Ontario Community Research Articles

Variations in RBC and frozen plasma utilization rates across 62 Ontario community hospitals.

Recent province-wide audits of frozen plasma (FP) and RBC use in Ontario showed a high rate of inappropriate transfusions. This was a retrospective, ecological study to determine variations in RBC and FP utilization rates across Ontario community hospitals between 2012 and 2017. Annual utilization rates were reported using descriptive statistics. Rates of blood component use were correlated with size of hospital, presence of specialized programs, and quality improvement (QI) initiatives, using Poisson regression. RBC and FP utilization rates decreased from 2012 to 2017 (p = 0.03 for FP; p < 0.01 for RBC). There was a 10-fold difference in RBC and FP transfusion rates between the highest and lowest users. Smaller hospitals (p < 0.05) and sites with any QI initiative (p = 0.006) were associated with lower FP utilization rates. Hospitals without cancer programs (p = 0.02) and sites with RBC guidelines (p = 0.05) or with technologists who prospectively screened transfusion orders (p = 0.01) had lower RBC transfusion rates. RBC utilization rates decreased further after the implementation of RBC guidelines (p = 0.02) and order sets (p = 0.005). There was a positive correlation between FP and RBC transfusion rates for each fiscal year (p < 0.005 for all years). RBC and FP utilization showed wide variation across community hospitals in Ontario. Overall, transfusion rates decreased over time. A further decrease was observed at sites with QI initiatives, supporting their implementation in reducing utilization. These data will serve as a baseline to highlight sites and practices where QI initiatives may be most beneficial and replicated in other jurisdictions.

Community networks of services for pregnant and parenting women with problematic substance use.

Integrated treatment programs for pregnant and parenting women who use substances operate at the intersection of multiple service systems, including specialized substance use services, the broader health system, child protection, and social services. Our objectives were to describe the composition and structure of community care networks surrounding integrated treatment programs in selected communities in Ontario, Canada. We used a two-stage snowball method to collect network data from 5 purposively selected integrated treatment programs in communities in Ontario. Front-line staff with integrated treatment programs identified their top 5 service partners, who were then contacted and asked to provide the same information (n = 30). We used social network analysis to measure the cohesiveness, reciprocity, and betweenness centrality in the integrated treatment program’s ego network. We described network composition in terms of representation of different service types. Across communities, common service partners were child protection, substance use or mental health services, parenting and child support, and other social services. Primary and pre-natal care, opioid agonist therapy, and legal services were rarely named as partners. Networks varied in network cohesiveness, as indicated by connectivity between the service partners and reciprocal ties to the integrated treatment programs. Integrated treatment programs commonly brokered the connections between other service partners. Findings suggest that these integrated treatment programs have achieved a level of success in developing cross-sectoral partnerships, with child protection services, parenting and child support, and social services featuring prominently in the networks. In contrast, there was a lack of close connections with physician-based services, highlighting a potential target for future quality improvement initiatives in this sector.

The Community Food Environment and Food Insecurity in Sioux Lookout, Ontario: Understanding the Relationships between Food, Health, and Place

ABSTRACTThe purpose of this community-based research project was to explore the community food environment and food insecurity in the northern Ontario community of Sioux Lookout. Previous informal conversations with local organizations identified food insecurity as a serious concern with particularly impactful consequences for Indigenous well-being. Community members were invited to a feast at the Friendship Centre where individuals participated in surveys (N = 76) and talking circles (N = 100) around the question: “When it comes to food what do you think is the most important issue in Sioux Lookout?” Four related themes emerged including: (1) The Community Food Environment; (2) Indigenous Food Knowledge; (3) Concerns about Health; and (4) Moving Forward. This article considers the community food environment and the relationships between people, food, culture, health, and place.

Abstract 17226: Increased Risk of Heart Failure Associated With Left Atrial Remodeling Without Known Atrial Fibrillation

Background: Atrial fibrillation (AF) significantly increases risk for heart failure (HF) and independently increases mortality and adverse in-hospital outcomes in HF patients. Validated clinical risk scores (ARC2H) can predict HF in patients with AF, but are limited in application as AF is frequently clinically silent or undetected. However, AF may be preceded by significant preclinical remodeling (left atrial enlargement (LAE) or excessive atrial ectopy (EAE)). Whether LAE and EAE are associated with HF prior to AF is unclear. Method(s): We analyzed consecutive adults &gt;65 years with outpatient echocardiography or Holter at 11 Ontario community cardiology clinics (2010-2017). Exclusions were history of AF, anticoagulation, pacemaker/ICD/ILR, and prosthetic valve. Using linked administrative databases, we assessed 5-year rates of HF (primary) and incident AF and death (secondary) associated with LAE and EAE and among subgroups (M vs. F; &lt;75 vs. &gt;75; CHADS-VASC 0-2 vs. 3-6). Competing risks cox proportional hazards estimated adjusted hazard of HF for severe LAE: &gt;47mm (M);&gt;52mm (F)) or increased APBs/hour (EAE: &gt;30) or both LAE and EAE, adjusting for age, vascular comorbidities and left ventricular (LV) dysfunction. Results: In 28,261 adults (mean 73+/-6 years), direct age-adjusted survival was reduced for those with severe LAE and EAE. 5-year rates of HF were increased for severe (8.8%) vs. moderate (3.5%) and mild (1.4%) LAE and for those with excessive (3.8%) vs. normal (2.5%) ectopy. For both LAE and EAE, those &gt;75 and with a CHADS score 3-6 showed marked increases in HF at 5 years compared to &lt;75 (LAE: 10.6% vs. 7.9%; EAE: 4.3% vs. 1.9%) and CHADS score 0-2 (LAE:21.4% vs. 6.6%; EAE: 8.9% vs. 2.4%). Severe LAE increased hazard of HF 2-fold (HR=2.07; p&lt;.0001), and incident AF over 3-fold (HR= 3.43; p&lt;.0001) and EAE increased hazard of HF (HR=1.31; p&lt;.0001) and incident AF (HR=1.13; p&lt;.0001). Those with both LAE and EAE showed an over 3-fold increased hazard of HF (HR=3.28; p&lt;.0014). Conclusions: Severe LAE and EAE without known AF are associated with increased risk of HF and AF after adjusting for LV dysfunction, particularly for those &gt;75 and with high vascular burden. These data have implications for risk stratification, AF screening, and trials for HF prevention in individuals with left atrial remodeling.

Explaining the Diffusion of Renewable Electricity Technologies in Canadian Remote Indigenous Communities through the Technological Innovation System Approach

This paper applies the Technological Innovation System (TIS) approach for the first time in the context of remote indigenous communities in Northwest Territories (NWT) and Ontario, Canada, to explain the diffusion of Renewable Energy Technologies (RETs). These communities need reliable and sustainable electricity to address social, environmental and economic development issues. The study examines the diffusion of RETs during the 2000–2016 period, identifies the systemic and transformational failures responsible for the functional performance of the TISs, and generates insights about factors that have the potential to sustain the development of RET projects. Findings suggest that the TIS-proposed causal mechanisms were present and performed as expected. Since the accumulation of TIS functions influences the rate of deployment of renewable technologies, policy intervention to improve local learning and networking could lead to accelerated diffusion of RETs to the benefit of remote communities and other stakeholders.

Assessing service and treatment needs of young people who use illicit and non-medical prescription drugs living in Northern Ontario, Canada

Background: The use of illicit and prescription drugs for non-medical purposes among youth and young adults living in Northern Ontario communities is a major public health concern. This problem is amplified in that there is insufficient knowledge on the types of services and treatment centers available for and utilized by young people with substance use issues in Northern Ontario. This needs assessment study aims to examine the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Methods/Design: A mixed-methods study design will be used to assess the service and treatment needs of youth and young adults (aged 14-25) who have used one or more illicit drug (excluding cannabis) and/or psychoactive prescription drug for non-medical purposes for at least 3 months and on at least 10 days in the last month. Participants will be recruited from approximately ten Northern, remote and rural communities across Northern Ontario using a mobile research lab. Eligible study candidates from each community will be asked to partake in a focus group and questionnaire exploring service and treatment utilization and needs. We will additionally collect basic socio-demographic information as well as examine patterns of problematic drug use. Interviews with service providers and community organizers will also be conducted in each community. Discussion: Findings from our study will highlight the availability, accessibility and utilization of existing services; identify the gaps and barriers in current service provision; and provide insight into the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Assessing the needs of young people who use drugs will allow service providers, community organizers and health policymakers to improve addiction-related services and treatment centers in Northern Ontario.

How integration of the federal Indian Register has enhanced First Nations-specific analysis of ICES data

IntroductionIn Ontario, First Nations are increasingly seeking population-level data about the health of their citizens. However, First Nations people are not readily identified in standard health administrative data and indirect strategies, such as the use of on-reserve addresses, are limited in scope and validity.&#x0D; Objectives and ApproachThe Chiefs of Ontario entered into a Data Governance Agreement with the Institute for Clinical Evaluative Sciences (ICES) that enabled the linkage of the federal Indian Register (IR) to data at ICES. This study examined the impact of the IR linkage on First Nations population estimates and location of residence, measured by postal code or residence code. Overall, and for each First Nation community in Ontario, we compared First Nations population estimates from the ICES data with and without the IR linkage to estimates available from Indigenous and Northern Affairs Canada (INAC).&#x0D; ResultsWithout the IR, using only Ontario residence codes or postal codes that were unique to a given community, 62,242 individuals were identified as living in First Nations communities. This is approximately 30% lower than the current INAC on-reserve population estimate of 92,234 for First Nations communities in Ontario. Adding the IR allowed the use of non-unique postal codes as well, resulting in the identification of an additional 15,183 First Nations individuals. It also allowed the identification of over 113,000 First Nations individuals who live outside of First Nations communities, especially in urban areas. Finally, the combination of residence information and the IR permits communities to identify their registered member living within and outside their communities.&#x0D; Conclusion/ImplicationsUsing the IR in combination with geographic residence information, made possible through the Data Governance Agreement signed between Chiefs of Ontario and ICES, will provide First Nations communities with more accurate and complete population estimates, which is key to the production of useful and relevant First Nations-specific health research.

It's About Time: Rapid Implementation of a Hub-and-Spoke Care Delivery Model for Tertiary-Integrated Complex Care Services in a Northern Ontario Community.

Children with medical complexity (CMC) in rural and northern communities have more difficulty accessing subspecialty health providers than those in urban centres. This article describes an alignment cascade in which leaders engaged peers and staff to rapidly roll out the implementation of a sustainably designed complex care model, integrated in the Champlain Complex Care Program and delivered in Timmins, Ontario. The Provincial Council for Maternal and Child Health's Complex Care for Kids Ontario (CCKO) strategy supports the implementation and expansion of a hub-and-spoke model of interprofessional complex care for CMC and their families. A nurse practitioner is the primary point of contact for the family and oversees coordination and integration of care; regional CCKO programs are committed to building capacity to provide safe, high-quality care for CMC in communities closer to their homes.

Exploring pharmacy service users' support for and willingness to use community pharmacist prescribing services.

In 2012, community pharmacists in Ontario, Canada gained regulatory authority to independently prescribe, including renew and adapt prescriptions. Studies have explored views of pharmacists, physicians and policymakers about pharmacist prescribing but less is known about the views of community pharmacy services users. To describe Ontario community pharmacy service users' support for and stated willingness to use pharmacist prescribing services. A qualitative descriptive study was conducted with 19 adults who had filled or refilled prescription(s) at a community pharmacy within the past three months. Participants were recruited through purposive and snowball sampling. Data were collected through one-on-one, semi-structured interviews between May and September 2016. Interview transcripts were coded and thematic analysis conducted. The first two transcripts were independently coded and analyzed by 2 researchers and after consensus was achieved, the lead researcher coded and analyzed the remainder of the data. Most community pharmacy service users lacked experience with pharmacist prescribing services but perceived some potential benefits, including personal convenience. The majority of participants supported pharmacist prescribing. Support for and stated willingness to use pharmacist prescribing services varied by the type of service and was contingent upon the clinical purpose of the prescription, pharmacists' access to patient clinical information (e.g. health records), and the extent of pharmacist-physician collaboration during the prescribing process. Community pharmacy service users in Ontario expressed varying support for and stated willingness to use pharmacist prescribing services. This seemed to be due to their perceptions of the pharmacists' role (compared to physicians) and concerns about risks. Understanding these contributing factors will help implement strategies that address concerns and facilitate use of community pharmacists' prescribing services.

The Characteristics and Outcomes of Patients Who Make an Emergency Department Visit for Hypertension After Use of a Home or Pharmacy Blood Pressure Device

Emergency department (ED) visits for hypertension are rapidly increasing. Hypertension guidelines began recommending use of self-measurement blood pressure (BP) devices in the early 2000s, which could be contributing to the increase. We aim to examine the proportion of ED visits for hypertension that occurred after a BP measurement with a self-measuring device, and the associated outcomes. This retrospective observational study included adults who made an ED visit and received a primary diagnosis of hypertension at 1 of 5 community and tertiary hospitals in Ontario, Canada, between April 2010 and March 2011. We categorized ED visits into 4 groups: those made after a home BP reading, a pharmacy reading, as a result of a physician referral, and all others (termed "not documented"). We examined rates of admission to the hospital, ED treatment (administration of antihypertensive medication andprescription provision), and post-ED clinical events (follow-up care, return ED visits, and long-term all-cause mortality) by group. Among 1,508 qualifying patients, median presenting ED BP was 182/97 mm Hg (interquartile range 164 to 200/85 to 109 mm Hg). The percentage of patients who presented to the ED after a reading at home, at a pharmacy, or by physician referral and the remaining patients not documented was 40.9%, 8.3%, 13.3%, and 37.5%, respectively. Overall, 109 patients (7.2%) were admitted to the hospital. The proportion of patients admitted after a home or pharmacy reading, after a physician referral, or who were not documented was 3.1%, 11.9%, and 11.0%, respectively. Two-year mortality rates were 5.4%, 0.0%, 6.5%, and 5.3% for the home, pharmacy, physician referral, and not documented groups, respectively. Among the 92.8% of patients who were discharged from the ED, 11% made another ED visit for hypertension within ayear. In this study, half of patients with an ED visit that was primarily for hypertension presented after elevated readings on self-measurement devices. Only 3% of these patients were admitted to the hospital.

Geographic differences in the experiences of HIV-related stigma for women living with HIV in northern and rural communities of Ontario, Canada.

In Canada, individuals living in northern and rural regions report more barriers to health service access. For people living with HIV, these barriers may be exacerbated by experiences of HIV-related stigma, and women living with HIV can be disproportionately affected because of intersections of multiple forms of oppression, including racism, sexism and classism. To further understand the impact of geography on the wellbeing of women living with HIV, this study assessed geographic differences in HIV-related stigma experiences among women in the Canadian HIV Women's Sexual & Reproductive Health Cohort Study (CHIWOS). CHIWOS is a multisite cohort study of women living with HIV in Canada that operates under community-based participatory research methodology along with GIPA (greater involvement of people with HIV/AIDS) and MIWA (meaningful involvement of women living with HIV/AIDS) principles. This analysis compared peer research associate-administered questionnaire data between participants in northern and southern Ontario, Canada, and between participants in rural and non-rural Ontario. Northern regions were defined by healthcare delivery jurisdiction. The primary outcome was the 10-item shortened HIV Stigma Scale score. Multivariable linear regression models assessed the association between rural and northern regions and stigma score. Sixteen women were excluded due to incomplete HIV Stigma Scale data. Of 701 women included in the analysis, 66 (9.4%) were from northern regions and 24 (3.4%) were from rural regions. Mean stigma scores were 23.9 (standard deviation (SD) 8.0) overall, 26.7 (SD 8.8) in northern regions, 23.6 (SD 7.9) in southern regions, 28.3 (SD 10.1) in rural regions, and 23.8 (SD 7.8) in non-rural regions. In multivariable analyses, northern and rural regions of residence were associated with a 3.05 (95% confidence interval (CI): 0.77, 5.32) and 4.83 (95% CI: 1.37, 8.28) point increase in stigma score, respectively. Living in both northern and rural regions of Ontario was associated with higher HIV Stigma Scale scores. These geographic discrepancies in experiences of HIV-related stigma highlight the need for region-specific programs to reduce HIV-related stigma and to support people living with HIV who are affected by HIV-related stigma, particularly those living in geographically isolated regions. Prior qualitative studies have documented the important impact of HIV-related stigma, and this study supports these observations with quantitative data from a population that is often under-represented in HIV research.

Pharmacists as immunizers, their pharmacies and immunization services: A survey of Ontario community pharmacists

To improve patient access to the influenza vaccine in Ontario, pharmacists have been authorized to administer the vaccine since 2012. A survey was conducted to describe pharmacist immunizers, their pharmacies and immunization services. Ontario community pharmacists completed an anonymous online survey regarding influenza immunization. Descriptive, comparative and multivariate statistics were used to analyze data on pharmacists' personal demographics, current workplace characteristics, immunization certification status and past and anticipated experience vaccinating. Of the 4307 community pharmacists contacted, 18.4% (n = 780) completed the survey. Most (81.3%, n = 603) were certified to administer vaccines, with those practising in urban pharmacies twice as likely to be certified compared to pharmacists practising in rural pharmacies (odds ratio = 2.04; 95% confidence interval, 1.04 to 4.01, p = 0.04). In the past influenza season, 70% of pharmacists had administered over 50 vaccines and 37% worked at pharmacies that had administered more than 300 vaccines. Respondent-provided profiles of immunization services described partnerships with public health, a variety of approaches for in-pharmacy and external advertising and patient vaccine access mainly through walk-in. Ontario community pharmacists demonstrate strong engagement with this expanded scope and there is further capacity for immunization service provision through engaging rural pharmacies, addition of other vaccines and leveraging the positive relationship with public health. Patients and the public benefit from easy access to the service and the additional in-store and external promotion of influenza vaccination that is provided by pharmacists and pharmacies. These provincial benchmarking data provide direction for maintaining and expanding community pharmacist-provided influenza immunization.

Cognitive profile of adults with intellectual disabilities from indigenous communities in Ontario, Canada

ABSTRACTBackground: Interpreting cognitive assessment results for individuals from indigenous communities can be complex. Factors such as culture, language, and education may influence results. Although there is research regarding the cognitive assessment of typically functioning individuals from indigenous communities there is limited information on adults with intellectual disabilities (ID). This is important because adults with ID are frequently referred for cognitive assessment.Methods: 60 adults from indigenous communities were assessed using the WAIS-IV. Scores for verbal and perceptual abilities were compared for age, sex, education, and first language spoken.Results: Higher perceptual abilities were found compared to verbal abilities. Only education significantly influenced scores, and it impacted both verbal and perceptual abilities.Conclusion: Adults with ID from indigenous communities were found to have significantly stronger visual-spatial compared to verbal abilities. More education was correlated with higher scores. Implications for practice include the importance of using a strength-based approach with an emphasis on visual, hands-on learning.

First foods as Indigenous food sovereignty: Country foods and breastfeeding practices in a Manitoban First Nations community

As a concept and in practice, Indigenous food sovereignty (IFS) offers insights into the social, cultural, and environmental challenges of a deficient food system. The associated poor health outcomes of this system include infant and child health issues such as early childhood caries and childhood obesity, and are a grave concern in many First Nations communities. Extant research has failed to consider the role of infant feeding traditions as an element of Indigenous food sovereignty. Breastfeeding and country food (also called traditional food or cultural food) consumption among infants has been long practiced in First Nations communities, resulting in healthier infants. The research described in this article originated with a research project called the Baby Teeth Talk study (BTT). This is a community-based trial which is testing a pre-natal/post-natal behavioural and preventive intervention for early childhood caries (ECC) among pregnant First Nations women and their infants in urban and on-reserve communities in Ontario and Manitoba. In Norway House Cree Nation, located in northern Manitoba, research participants shared stories on the methods used by caregivers for oral health care, including breastfeeding promotion. This paper reviews the literature relating to IFS, breastfeeding and the introduction of country food to infants. Through the voices of grandmothers in one community in Northern Manitoba, Canada, we connect the introduction of country food and breastfeeding to the larger IFS movement and positive health outcomes for infants, and improve the conceptualization and practice of IFS.

PERSPECTIVES OF NON-URBAN GENERAL PEDIATRICIANS ON DIAGNOSING AUTISM SPECTRUM DISORDER

Abstract BACKGROUND Wait times for autism spectrum disorder (ASD) diagnosis contribute to delayed access to ASD interventions, which are most effective at young ages. General paediatricians (GPs) represent a potential resource for increasing diagnostic capacity and decreasing wait times for ASD diagnostic assessments. No current research has yet to solicit perspectives of non-urban GPs on ASD diagnosis. OBJECTIVES The objective of this project was to explore the perspectives of GPs practicing in smaller Ontario communities regarding their diagnostic processes and their role in ASD diagnostic assessment. DESIGN/METHODS We performed a qualitative study using thematic analysis of GPs’ experiences with cases of suspected ASD. GPs from three small/medium-sized Ontario communities (population range: 14,000–64,000) were recruited to provide variation in perspectives. Semi-structured interviews were conducted, transcribed, and coded. A preliminary theoretical framework was developed and sent to participants with a request for feedback (member checking). Feedback did not necessitate any significant changes to the framework. RESULTS 14 GPs participated in interviews (7 from Community A, 4 from Community B, 3 from Community C). All participants considered ASD diagnosis to be in the GP’s scope of practice and part of their service to their community. Many sought out and self-funded additional ASD training as necessitated by their practices. Our framework identified three stages in the diagnosis of ASD: pre-assessment (gathering information prior to the first clinic visit), diagnosis, and service access. All of these stages are influenced by ecological factors including the individual patient/family, individual physician factors, factors reflecting the GP’s community group practice (i.e., how the group has decided its members will approach developmental referrals), and factors concerning the broader system of ASD care. CONCLUSION GPs practicing in non-urban Ontario communities routinely diagnose ASD and see this as part of their scope of practice. Compared to their urban counterparts, they emphasized a stronger sense of responsibility to provide this service to their communities. Strategies aimed at increasing diagnostic capacity should target group practices, increase availability of ASD specific training programs, and improve efficiency of clinic visits through pre-clinic information gathering. Further research regarding accuracy of GP assessments is required.

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

Building Dialogue on Prison Health: Improving Access to Harm Reduction in Federal Prisons

Drawing on a qualitative study with former federal prisoners in Ontario and key medical and community professionals from across the country, this commentary aims to build dialogue with the Correctional Service Canada on an essential harm reduction measure in prison, namely, prison needle and syringe programs (PNSPs). Research participants elucidated the main issues and challenges related to the implementation of PNSPs, listing correctional officers and the union that represents them as a central barrier. As the primary front-line workers in the prison setting and the staff with whom prisoners have the most frequent contact, correctional officers play a significant role in the success or failure of these indispensable programs. Yet despite the more than two decades of international evaluations that have demonstrated PNSP effectiveness in improving staff occupational safety, correctional officers and prison services remain resistant.

Pharmacy patron perspectives of community pharmacist administered influenza vaccinations.

One approach to boost influenza vaccination coverage has been to expand immunization authority. In 2012, the province of Ontario gave community pharmacists the authority to administer the influenza vaccine. This study investigates the perspectives of Ontario pharmacy patrons, who had not recently received this vaccine from a pharmacist, regarding this pharmacist service. A survey was administered in six Ontario community pharmacies to pharmacy patrons who had not received an influenza vaccination from a pharmacist during the previous year. The instrument included questions about influenza vaccination, and knowledge of and attitudes toward vaccines and pharmacist-administered immunization. A total of 541 pharmacy patrons completed the survey (53.9% response rate). About one-third (30.5%) of respondents were not aware that pharmacists could give the influenza vaccine, with younger individuals being less likely to be aware (OR 0.48, 95% CI 0.29-0.77, p < 0.05) and less likely to receive the vaccine annually (OR 0.28, 95% CI 0.19-0.42, p < 0.05). Leading reasons respondents gave as to why they did not receive their influenza vaccine from a pharmacist included not wanting or feeling they needed to be immunized (41.6%) and being used to receiving the vaccine from a physician (16.5%). Concerns about the experience and training of pharmacists and lack of privacy in a community pharmacy were uncommon. Reduced awareness of the availability of pharmacist-provided influenza vaccine is still common. Pharmacists have a significant opportunity to address lack of awareness and vaccine hesitancy issues. They can promote this service to increase influenza vaccination rates among pharmacy patrons who do not utilize this professional service.

Uptake and impact of regulated pharmacy technicians in Ontario community pharmacies.

Since 2010, most provincial Colleges of Pharmacists have licensed pharmacy technicians. The colleges hoped this would give pharmacists time to provide "expanded scope" activities such as medication reviews. Little is known, however, about the uptake and impact of pharmacy technicians on pharmacists' provision of such services. We address these questions using data for Ontario community pharmacies. Data on pharmacists and pharmacy technicians were obtained from the Ontario College of Pharmacists website in September 2016. Their place of employment was used to calculate the number of full-time equivalent (FTE) pharmacists and technicians employed at each community pharmacy. Pharmacy claims data for the 12-month period ending March 31, 2016, were obtained from the Ontario Public Drug Programs (OPDP). These data included number of MedsChecks performed, type of MedsCheck and number of prescriptions dispensed to OPDP beneficiaries. Pharmacy technicians were employed in 24% of the pharmacies in our sample. Technician employment rates were highest in Central Fill pharmacies and pharmacies serving long-term care facilities. In general, pharmacies employing 1 or fewer technician full-time equivalents (FTEs) had a slightly higher probability of providing MedsChecks and, of those that did provide Meds Checks Annuals, provided more of them. Pharmacies that hired 3 or more technician FTEs were markedly less likely to provide MedsChecks. Pharmacies differ in their employment of technicians and in the apparent impact of technicians on the provision of MedsChecks. However, these represent associations. Additional research is needed to assess the causal effect of technician employment on the provision of MedsChecks.

Prospective Teacherss Perceptions: A Critical Literacy Framework

The education of Aboriginal youth is, in some respects, in crisis. Aboriginal communities in Ontario (Canada) are as a group currently experiencing marginalization within the education system. As such it is imperative that efforts be made to better understand the system to improve the success rate for Aboriginal youth. The Ontario First Nation, Metis and Inuit Education Policy Framework (2007) has committed to “improve achievement among First Nation, Metis and Inuit students and to close the gap between Aboriginal and non-Aboriginal students”. English and Language Arts teachers (K to 12) are compelled to consider how the policy discourse of the 2007 Aboriginal Policy Framework implicates upon the socio-political and socio-historical currency of literacy in their instruction. Consequently, this qualitative study examined one component of a large-scale project, in the tradition of grounded theory, including the implications of Aboriginal education policy discourse on literacy instruction as it applies to over 200 prospective teachers enrolled in a Teacher Education Program in Ontario, Canada. Participants identified two themes that they believed Aboriginal students would find most challenging, including: (i) tension with provincial curriculum and, (ii) feelings of misrepresentation.