Showing papers in "Canadian Pharmacists Journal in 2011"
TL;DR: Responses in this study generally had a positive view of the pharmacy profession, but there was still some variation, perhaps showing that an inconsistent message is being communicated to the general public about the role of pharmacists.
Abstract: Background:Pharmacists generally enjoy a high ranking when members of the general public are asked to rate the most trusted professions. While it is a good thing that the pharmacy profession appear...
52 citations
TL;DR: A survey among practising pharmacists in Canada found that 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.
Abstract: 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...
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TL;DR: A substantial portion of community pharmacists in Newfoundland and Labrador do not have a solid understanding of oral anti-cancer therapy and educational gaps must be addressed to ensure patient safety as well as the safe handling and dispensing of OAAs by community pharmacist.
Abstract: Background:Over the past decade, there has been a sharp rise in the approval of orally administered anti-cancer agents for disease control. The increase in the use of oral anti-cancer agents (OAAs) raises concerns that community pharmacists may not have the training to safely dispense these agents and provide effective patient care. In order to identify the needs of community pharmacists with respect to oral anti-cancer therapy, a survey was conducted in the province of Newfoundland and Labrador.Methods:A structured electronic mailing strategy was used. Standardized data collection forms with a cover letter were electronically mailed to 560 practising pharmacists. Survey items included questions related to demographic information, practice setting, current knowledge related to cancer therapy, education needs, access to resources, patient education, patient and pharmacist safety and required elements of an OAA prescription.Results:The response rate was 39%. Only 9.6% of respondents felt that they had recei...
14 citations
TL;DR: Strategies to improve chronic disease management through a focused approach — case finding are discussed.
Abstract: The practice of pharmacy is moving from dispensing to patient-centred care. One component of this transition for pharmacists is involvement in chronic disease management (CDM). CDM is characterized by interventions designed to prevent or manage one or more chronic conditions using a community-wide, systematic and structured multidisciplinary approach. Indeed, there are numerous trials and a high level of evidence for the efficacy of pharmacist-led CDM. The “missing link” in most CDM programs is identification of patients who could benefit from the intervention. For example, a dyslipidemia program, no matter how elegantly designed, will be useless if pharmacists cannot systematically find those patients who have dyslipidemia. While pharmacists may participate in the traditional screening method approach for CDM, the yield is generally very poor, leading to frustration and poor uptake of clinical pharmacy services (and an unrealized potential for improving patient outcomes). In this paper we discuss strategies to improve CDM through a focused approach — case finding.
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TL;DR: Overall, knowledge of the Food Guide was poor, and pharmacy students appear unprepared to educate clients about recommendations in Canada's Food Guide, and their personal dietary habits fell far below recommendations.
Abstract: Background:Canada's Food Guide is a well-recognized tool used to optimize the diets of Canadians. Although community pharmacists are in an ideal position to educate their clients about healthy eating, it is not known if they are adequately prepared to do so.Methods:We developed a questionnaire to assess knowledge of and adherence to Canada's Food Guide among undergraduate pharmacy students at the University of Saskatchewan.Results:Of 354 registered pharmacy students, 291 completed the survey, for a response rate of 82.2%. Overall, knowledge of the Food Guide was poor. In almost every food group category, less than 50% of respondents could correctly identify the number of recommended daily servings for adults under 50 years of age. Self-reported adherence to the Food Guide was similarly poor. For instance, in the vegetables and fruit category, 86.5% (64/74) of males and 67.6% (140/207) of females failed to reach daily recommendations. Of the students who responded, the vast majority (93.4%; 254/272) believ...
12 citations
TL;DR: In this paper, the authors examined pharmacist preceptors' and pharmacy students' experiences at an interprofessional student-run clinic: Student Health Initiative for the Needs of Edmonton (SHINE), where students and preceptors from medicine, dentistry, pharmacy, nursing, social work and nutrition work together to care for adolescents and young adults from Edmonton inner city areas.
Abstract: Background:This study examines pharmacist preceptors' and pharmacy students' experiences at an interprofessional student-run clinic: Student Health Initiative for the Needs of Edmonton (SHINE). On Saturday afternoons, students and preceptors from medicine, dentistry, pharmacy, nursing, social work and nutrition work together to care for adolescents and young adults from Edmonton inner city areas.Methods:Pharmacist preceptors and pharmacy students were invited to participate in open-ended interviews to explore their experiences at the SHINE clinic. Qualitative data analysis techniques were used to identify themes in the transcribed interviews.Results:Three pharmacist preceptors and 3 pharmacy students were interviewed. Three themes arose: dynamic team roles, interprofessional role understanding and personal benefits. Preceptors' and students' interprofessional contributions varied based on the stage of the patient care process. Benefits of the SHINE clinic experience included enhancing preceptor skills, in...
12 citations
TL;DR: Few changes were made as a result of the adaptation program and minimal capital costs were incurred and perceived benefits related to providing the patient with continuity of care.
Abstract: Introduction:As of January 2009, pharmacists in British Columbia (BC) have been able to adapt prescriptions to provide renewals; change the dosage, formulation or regimen; and substitute therapeutically equivalent therapies for reasons of cost or continuity of care.Objectives:To describe and characterize pharmacy manager and owner perceptions of pharmacy adaptation services in BC.Methods:Over a 1-month period, pharmacy owners, dispensary managers and regional managers from “high-adapter” pharmacies (>60 adaptations/month) and “low-adapter” pharmacies (<10 adaptations/month) were interviewed. During the semi-structured interviews, participants were asked to comment on uptake, cost, revenue and general perceptions of adaptation services. All data were assessed using content analysis.Results:Very few capital costs were incurred. Those costs included additional human resource costs (training and staff), updating computer software to produce physician notification forms, fax machine upgrades, additional physic...
TL;DR: The EPPS WG was intended to provide expert advice on the specifics of the commitment made by the MOHLTC to increase funding for professional pharmacist’s services, including patient-focused clinical services that occur immediately before, during or shortly after dispensing a medication.
Abstract: 119 The Ontario government has initiated a number of changes to the prescription drug system over the past 5 years. Many of the changes are intended to reduce the money paid by the Ontario Ministry of Health and Long-Term Care (MOHLTC) for medications, through reductions in the reimbursed cost of generic medications and indirectly through banning professional allowances paid to pharmacists by generic manufacturers. These changes generated controversy and were played out in the public arena. At the same time as the funding reductions were announced, the Ontario MOHLTC also made a commitment to increase the funding available for professional services to patients provided by pharmacists, although the specifics of the funding were not described at the time of the announcement. The Expanding Professional Pharmacy Services Working Group (EPPS WG) was established in August 2010 to provide advice to the Minister of Health and Long-Term Care and the Executive Officer of Ontario Public Drug Programs, on pharmacist’s professional services that could offer value to Ontarians and were deemed ready for immediate implementation by community pharmacists. The work of the EPPS WG was intended to provide expert advice on the specifics of the commitment made by the MOHLTC to increase funding for professional pharmacist’s services. The services under review were patient-focused clinical services that occur immediately before, during or shortly after dispensing a medication or may be patient-focused nondispensing professional clinical services that are appointment-based or offered outside of the dispensing process. Policy-makers often rely on expert committees to generate recommendations that can help inform health policy decisions. Structured expert committee discussion of a topic, including a consideration of literature evidence, is one method to improve evidence-based decision-making by policy-makers. The ideal characteristics of respectable work produced by expert committees are that the work is transparent, evidence-based, systematic and takes into account the needs, constraints, values and preferences pertinent to the organizations, people and setting affected by the recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an increasingly accepted approach to grading quality of evidence and strength of recommendations. GRADE has been used worldwide to help develop recommendations about drugs, technologies, prevention screening and other health services. It incorporates processes that facilitate high-quality work by expert committees. It provides a structured approach that allows expert committees to address the ideal characteristics. The GRADE process separates judgments made about the quality of the literature evidence on the effectiveness, safety and other considerations from judgments made on the strength of the recommendations for the topic under review. GRADE itself was created based on the findings from an overview of the literature that examined the essential components of a system to grade evidence. The GRADE approach has been used by organizations worldwide, including the World Health Organization, the American College of Chest Physicians, the National Institute for Health and Clinical Excellence in the United Kingdom and the Canadian Agency for Drugs and P O L I C Y R E V I E W
TL;DR: A mixed-methods evaluation of pharmacist prescribing in Alberta and Ontario will allow for a greater understanding of pharmacists' perceptions of prescribing; the extent to which prescribing has been incorporated into pharmacy practice; and the factors facilitating its uptake.
Abstract: Background:Although pharmacists have been granted prescribing privileges in Alberta since 2007 and most other Canadian provinces have granted or put forward similar legislation since then, there is a lack of Canadian data exploring pharmacists' understanding and adoption of prescribing practice. Therefore, our goal is to investigate pharmacists' perceptions of prescribing, the extent to which prescribing has been incorporated into pharmacists' practices and the factors that have influenced its uptake.Methods (Study Design):We are conducting a mixed-methods evaluation of pharmacist prescribing in Alberta and Ontario consisting of 3 consecutive stages: 1) semi-structured interviews with a small cohort of pharmacists in Alberta and Ontario; 2) development of a survey guided by responses identified in Stage 1; and 3) a mixed-methods survey of a large random sample of pharmacists in Alberta.Conclusion:When complete, this study will inform researchers, policy-makers and educators about Ontario pharmacists' atti...
TL;DR: In this article, the authors find the best way to communicate risk of side effects to patients can be difficult for pharmacists, who are reluctant to discuss side effects for fear that such informa...
Abstract: Background:Finding the best way to communicate risk of side effects to patients can be difficult for pharmacists. Some practitioners are reluctant to discuss side effects for fear that such informa...
TL;DR: The 2011 Canadian Hypertension Education Program (CHEP) guidelines represent the 12th annual update to these guidelines and are available in full in the Canadian Journal of Cardiology or on the Hypertensions Canada website (www. hypertension.ca).
Abstract: Introduction Hypertension continues to be a common chronic disease affecting 1 in 5 adult Canadians. New data suggest that Canada has the highest reported rates of hypertension awareness, treatment and control, yet one-third of patients with hypertension in Canada remain uncontrolled and at risk of complications such as heart attack, stroke and heart failure. Importantly, in the high-risk group of patients with diabetes and hypertension, two-thirds are not controlled. As a highly accessible health professional, there is a public health need to have pharmacists take a proactive, responsible role in the management of hypertension. Indeed, there is strong evidence for pharmacists improving the care of people with hypertension. The 2011 Canadian Hypertension Education Program (CHEP) guidelines represent the 12th annual update to these guidelines and are available in full in the Canadian Journal of Cardiology or on the Hypertension Canada website (www. hypertension.ca). This is the 6th update of pharmacist-specific guidelines for the management of hypertension.
TL;DR: To ensure that physicians support pharmacy adaptation services, their concerns should be addressed in the adaptation guidelines and efforts should be made to include them in discussions and provide them with detailed communications.
Abstract: Background:In 2008, the BC provincial government introduced legislation that enabled pharmacists to adapt prescriptions. The purpose of this study was to examine the perceptions, attitudes and practices of family physicians as they relate to pharmacy adaptation services.Methods:Focus groups and interviews were conducted with physicians in 4 of the 5 regional health authorities of BC (Fraser, Interior, Vancouver Coastal and Vancouver Island) and transcripts were thematically coded and analyzed.Results:Forty physicians participated in the 4 focus groups and 4 physicians participated in supplementary interviews. Physicians perceived 6 key concerns arising from the initiative: compromised patient monitoring, physician liability, physician burden, pharmacists' ability to make appropriate adaptations, conflicts of interest and impact on physician-pharmacist relationships. Physicians also believed that communication about the adaptation initiative was inadequate and that they were not sufficiently included in it...
TL;DR: An overview of the epidemiology of pneumococcal, influenza and herpes zoster infections in older adults, as well as available vaccines and recommended immunization schedules, and the benefits and role of pharmacists in improving immunization rates are provided.
Abstract: Pneumococcal, influenza and herpes zoster infections cause significant morbidity and mortality in the aging population. Effective vaccines are available in Canada to prevent and minimize illnesses ...
TL;DR: Before-and-after studies were conducted to determine if a simple AD intervention could reduce inappropriate PPI prescribing in a Canadian community hospital setting and optimize prescribing practices.
Abstract: C P J / R P C • M A R C H / A P R I L 2 0 1 1 • V O L 1 4 4 , N O 2 Introduction Proton pump inhibitors (PPIs) are one of the most commonly prescribed class of drugs. Approximately 25% to 30% of patients receive a PPI in the hospital. Of these PPIs, approximately 40% to 60% are prescribed inappropriately. Despite the common use of PPIs, they are not without risks. Some of the common adverse effects include diarrhea and headache, which can occur in up to 10% of patients. Observational studies have shown that PPI use may be associated with an increased risk of community-acquired pneumonia, Clostridium difficile diarrhea and Campylobacter jejuni gastroenteritis, though evidence for a direct correlation remains inconclusive. In addition, the treatment of dyspeptic symptoms with PPIs prior to endoscopy can mask and delay the detection of gastric and esophageal carcinoma. Therefore, overuse of PPIs potentially poses negative health consequences and optimization of PPI prescribing may be of benefit to patients. Academic detailing (AD) is an effective method of improving physicians’ prescribing behaviour. It is defined as a one-on-one visit with a physician in his or her own setting, aimed at providing evidence-based information with the purpose of improving physician prescribing. An example of AD aimed at PPI use is providing the most recent guidelines pertaining to the physician’s specialty and a 1-hour presentation emphasizing the risks and benefits of using PPIs in stress ulcer prophylaxis. In a systematic review, Grindrod et al. found that reminders, audit and feedback, patientmediated interventions (i.e., patient educational materials and reminders via telephone, postcard or mail) and AD were consistently effective in positively influencing health practitioners’ prescribing behaviours. Another recent systematic review suggested that AD combined with social marketing — defined as a process that identifies the motivation for a behaviour, the barriers to change and the strategies to overcome those barriers — can improve prescribing. Most AD studies that have focused on PPIs were conducted in the community setting and data on the effectiveness of AD in changing prescribing behaviour of PPIs in hospitals are lacking. Therefore, we conducted a before-and-after study in order to determine if a simple AD intervention could reduce inappropriate PPI prescribing in a Canadian community hospital setting and optimize prescribing practices.
TL;DR: The majority of stakeholders were generally satisfied with the current status of the EPS, but they also perceived a few key weaknesses.
Abstract: The aim of the present study was to measure the attitudes and satisfaction of various stakeholders about an electronic prescribing service (EPS), in order to generate best practice recommendations for further improvement. Relevant stakeholders included physicians from different specialties, pharmacy staff (pharmacists and assistant pharmacists), nurses and outpatients. Participants (n = 283) were randomly selected from several clinical settings in Muscat, Oman. They were asked to fill out a questionnaire to measure their satisfaction with the EPS, as well as their attitude toward it, both before and after its integration with a computerized hospital information and management system (Al-Shifa). The overall level of satisfaction with the integrated EPS was high. Physicians, pharmacy staff and nurses highly agreed that the EPS reduced prescribing errors and they did not want to go back to the paper-based prescription system. Pharmacy staff and nurses viewed the EPS more positively and were more satisfied wi...
TL;DR: Examination of how pharmacy faculty members describe the health care role of pharmacists found that faculty members were more idealistic about patient-centred roles for pharmacists than community or hospital pharmacists, but a large proportion still describe a product-focused role.
Abstract: Objective:Previous research has shown that community pharmacists describe their role mostly in product-focused rather than patient-centred terms. We wondered if pharmacy faculty members think similarly, which might influence how students, and subsequently, new pharmacists think. The objective of this study was to examine how pharmacy faculty members describe the health care role of pharmacists.Method:We telephoned 101 randomly selected Canadian pharmacy faculty members. The surveyor posed as a sociology student studying the use of language. We asked a single question: “What does a pharmacist do?,” asking respondents to answer in a few short phrases that were recorded verbatim. Responses were analyzed by content and categories were established from previous studies, coded as “patient-centred,” “product-focused (dispensing),” “research” or “business-related.”Results:Ninety-four faculty members (71% were pharmacists) provided 200 responses. Of the responses, 40% were categorized as patient-centred, 32.5% wer...
TL;DR: Because of their multifactorial causes and the medical complexity of older adults, falls are a challenge for health care professionals to address, but there is evidence regarding risks and effective interventions that can reduce falls.
Abstract: Falls are the most common injury in older adults. more than one-third of seniors fall each year and half of them suffer repeated falls. In an institutional setting, almost half of seniors will have a fall each year. Compared to a younger population, seniors have 9 times more fall injuries, and up to 25% of seniors who fall experience a serious injury. The most serious injury is a hip fracture, which often leads to institutionalization and pain, loss of mobility and independence. Of all hip fractures in older adults, >90% are due to a fall. The consequences of falls are expected to increase as the population ages. It is predicted that by 2030 the number of injuries caused by falls will be 100% higher than current rates. In addition to direct physical injury to the person, falls also cause indirect harm, such as the development of fear of falling, resulting in a lack of confidence and eventual deconditioning. The health care system is also affected by increased hospital admissions, emergency department visits and ongoing rehabilitation. Health care professionals, the public and the media may interpret the term “fall” differently. The currently accepted definition for a fall is: a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor or the ground (other than as a consequence of sudden onset of paralysis, epileptic seizure or overwhelming external force). Because of their multifactorial causes and the medical complexity of older adults, falls are a challenge for health care professionals to address. Fortunately, there is evidence regarding risks and effective interventions that can reduce falls.
TL;DR: Strategies that might increase understanding of prescription labels for all literacy levels include using plain language, eliminating unnecessary words and phrases, and managing the way dispensing software translates commonly used abbreviations.
Abstract: Pharmacists maybe contributing to unintentional medication nonadherence in their patients by labelling prescription medications in an unclear way. Many patients have low literacy, and even those wi...
TL;DR: Preliminary evidence is provided that pharmacy students have similar mentorship needs as students in other disciplines and that a formal mentorship model can address these needs.
Abstract: Background:The value of mentoring is recognized in many fields, including pharmacy, as a means for one person (mentor) to help another person (protege) enhance his or her growth, knowledge and skills. The University of Alberta Faculty of Pharmacy and the Pharmacy Alumni Association conducted an 8-month mentorship pilot project involving pharmacy undergraduate students and alumni pharmacists. The focus was to assist students transitioning into the pharmacy workforce by providing guidance and advice from pharmacist mentors.Methods:A prototype mentorship model was developed. The model consisted of recruitment and matching processes and multiple structured and unstructured communication sessions (education and relationship-building). Seven student proteges and 7 licensed Alberta pharmacists participated in the pilot throughout the 2007–08 academic year. The formal evaluation was based on document reviews and participant interviews.Results:The key findings included: participants were very positive about the pi...
TL;DR: The objective of this paper is to summarize the evidence pertaining to the benefits and risks of ASA for primary prevention in patients without diabetes and to highlight recent guideline statements pertaining to ASA use to enable pharmacists to systematically evaluate each patient’s benefit/risk profile and incorporate information regarding patient-specific values and goals to make an evidence-based recommendation.
Abstract: C P J / R P C • N O V E M B E R / D E C E M B E R 2 0 1 1 • V O L 1 4 4 , N O 6 Background Pharmacists are commonly asked by their patients and the public about the value of taking low-dose acetylsalicylic acid (ASA) for cardioprotection. While the benefit/risk ratio for low-dose ASA (75 to 325 mg daily) favours its use in the secondary prevention of vascular events, its role in primary prevention is less clear. Although ASA 81 mg daily is approved for the primary prevention of cardiovascular disease (CVD) by Health Canada, and is commonly used for this purpose (53.6% of patients self-medicating with ASA were using it for primary prevention in a recent Canadian trial), recent data suggest that the benefits and risks are dependent upon individual patient characteristics. The objective of this paper is to summarize the evidence pertaining to the benefits and risks of ASA for primary prevention in patients without diabetes and to highlight recent guideline statements pertaining to ASA use. This will enable pharmacists to systematically evaluate each patient’s benefit/risk profile and incorporate information regarding patient-specific values and goals to make an evidence-based recommendation. While patients with diabetes are at increased risk for cardiovascular (CV) events, due in part to increased platelet reactivity, it has been suggested that they may have a different response to ASA than patients without diabetes. A review of ASA in this population is beyond the scope of this paper.
TL;DR: The extent to which pharmacists prioritize adherence support activities compared to other clinical responsibilities was determined by conducting a survey of Saskatchewan community pharmacists.
Abstract: with chronic diseases take prescribed medications regularly. As a direct result, nonadherent patients experience a reduced quality of life, higher rates of morbidity and death, and consume more health care resources compared to adherent patients. Considering the magnitude of the problem and the fact that community pharmacists are considered well positioned to influence nonadherent patients, it would seem logical that adherencesupport activities would be prioritized in community pharmacy practice. However, in the era of pharmaceutical care, community pharmacists are required to respond to all types of drugrelated-problems and it is not known whether adherence support ranks highly compared to the various activities that community pharmacists are expected to perform. The purpose of this study was to determine the extent to which pharmacists prioritize adherence support activities compared to other clinical responsibilities. To address this aim, we conducted a survey of Saskatchewan community pharmacists as part of an ongoing clinical practice research study.
TL;DR: It was concluded that the use of an adherence assessment form which the patient would complete to save pharmacist time and showed sufficient potential impact to warrant a study of its influence on adherence measures.
Abstract: Background:Nonadherence is so common that the majority of patients taking chronic medications will eventually stop their medication on their own. Pharmacists are in a position to intervene to impro...
TL;DR: Surveys for experienced pharmacists, pharmacy residents and pharmacy technicians that demonstrate internal consistency reliability are developed and can be used to identify learning needs either prior to a practice change or as part of continuing professional development planning.
Abstract: Background:A prior learning assessment (PLA) is a summative statement of an individual's learning acquired through education and experience. We developed PLA surveys for 3 groups of pharmacy staff: experienced pharmacists with supervisory or clinical roles; pharmacists entering a pharmacy practice residency program; and experienced pharmacy technicians.Methods:Each PLA survey was developed based on a literature review and desirable learning outcomes for a regional pharmacy program. PLAs consisted of numerous potential learning needs, including possible job roles, competencies, essential skills and areas of practice expertise in 11 domains. Pharmacy staff scored past exposure, perceived ability (prior experience) and interest for each potential learning need. Learning needs were calculated as interest score minus ability score.Results:23 of 38 (61%) experienced pharmacists, all 24 (100%) pharmacy residents and all 17 (100%) pharmacy technicians invited to complete the PLA responded. For each of the 11 doma...
TL;DR: Assessment of the reading grade level of the Plan B packaging information and of patient information materials on Plan B and emergency contraception found that they are written at reading grade levels beyond the recommendations for patient health literature.
Abstract: Background:Plan B recently became a schedule III product in Canada. Patients can now access Plan B without a pharmacist consult and may rely only on the packaging information provided to learn about the medication. It is recommended that health information materials directed at patients be written at or below a grade 8 level. We assessed the reading grade level of the Plan B packaging information and of patient information materials on Plan B and emergency contraception.Methods:Plan B packaging information was obtained from the manufacturer, and a convenience sample of 10 patient information materials on Plan B and emergency contraception were collected from pharmacies and clinics in Edmonton, Alberta, and from Canadian websites. The Fry graph and SMOG formula were used to measure readability of the materials.Results:The Plan B packaging information had a mean reading grade level of 12.8. The mean reading grade level of patient information materials was 12.9 for print materials and 13.4 for online materia...
TL;DR: An overview of home blood pressure monitoring (HBPM) and practical suggestions for its optimal use are provided.
Abstract: mature death worldwide, and affects 19% of Canadian adults, with an additional 20% having blood pressures in the high-normal range. While improvements in hypertension management have been made, approximately one-third of Canadians with hypertension remain uncontrolled. The Canadian Hypertension Education Program (CHEP) guidelines identify home blood pressure monitoring (HBPM) as an important component in the diagnosis and management of hypertension. This article provides an overview of HBPM and practical suggestions for its optimal use.