Rural Pharmacists Research Articles

Pharmacists' "Full Scope of Practice": Knowledge, Attitudes and Practices of Rural and Remote Australian Pharmacists.

PurposePoor health outcomes for patients living in rural and remote areas of Australia are often attributed to the lack of a range of accessible health professionals delivering health services. Community pharmacists are already an integral part of these communities and as such are often the most frequently consulted health professionals. The aim of this study was to explore rural pharmacist knowledge and experiences of expanded pharmacy and to identify the barriers and enablers to remote pharmacists providing expanded pharmacy services (EPS), which can be described as services outside of usual medication management tasks.MethodsRural and remote pharmacists (Modified Monash Model (MMM) categories 2–7) participated in an online survey. Descriptive statistics and chi-squared tests were performed and data from open-ended questions were analyzed, categorized into themes and quantitized.ResultsTwo-thirds (n=13, 68%) of rural pharmacists surveyed (n=19) had knowledge of EPS in rural pharmacies and the majority (n=17, 89%) agreed that these services would benefit rural communities. Mental health service referral was considered very/extremely important by the majority (n=16, 84%) of respondents; however, no pharmacists were currently providing mental health screening services while (n=15, 79%) were willing to provide these services. While staff shortages, costs, time and training were indicated to be the main barriers to the provision of EPS, enablers included accessibility of rural pharmacies and a perceived need.ConclusionThis study indicated that pharmacists are already providing some EPS and see value in their implementation; however, what constitutes an expanded service was unclear to some participants. Mental health services were highlighted as most important demonstrating a recognized burden of mental illness in rural and remote locations. Findings from this pilot study will provide further understanding for future development of the pharmacist’s scope of practice and implementation of EPS.

Strategies to increase the pharmacist workforce in rural and remote Australia: a scoping review.

Despite reports suggesting an oversupply of pharmacists, there is currently an inadequate supply in rural and remote Australia. This can lead to a reduction in pharmaceutical services for an already vulnerable population. The objective of this study was to identify strategies for increasing the pharmacist workforce and factors associated with retention in rural and remote Australia Methods: Database searches of Ovid Medline (Medline and Embase), CINAHL and Scopus were conducted. Full text of relevant studies conducted in Australia, reported in English and published between 2000 and 2019 were retrieved. The record titles were independently screened by two investigators, after which abstracts of disputed articles were collected for further evaluation. Where agreement could not be reached, a third independent investigator screened the residual articles for inclusion or exclusion. Overall, 13 articles focusing on the pharmacy profession were retrieved. Strategies that have been employed to increase the rural and remote pharmacist workforce include the establishment of pharmacy schools in rural areas, inclusion of rural content in undergraduate pharmacy curriculum, enrolment of students from rural backgrounds, rural placement and employment of sessional pharmacists. Factors associated with retention were personal, workplace or community factors. There is limited research focusing on the recruitment and retention of pharmacists in rural and remote Australia. Given that pharmacies in rural and remote areas are very accessible and often function as one-stop health hubs, additional personal, workplace and community support should be provided for rural pharmacists and pharmacy students undergoing placements in rural and remote communities.

A qualitative analysis of pharmacists' responses to naloxone inquiries in rural Georgia.

Given their critical gatekeeper function regarding naloxone access in rural areas, the purpose of the current study was to examine rural pharmacists’ knowledge and attitudes regarding naloxone use and access (Georgia, 2019), all 364 rural community pharmacies in Georgia were contacted using “secret shopper” methodology and asked about the availability, accessibility, and use of naloxone. A script provided specific questions for data collection. Callers recorded general notes about the call, including the dispositions and impressions of the pharmacists. Thematic analysis was conducted to identify key themes. Rural pharmacists exhibited two classes of attributes: Active Facilitators and Passive Hindrances. Active facilitators supported callers in their search for naloxone, but passive hindrances discouraged callers in a way that was not perceived to be malicious or intentional. Three types of active facilitators emerged: positive approach, helpful suggestions, and knowledgeable and informed. Two types of passive hindrances emerged: negative attitudes and insufficient knowledge. Community pharmacies are sometimes the only formal healthcare access point in rural communities. It is vital for pharmacists to be active facilitators of naloxone access for maximized public health impact. Specific interventions are needed to increase the ability of rural pharmacists to support access to naloxone.

Perspectives on prescribing hormonal contraception among rural New Mexican pharmacists

ObjectivesNew Mexico is a large rural state with high rates of unintended pregnancy and limited access to contraception. In 2017, the New Mexico Pharmacist Prescriptive Authority Act was amended to allow pharmacists to prescribe hormonal contraception. We explored pharmacist perspectives on prescribing hormonal contraceptives, including perceived barriers and facilitators to implementation in rural New Mexico and opinions on over-the-counter (OTC) access, and prescribing and inserting subdermal contraceptive implants. MethodsThis qualitative study recruited rural pharmacists using contact information from the New Mexico Board of Pharmacy and at a state-level pharmacist conference. We conducted semistructured telephone interviews with pharmacists focusing on benefits and concerns about prescribing hormonal contraception, resources required, perspectives on OTC access, and interest in prescribing and placing contraceptive implants. Deidentified transcribed interviews were analyzed by 2 independent coders for emerging themes. ResultsFrom November 2017 to January 2018, we recruited 25 rural pharmacists and conducted 21 interviews. The majority of participants were male (71%), aged over 60 years (43%), and in practice for over 20 years (52%). Interviewees were mostly positive about prescribing hormonal contraception citing community benefits. The top 3 perceived barriers were training needs, reimbursement, and liability. The top 3 facilitators were the availability of private areas within pharmacies, pharmacists’ role as knowledgeable health care team members, and pharmacist accessibility without appointments. Most pharmacists did not support OTC access to hormonal contraception, and over half were interested in certification to prescribe and place subdermal contraceptive implants. ConclusionNew Mexico pharmacists identified community benefits of pharmacy access to hormonal contraception and were interested in training. Several barriers must be addressed to realize the potential of this practice expansion.

Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky

BackgroundBuprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. MethodsIn this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. ResultsTwelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a “Drug Enforcement Administration (DEA) cap” on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. ConclusionsInitiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.

Exploring Opportunities to Leverage Pharmacists in Rural Areas to Promote Administration of Human Papillomavirus Vaccine.

Rural pharmacists have been identified as potential partners, along with health care providers, schools, and public health agencies, in administering and promoting the human papillomavirus (HPV) vaccine. We sought to understand the role of pharmacists in this work. We interviewed 11 pharmacists working at independently owned pharmacies in Iowa to explore their perspectives on HPV vaccine administration and promotion. Most pharmacists agreed that HPV vaccination was within their professional scope. They identified factors that facilitate vaccine administration (eg, accessibility of pharmacies). They also reported personal barriers (eg, lack of information, concerns about safety) and organizational barriers (eg, time and staff capacity). Future work should focus on alleviating barriers and building on strengths to improve vaccination rates and ultimately prevent HPV-related cancers.

The Rural Pharmacy Practice Landscape: Challenges and Motivators.

BackgroundHealth outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists’ choice to practice rurally.MethodsRural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice.ResultsLack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of “rural and remote communities as socially isolated was a stigma that needed to be stopped”.ConclusionThis study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce.

'The public rely on me a lot': Rural pharmacists' perspectives on their roles in oral health care.

To examine rural pharmacists' perspectives on their roles in oral health in rural communities and collaborations with dental practitioners. A qualitative research study using face-to-face, semistructured interviews. Interview data were thematically analysed with the assistance of Nvivo 10. Eleven rural communities across rural Tasmania. Twenty community pharmacists. Five major themes emerged: (i) barriers for patients to access dental services; (ii) oral health presentations to rural pharmacies; (iii) roles of pharmacists in oral health care (subthemes: advice; health promotion; and referrals); (iv) collaborations with dental practitioners; and (v) oral health education and training. This study suggests that rural community pharmacists had advisory and referral roles in oral health and acknowledged that they could play a greater role in oral health promotion. It was suggested that oral health could be incorporated into existing pharmacy health promotion and surveillance activities. There was a lack of collaboration between pharmacists and dentists or dental services and limited oral health education and training provided to pharmacists. Stronger collaboration between pharmacists and dental practitioners and better oral health training for pharmacists may enhance their role in promoting oral health within rural communities.

The Effect of Demographic and Social Factors on the Decision-Making of Community Pharmacists in Ethical Dilemmas.

Objective:The objective of the study is to investigate the effect of demographic and social factors on the decision-making of community pharmacists when confronted with ethical dilemmas during their professional practice.Methods:This was a questionnaire-based, cross-sectional study. A total of 1057 community pharmacists were approached. The final participants were 742. Independent-sample t-test and one-way analysis of variance were used to analyze the factors (age, gender, work experience, education qualification, number of pharmacists per pharmacy, and pharmacy location).Findings:Older pharmacists, experienced pharmacists, and urban pharmacists have less ethical dilemma compared to the younger pharmacists, less work experience pharmacists, and rural pharmacists, respectively.Conclusion:Individual factors such as age, gender, work experience, and educational level and organizational factors such as the number of pharmacists in a pharmacy and location of pharmacy may influence the ethical dilemma of community pharmacists.

Exploring influences on pharmacists' and students' ethical reasoning in a changing practice landscape in Australia.

Background Practising pharmacists continuously develop their ethical reasoning skills, which evolve with practice experience and exposure to challenging scenarios. Considering the recent expansion of the roles of pharmacists and the paradigm shift in pharmacy practice, it is timely to explore community pharmacists' attitudes regarding the importance of ethics and their ethical reasoning. Objective To explore underlying factors influencing community pharmacists' and pharmacy students' ethical reasoning and attitudes towards pharmacy ethics, ethical reasoning processes and perceived current dilemmas. Setting Practising registered community pharmacists, pharmacists with provisional registration (interns) and final year pharmacy students in Australia. Method Two focus group discussions and two interviews were conducted with 16 Western Australian community pharmacists, interns and students. Participants were purposively selected for gender, background, practice setting, and practice experience. Main outcome measure Emerging themes embracing important influences on community pharmacists', interns' and students' ethical reasoning and perceived current ethical dilemmas and challenges. Results Two major themes embraced participants' ethical reasoning processes and conduct: (1) fundamental underpinning, from personal values and practice exposure, and (2) paradigm influenced, such as the changing healthcare landscape, expansion of roles, management of dilemmas, and competence. Increased frequency and complexity of ethical dilemmas related to role expansion. Rural pharmacists experienced unique ethical dilemmas in relation to practice isolation, privacy and confidentiality. Conclusion Changes in the community pharmacy practice environment has increasingly exposed pharmacists to more complex ethical dilemmas. Pharmacists practising in rural communities experience unique challenges. Structured and sound ethical reasoning skills are essential as pharmacists are faced with contemporary challenges.

Scoping the impact of curriculum and placement on the rural pharmacy workforce.

The objective of this review was to scope the impact of university rural curriculum and rural clinical placements on students' intentions to practise rurally and rural pharmacists' choice of rural practice. The scoping review used Arskey and O'Malley's methodological framework, searching the following databases: MEDLINE, CINAHL, Informit and Scopus. This scoping review followed PRISMA for article reporting. Studies were selected from those conducted in Australia, USA, Canada and Africa. Pharmacy undergraduate students, interns, registered and academic pharmacists were included. The pharmacy curriculum at universities and placements undertaken, specifically in rural and remote settings, were evaluated to determine their influence on intention to practise as a rural pharmacist. The search strategy generated 294 records, 31 of which were included in the scoping review. Key findings were mapped to two domains, which broadly included the impact of rural placements and curriculum on intention to practise rurally. Some universities have attempted to introduce a rural curriculum, but reported resources as a barrier and the lack of resulting evidence of students' intention to practise rurally. Although results indicate rural placements have had a positive influence on students' intention to work rurally, this intention has been measured immediately after exposure to rural practice and might not reflect future intentions. This review highlights significant gaps in the impact particularly of a rural curriculum and rural clinical placements in relation to the current rural pharmacist workforce. A greater understanding of this topic may guide recommendations for future strategies to address rural pharmacy workforce maldistribution.

Perspectives on prescribing hormonal contraception among rural New Mexican pharmacists

Perspectives on prescribing hormonal contraception among rural New Mexican pharmacists

Influencing the future of rural-focused pharmacy education: Identifying factors pertinent to pharmacy practice in rural health environments

IntroductionTo identify themes regarding the skills used on a regular basis by pharmacists practicing in rural areas. MethodsA cross-sectional qualitative survey was administered to pharmacists working in a non-clinical capacity in rural community and hospital practice. Pharmacists were identified in conjunction with departments of experiential education, boards of pharmacy, and other rural health experts. Contacts were interviewed using a semi-structured approach with thematic saturation determining the number of interviews. Themes were identified by reviewing interview notes and transcripts for repeated phrases, concepts, and ideas then compared with the literature. ResultsFifteen pharmacists practicing in rural areas were interviewed. Themes related to practice environment, patient population, skills used by rural pharmacists, preparation of students, and continuing education needs were identified. Many of the identified themes are corroborated by published literature. One pharmacy-specific theme not corroborated was “pharmacy specialization is not helpful”. Discussion and conclusionsThe results of this study coupled with data from rural medical education may be useful for educators developing rural-focused coursework via reverse design.

A Rural Scope of Practice for Pharmacists

Introduction : Too few medical graduates opt to become general practitioners or family physicians, particularly in rural areas. Predicted to worsen in the next decade as current practitioners retire, to meet health needs it will be essential to make the best use of all available health professionals. Building on existing collaboration and with better use of technology, community pharmacists have the skills and knowledge to provide expanded services. A ‘rural’ scope of practice for pharmacists, allowing more autonomous practice, could improve health provision and pharmacist retention in rural areas. Objective : To show how pharmacists could better meet the health needs of rural New Zealanders by providing accessible, safe and affordable care in line with New Zealand’s health strategies. Targeted population : Policy makers, health providers or funders, pharmacists and other health professionals practising in rural or provincial areas. Exemplified by the author’s experience as a community pharmacist in Greymouth, a provincial town on the West Coast of New Zealand’s South Island. Highlights : There is a high reliance on locums due to the shortage of medical practitioners in rural areas. A lack of continuity of care has been associated with increased hospital admissions. Community pharmacists are highly accessible with a quarter of New Zealand’s population visiting a pharmacy every month. Comparisons are drawn with changes in scopes of practice for New Zealand health professionals and developments in expanded pharmacist services in other jurisdictions; the United Kingdom and Canada. There is potential for pharmacists to work more collaboratively with better integration, using technology to build on existing collegial relationships. A role between the current ‘pharmacist’ and ‘pharmacist prescriber’ scopes of practice would allow more autonomous practice by pharmacists in rural or hard to staff areas. Using existing linkages with university rural outposts could give pharmacists additional training and a transferable qualification while improving health care provision. Various solutions are offered, to improve services available from rural pharmacists, including creating a vocational scope in rural pharmacy. A ‘rural’ scope of practice, not available to urban pharmacists, fits with New Zealand’s current health policy framework which encourages team work and top of scope practice. Transferability : Rural scopes of practice apply in some medical and nursing fields. Expanded scopes of practice for pharmacists have been successful in other jurisdictions. Rural scopes of practice could be applied to pharmacists and other allied health professionals practising in rural or high needs areas. Conclusions : Experience elsewhere shows pharmacists can use their skills to do more for patient care. Where offered, these services are safe, effective and well received by patients while improving pharmacist job satisfaction. They reduce presentations to medical practices or emergency departments, leading to better use of resources. By providing a richer professional environment, a rural scope of practice for pharmacists could incentivise relocation to areas difficult to staff.

Elucidating the endocrine therapy experience of South Carolina breast cancer survivors.

186 Background: Literature consistently shows high discontinuation and non-adherence rates for patients taking endocrine therapy (ET) for breast cancer treatment. The aim of this study is to understand from the breast cancer survivor perspective which modifiable aspects have the greatest impact on the likelihood of ET continuation. Methods: Twenty-two hormone receptor-positive breast cancer survivors under age 64 who had been prescribed ET since 2000 were recruited for participation in focus groups conducted in four South Carolina locations. Qualitative data analysis was completed by a three-member team using an inductive narrative approach. Themes were examined by participant decision to continue or discontinue ET. Results: Participants’ conversations centered around a quality of life cost-benefit analysis that they felt was unique to the individual and could not be generalized by providers. Main themes included the significance of the patient/provider relationship, the desire for a more holistic approach to care, and the need for affirmation in the decision to take ET (i.e. through breast cancer social network, family, faith, research). There was clear support for the utility of multidisciplinary cancer care teams. The roles of nurse navigator and rural pharmacist were specifically highlighted. Participants expressed concerns regarding ET’s damage to their bodies, and participants discussed the dilemma of not having enough time to spend caring for self. Conclusions: The few studies that have addressed currently used interventions to improve adherence showed little to no improvement over usual care. It is imperative that research be conducted that employs a patient-centered perspective. Knowledge gained through further study exploring patient concerns, multidisciplinary teams, and holistic care are needed. There is also a need for novel patient-centered interventions in research to improve compliance and enhance the ET experience for breast cancer survivors.

Rural and remote pharmacists: lessons from beyond the borders

Rural and remote pharmacists: lessons from beyond the borders

Improving medication adherence and reducing treatment costs through a high-touch pharmacist intervention in a dual-eligible medicare population with hepatitis c

Electronic prescribing (ERx) is the ability for prescriber to send a digital prescription directly to a pharmacist through a dedicated secure network. A number of federally funded incentives such as the health information technology for economic and clinical health (HITECH) and Meaningful Use standards have led to ERx implementation. ERx is an integral part of primary care practice and today most community pharmacies are enabled to accept e-prescriptions.Little is known about the experience of rural pharmacists, primary care providers and patients regarding e-prescribing. This paper reports on the results of ERx from their perspectives. The findings are a portion of a larger qualitative descriptive study focused on the meaning of Meaningful Use in remote rural communities. One remote rural community in the Pacific Northwest was used for this research endeavor.Explore understandings of e-prescribing from both pharmacist and primary care provider perspective.Explore patients' understandings and experiences of e-prescribing.The conceptual model for this research was the Ecological Transactional Model. This model informed the research design, interview questions and analysis. A qualitative descriptive methodology – focused ethnography was used for this study. Six key informant interviews, 14 patient interviews and 15 hours of participant observation provided the data. Data analysis occurred collectively between a social pharmacy researcher, a primary care nurse practitioner–researcher and pharmacy graduate students. The research qualitatively identified contextual understandings and dimensions of ERx in this setting.Based on a focused ethnographic methodology, contextual understandings of rurality and role identity, both pharmacist and primary care provider, were explored. Perspectives on ERx of patients, clinic manager and RN staff were also elicited. Three dimensions of ERx were identified – technological, structural and communication.The structural, technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients.

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

Background:The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services.Objective:To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas.Methods:This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota.Results:Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community.Conclusion:Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.

Pharmacy and primary care perspectives on e-prescribing in a rural community: A focused ethnography.

Electronic prescribing (ERx) is the ability for prescriber to send a digital prescription directly to a pharmacist through a dedicated secure network. A number of federally funded incentives such as the health information technology for economic and clinical health (HITECH) and Meaningful Use standards have led to ERx implementation. ERx is an integral part of primary care practice and today most community pharmacies are enabled to accept e-prescriptions. Little is known about the experience of rural pharmacists, primary care providers and patients regarding e-prescribing. This paper reports on the results of ERx from their perspectives. The findings are a portion of a larger qualitative descriptive study focused on the meaning of Meaningful Use in remote rural communities. One remote rural community in the Pacific Northwest was used for this research endeavor. Explore understandings of e-prescribing from both pharmacist and primary care provider perspective. Explore patients' understandings and experiences of e-prescribing. The conceptual model for this research was the Ecological Transactional Model. This model informed the research design, interview questions and analysis. A qualitative descriptive methodology - focused ethnography was used for this study. Six key informant interviews, 14 patient interviews and 15hours of participant observation provided the data. Data analysis occurred collectively between a social pharmacy researcher, a primary care nurse practitioner-researcher and pharmacy graduate students. The research qualitatively identified contextual understandings and dimensions of ERx in this setting. Based on a focused ethnographic methodology, contextual understandings of rurality and role identity, both pharmacist and primary care provider, were explored. Perspectives on ERx of patients, clinic manager and RN staff were also elicited. Three dimensions of ERx were identified - technological, structural and communication. The structural, technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients.

'Pharmacy on the edge': a collaborative to support the development of remote and rural pharmacist career pathways

'Pharmacy on the edge': a collaborative to support the development of remote and rural pharmacist career pathways