characterize how pharmacists incorporated prescribing into practice 3 years after this legislation was approved.

What prescribing means to pharmacists: a qualitative exploration of practising pharmacists in Alberta

In 2007 Alberta, Canada, became the first North American jurisdiction to adopt prescribing legislation for pharmacists. In light of these legislative changes and expanded scope of pharmacy practice, we evaluated what ‘prescribing’ means to pharmacists in Alberta and the application of prescribing in pharmacy practice.

Pharmacy Course on Women's and Men's Health

Objective. To design and implement an integrated course dedicated to womens and mens health. Design. A womens and mens health module that integrated the basic and clinical sciences was developed and implemented as part of the core undergraduate pharmacy curriculum. Instruction included classroom lectures, large- and small-group case discussion, self-directed learning assignments, and case-based simulations with standardized patients, all of which focused on conditions impacting womens and mens health. Assessment. Assessment of student learning included multiple-choice and written examinations using case vignettes when possible, evaluation of documentation of patient care process with standardized patient interactions, and group case assignments. Students appreciated the scope of topics, the active-learning opportunities, and use of simulated patients, as well as teaching by experts in the area. Conclusion. A mandatory course in womens and mens health was well received by students and ensured that these important issues were addressed in the undergraduate pharmacy curriculum.

University-Based Continuing Education for Pharmacists

University-based continuing education (CE) fulfills an important role to support the professional development of pharmacists, advance the practice of pharmacy, and contribute to societal needs for research and healthcare services. Opportunities for pharmacists to engage in new models of patient care are numerous worldwide, particularly as pharmacists’ scope of practice has expanded. Approaches to CE have changed to address the changing needs of pharmacists and now include a variety of approaches to support development of knowledge and skills. There is emphasis on the learning process as well as the knowledge, with the introduction of the concept of continuing professional development (CPD). As institutions of research and education, universities are uniquely positioned to bridge the gap between academic and practice environments, providing opportunities for translation of knowledge to practice. The Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta is a provider of CE in Alberta, Canada, where an expanded scope of pharmacy practice includes prescribing, administering injections, accessing electronic patient records, and ordering laboratory tests. In this paper, the Faculty offers views about future directions for CE, including the integration of CE with core faculty activities, expanding the audience for CE, areas of focus for learning, and partnerships. Finally, we hope to ignite dialogue with others in the profession about the role and function of university-based CE.

Survey of pharmacist prescribing practices in Alberta

PURPOSE Results of a survey to characterize pharmacist prescribing in the Canadian province of Alberta are reported. METHODS A cross-sectional survey of a random sample of pharmacists registered with the Alberta College of Pharmacists was conducted. The survey was developed in four stages, with evidence of reliability and construct validity compiled. Analysis of variance and chi-square testing were used to compare prescribing behaviors. RESULTS Three hundred fifty of 692 invited pharmacists (51%) completed the survey, with 76.9% and 11.1% indicating that they practiced in community and hospital settings, respectively, and 12.0% practicing in a consultant role (i.e., on a primary care team or in a long-term care setting). Overall, 93.4% of the pharmacists had prescribed. The most common practices were renewing prescriptions for continuity of therapy (92.3%), altering doses (74.3%), and substituting a medication due to a shortage (80.6%). Twenty-three pharmacists (6.6%) indicated that they did not prescribe because they were on an interprofessional team, had a consulting role, or preferred to fax physicians to request orders. Pharmacists with additional prescribing authorization (6.3% of the total survey population) were more likely to prescribe to adjust ongoing medications (63.6%) than to initiate a new medication (18.2%). CONCLUSION A survey showed that Alberta pharmacists prescribed in a manner that mirrored their practice environment. Compared with other groups, hospital and consultant pharmacists were more likely to adapt prescriptions, and community pharmacists were more likely to renew medications. Pharmacists in rural areas were prescribing most frequently.