Canadian Pharmacists Association Research Articles

Resources and interventions to support psychological health and wellbeing in the pharmacy workforce: Analysis and use of a health worker ‘burnout’ toolkit

BackgroundPharmacists have experienced declines in psychological health and wellbeing post-pandemic. The phenomena of moral distress, disengagement and burnout are associated with workforce attrition, unfitness to practice and inferior quality of patient care. A working group of the Canadian Pharmacists Association (CPhA) was formed to identify resources and interventions (R&I) for occupational psychological health and wellbeing. ObjectiveTo characterize R&I from an evidence-based national health worker ‘burnout’ Toolkit with potential to support the pharmacy workforce. MethodsAll R&I included within a draft ‘burnout’ Toolkit from the Canadian Health Workforce Network (CHWN) were screened to determine relevancy and usefulness for the pharmacy workforce. R&I with higher grades were data-charted to capture information on topic and content delivery. Final R&I were determined through consensus meetings where ‘highly rated’ R&I were discussed and selected. ResultsOf 140 original CHWN Toolkit R&I, 53 (37.8%) were of potential relevance or usefulness to improve well-being for most in the pharmacy workforce. Of those 53 R&I, 28 (20% of original) were final selections. The majority of R&I at each stage were focused on ‘preventing burnout’ and ‘promoting mental health’ (>60%) rather than ‘addressing burnout’, ‘supporting recovery’ or managing specific issues in the workplace (i.e. stigma, discrimination, bullying, hostility, workload). No R&I were specifically developed or studied within the pharmacy workforce. ConclusionsHealth professions may benefit from the CHWN Toolkit and the knowledge translation activity described here. R&I relevant and useful to the pharmacy workforce generally require adaptation for dissemination and/or implementation. The set of final R&I form the basis for orchestrated plans to support the pharmacy workforce with respect to psychological health and wellbeing. There is a relative lack of R&I devoted to addressing and recovering from burnout and workload management issues.

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.

Empowering Patients to Start a Conversation: 5 Questions to Ask about Your Medications.

This quality improvement initiative to help prevent known medication-related failures during transitions of care was co-led by Patients for Patient Safety Canada, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists. Initially, the intervention was to develop, test, evaluate and disseminate a medication safety "checklist" for patients and healthcare providers. Through small tests of change, the checklist was redesigned as the "5 Questions to Ask about Your Medications." Collective results demonstrate a shared commitment among more than 200 organizations to empower patients with questions to ask about their medications.

Assessing Canada's Drug Shortage Problem

Drug shortages provoke great anxiety among patients who cannot obtain trusted medications for chronic conditions. For pharmacists and the care team, shortages demand time-consuming and often frustrating searches for alternatives. For patients, they result in the stress and harm of delayed treatments and surgeries. For governments, they increase healthcare expenditures to acquire the scarce products or their replacements from other sources or innovator substitutes. Some studies have shown that drug shortages might lead to illness and even premature death (Metzger, Billett, and Link 2012; United States 2015). In this Commentary, we examine the size of the drug shortage problem in Canada between 2010 and 2017, scan the stated reasons for shortages internationally, and look at various proposed solutions. Approximately 1,000 shortages have been reported annually, affecting 1,250 products during a recent three-year period. Indeed, the number of shortages appears to be increasing, although this apparent rise might be explained by growing pressure to adhere to the policy of mandatory notification introduced in 2016, even if its enforcement is still lacking. The majority (77 percent) of drug shortages involve generic drugs, although a significant proportion (23 percent) also affected innovator drugs. These figures correspond to the relative prescription volume of generic and innovator drugs. Several surveys by pharmacists, physicians and various specialties have documented the extent of the drug shortage affecting the majority of practitioners in every province, and find it present over a wide array of products (Canadian Pharmacists Association 2010, 2011; Hall et al. 2013; Sullivan 2014). The precise causes of Canadian drug shortages are unknown and little has been done to conduct root-cause analysis or explore the consequences of Canada’s limited capacity to supply its needs for medicines with locally manufactured active ingredients and finished products. Drug shortages are a global problem, although their manifestations vary among countries. Most countries do not measure them, but media sources report on individual crises as they emerge, detailing their effects on pressing health problems. A stable supply solution of a diversity of medicines is necessary to keep healthcare costs down, avoid expensive solutions to sudden emergencies and maintain access to medications for the entire population, including the 10 percent of Canadians who cannot afford their prescription drugs (Law et al. 2012). We hope that regular analysis of the drug shortage problem will generate insight into the extent of the problem, its possible causes and provide a baseline for assessing the effectiveness of policies created to manage and prevent it. We urge Health Canada to provide annual reports on the drug shortage problem in an effort to define it, explain it and, above all, solve it. Only when the causes are identified can solutions be found.

Full scope of practice.

As a pharmacist working within a primary care team, I am fortunate to practise in a manner not dissimilar to the model outlined by Gobis and colleagues in their recent article, “The UBC Pharmacists Clinic: A Catalyst for Practice Change.”1 Let me state that there are few things more gratifying than practising to the full scope of my potential and effecting positive patient outcomes. Make no mistake, though: being a pharmacotherapy specialist collaborating with other patient care providers is a move to the major leagues for many pharmacists. Such a transition requires courage and commitment—courage to venture outside the comfort zone to exceed the standards of care, and commitment to acquire the skills necessary to adopt an evidence-based, patient-centred approach. For their part, the professional organizations, including the Canadian Pharmacists Association, should receive credit for providing educational tools to aid pharmacists in expanding their scope. While some may point out that the lack of infrastructure remains a barrier for pharmacists to optimize their clinical time, no one should claim that continuing education resources are unavailable to help pharmacists engage in advanced levels of practice.

Expected health benefits of e-Therapeutics Highlights according to pharmacists and physicians.

The purpose of this research brief is to describe the expected health benefits of e-Therapeutics Highlights,* as evaluated by Canadian pharmacists and family physicians. The Canadian Pharmacists Association (CPhA), the College of Family Physicians of Canada (CFPC) and the Information Technology Primary Care Research Group (McGill University) collaborated to create an innovative continuing education program, called e-Therapeutics Highlights. Highlights are key treatment recommendations from e-Therapeutics+.** CPhA produces and maintains e-Therapeutics+, a web portal comprising clinical topic summaries that are authored and peer reviewed by subject matter experts (www.e-therapeutics.ca). Once a week, CPhA and CFPC members receive an e-Therapeutics Highlight delivered by e-mail, which they have the option of evaluating by means of a reflective learning activity based on the Information Assessment Method (IAM).1 For each rated Highlight, pharmacists receive continuing education units, and family physicians receive Mainpro credits. We present the aggregated results of IAM ratings as a way of summarizing the wisdom of the crowd of Highlight raters. Crowdsourcing is a force multiplier, defined as the release of online material to a crowd of users who may be interested in contributing ideas or performing a task such as rating a Highlight (voting) and submitting their work to a platform or an organization such as the CPhA, for the profit of the entire community.2,3 Large groups can be collectively wise in identifying relevant information.4 This principle of “crowdsourcing” has been applied to the development of innovative learning network approaches such as those seen in Wikipedia and various voting systems.5,6 Crowdsourcing allows the traditional “ask-the-user” approach to reach a wider audience.7,8

Canadian community pharmacists' use of digital health technologies in practice.

In 2010, a pan-Canadian study on the current state and benefits of provincial drug information systems (DIS) found that substantial benefits were being realized and that pharmacists perceived DIS to be a valuable tool in the evolving models of pharmacy practice. To understand changes in digital health and the impact on practice since that time, a survey of community pharmacists in Canada was conducted. In 2014, Canada Health Infoway (Infoway) and the Canadian Pharmacists Association (CPhA) invited community pharmacists to participate in a Web-based survey to understand their use and perceived benefits of digital health in practice. The survey was open from April 15 to May 12, 2014. Of the 447 survey responses, almost all used some form of digital health in practice. Those with access to DIS and provincial laboratory information systems (LIS) reported increased productivity and better quality of care. Those without access to these systems would overwhelmingly like access. There have been significant advances in digital health and community pharmacy practice over the past several years. In addition to digital health benefits in the areas of productivity and quality of care, pharmacists are also experiencing substantial benefits in areas related to recently expanded scope of practice activities such as ordering lab tests. Community pharmacists frequently use digital health in practice and recognize the benefits of these technologies. Digital health is, and will continue to be, a key enabler for practice transformation and improved quality of care. Can Pharm J (Ott) 2016;149:xx-xx.

Report on pharmacy specialization in Canada.

Specialization in pharmacy has been a topic of interest for Canadian thought-leaders within the profession since the mid-1980s. Over the years, a number of initiatives have taken place to explore and advance this concept, such as the formation of the now-defunct Canadian Board of Specialties in Pharmacy, the Pharmacy Examining Board of Canada’s Committee on Specialty Certification, the Task Group on Specialization in Canada and the Quebec initiative for the formal recognition of pharmacy specialties. With the expansion of pharmacists’ scopes of practice in Canada and the increased momentum of pharmacist specialization south of the border, the subject has gained renewed interest among hospital and community pharmacy practitioners and employers. The Board of Pharmacy Specialties (BPS) was established in the United States in 1973 and provides certification to pharmacists in areas such as pharmacotherapy, ambulatory care, nuclear, nutrition and psychiatric pharmacy. Until recently, the number of pharmacists obtaining certification through BPS was quite limited: by 2014, BPS had certified only 8% (21,906/290,780) of the country’s pharmacists (BPS Executive Director William Ellis, personal communication, Dec. 9, 2014). This number is increasing rapidly, however, and the organization expects to provide 25% (81,950/est. 327,800) of US pharmacists with specialty certification by 2020.1-3 Many international pharmacists are also now obtaining specialty certification through BPS as well as the Commission for Certification in Geriatric Pharmacy (CCGP), whether or not they receive official recognition for this certification in their home countries. The Blueprint for Pharmacy initiative, led by the Canadian Pharmacists Association (CPhA), has incorporated pharmacist specialization with its priority of education and continuing professional development since the Blueprint’s Vision for Pharmacy document was published in 2008. The most recent Blueprint undertaking around specialization involved contracting Intergage Consulting Group Inc. through a Request for Proposals process in 2014 to conduct a needs assessment of pharmacist specialization in Canada. The research included a literature and high-level jurisdictional review, interview consultations with key stakeholders, a national survey of pharmacists and pharmacist employers, and 2 roundtable consultations with thought-leaders and stakeholders. The purpose of the research was to obtain a current profile of the level of need, demand and feasibility of introducing a formal specialty certification and/or recognition process to Canada. The final report can be accessed at www.blueprintforpharmacy.ca.4

Election 2015: Communicating pharmacy's priorities.

Canadians will be heading to the polls in a federal election widely expected to occur October 19, 2015. Although the pundits would argue that political parties have been campaigning for months already, most election-related activities, such as public debates and door-to-door campaigning by candidates, will begin to ramp up in late summer and fall. As the 2015 federal election campaign moves into high gear, the Canadian Pharmacists Association (CPhA) has identified key recommendations and messages for federal political candidates on 3 key national issues of importance to the profession. These 3 issues include the following: Pan-Canadian Pharmacare Program: CPhA is seeking commitment from all federal political parties to work with the provinces/territories, health care professionals and other stakeholders towards the development of a pan-Canadian pharmacare program. Such a program must address coverage gaps between public and private systems, protect Canadians from undue financial hardship and guarantee access to a stable supply of clinically and cost-effective medications. Furthermore, the inclusion of access to pharmacy services under a pharmacare model is key to achieving better health outcomes and cost savings. National Plan for e-Prescribing: CPhA is calling on all parties to work with the provinces/territories, health care professionals and other stakeholders to implement a seamless e-prescribing system in Canada. CPhA is looking for the federal government to support the development and implementation of a common national standard for e-prescribing that ensures that Canadians’ prescription information can be more easily shared and accessed between relevant health providers, while respecting patient privacy and confidentiality. Strengthened National Immunization Strategy for Canada: Given Canada’s relatively low rates of immunization compared with other industrialized countries, CPhA is calling for a revamped National Immunization Strategy. The goal of a revamped strategy would be to increase immunization rates through a comprehensive approach that would include further expanding pharmacists’ scope of practice to administer vaccines. The National Strategy would also target increased research, comparable access and enhanced education/outreach, including building a partnership with the provinces/territories and health professionals to increase public awareness of the importance of vaccinations. In the lead-up to October 19, CPhA is encouraging pharmacists and other Canadians to promote and discuss these key recommendations with political candidates from all parties. To assist you, CPhA has assembled an election website at www.pharmacists.ca/election. On this website, you will find a print-ready brochure that summarizes the key recommendations, a more detailed platform document that provides background and rationale for these recommendations and an online tool that allows you to quickly and easily contact the candidates in your riding and send them messages of support for the above-mentioned priorities. Elections provide voters with an excellent opportunity to learn about and pin down the views of candidates and political parties on specific issues. This election is no different. Go to www.pharmacists.ca/election to share your thoughts with your candidates, and help CPhA advance these core issues. ■

We know ADAPT works-Now it works for you.

Have you heard about ADAPT? of course you have; everyone has. A recent survey shows that more than 78% of Canadian pharmacists are aware of ADAPT, an online patient care skills development program from the Canadian Pharmacists Association. Peer-reviewed published research demonstrates how transformative the program is: a 2014 study1 showed that 85% of ADAPT participants continue to report sustained increases in skills and confidence long after they’ve finished the program. What’s more, 40% of these pharmacists report billing more for medication management services as a result of ADAPT!

The time has come to fix the Non-Insured Health Benefits (NIHB) program.

In April 2015, the Auditor General of Canada released a report looking at the deplorable delivery of health care services in remote First Nations communities. The poor state of health care delivery to First Nations people in Canada should come as no surprise to pharmacists or any other health provider, regardless of the community setting. For many years, pharmacists and provincial pharmacy associations have raised concerns and issues with the operation of the Non-Insured Health Benefits (NIHB) program, the federal program that delivers health care to Canada’s First Nations people. These problems have included inadequate communication of policy changes, lack of standardized scope of practice and compensation models, lack of clarity regarding patient coverage benefits, inadequate travel arrangements and many others. Too many pharmacists have said that they are often put in the position of having to explain NIHB policy details or changes that should rightfully be communicated by NIHB themselves. Pharmacists have not been alone in raising concerns with NIHB. Many other health providers have raised similar and additional concerns as those expressed by pharmacists, and the Assembly of First Nations (AFN) has been particularly vocal in raising its concerns with the program. This is why in 2014, the federal Minister of Health and the Grand Chief of the Assembly of First Nations announced a full-scale review of the NIHB program. The purpose of this review, which is expected to last until 2017, is to conduct a thorough examination of NIHB operations and policies with the expectation of significant program reform. In spring 2015, the working group tasked with conducting this review (comprising representatives from AFN and the First Nations and Inuit Health Branch of Health Canada) issued a Critical Path document identifying the major sectors and issues that the review will address; pharmacy has been identified as one of the key sectors slated for specific examination starting in December 2015. In 2014, the Canadian Pharmacists Association (CPhA) brought together and has since led a coalition of 8 national health provider organizations looking to be engaged in the NIHB review. As a result of this leadership, the review has agreed that the perspective of health provider groups needs to be considered as part of this review process. CPhA has also engaged with provincial pharmacy associations to better understand their specific concerns and issues with NIHB from a pharmacy perspective and has communicated those concerns to the AFN. Regarding next steps, the health provider organizations, including CPhA, have agreed to consult individually with their own members to get thoughts and feedback on measures that could be taken to improve NIHB policy and operation. This feedback is expected to be collected over the summer and early fall of 2015 and will help inform the process moving forward, including the examination of pharmacy-specific issues. The challenges facing NIHB and delivery of health care to First Nations people in Canada are daunting, and therefore this process will take time. But with health outcomes that are significantly lower than the average Canadian, First Nations people in Canada should be a priority population when it comes to improving the delivery of health care in Canada. The voices of pharmacists and other health providers as part of this review will provide an invaluable contribution, as will their ongoing efforts to deliver improved day-to-day care. CPhA looks forward to continuing to lead health providers in adding their voices to this process. ■

CPhA National Survey: Canadians trust pharmacists and support their enhanced role in the delivery of quality care and services.

For Pharmacist Awareness Month 2015, the Canadian Pharmacists Association (CPhA) commissioned a national survey to determine Canadians’ perceptions and attitudes toward pharmacists and the range of health care services they provide. The survey, conducted by Abacus Data from February 14 to 22, 2015, with a sample of 2937 Canadians, yielded a range of positive results, demonstrating the high level of trust and confidence Canadians place in pharmacists. The number and scope of services that pharmacists can provide to patients has increased significantly over the past several years, and the survey results demonstrate that Canadians continue to support these expanded services. A large majority of Canadians trust pharmacists to provide advice on vaccinations (88%), the management of chronic conditions (88%), healthy lifestyle changes such as smoking cessation and weight loss (91%) and the management of common ailments like the cold or flu (94%). This high level of trust reflects the expanding role pharmacists are undertaking—and being recognized for—in the delivery of health care in Canada. Canadians not only trust pharmacists to provide a range of health care services, but according to the survey results, they are also very likely to use them. When asked whether or not they would consider going to their pharmacist to receive health care services, a majority indicated that they would consider going to their pharmacist for a flu shot or other vaccine (79%), for advice on medications (89%), for an appointment to review and discuss medications (82%), for smoking cessation advice (75%), for prescribing medications for minor health conditions (78%), for screening for medical conditions such as diabetes (66%) and for advice on the management of chronic disease such as diabetes or hypertension (69%). Canadians also make the connection between an expanded role for pharmacists and better health outcomes. Ninety-six percent of respondents had a positive impression of pharmacists, and 82% believed that pharmacists play a central or important role in the delivery of health care. Most Canadians agree that expanding the role of pharmacists would improve patients’ overall quality of life (82%), reduce overcrowding in emergency rooms and walk-in clinics (85%) and reduce overall health care costs (79%). Canadians clearly agree that the health care system would be improved by further enhancing the role of pharmacists in the delivery of health care services. Pharmacist Awareness Month is an opportunity to celebrate pharmacists and educate Canadians on the contribution that pharmacists make in the delivery of quality health care. The tagline for 2015, “Pharmacists: Trusted Care When and Where You Need It,” conveys the message that pharmacists are not only trusted leaders in the provision of frontline care but, as one of the most accessible health care providers in Canada, are able to provide quality care conveniently and quickly—a message that is clearly demonstrated in these survey results. More information about the survey, including province-specific results, can be located on the Pharmacist Awareness Month website at www.pharmacists.ca/pam.■

Pharmacy awareness: a continuous process.

JCPH – Vol. 68, no 2 – mars–avril 2015 182 of Pharmacy Regulatory Authorities, the Canadian Pharmacists Association, the Canadian Association of Pharmacy in Oncology, the Association des pharmaciens des etablissements de sante du Quebec, the Canadian Patient Safety Institute, the Institute for Safe Medication Practices Canada, and the Canadian Association of Pharmacy Technicians. CSHP’s advocacy efforts at both the National and Branch levels are necessary and appropriate, but advocacy at the grassroots level is crucial. At the front line, dealing with the daily workload and patient care demands, individual practitioners often find it difficult to see how they personally can be advocates for change and for the profession. I would invite you to consider the possibility that each and every interaction that a pharmacist has with either a health care professional or a patient is a moment of advocacy, not just for the profession, but also for the patient. What a powerful combination.

The Health Action Lobby releases its pre-election health platform.

The Canadian Pharmacists Association (CPhA) is a leading organization within the Health Action Lobby (HEAL), a coalition of 40 national health care organizations with a mandate to represent the collective interests of the health community with the federal government. In December, HEAL released its health care platform for federal political parties in advance of the next federal election. With a federal election expected in October 2015, HEAL has been working for the past 2 years to develop a set of recommendations aimed at strengthening the Canadian health care system. CPhA has been at the forefront in the development of the recommendations. The platform identifies steps that could be taken by the federal government to accelerate the pace of innovation, meet the changing health needs of Canadians, strengthen strategic partnerships with the provinces and territories and improve the health of Canadians and the care they receive. To meet these objectives, the HEAL platform identifies 6 key themes: Although HEAL recognizes that health care is delivered by provinces and territories, given the federal government’s own responsibilities in health, including the fact that it is the fifth largest health delivery body and a significant funder, the federal government needs to work more collaboratively with provinces and territories. Federal participation at the Council of the Federation’s Health Care Innovation Working Group would be a good first step. Greater clarity is needed with regard to the role of the federal government. HEAL has developed a vision statement that should guide future federal policy making in health care. A series of principles to transform the health system have been included in the platform, based on the work of the Institute for Healthcare Improvement and the Triple Aim approach. HEAL believes that federal funding for health care should reflect the Romanow Commission’s goal of 25% of total cost, up from its current level of approximately 20%. To more equitably distribute federal funds, HEAL is also recommending a Demographic Top-Up Fund that would reflect provinces/territories with older populations requiring greater health care assistance. HEAL believes the federal government can play a more direct role in 3 key areas: Canada’s aging population—HEAL would like a national dialogue on how to help Canadians finance the costs associated with aging. HEAL is also proposing a National Community-Based Health Infrastructure Fund to ensure an adequate supply of nursing home and long-term care beds. Access to prescription drugs—HEAL has adopted CPhA’s 2008 position on catastrophic drug coverage, which calls on the federal government to introduce a catastrophic drug insurance program that would prevent undue financial hardships in the event of exorbitant costs for medicines. Accelerating the spread of innovation—HEAL is proposing the creation of a National Health Innovation Fund that could accelerate the adoption of innovative practices in primary care, mental health and addictions, and health human resources. The federal government needs to develop a set of pan-Canadian health system performance indicators that would be used by all jurisdictions. These indicators would provide Canadians and policy makers with a clearer picture of how health systems are performing in comparison to objectives. This platform is intended to provide political parties with the unified views and perspectives of the health community on ways the federal government can strengthen the health care system in Canada. In the lead-up to and during the next federal election, we encourage pharmacists, as integral members of the health care community, to attend all candidates’ debates, meet with your candidates in person or send them a note indicating your support for these ideas and asking where they stand on issues related to health care.

CPhA Advocacy: Year in review.

The past year was an exciting and productive one for the Canadian Pharmacists Association’s (CPhA) advocacy efforts. CPhA’s accomplishments include the following: Working closely with the Council of the Federation: In 2013, the Council of the Federation (now called “Canada’s Premiers”) asked that provincial and territorial officials look into ways in which pharmacists could be better used in a team-based environment. In early 2014, a CPhA-produced document that identified best practices in the delivery of 4 specific services by pharmacists was approved and shared with all jurisdictions. An initiative was also launched to identify innovative team-based models involving pharmacists (a report identifying these models is expected to be released by the end of 2014). Better promoting the profession of pharmacy: 2014 witnessed better coordination among national and provincial pharmacy associations in promoting the profession during Pharmacists Awareness Month in March. Among the many initiatives launched, CPhA produced a professional video explaining the expanded services that pharmacists now offer. Engaging with third-party payers: In 2014, CPhA strengthened its relationship with third-party payers by creating the Pharmacy Health Insurance Steering Coalition (PHISC), a group of senior representatives from pharmacy and the third-party payer community. Among CPhA’s other accomplishments was the creation of a Value for Services Toolkit that provides information supporting pharmacy’s case to include coverage of expanded pharmacy services in private plans, an initiative that will continue into 2015. Changing the federal regulation on retention of electronic prescriptions: Starting in late 2013, CPhA began lobbying Health Canada to reform the regulation in the Food and Drug Act requiring pharmacies to retain 2 years’ worth of paper prescriptions. CPhA’s recommendation was to allow for electronic retention of prescriptions, similar to what a number of provinces have already enacted. In July 2014, Health Canada confirmed that the federal government would now interpret the regulation to allow for electronic retention of prescriptions. Passage of Vanessa’s Law on drug safety: In November 2014, Royal Assent was given to Bill C-17, otherwise known as Vanessa’s Law. This legislation is intended to strengthen drug safety regulations by making it mandatory for health institutions to report adverse drug reactions, and it provides the federal government with additional powers to recall drug products deemed unsafe. CPhA appeared before both a House and Senate Committee to indicate support for this bill. Continuing to represent pharmacy before Parliament: CPhA appeared 6 times before Senate and House of Commons Committees, speaking on such issues as drug safety, e-cigarettes, drug shortages and scope of practice. Gearing up for the 2015 federal election: Over the past 2 years, CPhA has been working closely with the Health Action Lobby (HEAL), a coalition of 40 national health organizations, to develop a united platform in advance of the next federal election. This platform was finalized in fall 2014 and unveiled in December. It will be communicated to Canadians and political parties throughout 2015 in the lead-up to the next election. Building on these successes, 2015 promises to be a year of growth in CPhA’s advocacy efforts. With a new Board Advocacy Committee, a new Vice President and advocacy department, and a renewed resolve on the part of the Board to strengthen CPhA’s advocacy efforts, CPhA will be better positioned to influence the issues that impact both pharmacy and the broader health system.

Learning and networking: utilization of a primary care listserv by pharmacists.

Expanding into new types of practice, such as family health teams, presents challenges for practising pharmacists. The Primary Care Pharmacy Specialty Network (PC-PSN) was established in 2007 to support collaboration among pharmacists working in primary care. The PC-PSN offers to its members a listserv (also referred to as an electronic mailing list) jointly hosted by the Canadian Society of Hospital Pharmacists and the Canadian Pharmacists Association. To characterize PC-PSN membership and participation in the listserv and to examine how the listserv is used by analyzing questions posted, concerns raised, and issues discussed. Qualitative content analysis was used to examine 1 year of archived PC-PSN listserv posts from the year 2010. Two coders used NVivo software to classify the content of posts. Research team members reviewed and discussed the coding reports to confirm themes emerging from the data. Overall, 129 people (52.9% of the 244 listserv members registered at the end of the calendar year) posted to the listserv during the study period. These participants worked in various practice settings, with over half residing in Ontario (68/129 [52.7%]). A total of 623 posts were coded. Agreement between coders, for a sample of posts from 10 users, was acceptable (kappa = 0.78). The listserv was used to share information on a diverse set of topics, to support decision-making and acquire solutions for complex problems, and as a forum for mentorship. The qualitative content analysis of the PC-PSN listserv posts for the year 2010 showed that the listserv was a medium for information-sharing and for providing and receiving support, through mentorship from colleagues. Apparent learning needs included effective question-posing skills and application of evidence to individual patients.

Going it on their own: Young pharmacists strike out on their own to provide patient-centred care.

In June I Visited Reid McDonald and Anita Cumbleton, who have just opened Sunset Ridge Pharmacy in a new subdivision in the north part of Cochrane, Alberta (population 21,000), about 35 minutes northwest of Calgary. As you can see from the photo, they are still awaiting their signage. I would describe the design of their clinic as “patient-focused.” Central to this are 2 patient examination rooms (see photo below; left of center). There is only a very small dispensary and a small selection of OTC products (Reid and Anita have deliberately avoided alternative and unproven therapies). This is a pharmacy designed for patient care. Indeed, their business model is based on billing Alberta Health for their clinical services. So far, the major challenges have been getting their pharmacy known (this is a very new subdivision, not completed yet) and meeting local physicians and other health care providers. Their grand opening in the beginning of July was very successful and included fundraising for a local charity, air time on the local radio station and a newspaper article.1 Anita and Reid have met with the leadership of the local Primary Care Network. Not surprisingly, the physicians wanted to know what Anita and Reid “were going to do to their patients” and didn’t appreciate the need for chronic care management and education (the physicians think they already provide those services for everyone). However, the physicians acknowledged that Anita and Reid were the first pharmacists to approach them about collaboration, and the two have scheduled a follow-up meeting with some of the physicians. Interestingly, Reid and Anita have been “visited” surreptitiously by other pharmacists in the area, none of whom have had the professional courtesy to introduce themselves. This is a young couple who have taken a courageous step forward to realize their vision of patient care. We all wish them well. Our other new practitioner, Bryan Gray, recently received the Canadian Pharmacists Association New Practitioner Award.2 Bryan embodies the very spirit of the award—showing exemplary courage and commitment to patient care and the profession. Back home in Thunder Bay, Bryan and his staff have been busy. Since establishing River Terrace Medical Pharmacy in late February, Bryan and his staff have seen tremendous growth. He says, “As an independent pharmacy, our competitive edge is service.” He is confident that the pharmacy is able to provide that higher level of service to patients. Bryan gives much of the credit to his team of technicians and pharmacists: Laura Bron (pharmacist), Mehgan Woods (technician), Vikki Kinsman (technician) and Janet Proctor (pharmacist). Some new programs that they are starting include a discrete methadone service, point-of-care anticoagulation service, medication synchronization (synchronizing refills for chronic medications) and preparation for this fall’s flu season. Check out their website: www.RTPharmacy.com. Bryan recently received his designation as a Certified Diabetes Educator. He also remarks that his MBA courses at Lakehead University have helped a lot, especially in terms of marketing, human resources, accounting and organizational behavior. These are big steps for these new practitioners. The words and phrases that come to mind are courage, vision, focus on patient care, commitment, professionalism and unwillingness to accept the status quo. We need more of this from our profession.

New program helps pharmacists give better patient care with lab tests.

The Canadian Pharmacists Association (CPhA) introduced a new continuing professional development program in March to train pharmacists in ordering, monitoring and interpreting lab tests. “Lab Tests—Ordering, Monitoring and Interpreting Laboratory Tests to Optimize Medication Management” is a response to some provinces increasing pharmacist authority to order lab tests or access lab results. Interest from the Pharmacists’ Association of Saskatchewan (PAS) first indicated that CPhA was on the right track about 3 years ago. “We were getting signals that pharmacists were going to get the authority. We wanted to meet the demand when the changes happened,” says Phil Emberley, Director, Pharmacy Innovation. PAS was the leader in the creation of the new program (known as Lab Tests), Emberley says. “Given the other work we do with continuing professional development, they thought we could take this on.” CPhA started by working with the University of Waterloo to tailor a course it offered to meet the needs of practising pharmacists. Lab Tests was reviewed by practising pharmacists and academics to make sure the content was accurate and appropriate for pharmacists. Emberley is also going to take the program himself. “It’s really meeting a need,” he says. Currently pharmacists have more authority in Alberta, Manitoba, New Brunswick and Nova Scotia, while other provinces are considering it to various degrees. “When you have access to lab test results, there’s a professional responsibility implied that you’ll know how to use them to improve the care of patients,” Emberley says. The new program is the solution for pharmacists who have access to lab values but aren’t confident in knowing how to use them. Pharmacists having access to lab values and the skills to interpret them will benefit their patients and other health care providers, as well as pharmacists themselves, says Jennifer Gibson, a hospital-based pharmacist in Winnipeg, Manitoba. Patients will benefit from having all their health care providers able to evaluate their care appropriately, while physicians will have more support from and confidence in pharmacists. Time will be saved from streamlined communications between prescriber and pharmacist once both have the same patient information, Gibson explains. She works with kidney transplant recipients and says lab values are completely integrated into everything she does. Hospital pharmacists already have access to lab values, and she sees the authority continuing to spread with expanded scope and legislation changing across the country. Gibson is also a moderator for CPhA’s ADAPT patient care skills development program, which has a lab values component that provides some basic information on common tests. A recent conversation between moderators and students highlighted the difference in authority between provinces and the need for a program like Lab Tests to give pharmacists a better understanding of lab values. Maryann Chmilar, another ADAPT moderator, is a hospital-based pharmacist in Alberta, where pharmacists have to register with their provincial association before they can order and access lab values. “Along with the privilege and efficiency comes increased responsibility for patient care,” she says. “There’s a responsibility to look at the results and come up with care recommendations. The responsibility is all the way through.” For almost every condition and most medications there is a relevant lab value that will tell you the status of the condition and the effects or side effects of the drug, Chmilar says. Knowing how to monitor and interpret lab values is key to assessing care and knowing whether adjustments are required. “You can’t fix what you don’t know about,” she says. She plans on taking the Lab Tests program as a refresher, adding that online courses are a convenient way to keep up with improvements in care. The 12.75 CEU online module course discusses pharmacist responsibility for lab tests and basic skills in interpretation. Electrolyte, kidney function, liver, endocrine, cholesterol and hematologic tests are covered. Participants can start as soon as they register and can learn at their own pace in their own time. ■

Increasing the safe and effective use of medications

One of the most underreported health-related stories of 2013 was the increased emphasis that the federal government has placed on the issue of prescription drug abuse and drug safety. Ottawa was clear in the Speech from the Throne in October 2013 that it would undertake a series of measures to increase patient safety and reduce medication-related errors, an important promise when one considers that up to 1 in 9 hospitalizations result from adverse drug reactions (ADRs). The government is thus far living up to that commitment. Over the past year, we have seen the introduction of a variety of measures designed to strengthen drug safety and reduce prescription drug abuse, notably the following: In June, the federal government announced its plain language labeling initiative, to ensure that drug labels and safety information are available in plain language so Canadians can better understand how and when to take their medications. As part of this initiative, Health Canada is providing $3.2 million to the Institute for Safe Medication Practices Canada to study the reasons behind medication misuse. In December, the Minister of Health tabled in the House of Commons Bill C-17, the Protecting Canadians from Unsafe Drugs Act, otherwise known as “Vanessa’s Law” (named in honour of Vanessa Young, the daughter of Conservative Member of Parliament Terence Young, who died after taking a prescription drug that was later found to be unsafe and was withdrawn from the market). Among other things, this bill will provide the federal government with powers to recall medications proven to be unsafe, will require mandatory ADR reporting by hospitals (the definition of a reportable reaction will be decided as regulations are developed) and will compel drug companies to revise labels to clearly reflect health risk information, including updates for health warnings for children. Also in December, several Conservative Members of Parliament held consultations with stakeholders to develop a strategy on a national Take Back Your Medications day, which would be a national initiative aimed at encouraging Canadians to drop off any unused medications to designated locations, possibly including pharmacies. Although a federally run Take Back Your Medications day remains a longer-term objective, the Minister of Health has been open to the idea. Over the fall, the House of Commons Standing Committee on Health held hearings into the government’s role in addressing prescription drug abuse. The Committee has already heard from many witnesses, including CPhA, on how the government can continue to play a role in improving the safe and effective use of medications. A report from the Committee is expected in spring 2014, with possible additional actions after that. The Canadian Pharmacists Association (CPhA) has been at the forefront in supporting and encouraging these initiatives. CPhA provided input into the development of these initiatives, expressed its qualified support for measures addressing drug safety and continues to meet with Health Canada officials to provide feedback into policy in this area. During its appearance before the Standing Committee on Health, CPhA argued for such measures as expanding scope of practice so that pharmacists could address safety issues head-on, enhancing training opportunities for pharmacists and ensuring that regulations prevent the entry of drugs with high risks of addiction to market. There is no question that drug safety and appropriate use of medication are the top priority of pharmacists. Recent media stories have called into question the safety and efficacy of medications in Canada. By supporting these measures and continuing to have a dialogue with the federal government on additional ways in which medication safety can be improved, CPhA, on behalf of pharmacists across Canada, is making it clear that safety is priority number one for the profession. ■

Ontario pharmacists concerned about federal oversight of imported medications in light of birth-control pill recalls

Ontario pharmacists are among the Canadian health professionals publicly calling for more rigorous oversight of imported drugs, in light of 3 recalls of oral contraceptives across Canada since April 2013. More than 620,000 packages of 3 types of generic birth-control pills were recalled in Canada between April and September. These include Alysena from Apotex, and Freya-28 and Esme-28, both of which are manufactured in India for Mylan Pharmaceuticals in the United States. All the recalls were connected to problems with too many placebos in place of active-ingredient doses. The recalls have raised questions about the product integrity of some medications sold in Canada, said the Ontario Pharmacists Association (OPA) in a September 11 news release. The OPA urges Health Canada to increase scrutiny of brand and generic manufacturers for all aspects of drug production, including the packaging of finished products both in and outside of Canada. The Society of Obstetricians and Gynaecologists of Canada and the College of Family Physicians of Canada have also raised red flags about federal oversight of quality and safety in the manufacture and distribution of oral contraceptives and other medications. Pharmacists have a number of concerns with respect to the recalls, including some related to the recall process itself, said the OPA CEO, Dennis Darby, in an interview with CPJ. “There was no real notice,” he says. “Pharmacists found out at the same time as the media and public, so they didn’t have a chance to prepare. As the media reports were coming out, the OPA was getting calls from pharmacists asking what they should do.” Many pharmacists have been able to deal with the birth-control pills in question by taking an extra step for patients, Mr. Darby says. “Because one can see if the packages were prepared incorrectly, many pharmacists are opening up the packages in front of the patient to make sure all is fine. In this case, it was relatively easy for pharmacists to find out if there was a mistake—but that’s not always going to be the case for a recall.” It is critical for Health Canada to ensure the highest standards of oversight over pharmaceutical products imported into the country, he adds. “How do we make sure that we have a quality assurance system in place that can reassure Canadians?” —Dennis Darby, Chief Executive Officer, Ontario Pharmacists Association “As medications become more globally sourced, we ask the question—how do we make sure that we have a quality assurance system in place that can reassure Canadians and health care professionals that the products we are providing to patients meet the quality standards we expect?” Because these oversight issues are the responsibility of federal regulators, the OPA would like to work with the Canadian Pharmacists Association and other provincial pharmacist associations to address some of these areas of concern, says Mr. Darby.