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Nakhla N, Leung V, Schwartz KL. L’élargissement des pouvoirs de prescrire des pharmaciens pourrait contribuer à améliorer l’accès aux soins de santé et leur qualité. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:445-448. [PMID: 39122419 PMCID: PMC11328709 DOI: 10.46747/cfp.700708445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Nardine Nakhla
- Pharmacienne communautaire et membre du corps professoral de l'École de pharmacie de l'Université de Waterloo (Ontario)
| | - Valerie Leung
- Responsable du programme de gestion des antimicrobiens à Santé publique Ontario, à Toronto
| | - Kevin L Schwartz
- Chef de la Division des maladies infectieuses au St Joseph's Health Centre à Toronto, codirecteur médical du programme de gestion des antimicrobiens à Unity Health Toronto, médecin universitaire spécialisé en contrôle des infections et en gestion des antimicrobiens à Santé publique Ontario, professeur adjoint à l'École Dalla Lana de santé publique de l'Université de Toronto et scientifique adjoint à l'ICES
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Nakhla N, Leung V, Schwartz KL. Expansion of pharmacist prescribing could help improve health care access and quality. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:441-443. [PMID: 39122432 PMCID: PMC11328721 DOI: 10.46747/cfp.700708441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Nardine Nakhla
- Community pharmacist and faculty member at the University of Waterloo School of Pharmacy in Ontario
| | - Valerie Leung
- Antimicrobial Stewardship Program Lead at Public Health Ontario in Toronto
| | - Kevin L Schwartz
- Division Head of Infectious Diseases at St Joseph's Health Centre in Toronto, Co-medical Director of the Antimicrobial Stewardship Program at Unity Health Toronto, an academic infection control and antimicrobial stewardship physician at Public Health Ontario, Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto, and Adjunct Scientist at ICES
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Chiang V, Guirguis L, Warren AL, Topps D, Anderson SJ, Hecker KG. Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100357. [PMID: 38023635 PMCID: PMC10663664 DOI: 10.1016/j.rcsop.2023.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Prescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. Objectives To explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. Methods Eight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. Results There were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. Conclusions This study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.
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Affiliation(s)
- Vincent Chiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada
| | - Amy L. Warren
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - David Topps
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Sarah J. Anderson
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Canada
| | - Kent G. Hecker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Faculty of Veterinary Medicine, University of Calgary, Canada
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Ashkanani FZ, Rathbone AP, Lindsey L. The role of pharmacists in deprescribing benzodiazepines: A scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100328. [PMID: 37743854 PMCID: PMC10511800 DOI: 10.1016/j.rcsop.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/14/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Polypharmacy can increase the risk of adverse drug events, hospitalisation, and unnecessary healthcare costs. Evidence indicates that discontinuing certain medications, such as benzodiazepines, can improve health outcomes, by resolving adverse drug effects. This scoping review aims to explore the pharmacists' role in deprescribing benzodiazepines. Method A scoping review has been conducted to distinguish and map the literature, discover research gaps, and focus on targeted areas for future studies and research. A systematic search strategy was conducted to identify relevant studies from PubMed, Medline, and EMBASE databases. The eligibility criteria involved studies that focused on the role of pharmacists in benzodiazepine deprescribing, quantitative and qualitative studies conducted in humans, full-text articles published in English. Results Twenty studies were identified, revealing three themes: 1) pharmacists' involvement in benzodiazepine deprescribing, 2) the impact of their involvement, and 3) obstacles impeding the process. Pharmacists involved in deprescribing procedures, mainly through completing medication reviews, collaborative work with other healthcare providers, and education. Pharmacists' involvement in benzodiazepine deprescribing intervention led to better health and economic outcomes. Withdrawal symptoms after medication discontinuation, dependence on medication, and lack of time and guidelines were identified in the literature as barriers to deprescribing. Conclusion Pharmacists' involvement in deprescribing benzodiazepines is crucial for optimizing medication therapy. This scoping review examines the pharmacists' role in benzodiazepine deprescribing. The findings contribute to enhancing healthcare outcomes and guiding future research in this area.
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Affiliation(s)
- Fatemah Zakariya Ashkanani
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Adam Pattison Rathbone
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Laura Lindsey
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
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Jin H, Huang Y, Xi X, Chen L. Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians. BMC MEDICAL EDUCATION 2023; 23:357. [PMID: 37217963 DOI: 10.1186/s12909-023-04353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists. METHODS A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China. RESULTS A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%). CONCLUSION Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.
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Affiliation(s)
- Hang Jin
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China
| | - Yuankai Huang
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China
| | - Xiaoyu Xi
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China.
| | - Lei Chen
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China.
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Do entry year pharmacy students have similar personal characteristics? Comparing personalities, professional goals, and role perceptions. Res Social Adm Pharm 2023; 19:634-642. [PMID: 36702707 DOI: 10.1016/j.sapharm.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/18/2022] [Accepted: 01/01/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Schools and faculties of pharmacy are responsible for selecting students to admit into the profession. Despite many similarities, admission processes, pharmacists' training, and scope of practice are different across jurisdictions. Students that are selected for admission may then differ in a number of ways, including by personality traits and other individual difference measures. OBJECTIVE To compare the trait characteristics between students entering a New Zealand (NZ-University of Otago) and Canadian ((University of Waterloo) pharmacy programme and to compare their professional goals and role perceptions. METHODS Incoming first year students at each university were invited to take an online questionnaire that included personality characteristics and potential predictors of involvement in pharmacists' roles: (1) the Big Five Inventory (openness, conscientiousness, extraversion, agreeableness, neuroticism); (2) the Achievement Goals Questionnaire-Revised; (3) the Rational Experiential Inventory; and (4) Counsellor Role Orientation. Statistical tests were conducted to determine if there were differences between entry level pharmacy students from NZ and Canada. RESULTS 184 students (97/150 Otago, 87/118 Waterloo) completed the survey. On average, Waterloo students scored higher on agreeableness (M = 80 vs. 76, p = 0.06), conscientiousness (M = 70 vs. 68, p = 0.30), mastery-approach (M = 93 vs.90, p = 0.06), and faith-in-intuition (M = 67 vs. 61, p = 0.03) compared to Otago pharmacy students who were higher for openness M = 70 vs. 66, p = 0.09). An item measuring reliance on physicians for medicine advice was endorsed more by Otago pharmacy students (M = 35 vs. M = 15, p < 0.001). Items on time pressure (e.g., "It takes too much time to for a pharmacist to talk with a patient about the medication they receive") were higher for Otago students (M = 41 vs. M = 38, p = 0.26). Higher scores for pharmacist restriction ("There should be legal restrictions on what pharmacists can tell patients") were also seen among Otago students (M = 26 vs. M = 12, p < 0.001). There were important differences between entry level pharmacy students and practicing pharmacists in both jurisdictions. DISCUSSION While entry-level pharmacy students had similar personality profiles, differences were observed in role expectations and in experiential learning orientation. This highlights differing societal views on the role of pharmacists in each respective country. Pharmacy schools should study their student bodies when designing their curricula and electives, helping ensure graduates feel like they have the training to do what they need to do. Future work will determine if these personality and learning goals influence students' preparation for practice.
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Chang A, Chaudhry S, McCormack D, Gomes T, Shivji A, Tadrous M. Impact of the COVID-19 Controlled Drugs and Substances Act exemption on pharmacist prescribing of opioids, benzodiazepines and stimulants in Ontario: A cross-sectional time-series analysis. Can Pharm J (Ott) 2022; 155:326-333. [PMID: 36386607 PMCID: PMC9647400 DOI: 10.1177/17151635221126481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Due to the coronavirus disease 2019 (COVID-19) pandemic, Health Canada issued an exemption to the Controlled Drugs and Substances Act (CDSA) on March 19, 2020, enabling pharmacists to act as prescribers of controlled substances to support continuity of care. Our study investigates utilization of the CDSA exemption by Ontario pharmacists with the intent to inform policy on pharmacist scope of practice and to improve future patient outcomes. METHODS We conducted a time-series analysis of pharmacist-prescribed opioid, benzodiazepine and stimulant claims data using Ontario Narcotics Monitoring System (NMS) data between January 2019 and December 2021. We used ARIMA modelling to measure the change to these classes of claims and to opioid claims containing quantities greater than a 30-day supply. RESULTS Postexemption, the average weekly number of pharmacist-prescribed opioid, benzodiazepine and stimulant claims rose by 146% (160 to 393 claims/week), 960% (49 to 515 claims/week) and 2150% (8 to 177 claims/week), respectively. There was a 2-week lag period between the time of announcement and the statistically significant increase in claims on April 5, 2020(p < 0.0001). The total number of claims for opioid quantities exceeding a 30-day supply decreased by 60%. Cumulative pharmacist-prescribed claims accounted for under 2% of the total NMS claims. INTERPRETATION Ontario pharmacists used the CDSA exemption but were prescribing at low rates. These findings suggest an effective change to pharmacy practice as the low rates show pharmacists used the exemption as a last line of defense. This may lead to further studies exploring treatment breaks during the COVID-19 pandemic and future changes to pharmacist scope to benefit patients.
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Affiliation(s)
- Ann Chang
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | | | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto
- Li Ka Shing Knowledge Institute, Unity Health, Toronto
| | | | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto
- Women's College Hospital, Toronto, Ontario
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Olufemi-Yusuf DT, Kung JY, Guirguis LM. Medication reviews in community pharmacy: a scoping review of policy, practice and research in Canada. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
This scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions.
Methods
We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed.
Key findings
Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework.
Summary
Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally.
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Affiliation(s)
- Damilola T Olufemi-Yusuf
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
| | - Janice Y Kung
- Public Services Librarian, John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Lisa M Guirguis
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
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Wu JHC, Khalid F, Langford BJ, Beahm NP, McIntyre M, Schwartz KL, Garber G, Leung V. Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective. Can Pharm J (Ott) 2021; 154:179-192. [PMID: 34104272 PMCID: PMC8165883 DOI: 10.1177/1715163521999417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Pharmacist prescribing authority is expanding, while antimicrobial resistance is an increasing global concern. We sought to synthesize the evidence for antimicrobial prescribing by community pharmacists to identify opportunities to advance antimicrobial stewardship in this setting. Methods: We conducted a systematic review to characterize the existing literature on community pharmacist prescribing of systemic antimicrobials. We searched MEDLINE, EMBASE and International Pharmaceutical Abstracts for English-language articles published between 1999 and June 20, 2019, as well as hand-searched reference lists of included articles and incorporated expert suggestions. Results: Of 3793 articles identified, 14 met inclusion criteria. Pharmacists are most often prescribing for uncomplicated urinary tract infection (UTI), acute pharyngitis and cold sores using independent and supplementary prescribing models. This was associated with high rates of clinical improvement (4 studies), low rates of retreatment and adverse effects (3 studies) and decreased health care utilization (7 studies). Patients were highly satisfied (8 studies) and accessed care sooner or more easily (7 studies). Seven studies incorporated antimicrobial stewardship into study design, and there was overlap between study outcomes and those relevant to outpatient antimicrobial stewardship. Pharmacist intervention reduced unnecessary prescribing for acute pharyngitis (2 studies) and increased the appropriateness of prescribing for UTI (3 studies). Conclusion: There is growing evidence to support the role of community pharmacists in antimicrobial prescribing. Future research should explore additional opportunities for pharmacist antimicrobial prescribing and ways to further integrate advanced antimicrobial stewardship strategies in the community setting. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | | | | | - Nathan P Beahm
- the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Mark McIntyre
- the Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto
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Lukas S, Crowe SJ, Law M, Kahaleh A, Addo-Atuah J, Nonyel NP, Ombengi D, Singhal M, Sultan D, Tamukong R. An Ethics-based Approach to Global Health Research Part 2: Strategies for Overcoming Logistic and Implementation Challenges. Res Social Adm Pharm 2020; 16:1580-1587. [PMID: 32811755 DOI: 10.1016/j.sapharm.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/31/2023]
Abstract
With the growth of global pharmacy partnerships and collaborative research, particularly between high-income countries and low- or middle-income countries, it is necessary to establish best practices for fair and ethical collaboration and research. There is a gap in the pharmacy literature in this regard. Through this commentary, authors will present a pathway for future global health researchers including generating ideas based on mutual needs of the partnership and the community; exploring the importance of regulations including the need to conduct research and partnership projects within the confines of each participant's professional scope of practice, expertise, and licensure; describing the need to develop agreements and the components that should be included in such an agreement; discussing ethical guidelines for research planning, obtaining ethical approval, and planning for adverse events; and illustrating ethical considerations for research implementation with considerations around consent, data collection, linking patients to care after the completion of the study, and dissemination. Global examples, with a pharmacy-specific approach where applicable, within each section highlight the importance of discussion and action around ethics and equity when pursuing collaborative research, recognizing that many of these situations involve difficult decisions.
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Affiliation(s)
- Stephanie Lukas
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110, USA.
| | - Susie J Crowe
- Bill Gatton College of Pharmacy, Maple Avenue, Bldg. 7. Mountain Home, TN, USA.
| | - Miranda Law
- Howard University College of Pharmacy, 2300 4th St NW, Washington, DC, 20059, USA.
| | - Abby Kahaleh
- Roosevelt University College of Pharmacy, 1400 N Roosevelt Blvd Schaumburg, IL, 60173, USA.
| | - Joyce Addo-Atuah
- Touro College of Pharmacy, 230 W 125th Street, Room 429, New York, NY, 10027, USA.
| | - Nkem P Nonyel
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, 1 College Backbone Road, Princess Anne, MD, 21853, USA.
| | - David Ombengi
- Medical College of Wisconsin School of Pharmacy and Department of Family Medicine, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Mudit Singhal
- D'Youville School of Pharmacy, 320 Porter Avenue, Buffalo, NY, 14201, USA.
| | - Dawood Sultan
- Mercer University College of Health Professions, 3001 Mercer University Drive, Atlanta, GA, 30341-4155, USA.
| | - Robert Tamukong
- Mbarara University of Science &Technology, P.O.Box 1410, Mbarara, Uganda.
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Nusair MB, Hijazi BM, Jalaileh RA, Naji EA, Mohd HA. Pharmacists' readiness to adopt prescribing authority in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
The overall objective of this study is to assess the views and attitudes of Jordanian pharmacists on expanded pharmacist prescribing role.
Methods
A cross-sectional, questionnaire-based study was conducted using a web-based questionnaire. Pharmacists were invited to take part in this study through pharmacists' Facebook groups for pharmacists in Jordan. Descriptive statistics were used to analyze the data in addition to the t-test to compare the mean difference of support levels toward supplementary and independent prescribing.
Key findings
A total of 521 pharmacists took part in this study. The majority of respondents (n = 482; 92.5%) believe that pharmacists in Jordan should have an expanded prescribing role. Respondents were significantly in favour of supplementary prescribing (P < 0.05) than independent prescribing for various medical condition (e.g. diabetes and asthma). Respondents identified securing more roles in healthcare (n = 464; 89%) and increasing pharmacy profits (n = 420; 80.7%) as key facilitators to adopt this new role. Whereas inadequate training in the diagnosis of disease (n = 457; 87.7%), and inadequate training in patient assessment and monitoring (n = 453; 86.9%) were reported as the most likely barriers.
Conclusion
Overall, Jordanian pharmacists strongly supported the expanded prescribing role and favoured supplementary prescribing for chronic conditions (e.g. diabetes). The study highlighted the need for additional training in various areas (e.g. diagnosing and managing some clinical conditions) to prepare Jordanian pharmacists for this new role.
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Affiliation(s)
| | - Bayan M Hijazi
- Faculty of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Elaf A Naji
- Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Hana A Mohd
- Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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Said A, Hussain N, Abdelaty LN. Physicians' and pharmacists' perception and practice of hospital pharmacist professional role in Egypt. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:491-497. [PMID: 32497350 DOI: 10.1111/ijpp.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate physicians' and pharmacists' perceptions of the importance of pharmacists' role in healthcare in Egypt, and actual delivery of these roles in practice. Identifying any differences and inconsistencies between these will inform future strategies that maximize pharmacists' professional contribution to hospital practice. METHODS A self-administered questionnaire using a 5-point Likert scale was distributed to a convenience sample of physicians (500) and pharmacists (500) practicing in selected private or public hospitals in Egypt. The main sections of the questionnaire comprised statements that pertained to physicians'/pharmacists' views on the importance of pharmacists' roles and their actual delivery in practice. KEY FINDINGS In this study, physicians showed low scores for both the importance of and the delivery of advanced patient-facing clinical pharmacy roles such as suggesting prescription medications, and designing treatment plans. In comparison, pharmacists were more positive on both of these aspects of their roles. High mean scores were reported by the physicians for pharmacist's traditional roles such as patient counselling, assessing compliance, preventing medication errors and treating minor illnesses. Both physicians and pharmacists reported poor pharmacists practice as drug information resources despite their high perception of the importance of that role. CONCLUSION This study suggested that in hospitals in Egypt, there are significant differences between physicians' and pharmacists' perception and practice, and pharmacists' clinical skills are underutilized in health care.
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Affiliation(s)
- Amira Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, Abu Dhabi, UAE
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, Abu Dhabi, UAE
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Diab MI, Ibrahim A, Abdallah O, El-Awaisi A, Zolezzi M, Ageeb RA, Elkhalifa WHI, Awaisu A. Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar. Int J Clin Pharm 2020; 42:110-123. [PMID: 31898166 PMCID: PMC7162834 DOI: 10.1007/s11096-019-00946-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022]
Abstract
Background Pharmacists in many developed countries have been granted prescribing authorities under what is known as "non-medical prescribing" or "pharmacist prescribing". However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists' perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.
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Affiliation(s)
- Mohammad Issam Diab
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Angham Ibrahim
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Oraib Abdallah
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Rwedah Anwar Ageeb
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
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Hindi AMK, Seston EM, Bell D, Steinke D, Willis S, Schafheutle EI. Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e459-e470. [PMID: 30884013 DOI: 10.1111/hsc.12746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10). Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings.
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Affiliation(s)
- Ali M K Hindi
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Elizabeth M Seston
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Dianne Bell
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Douglas Steinke
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Sarah Willis
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Ellen I Schafheutle
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
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Schindel TJ, Yuksel N, Breault R, Daniels J, Varnhagen S, Hughes CA. Pharmacists' learning needs in the era of expanding scopes of practice: Evolving practices and changing needs. Res Social Adm Pharm 2019; 15:448-458. [DOI: 10.1016/j.sapharm.2018.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 11/26/2022]
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16
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Lai HY, Chen MM, Chen CT, Chang TW, Lee ST, Lee CY. A Scoping Review of Medical Education Research in Neurosurgery. World Neurosurg 2019; 126:e1293-e1301. [PMID: 30898758 DOI: 10.1016/j.wneu.2019.03.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the state of medical education (ME) research in neurosurgery. As ME started to develop in neurosurgery in recent years, it is important to understand the current status and develop the theory for advancement in neurosurgery. The aim of this study was to undertake a scoping review of neurosurgery literature on ME research. METHODS MEDLINE, SCOPUS, and PubMed databases were searched. Inclusion criteria were full-text articles in English published from January 2006 to December 2017. Research aspects included country of publication, annual number of publications, journal types, type of participants, frequently researched topics, and research design. Search terms included neurosurgery, medical education, teaching, training, learning, and curriculum. RESULTS A total of 9863 references were found across 3 databases. After duplicate removal and further screening, 533 references remained for coding analysis. ME research activity in neurosurgery is increasing and commonly observed in Western countries. Identified articles were mostly quantitative, with curriculum, assessment (especially simulation), and teaching and learning being the most dominant research themes. CONCLUSIONS This study highlights the need for enhanced quantity and quality of ME research in neurosurgery. It identifies areas of highest priority and aspects to be improved and provides us with a rationale for future development in ME in neurosurgery. These findings reveal future education research direction and programmatic research areas, while also establishing a benchmark to assess changes in educational scholarship over time.
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Affiliation(s)
- Hung-Yi Lai
- Department of Neurosurgery, Chang-Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Mi-Mi Chen
- Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang-Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang-Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang-Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang-Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung Medical Education Research Center, Taoyuan, Taiwan.
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Faruquee CF, Guirguis LM, Hughes CA, Makowsky MJ, Sadowski CA, Schindel TJ, Cor KM, Yuksel N. Characterizing pharmacist prescribers in Alberta using cluster analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
Legislative and regulatory bodies in Canada have authorized pharmacists to prescribe in different provinces. Albertan pharmacists have the broadest prescribing scope. Our objective was to cluster Albertan pharmacists into different prescriber groups based on their self-reported prescribing practice and to compare the groups according to practice settings, the proportion of Additional Prescribing Authority (APA) pharmacists and support experiences.
Methods
A cross-sectional survey was administered among a sample of 700 Albertan practicing registered pharmacists in 2013 to identify their involvement in different types of prescribing activities. Cluster analysis was used to group participants based on their reported prescribing practices. Chi-squared test was used to compare prescriber groups by practice settings and the proportion of APA pharmacists. One-way analysis of variance was used to compare the groups by their support experiences.
Key findings
Three major groups of pharmacist prescriber were identified – ‘renewal prescriber’ (74%), ‘Modifier’ (17%) and ‘Wide ranged prescriber’ (9%). Prevalence of ‘renewal prescriber’ in the community setting was 85.8% whereas ‘Modifier’ was predominant (66.7%) in the collaborative setting. Higher support experience facilitated the wide range prescribing. Pharmacists with APA were most likely to be classified into ‘Modifier’ (17.6%) or ‘Wide ranged prescriber’ (13.8%) groups than the ‘renewal prescriber’ group (3.1%).
Conclusions
Although legislation allowed Albertan pharmacists to have the broadest scope of prescribing authority, few are practicing with the fullest scope. Prescribing practice varies based on practice setting and support experience. Future research could explore factors influencing the types of adoption and measure the shifting of prescribing type over time.
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Affiliation(s)
- Chowdhury F. Faruquee
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lisa M. Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Christine A. Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mark J. Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Theresa J. Schindel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Ken M. Cor
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Nese Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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19
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Jebara T, Cunningham S, MacLure K, Awaisu A, Pallivalapila A, Stewart D. Stakeholders' views and experiences of pharmacist prescribing: a systematic review. Br J Clin Pharmacol 2018; 84:1883-1905. [PMID: 29873098 PMCID: PMC6089831 DOI: 10.1111/bcp.13624] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS The aims of this systematic review were to: (1) critically appraise, synthesize and present the available evidence on the views and experiences of stakeholders on pharmacist prescribing and; (2) present the perceived facilitators and barriers for its global implementation. METHODS Medline, CINAHL, International Pharmaceutical Abstracts, PsychArticles and Google Scholar databases were searched. Study selection, quality assessment and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was undertaken due to heterogeneity, the nature of study types and outcome measures. RESULTS Sixty-five studies were identified, mostly from the UK (n = 34), followed by Australia (n = 13), Canada (n = 6) and USA (n = 5). Twenty-seven studies reported pharmacists' perspectives, with fewer studies focusing on patients' (n = 12), doctors' (n = 6), the general public's (n = 4), nurses' (n = 1), policymakers' (n = 1) and multiple stakeholders' (n = 14) perspectives. Most reported positive experiences and views, regardless of stage of implementation. The main benefits described were: ease of patient access to healthcare services, improved patient outcomes, better use of pharmacists' skills and knowledge, improved pharmacist job satisfaction, and reduced physician workload. Any lack of support for pharmacist prescribing was largely in relation to: accountability for prescribing, limited pharmacist diagnosis skills, lack of access to patient clinical records, and issues concerning organizational and financial support. CONCLUSION There is an accumulation of global evidence of the positive views and experiences of diverse stakeholder groups and their perceptions of facilitators and barriers to pharmacist prescribing. There are, however, organizational issues to be tackled which may otherwise impede the implementation and sustainability of pharmacist prescribing.
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Affiliation(s)
- Tesnime Jebara
- School of Pharmacy and Life SciencesRobert Gordon UniversityUK
| | | | - Katie MacLure
- School of Pharmacy and Life SciencesRobert Gordon UniversityUK
| | | | | | - Derek Stewart
- School of Pharmacy and Life SciencesRobert Gordon UniversityUK
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Shearer B, Ng S, Dunford D, Kuo IF. Training Needs of Manitoba Pharmacists to Increase Application of Assessment and Prescribing for Minor Ailments into Practice: A Qualitative and Quantitative Survey. PHARMACY 2018; 6:pharmacy6030082. [PMID: 30081557 PMCID: PMC6165543 DOI: 10.3390/pharmacy6030082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022] Open
Abstract
Current literature demonstrates the positive impact of pharmacists prescribing medication on patient outcomes and pharmacist perceptions of the practice. The aim of this study was to understand the factors affecting prescribing practices among Manitoba pharmacists and identify whether additional training methods would be beneficial for a practice behavior change. A web-based survey was developed and participation was solicited from pharmacists in Manitoba. Descriptive statistics were calculated to summarize the frequency of demographic characteristics. Chi-square tests were used to explore possible correlations between variables of interest and thematic analysis of qualitative data was completed. A total of 162 participants completed the survey. The response rate was 12.3%. Of those who had met the requirements to prescribe, none were doing so on a daily basis and 23.5% had not assessed or prescribed since being certified. Respondents identified the top barriers for providing this service as a lack of sufficient revenue and a lack of time. Qualitative analysis of responses identified additional barriers including a limiting scope and inadequate tools. Approximately half (54.4%) of respondents expressed that additional training would be of value. The themes identified from the survey data suggest that practice-based education would help pharmacists apply skills. In addition, expansion of prescribing authority and strategies addressing remuneration issues may help overcome barriers to pharmacists prescribing within Manitoba.
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Affiliation(s)
- Brenna Shearer
- College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada.
- Independent Researcher Pharmacists Manitoba, Winnipeg, MB R3C 4H1, Canada.
| | - Sheila Ng
- College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada.
| | - Drena Dunford
- College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada.
| | - I Fan Kuo
- College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada.
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21
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Isenor JE, Minard LV, Stewart SA, Curran JA, Deal H, Rodrigues G, Sketris IS. Identification of the relationship between barriers and facilitators of pharmacist prescribing and self-reported prescribing activity using the theoretical domains framework. Res Social Adm Pharm 2018; 14:784-791. [DOI: 10.1016/j.sapharm.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
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Au B, Dersch-Mills D, Ghosh S, Jupp J, Chambers C, Cusano F, Danilak M. Implementation of additional prescribing authorization among oncology pharmacists in Alberta. J Oncol Pharm Pract 2018; 25:584-598. [DOI: 10.1177/1078155217752076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. Methods A descriptive, cross-sectional survey of all oncology pharmacists in Alberta was conducted using a web-based questionnaire over four weeks between March and April 2016. Pharmacists were identified from the Cancer Services Pharmacy Directory and leadership staff in Alberta Health Services. Descriptive statistics were used to describe the practice setting, prescribing practices, motivators to apply for additional prescribing authorization, and the facilitators and barriers of prescribing. Logistic regression was used to explore factors associated with having additional prescribing authorization. Results The overall response rate was 41% (71 of 175 pharmacists). Oncology pharmacists with additional prescribing authorization made up 38% of respondents. They primarily worked in urban, tertiary cancer centers, and practiced in ambulatory care. The top 3 clinical activities they participated in were medication reconciliation, medication counseling/education, and ambulatory patient assessment. Respondents thought additional prescribing authorization was most useful for ambulatory patient assessment and follow-up. Antiemetics were prescribed the most often. The median number of prescriptions written in an average week of clinical work was 5. Competence, self-confidence, and the potential impact on patient care/perceived impact on work environment were the strongest facilitators of prescribing. The strongest motivators to apply for additional prescribing authorization were relevancy to practice, the potential for increased efficiency, and advancing the profession. Conclusion The current majority of oncology pharmacist prescribing in Alberta occurs in ambulatory care with a large focus on antiemetic prescribing. Pharmacists found additional prescribing authorization most useful for ambulatory patient assessment and follow-up.
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Affiliation(s)
- Bianca Au
- Alberta Health Services, Cancer Services
| | | | - Sunita Ghosh
- Alberta Health Services, Cancer Services
- Department of Medical Oncology, University of Alberta, Edmonton, Canada
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Mansell K, Edmunds K, Guirguis L. Pharmacists' Scope of Practice: Supports for Canadians with Diabetes. Can J Diabetes 2017; 41:558-562. [PMID: 29037573 DOI: 10.1016/j.jcjd.2017.08.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The pharmacists' role in Canada has significantly advanced over the past decade, resulting in increasing access to primary care services. This study aimed to characterize pharmacists' expanded scope of practice as it relates to providing services to Canadians with diabetes. METHODS This environmental scan characterized services that could be useful to Canadians with diabetes in each of the provinces (excluding the territories): immunizations, medication prescribing, ordering and interpreting laboratory tests, and medication reviews. Researchers also collected information on pharmacists' access to health information. Data were collected from regulatory authorities in each province, from pharmacy stakeholders and through a web search. RESULTS Pharmacists' scope of practice varies widely across the Canadian provinces. Three provinces have medication-review programs focused specifically on diabetes, and many people with diabetes can access publicly funded medication reviews. Other than in Quebec, pharmacists can provide influenza (publicly funded) and pneumococcal vaccinations (publicly funded in British Columbia, Alberta and Manitoba). All pharmacists in Canadian provinces can renew prescriptions to ensure continuity of therapy. Pharmacists have varying levels of other prescriptive authority. Pharmacists in all provinces (except Ontario) can access provincial prescription information; in 4 provinces, they can access laboratory results, and in 3 provinces, they can order and interpret laboratory results, such as glycated hemoglobin levels. CONCLUSIONS Canadians with diabetes can expect to receive influenza vaccines and have medications renewed at their pharmacies. Many patients with diabetes qualify for a publicly funded medication review, and some provinces allow pharmacists to order and interpret laboratory results. This expanded scope provides greater opportunities for pharmacists to help support patients with diabetes in conjunction with other health-care team members.
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Affiliation(s)
- Kerry Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Kirsten Edmunds
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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24
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Habicht D, Ng S, Dunford D, Shearer B, Kuo IF. Incorporating assessment and prescribing for ambulatory ailments skills into practice: An environmental scan of continuing education for pharmacist prescribing in Canada. Can Pharm J (Ott) 2017; 150:316-325. [PMID: 28894501 DOI: 10.1177/1715163517723352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pharmacists in Canadian provinces are at different stages of applying prescribing legislation into practice. The purpose of this environmental scan was to examine differences in legislation, remuneration, professional uptake, continuing education requirements and continuing education resources relating to pharmacist prescribing for ambulatory ailments, with a focus on continuing education. METHODS Data were collected between May and December 2016 using websites and communication with provincial professional regulatory bodies, advocacy bodies, drug coverage programs and other organizations that offer continuing education for pharmacists. RESULTS Training requirements to prescribe for ambulatory ailments vary provincially, including no training requirements, online tutorials and a comprehensive application process. Government-funded remuneration for prescribing services is absent in most provinces. Pharmacist uptake of the training required to obtain prescribing authority ranges from 30% to 100% of pharmacists. Continuing education programs on the topic of prescribing across the country include online courses, in-person courses, webinars, panel discussions and preparation courses. CONCLUSION Many aspects of pharmacist prescribing for ambulatory ailments, including the style and content of continuing education resources, vary from province to province. Further research on this topic would help to determine the effect of these differences on the success of incorporating pharmacist prescribing into practice.
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Affiliation(s)
- Dana Habicht
- College of Pharmacy (Habicht, Ng, Dunford, Shearer, Kuo), University of Manitoba; and Pharmacists Manitoba (Shearer), Winnipeg, Manitoba. S. Ng and D. Dunford are PharmD candidates at the University of Colorado
| | - Sheila Ng
- College of Pharmacy (Habicht, Ng, Dunford, Shearer, Kuo), University of Manitoba; and Pharmacists Manitoba (Shearer), Winnipeg, Manitoba. S. Ng and D. Dunford are PharmD candidates at the University of Colorado
| | - Drena Dunford
- College of Pharmacy (Habicht, Ng, Dunford, Shearer, Kuo), University of Manitoba; and Pharmacists Manitoba (Shearer), Winnipeg, Manitoba. S. Ng and D. Dunford are PharmD candidates at the University of Colorado
| | - Brenna Shearer
- College of Pharmacy (Habicht, Ng, Dunford, Shearer, Kuo), University of Manitoba; and Pharmacists Manitoba (Shearer), Winnipeg, Manitoba. S. Ng and D. Dunford are PharmD candidates at the University of Colorado
| | - I Fan Kuo
- College of Pharmacy (Habicht, Ng, Dunford, Shearer, Kuo), University of Manitoba; and Pharmacists Manitoba (Shearer), Winnipeg, Manitoba. S. Ng and D. Dunford are PharmD candidates at the University of Colorado
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Slipp M, Burnham R. Medication management of chronic pain: A comparison of 2 care delivery models. Can Pharm J (Ott) 2017; 150:112-117. [PMID: 28405255 DOI: 10.1177/1715163517690540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of chronic pain is high and increasing. Medication management is an important component of chronic pain management. There is a shortage of physicians who are available and comfortable providing this service. In Alberta, pharmacists have been granted an advanced scope of practice. Given this empowerment, their availability, training and skill set, pharmacists are well positioned to play an expanded role in the medication management of chronic pain sufferers. OBJECTIVE To compare the effectiveness and cost of a physician-only vs a pharmacist-physician team model of medication management for chronic nonmalignant pain sufferers. METHOD Data was analyzed for 89 patients who had received exclusively medication management at a rural Alberta multidisciplinary clinic. 56 were managed by a sole physician. 33 were managed by a team (pharmacist + physician). In the team model, the physician did the medical assessment, diagnosis, and established a treatment plan in consultation with the patient and pharmacist. The pharmacist then provided the ongoing follow-up including education, dose titration and side effect management and consulted with the physician as needed. Change in pain (Numerical Rating Scale) and disability (Pain Interference Questionnaire) over the course of treatment were recorded. The treatment duration and number of visits were used to calculate cost of care. RESULTS Both models of medication management resulted in significant and comparable improvements in pain, disability and patient perception of medication effectiveness. Patients in the physician-only group were seen more frequently and at a greater cost. The pharmacist-physician team approach was markedly more cost-effective, and patients expressed a high level of satisfaction with their medication management. CONCLUSIONS The pharmacist-physician team model of medication management results in significant reductions of pain and disability for chronic nonmalignant pain sufferers at a reduced cost and is well accepted by patients.
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Affiliation(s)
- Marlene Slipp
- Central Alberta Pain and Rehabilitation Institute (Slipp, Burnham), Lacombe, Alberta
| | - Robert Burnham
- Central Alberta Pain and Rehabilitation Institute (Slipp, Burnham), Lacombe, Alberta
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Gray M, Mysak T. The road to pharmacist prescribing in Alberta Health Services. Am J Health Syst Pharm 2016; 73:1451-5. [DOI: 10.2146/ajhp150786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Margaret Gray
- Pharmacy Services—Alberta Health Services, Edmonton, Canada
| | - Tania Mysak
- Pharmacy Services—Alberta Health Services, Edmonton, Canada
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