College Of Pharmacists Research Articles

Abstract 9876: Optimizing Public Naloxone Kit Locations Through Mathematical Modeling

Introduction: Use of bystander-administered naloxone may lead to improved likelihood of recovery from opioid overdose. We sought to determine the accessibility of public access naloxone kits on nearby opioid overdose incidents if placed at public transit stops, compared to placing kits outside pharmacies or with existing public access automated external defibrillators (PADs). Methods: We included all incidents in Metro Vancouver, British Columbia responded to by British Columbia Emergency Health Services coded as a drug overdose with naloxone administered on-scene (Dec. 2014 to Aug. 2020). We geo-coded all public transit bus stops and used a mathematical optimization model to select bus stops where publicly accessible naloxone kits could be placed to maximize accessibility (defined as ≤100 m walking distance) to opioid overdoses. We evaluated accessibility on out-of-sample OHCAs using five-fold cross validation and compared against two baseline policies: placing publicly accessible naloxone kits at all pharmacies identified by the College of Pharmacists of British Columbia, and placing kits at all PADs identified by the British Columbia AED Registry. Statistical analysis was conducted using McNemar’s test. Results: We identified 14,318 opioid overdoses, 8,972 bus stops, 736 pharmacies, and 425 PADs. Accessibility of public naloxone kits for opioid overdose locations was 5.1% when placed at all pharmacies and 3.5% when placed with all existing PADs. Optimized naloxone kit placement using bus stops as candidate locations resulted in significantly higher accessibility than both pharmacy and PAD-based placement at 14.8% with 10 optimized locations (P<0.001), increasing to 36.7% with 500 locations (P<0.001). Conclusion: Optimizing placement of public access naloxone kits at select public transit locations can provide significantly higher accessibility to opioid overdose locations compared to placement at pharmacies or at existing PAD locations.

Insights from Regulatory Data on Development Needs of Community Pharmacy Professionals.

The aim of this study was to use data available to a Canadian health professions regulator (Ontario College of Pharmacists) to identify areas of opportunity where practitioners (pharmacists and pharmacy technicians) could benefit from further development, in order to optimize practice and improve the quality of care. Four de-identified datasets were used to extract themes from areas of jurisprudence (1969 exam records), member practice assessments (2610 records), pharmacy assessments (2024 records) and conduct (640 case records). Outcome measures included performance in examinations and assessments and competency gaps identified in conduct investigations. Thematic analysis of outcomes was done in two stages. First, the four outcomes were derived independently for each dataset. Second, the top five issues were extracted for each dataset. It was hypothesized that common themes in competency gaps across all four datasets would emerge from this top five selection. We found three main common areas of opportunity where practitioners could benefit from further development: patient assessment and safety; documentation; and ethical, legal and professional responsibilities.

An evaluation of bylaw and policy changes on pharmacy robberies in British Columbia

On 15 September 2015, the College of Pharmacists of British Columbia (BC) implemented a set of by-law and security policy changes in an effort to reduce robberies and burglaries in BC pharmacies. Prior to these by-law and security policy changes, pharmacy robberies were increasing in BC for approximately 5 years. After implementation, pharmacy robberies decreased significantly. In this paper, we evaluate the potential impact of the by-law and security policy changes on pharmacy robberies in four regions within BC. We find strong evidence supporting that the reduction in pharmacy robberies is a result of this by-law and accompanying security policy changes. Specifically, there was an immediate and substantial drop in pharmacy robberies within Vancouver, with a change in trend (now decreasing instead of increasing) for the Interior and Lower Mainland less Vancouver. These results should be considered support for maintaining these by-laws and security policy changes in BC and potential implementation in other areas of Canada experiencing similar issues.

Community Pharmacists' Perspectives on Dispensing Medications With the Potential for Misuse, Diversion, and Intentional Overdose: Results of a Province-Wide Survey of Community Pharmacists in Canada

ABSTRACTBackground: Community pharmacists frequently encounter patients at risk of medication misuse, diversion, and intentional overdose. However, few studies have examined the perspective of the pharmacist on the identification and management of these patients. Objective: To understand the perspective of community pharmacists on the dispensing of select medications commonly associated with misuse, diversion, and overdose. Methods: An online survey was disseminated by electronic mail to community pharmacists listed in the College of Pharmacists of Manitoba directory. The survey was open from July to September 2014. Descriptive statistics were used to describe demographic information of the pharmacist and practice setting, and pharmacists' perceptions on the dispensing of select medications. Results: A total of 82 community pharmacists completed the survey. Most pharmacists considered a one-month supply appropriate for a psychotropic agent; but a 7–10 day-supply was considered appropriate for an opioid for acute pain. Factors that aid pharmacist decisions on providing select medications to patients include familiarity with the patient, ease of access to medical history information, and ease of access to the prescribing physician. Only 10.3%, 16.2%, and 32.4% felt they have received adequate training on the management of patients at risk for suicide, drug diversion, and medication misuse, respectively. Conclusion: Findings from this study demonstrated a need for improved systems for managing patients at risk for medication misuse, diversion, and overdose. Strategies that warrant further attention for limiting the means of medication misuse include increased access to electronic medical records and providing additional continuing education support for community pharmacists.

Redefining the Practice of Medicine: Euthanasia in Quebec

An Act Respecting End-of-Life Care (ARELC) is intended to legalize euthanasia by physicians in the province of Quebec, a legally contentious project because of Canadian constitutional law. This paper does not take a position on the desirability of euthanasia or assisted suicide, but reviews ARELC in detail from the perspective of physicians who do not wish to be involved with such procedures for reasons of conscience. The Table of Contents following this summary outlines the paper, which consists of nine parts and three appendices. Each part opens with an abstract.Part 1 offers an overview of ARELC and closes with a review of the long term prospects for the implementation of the law. Part 2 discusses the law in detail, including definitions of key terms and procedural requirements. It also explains how a revision of the original text authorizes two different kinds of euthanasia: a regulated process for competent patients, and an unregulated process for incompetent patients. This aspect of the new law has not received attention.The issue of slippery slopes is addressed in Part 3, with particular reference to the guidelines provided in the law. Part 4 considers the tension among health care workers generated by the killing of patients, and closes with an overview of the institutional and legal mechanisms available to implement the law. Appendices A and B provide detailed information about these mechanisms.Most physicians do not personally kill patients even in jurisdictions where euthanasia or assisted suicide are legal. This fact collides with ARELC’s declaration that access to euthanasia is a right. Part 5 discusses the implications of this collision in Quebec. Appendix C provides statistics on physician participation in euthanasia and assisted suicide.Since most physicians will not actually kill patients, and most euthanasia proponents do not insist that objecting physicians should do so, attacks on freedom of conscience are more likely to take the form of demands that physicians facilitate the procedure by referral or other means. Accordingly, Part 6 uses the criminal law and examples of capital punishment, torture and female genital mutilation to explore the concept of morally significant participation in what is believed to be wrong.Physicians may have reasons other than conscientious objection for refusing to kill a patient. The various reasons for refusal and ARELC’s provision for conscientious objection are noted in Part 7, including the continuing criminal prohibition of euthanasia by Canadian criminal law. Of particular interest is the extent of immunity from prosecution being sought by physicians, and the degree of immunity that the government is actually willing to grant.ARELC exempts palliative care hospices from the requirement to provide euthanasia, but the exemption has been challenged and hospice administrators are concerned that the legalization of the procedure will eventually compromise their operations. Part 8 offers an overview of the challenges and their concerns.As a general rule, it fundamentally unjust and offensive to human dignity to require people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence. Thus, it was a serious error to include this a requirement in Code of Ethics for Quebec physicians and pharmacists. Part 9 uses the concept of examined emotions to demonstrate that this error became intuitively obvious to the College des medecins and College of Pharmacists when the subject shifted from facilitating access to birth control to facilitating the killing of patients.

Attitudes of Alberta Pharmacists Pertaining to Traditional Chinese Medicine Practice and Complementary Alternative Medicine

Objective: To evaluate the perceived attitudes toward the use of Complementary Alternative Medicine (CAM) and Traditional Chinese Medicine (TCM) by pharmacists in Alberta Methods: An online survey was created using Google Documents®. The URL link was distributed to all registered pharmacists through Alberta College of Pharmacists monthly electronic newsletter “The Link”. Results: A total of 217 (5%) pharmacists completed the survey. Over half (54%) of pharmacists either approve or strongly approve, 20% either strongly disapproved or disapprove with the use of CAM and TCM. Sixty-four percent of pharmacists felt that they were not prepared to counsel patients regarding CAM and TCM, while 88% of pharmacists agree that TCM and CAM should be integrated in the pharmacy curriculum at the University of Alberta. Conclusions: Pharmacists felt they are not prepared to counsel patients regarding CAM and TCM. While most pharmacists have a positive attitude towards the use of CAM and TCM, it has also been identified that CAM and TCM courses should be included in the curriculum to better prepare future pharmacists.

Nova Scotia pharmacists' knowledge of, experiences with and perception of factors interfering with their ability to provide emergency contraceptive pill consultations

The objective of this research was to explore pharmacists' knowledge of, experiences with and perception of factors interfering with their ability to provide non-prescription emergency contraceptive pill consultations in the Canadian province of Nova Scotia. A self-administered paper questionnaire was mailed, using Dillman's tailored design method, to all pharmacists (n = 1123) registered with the Nova Scotia College of Pharmacists. The response rate was 53.0% (595/1123), with 451 respondents working in community practice. Most respondents reported that they had provided consultations for the emergency contraceptive product Plan B since it became available without a prescription (93.6%), and that Plan B is kept behind the pharmacy counter (83.6%). Pharmacists most frequently (47.8%) reported spending 6-10 min providing Plan B consultations. Respondents were generally knowledgeable about Plan B; however, only 39.2% knew that it can be effective for up to 5 days and 69.3% knew that the incidence of vomiting is less than 50%. The factors interfering the most with providing Plan B consultations were lack of privacy (46.1%) and lack of staff to cover during the consultation (50.9%). In general, Nova Scotia pharmacists are knowledgeable about emergency contraceptive pills; however, education regarding effective timing for use of such pills would be helpful. Private areas for counselling and consideration of pharmacy staffing schedules in community pharmacies may help address pharmacist concerns regarding their ability to provide Plan B consultations.

The Alberta College of Pharmacists (ACP) has approved an evaluation process for pharmacists applying for additional prescribing authorisation.

The Alberta College of Pharmacists (ACP) has approved an evaluation process for pharmacists applying for additional prescribing authorisation.

Reply to Clozapine Interchangeability Issues

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Sir: My colleagues and I appreciate Dr. Flynn's comments on our article1 and the opportunity to clarify some aspects of our study. As stated in our article, Canadian provinces have adopted different approaches to clozapine interchangeability according to their particular policies and evaluation processes. British Columbia Pharmacare may apply their "low cost alternative" policy to certain drug categories, but interchangeability is established by the College of Pharmacists.†‹

Assessment of Pharmacists' Patient Care Competencies: Validity Evidence from Ontario (Canada)'s Quality Assurance and Peer Review Process

Maintenance of competence is integral to health care practitioners’ continuing professional development. The adequacy and value of indirect assessment of competence (through, for example, learning portfolios or attendance at educational events) has been questioned. Direct assessment (such as written tests of clinical knowledge or objective structured clinical examinations, OSCEs) has been advocated as a more meaningful indicator of a practitioner’s competence. This paper describes the Ontario (Canada) College of Pharmacists’ experience with direct assessment through the Peer Review/Quality Assurance process. This process consists of a self- assessment questionnaire, ongoing maintenance of a learning portfolio, a written test of clinical knowledge, and an OSCE. Each year, a randomly selected group of pharmacists in Ontario undertake the Peer Review process. After five years of operation, 992 pharmacists had participated in this program; 86% of participants met or exceeded standards and were encouraged to continue with their own professional development while 14% of participants did not meet standards in identified assessment areas, and were directed to a peer-assisted process to facilitate professional development. Findings suggest individuals who were educated outside Canada or the United States, those in community pharmacy practice, and those who had been in practice 25 years or more demonstrated greatest difficulty in meeting standards. The implications of these results for pharmacy practice and professional development are discussed as are issues related to direct and indirect assessment of clinical skills.

A Proposed American College of Pharmacists

A Proposed American College of Pharmacists

A Proposed American College of Pharmacists

A Proposed American College of Pharmacists