Alberta Pharmacists Research Articles

Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians

BackgroundPrescribing 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. ObjectivesTo explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. MethodsEight 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. ResultsThere 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. ConclusionsThis 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.

Exploring the landscape of aesthetic pharmacy practice

BackgroundAs pharmacy practice evolves, an increasing number of pharmacists are diversifying into non-traditional roles such as aesthetic procedures. Despite this shift, comprehensive research exploring demographic patterns, motivations, practice settings, and perceived support and barriers among pharmacists in this specialty, particularly in Alberta, Canada, remains scant. ObjectivesThis study aimed to explore the demographics, experience, practice settings, types of aesthetic services offered, and perceptions of support from the Alberta College of Pharmacy (ACP) among Alberta pharmacists. It also sought to understand the relationship between pharmacists' years of practice and the complexity of the aesthetic services they provide and to assess the impact of contacting the ACP on their perceptions of clarity in the aesthetic injection regulatory framework. MethodsAn online survey was disseminated to registered pharmacists in Alberta, gathering data on demographics, experience, practice settings, aesthetic services offered, and perceived barriers and support. Statistical analysis was used to identify significant trends and associations, employing Chi-square, Kendall's tau-c, and Gamma tests. ResultsThe results showed a significant association between younger age and involvement in aesthetic practice, with a substantial presence in hospital settings. Part-time pharmacists showed stronger involvement, and those with less than five years of experience were more likely to practice aesthetic injections. No statistically significant relationship was found between the years of practice and the complexity of aesthetic services. Clear dissatisfaction was evident regarding the support and communication from the ACP, with contact with the ACP not necessarily resulting in clarity regarding aesthetic practice regulations. ConclusionThe findings suggest that aesthetic practices are becoming a significant part of pharmacy practice, particularly among younger, part-time pharmacists associated with hospital settings. However, this shift calls for improved support, clearer guidelines, and better communication from the ACP, particularly around aesthetic practice regulations.It also emphasizes the need for regulatory bodies to ensure pharmacists are equipped to offer these services safely and effectively, which could be crucial in shaping future policy-making and professional development initiatives.

A survey of Alberta pharmacists' actions and opinions in regard to administering vaccines and medications by injection.

Pharmacists in Alberta have been authorized to administer vaccines and other medications by injection for more than 10 years; however, little is known about the provision of this service and their opinions regarding this service. Understanding pharmacists' experiences regarding injection services would inform development of strategies to improve provision of injection services. To describe the actions related to administering an injection, including identification of commonly administered medications, and to identify perceived barriers and facilitators pharmacists face when providing injection services. An online survey was developed and loaded into REDCap, and e-mail invitations were sent to 5714 pharmacists registered with the Alberta College of Pharmacy in October 2020. Responses were analyzed using descriptive statistics. Pharmacists who administered at least one injection in the previous year were considered active providers, and their opinions regarding injection services were compared with nonactive providers. A total of 397 pharmacists responded to our survey, mean age was 42 years, 66% were female, 82% were community pharmacists, and 90% were active providers. The most common injection, administered by 98% of active providers, was influenza vaccine, followed by vitamin B12 (95%), herpes zoster vaccine (88%), hepatitis vaccines (86%), and pneumococcal vaccines (82%). Nonactive providers were more likely than active providers to report that comfort with administering injections (P < 0.001) and managing adverse reactions (P= 0.013) were moderate or major barriers to providing injections. More than 60% of pharmacists indicated that access and automated reporting to the provincial immunization registry would be essential to increasing the frequency of providing injection services. We identified that Alberta pharmacists administer a wide variety of vaccines and other medications by injection. Respondents identified several barriers and facilitators to providing these services. Addressing these barriers may help improve provision of injection services by pharmacists.

The COVID conversations: A content analysis of Canadian pharmacy organizations' communication of pharmacists' roles and services during the COVID-19 pandemic.

The COVID-19 pandemic presented a unique challenge for pharmacists as they navigated information scarcity on the frontlines while being identified as information experts. Alberta pharmacists looked to their professional organizations for direction regarding what their roles should be in a crisis. The objective of this study was to explore pharmacists' roles and services and how they were communicated by pharmacy organizations during the first year of the COVID-19 pandemic. The study used a conventional content analysis method to explore the online communication of relevant pharmacy organizations for Alberta pharmacists. Five organization websites (National Association of Pharmacy Regulatory Authorities, Canadian Pharmacists Association [CPhA], Canadian Society of Hospital Pharmacists [CSHP], Alberta College of Pharmacy [ACP] and the Alberta Pharmacists' Association [RxA]) were examined to identify and catalogue publicly accessible documents that communicated pharmacists' roles and services during the first year of the pandemic for Alberta pharmacists. A total of 92 documents were collected from CPhA (60), CSHP (2), ACP (26) and RxA (4). While most documents communicated information about pharmacists' roles in public health, patient care and drug and personal protective equipment supply, more than one-third of the documents (32/92, 34.8%) required contextual information to interpret the communication. There was an observed shift in the communication after the first 6 months, becoming more direct in its messaging and context. These pharmacy organizations communicated information for pharmacists' roles and services to provide direction and guidance in the ever-changing context of the COVID-19 pandemic for Alberta pharmacists. Their communication became clearer and more direct as the pandemic progressed, requiring less inference to understand the intended message.

The Efficacy of a Didactic and Case-Based Pharmacogenomics Education Program on Improving the Knowledge and Confidence of Alberta Pharmacists.

BackgroundPharmacogenomics (PGx) is the study of how genetic variations for functional proteins, such as metabolizing enzymes and drug receptors, impact drug pharmacokinetics and pharmacodynamics. In theory, pharmacists are well suited to utilize PGx in tailoring medications to patient genetics when providing medication therapy management services. However, PGx education needs to reach pharmacists prior to implementation. The aim of this study is to develop and evaluate a PGx course for pharmacists.MethodsA PGx education program was created and offered synchronously (virtual) and asynchronously (self-study) to pharmacists in Alberta, Canada. Lectures were delivered by experts live (virtual) with a question-and-answer period for synchronous sessions. These sessions were recorded for asynchronous delivery. Six case studies were discussed in large and small groups (“breakout rooms”) in synchronous sessions, and provided for self-study in the asynchronous subgroup. Topics included genetic and PGx concepts; therapeutic applications; ethical, legal, and social considerations; and practical implementation. Pre- and post-course surveys measured self-rated knowledge using a 5-point Likert Scale and tested objective knowledge with a graded quiz.ResultsThirty-six pharmacists completed the course and both surveys. Participants reported backgrounds in community (88.9%) and hospital (38.9%) practice. Prior education in PGx was reported by 44.4% from degree programs and 27.8% from continuing education. Overall responses to statements about confidence in PGx moved from a median of “Disagree” at baseline to “Agree” after receiving PGx education (2-point difference [1,2] on 5-point Likert Scale; p < 0.001), indicating an increase in self-assessed competency in PGx. Likewise, mean participant grades on the knowledge quiz improved (20.8±21.9% pre-course vs 70.2±19.1% post-course, p < 0.001). There was no difference in these results between synchronous and asynchronous groups.ConclusionA didactic and case-based PGx education program was effective at increasing pharmacist knowledge and confidence in PGx in both synchronous and asynchronous environments. Knowledge gained can be utilized in delivery of patient-centered, personalized medication therapy management in the pharmacy setting.

Clinical Pharmacists' Knowledge of and Attitudes toward Older Adults.

Background: Although pharmacy literature suggests that pharmacists have a positive attitude towards older adults, there is a paucity of studies that have measured pharmacists’ knowledge or attitudes towards older people. The purpose of our study was to assess the knowledge and attitudes of hospital pharmacists toward older adults. Methods: An electronic survey was distributed over two months to clinical hospital pharmacists across the province of Alberta, Canada. The survey was composed of two validated tools, the Palmore Facts of Aging Quiz (PFAQ) and Kogan’s Attitude toward Old People Scale (KOPS). PFAQ is scored from 0 (poor knowledge) to 25 (high knowledge) and KOPS from 34 to 204, with higher than 119 indicating a positive attitude. Results: A total of 153 pharmacists completed the survey (response rate of 24%). The mean age was 39 (SD 10.8) years; the average years practiced was 15 (SD 11), and the majority of respondents (n = 65) reported that >50% of patients in their practice were geriatrics. The mean correct responses on the PFAQ were 18.8 (SD 2.6). KOPS had a mean score of 156.8 (SD 14), with only one pharmacist score falling below 119, indicating a negative attitude. There was a statistically significant, positive correlation between attitudes and knowledge (r = 0.38, p < 0.05), as well as the increasing age of the respondents (r = 0.18, p = 0.03). The remaining measured categories (i.e., gender, years of pharmacy practice) had no significant effect. Conclusion: Clinical hospital pharmacists in Alberta have a positive attitude toward geriatric patients, as well as a satisfactory knowledge of older adults.

A survey of Alberta pharmacists' attitudes, comfort and perceived barriers to a community-based naloxone program.

Community pharmacists play an important role in the wellness of patients, families and friends affected by prescription and illicit opioid drugs. They are key partners of the Community Based Naloxone (CBN) Program in Alberta and similar programs across other Canadian jurisdictions. This publicly funded program is an evidence-based response to the opioid overdose crisis, facilitating access to and distribution of naloxone kits through pharmacies. The study aimed to describe Alberta community pharmacists' practices, training, comfort levels and views in dispensing naloxone kits through the CBN program and detail potential perceived barriers to program participation. The study was conducted as a cross-sectional online survey of Alberta pharmacists. Data collected from the survey were descriptive and evaluated using Microsoft Excel. Fisher exact tests were used to study the associations in responses among several demographic characteristics and related to dispensing practices, pharmacists' beliefs and perceived barriers. A total of 255 responses were included in the final analysis, with 89.8% of pharmacists replying "yes" to CBN program participation. Pharmacists on average were "comfortable" dispensing naloxone to patients for varying indications, with 85% reporting always providing education when dispensing naloxone to an individual for the first time. About 41% of pharmacists reported no barriers to the program, with the most common perceived barriers being lack of time (29%), demand (20%) and funding (19%). Most community pharmacists who responded to the survey participate in the CBN program in Alberta. They held positive beliefs about their role in screening patients for the risk of opioid overdose and are confident in their abilities to recommend and educate on naloxone kits. Proactive screening appeared lower, however, and dispensing kits were potentially variable. Addressing factors such as time, funding for services and demand may help further pharmacist uptake and success of the program. Can Pharm J (Ott) 2021;154:xx-xx.

A De Novo Pharmacist-Family Physician Collaboration Model in a Family Medicine Clinic in Alberta, Canada.

Collaborative practice in health-care has proven to be an effective and efficient method for the management of chronic diseases. This study describes a de novo collaborative practice between a pharmacist and a family physician. The primary objective of the study is to describe the collaboration model between a pharmacist and family physician. The secondary objective is to describe the pharmacist workload. A list of patients who had at least one interaction with the pharmacist was generated and printed from the electronic medical record. There were 389 patients on the patient panel. The pharmacist had at least one encounter with 159 patients. There were 83 females. The most common medical condition seen by the pharmacist was hypertension. A total of 583 patient consultations were made by the pharmacist and 219 of those were independent visits. The pharmacist wrote 1361 prescriptions. The expanded scope of practice for pharmacists in Alberta includes additional prescribing authority. The pharmacists’ education and clinical experience gained trust from the family physician. These, coupled with the family physician’s previous positive experience working with pharmacists made the collaboration achievable.

Evaluation of comprehensive annual care plans by pharmacists in Alberta for patients with complex conditions

ObjectivesTo characterize the population of patients who received a pharmacist-billed comprehensive annual care plan (CACP) in Alberta and to evaluate any changes in health care use for such patients, including physician visits, hospitalizations, and emergency department (ED) visits. MethodsWe used administrative data from Alberta Health to identify all individuals in Alberta who received a pharmacist CACP between July 1, 2012, and March 31, 2015. Two control patients were identified for each CACP patient, matched on age, sex, provider, date of service, and qualifying conditions. Controlled interrupted time series analyses were used to evaluate changes in physician visits, all-cause and ambulatory care–sensitive condition (ACSC)–related hospitalizations, and ED visits in the 12 months before and after the CACP index date. ResultsBetween July 1, 2012, and March 31, 2015, 188,640 pharmacy CACPs were billed in Alberta. Of these, 137,178 CACP patients were matched to 241,658 control patients. Those who received a CACP were associated with an overall decrease in all-cause hospitalizations, ACSC-related ED visits, and physician visits (181, 144, and 1206 events per 10,000 people, respectively, P < 0.05) compared with controls. However, among those who received a CACP, all-cause ED visits and ACSC-related hospitalizations increased by 40.1 and 8 visits per 10,000, respectively (P < 0.05), compared with controls. ConclusionThe uptake of the pharmacy CACP remuneration model has been substantial since 2012. Overall, the CACP philosophy of a single yearly assessment has demonstrated limited impact on major health care use.

An evaluation of Alberta pharmacists' practices, views and confidence regarding prescription drug abuse and addiction within their practice setting.

Pharmacists play an important role in managing patients with prescription drug abuse and addiction (PDAA). The objective of this study was to explore Alberta pharmacists' practices, views and confidence in the management of patients at risk of or living with PDAA in their practice setting. A 26-question online questionnaire was distributed to 4261 pharmacists across Alberta, of whom 656 (15%) participated. The questionnaire consisted of 17 multiple-choice, 6 multipart and 3 free-response questions. Questionnaire responses were collected and analyzed in Qualtrics. Sixty-six percent (n = 408) of pharmacists indicated that PDAA was prevalent in their practice setting, with 55% (n = 340) of respondents encountering more than 6 patients with suspected or known PDAA a month. Thirty-five percent (n = 198) of pharmacists indicated they were moderately confident at identifying patients with potential PDAA. However, 41% (n = 235) of the pharmacists indicated that they only discuss PDAA with identified patients less than half of the time. Pharmacists lacked confidence in their ability to discuss PDAA treatment options with their patients as well as collaborate with addiction treatment facilities. Lack of training or knowledge in PDAA (48%) and uncertainty of how to initiate discussion or effectively communicate with patients about PDAA (39%) were identified as barriers that significantly or very significantly hindered respondents from managing PDAA in their practice. Although many pharmacists are moderately confident in identifying patients with potential PDAA, several barriers hinder intervention. Providing pharmacists with additional training and resources may better equip them to manage PDAA within their practice settings. Can Pharm J (Ott) 2019;152:xx-xx.

Exploring discrepancies between pharmacists’ perceived and actual roles towards optimising care in patients prescribed direct oral anticoagulants: a survey

AbstractBackgroundPharmacists are among the most accessible healthcare professionals, and scopes of practice are evolving. There is a paucity of literature evaluating community pharmacists’ degree of comfort with managing high‐risk medications, including anticoagulants.AimTo describe discrepancies between perceived and actual roles in care optimisation of patients prescribed direct oral anticoagulants (DOACs), as well as the level of collaboration between pharmacists and other healthcare providers, and barriers to action among pharmacists.MethodsCommunity‐based pharmacists in Alberta, Canada, were surveyed to evaluate perceived and actual roles, collaboration and barriers. Discrepancies between perceived and actual roles were compared for individual items, and total scores were calculated.ResultsIn all, 177 (5%) pharmacists responded to the survey. Perceived role scores were high, and actual role scores were generally lower (median scores 42/52 vs 61/65). Actual role items with the lowest scores were: knowledge of the patient's medical conditions and indication for DOAC; provision of information about the condition being treated with a DOAC; review pertinent laboratory tests at initial prescription fill and refill; and follow‐up on adherence and side‐effects. Discrepancy rates between perceived and actual roles were low. There was moderate correlation between perceived and actual role scores (Spearman's ρ = 0.512, p &lt; 0.001). Responders reported a high degree of collaboration with physicians. Several system‐ and organisation‐level barriers were identified, although overall barrier burden was low.ConclusionCommunity‐based pharmacists perceived a significant role for pharmacists in optimising DOACs for patients, and higher perceived role scores were associated with greater action in actual roles. Removing system‐level barriers, and improving communication with prescribers about indications for DOACs, should be prioritised to enhance the role of the pharmacist.

The availability of pharmacists with Additional Prescribing Authorization in relation to the distribution of vulnerable populations - A cross-sectional study.

For vulnerable patients- such as immigrants or those with low income- to benefit from pharmacists' advanced services, such as independent prescribing, pharmacists must be accessible to these populations. This research examines the geographical relationship between Alberta pharmacists with Additional Prescribing Authorization (APA) and a neighbourhood's proportion of vulnerable populations. Publicly available data were extracted from the Alberta College of Pharmacy website for active registered pharmacists' primary location of practice and APA status. Pharmacists with APA were grouped depending on the postal codes of their main self-reported place of practice. These postal codes were converted to geospatial locations and then linked to aggregated dissemination area's (ADA's) income and immigrant quintiles. The mean number of APA pharmacists per ADA was compared using analysis of variance (ANOVA) between income and immigrant quintiles. The number of APA pharmacists per ADA in the highest and lowest income and immigrant quintiles was compared using negative binomial regression model. The records of 3,742 pharmacists with 1,054 unique postal codes of practice sites were included in the study and were linked to unique ADAs (N = 527). Almost one half of all ADAs in Alberta (47.6%, n = 251) had no APA pharmacist. Income quintiles of ADAs were associated with the mean number of APA pharmacists (p < 0.001), with high income areas estimated to have 0.44 more APA pharmacists (p = 0.01). Similarly, areas with the highest quintile of recent immigrants were estimated to have 0.66 more APA pharmacists than other ADAs (p < 0.01). A sizable proportion of the Alberta population still does not have access to a pharmacist with APA, and those with APA seem to concentrate in areas with higher income and higher proportions of the population who are immigrants. Future research should examine the utilization of expanded scope of practice in relation to the distribution of vulnerable populations.

Implementation of additional prescribing authorization among oncology pharmacists in Alberta.

To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. 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. 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. 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.

Positioning pharmacists\u2019 roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada

BackgroundA comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists’ roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences.MethodsPublicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists’ Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists’ roles were constructed in communications about the Compensation Plan.ResultsIn total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists’ changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists’ roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists’ changing roles were positioned in alignment with the aims of primary health care.ConclusionsSocial positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists’ changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.

Survey of pharmacist prescribing practices in Alberta.

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

The road to pharmacist prescribing in Alberta Health Services

The implementation of policy within a health organization to support a new legislative and regulatory framework of pharmacist prescribing in the Canadian province of Alberta is described. The evolution of pharmacists' practice activities to encompass medication management through independent prescribing authority has occurred in many jurisdictions around the world. In 2007, Alberta pharmacists were granted the most progressive scope of practice in all of North America. Pursuant to a series of legislative and regulatory initiatives enacted since 2000, the provincial health authority, Alberta Health Services (AHS), has worked to (1) establish a policy framework that supports pharmacist prescribing, (2) provide opportunities for pharmacist prescribing in both inpatient and ambulatory care practice environments, and (3) provide motivation and resources for AHS pharmacists to acquire "additional prescribing authorization" (APA) that enables them to independently prescribe and manage patients' ongoing drug therapy. Pharmacists with APA currently are permitted to prescribe all medications requiring a prescription, with the exception of opiates and other controlled substances; efforts to expand pharmacist prescribing to include those medications are ongoing. Currently, nearly half of all AHS pharmacists have APA. The health authority plans to make APA a standard expectation for all clinical pharmacists working in collaborative practice settings. Opportunities provided to Alberta pharmacists by legislation have been embraced by the provincial health authority. The AHS leadership remains committed to ensuring that its pharmacists practice to the full extent of their scope of practice and actively encourages and supports them in their efforts to provide optimal patient care.

Pharmacists' responses to natural disasters: Insights into the soul of pharmacists and our role in society.

In this issue, we feature an article from Denise A. Epp, a Canadian now living in Japan (and obtaining her PhD in pharmacy). She tells the stories of how pharmacists in Japan and Canada have responded to major disasters. After the Tohoku earthquake-tsunami-nuclear disaster, Yoshirou Tanno, despite his significant personal losses, immediately helped to set up the emergency evacuation centre in the local school, coordinated pharmacist volunteers to get people their medications and set up a temporary pharmacy. She also tells the story of Anita and Bob Brown in Okotoks, Alberta, and the services they provided to patients from nearby High River, which had been particularly hard hit by the floods of June 2013. Ms. Brown was one of the first Alberta pharmacists to receive her prescribing authorization, and the overrun local health centre began to direct patients to see her. The Browns courageously mobilized their staff to provide care to the many displaced patients who needed their help. Read the article—it’s heartwarming and inspirational. As a follow-up to this story, on April 14 to 16 of this year, the Kumamoto area of Japan was struck with several earthquakes and aftershocks. Ms. Epp emailed me in May to tell me that Mr. Tanno was there—1600 km from his home—providing emergency pharmacy services. Because he has lived through such a disaster, he has a unique rapport with the latest earthquake victims. Mr. Tanno’s vest and helmet, which identify him as a pharmacist at the disaster sites (photo credit: Yoshirou Tanno). As I write this, the tragic wildfires in Fort McMurray and surrounding area are ongoing. The evacuation of Fort McMurray has resulted in 40,000 people temporarily relocating to Edmonton, often with nothing but the clothes on their backs. I spoke to Deb Van Haaften, Executive Director, Pharmacy, Edmonton Zone, Alberta Health Services, who, along with Sandra Leung (the pharmacist in charge of home care services), are providing administrative leadership during the crisis. When I spoke to her, Ms. Van Haaften had just completed a shift at the evacuation centre set up at the Northlands Expo complex. The centre has been providing food, clothing, shelter and health care support for evacuees. She got the call last week—Alberta Health Services wanted pharmacists to be there 24 hours a day. Interestingly, they didn’t want pharmacists to dispense drugs but rather to assess patients and prescribe their medications. I repeat, Alberta Health Services wanted pharmacists for their ability to prescribe, not dispense. Pharmacists are also helping assess patients’ coverage of medications. For those unable to pay, they have set up a partnership with a community pharmacy, and Alberta Health Services is covering the costs. And they have even set up a shuttle bus to take patients from the evacuation centre to the pharmacy. They have also been asked to help patients requiring methadone and tuberculosis therapies. One of Japan’s 3 mobile pharmacy vans arrived in the Kumamoto area the day after the second earthquake struck (photo credit: Denise A. Epp). Yesterday, the first pharmacist (from the Royal Alexandra Hospital in Edmonton) was sent to the field hospital set up in Fort MacMurray. Her mission will be to serve the first responders’ needs. And the challenges continue: as of today, they have noted acute diarrheal illnesses in many evacuees, likely a Norwalk or similar virus. This is the scene at the Northlands Expo Centre where pharmacists are busy assessing and prescribing for victims of the Fort McMurray disaster (photo credit: Deb Van Haaften). In all of this, hospital pharmacists have volunteered to help, 24/7. The Royal Alexandra Hospital pharmacy is busy restocking emergency medical supplies. Many community pharmacies have also stepped up to meet the needs of patients. These are all very different tragedies. But I note a few strong themes: courage, selflessness, and above all, patient-centredness. This is an inspiring demonstration (and recognition) of the role that we play in society. Indeed, the actions of these and other pharmacists in the face of disasters could be a defining moment for pharmacy. ■

Factors Affecting Number of Diabetes Management Activities Provided by Pharmacists.

Legislative changes since 2007 have given Alberta pharmacists additional authorizations and new practice settings, which should enhance provision of clinical services to patients. This study examined whether these changes are related to the number of diabetes management activities provided by pharmacists. Cross-sectional surveys of Alberta pharmacists were conducted in 2006 and 2015. Both questionnaires contained 63 diabetes management activities, with response options to indicate how frequently the activity was provided. Respondents were grouped by survey year, practice setting, diabetes-specific training and additional authorizations. The number of diabetes management activities provided often or always were compared among groups by using analysis of variance. Data from 128 pharmacists participating in the 2006 survey were compared with 256 pharmacists participating in the 2015 survey; overall mean age was 41.6 (±10.9) years, 245 (64%) were women, mean duration of practice was 16.1 (±11.8) years, 280 (73%) were community pharmacists, 75 (20%) were certified diabetes educators (CDEs), and 100 (26%) had additional prescribing authorization (APA). Pharmacists provided a mean of 28.7 (95% CI 26.3 to 31.2) diabetes management activities in 2006 and 35.2 (95% CI 33.4-37.0) activities in 2015 (p<0.001). Pharmacists who were CDEs provided significantly more activities compared to other pharmacists (p<0.001). In 2015, working in a primary care network and having APA were also associated with provision of more activities (p<0.05 for both comparisons). Pharmacists provided more diabetes management activities in 2015 than in 2006. The number of diabetes management activities was also associated with being a CDE, working in a primary care network or having APA.

Professional use of social media by pharmacists.

A recent trend among health care professionals is the use of social media for professional purposes. These rapidly expanding media allow for timely and efficient access to health information, but they also carry the potential for increased liability. There is a paucity of research detailing how health care professionals, specifically pharmacists, use social media. To characterize the use of social media by pharmacists in the Canadian province of Alberta and to identify independent determinants of and perceived barriers to using social media for professional purposes. Data for this mixed-methods study were collected by an online survey in March and April 2014. Alberta pharmacists were invited to participate via e-mail distributed by 2 professional organizations. The survey had 273 respondents. Of these, 226 (82.8%) stated that they had a social media account for either personal or professional purposes, and 138 (61.1%) of these reported using social media for professional purposes, although most respondents used social media predominantly for personal reasons. The most commonly reported social media applications were Facebook and Twitter, accessed primarily via smartphones. Of the 273 respondents, 206 (75.5%) had a Facebook account, and 101 (49.0%) of these used Facebook to some extent for professional purposes. Twitter users (104 [38.1%] of respondents) had a higher rate of professional utilization (57/104 [54.8%]). The most commonly identified barrier to using social media for professional purposes was concern over liability. Positive predictors of use of social media for professional purposes included younger age and fewer years of professional experience. Participants perceived the most beneficial aspect of social media (in professional terms) as connecting with pharmacist colleagues. More than 80% of pharmacists in Alberta reported that they had a social media account, and over half of them reported using their accounts for professional purposes. Although Facebook had a higher reported rate of utilization in general, a greater proportion of respondents reported using Twitter for professional purposes. Individuals and organizations seeking to expand their professional social media presence should focus on Twitter.

Prescribing by pharmacists in Alberta and its relation to culture and personality traits.

As evidence for the efficacy of pharmacists' interventions, governments worldwide are developing legislation to formalize new practice approaches, including independent prescribing by pharmacists. Pharmacists in Alberta became the first in Canada availed of this opportunity; however, uptake of such has been slow. One approach to understanding this problem is through an examination of pharmacists who have already gained this ability. The primary objective of this study was to gain descriptive insight into the culture and personality traits of innovator, and early adopter, Alberta pharmacists with Additional Prescribing Authorization using the Organizational Culture Profile and Big Five Inventory. The study was a cross-sectional online survey of Alberta pharmacists who obtained Additional Prescribing Authorization (independent prescribing authority), in the fall of 2012. The survey contained three sections; the first contained basic demographic, background and practice questions; the second section contained the Organizational Culture Profile; and the third section contained the Big Five Inventory. Sixty-five survey instruments were returned, for a response rate of 39%. Respondents' mean age was 40 (SD 10) years. The top reason cited by respondents for applying for prescribing authority was to improve patient care. The majority of respondents perceived greater value in the cultural factors of competitiveness, social responsibility, supportiveness, performance orientation and stability, and may be more likely to exhibit behavior in line with the personality traits of extraversion, agreeableness, conscientiousness and openness. Inferential statistical analysis revealed a significant linear relationship between Organizational Culture Profile responses to cultural factors of social responsibility and competitiveness and the number of prescription adaptations provided. This insight into the experiences of innovators and early adopter pharmacist prescribers can be used to develop more specific and targeted knowledge implementation studies to improve the uptake and integration of prescribing by pharmacists.