Scope Of Practice For Pharmacists Research Articles

Characterizing Current and Optimal Involvement of Hospital Pharmacists in the Discharge Process: A Survey of Pharmacists in British Columbia.

Transitions of care represent a vulnerable time when patients are at increased risk of medication errors. Medication-related problems constitute one of the main contributors to hospital readmissions. Discharge interventions carried out by pharmacists have been shown to reduce hospital readmissions. Although clinical pharmacists in British Columbia are involved in discharges, their degree of involvement and the interventions they prioritize in practice have not been fully elucidated. To characterize the current involvement of BC hospital pharmacists at the time of discharge, to identify which discharge interventions they believe should be prioritized, and who they feel should be responsible for these interventions, as well as to identify strategies to optimize the discharge process. A survey of BC hospital pharmacists was conducted in January and February 2022. The survey included questions about pharmacists' current involvement at the time of discharge, interventions required for a successful discharge, solutions for optimizing the patient discharge process, and participants' baseline characteristics. The survey response rate was 20% (101/500). Pharmacists reported performing all interventions for less than 60% of their patients. Interventions such as medication reconciliation on discharge, medication education, and ensuring adherence were considered very important for a successful discharge and were considered to be best performed by pharmacists. Solutions for optimizing the discharge process included improved staffing, weekend coverage, timely notification of discharge, and prescribing by pharmacists. Despite the belief that most interventions listed in the survey are necessary for successful discharge, various barriers prevented pharmacists from providing them to all patients. Increased resources and expanded scope of practice for pharmacists could reduce hospital readmissions and enable broader implementation of discharge interventions.

Implementation of pharmacist-led services for sexual and gender minorities: A multisite descriptive report.

This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida. Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence. The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care.

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

BackgroundPrescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. ObjectivesTo explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. MethodsEight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. ResultsThere were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. ConclusionsThis study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.

Implementation and expansion of inpatient and ambulatory pharmacist credentialing and privileging at an academic medical center.

This article highlights one academic medical center's effort to implement a complete credentialing and privileging (C&P) process for both inpatient and ambulatory clinical pharmacists. The C&P process offers a recognized method to advance pharmacy practice. Credentialing is defined as a process whereby an individual is deemed qualified in a specific subject matter area. Privileging is the process whereby an institution grants authority to an individual to perform services based on credentials. Federal guidelines permit pharmacists to obtain the same level of privileges as professional medical staff, such as physicians, if relevant state laws allow for the corresponding pharmacist scope of practice. States establish laws and regulations that specify the scope of practice for various types of licensed healthcare professionals, including pharmacists. Many health systems have attempted pharmacist C&P practices in both the inpatient and ambulatory care setting with varying degrees of success and reach. Privileged pharmacists provide established benefits and value to other members of the healthcare team. Oregon Health & Science University (OHSU) pursued C&P for both inpatient and ambulatory clinical pharmacists. Initiation and implementation processes were complex and accompanied by a variety of challenges. OHSU operates with advanced pharmacy practice integrated into the interdisciplinary patient care team. Pharmacist C&P allows pharmacists to demonstrate significant clinical benefits and quality improvement in patient care delivery in both inpatient and ambulatory settings.

Impact of the COVID-19 Controlled Drugs and Substances Act exemption on pharmacist prescribing of opioids, benzodiazepines and stimulants in Ontario: A cross-sectional time-series analysis.

Due to the coronavirus disease 2019 (COVID-19) pandemic, Health Canada issued an exemption to the Controlled Drugs and Substances Act (CDSA) on March 19, 2020, enabling pharmacists to act as prescribers of controlled substances to support continuity of care. Our study investigates utilization of the CDSA exemption by Ontario pharmacists with the intent to inform policy on pharmacist scope of practice and to improve future patient outcomes. We conducted a time-series analysis of pharmacist-prescribed opioid, benzodiazepine and stimulant claims data using Ontario Narcotics Monitoring System (NMS) data between January 2019 and December 2021. We used ARIMA modelling to measure the change to these classes of claims and to opioid claims containing quantities greater than a 30-day supply. Postexemption, the average weekly number of pharmacist-prescribed opioid, benzodiazepine and stimulant claims rose by 146% (160 to 393 claims/week), 960% (49 to 515 claims/week) and 2150% (8 to 177 claims/week), respectively. There was a 2-week lag period between the time of announcement and the statistically significant increase in claims on April 5, 2020(p < 0.0001). The total number of claims for opioid quantities exceeding a 30-day supply decreased by 60%. Cumulative pharmacist-prescribed claims accounted for under 2% of the total NMS claims. Ontario pharmacists used the CDSA exemption but were prescribing at low rates. These findings suggest an effective change to pharmacy practice as the low rates show pharmacists used the exemption as a last line of defense. This may lead to further studies exploring treatment breaks during the COVID-19 pandemic and future changes to pharmacist scope to benefit patients.

Call to action: The pharmacist’s role in improving contraceptive knowledge and access

Pharmacists have the knowledge and training to participate in contraceptive education and management and should feel empowered to do so. Advocating for legislation to expand the pharmacist’s role in this setting can improve patient access to hormonal contraceptives. As the nation digests the Supreme Court’s decision to overturn Roe vs. Wade, many health care providers have stopped to think about what our role will be in this uncertain future. Approximately, 20 states/jurisdictions have legislation in place that allows pharmacists to prescribe or dispense oral contraceptives without a prescription; broadening the scope of practice for pharmacists increases patients’ access to care, and may improve overall adherence. When compared to clinician-initiated contraception, pharmacists were more likely to prescribe contraception to eligible women and had a higher rate of continuation at 12 months. In addition, pharmacists providing education to both patients and prescribers can help debunk misinformation on hormonal contraceptives which may impact access and adherence. With the recently changing federal—and in many instances state—legislation, pharmacists will need to seek out more opportunities to facilitate access to hormonal contraceptives and increase knowledge surrounding emergency contraceptive options and other medications used for reproductive health. Pharmacists have the knowledge and accessibility to assist in contraceptive care. Now, more than ever, pharmacists’ involvement in hormonal contraceptive care will be a necessary step to ensure that our patients receive the appropriate care they deserve.

New interprofessional health sciences precepting legislation provides opportunity to assess student and preceptor knowledge, experience, and confidence

Recent passage of a bill in Washington State permits licensed health professionals to serve as interprofessional preceptors for students in volunteer service settings where the knowledge and skills being utilized fall under the scope of practice of both the preceptors and students involved. Passage of the bill was made possible through strong advocacy efforts among an interprofessional team of students. The new law allows for increased interprofessional service-learning opportunities for both students and preceptors. The COVID-19 pandemic brought abrupt changes to in-person service learning for health sciences students. Yet, when an urgent need to provide COVID-19 testing arose, the new law made it possible for volunteer preceptors (n = 7) from medicine and nursing to supervise pharmacy students (n = 12) who provided COVID-19 testing at a mobile community clinic. Following the multi-day testing event, preceptors and students completed an electronic survey, documenting positive changes in interprofessional knowledge, skills, experience, and attitudes. • New law allows precepting across health professions in service-learning settings. • Preceptors and students benefit from interprofessional service-learning opportunities. • Interprofessional precepting expands non-pharmacist preceptor understanding of pharmacy student training and pharmacist scope of practice.

Report of the 2020-2021 Strategic Engagement Standing Committee

EXECUTIVE SUMMARY For the American Association of Colleges of Pharmacy (AACP), strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The 2020-2021 Strategic Engagement Standing Committee was charged with identifying effective strategies to leverage the temporary expansion of pharmacist practice capabilities granted during the COVID-19 pandemic for sustained practice. The group was also tasked with looking at ways to partner with the Association of American Medical Colleges (AAMC), our medicine counterparts to develop a plan for collaborating with them to advance interprofessional practice. In this unique year, all standing committees were charged with reading all the reports last year to put President Lin's charges into perspective with the hopes of carrying over the overall theme and work of the previous years committee. Overall, throughout the COVID-19 pandemic, there have been several expansions on the scope of practice for pharmacists and vary by state. We hope to draw out some of those expansions to see how we can build upon efforts to make those permanent.

Pharmacy in the future: A consumer perspective

Pharmacy in the future: A consumer perspective

“The gatekeepers in prevention”: Community pharmacist perceptions of their role in the opioid epidemic

Background: Community pharmacists are at the frontline of patient care, yet their role in the opioid epidemic remains unclear. This qualitative study examines the perception of community pharmacists about their role in the opioid epidemic and challenges to fulfilling this role. Methods: A secondary analysis of cross-sectional survey data from an Indiana census of community managing pharmacists was conducted. Qualitative data were coded using a priori and emergent themes. A priori categories included the perceived role of pharmacists in the opioid epidemic and perception of practice barriers. Results: A total of 215 Indiana community managing pharmacists participated in this study. Pharmacists understood themselves as gatekeepers in preventing opioid misuse and overdose. Reported pharmacy practices included providing patient education and communicating with prescribers. Challenges to fulfilling this role included pharmacy structure and operation, lack of patient and provider clarity about pharmacist scope of practice, and pharmacist perception that that there is no available discretionary time to support additional services. Conclusion: Pharmacists believe they have a vital role in combatting opioid misuse and overdose but are hampered by structural aspects of pharmacy practice and lack of recognition of their role. Pharmacy associations and policy partners are encouraged to identify opportunities to address these barriers.

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

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

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

Helping Québec Pharmacists Seize the Vaccination Service Opportunity: The Pharmacy Best Practice Workshops.

Vaccinations are a safe and effective way to protect against infectious diseases. The World Health Organization estimates vaccines have saved more lives than any other interventions and every year about two to three million deaths are averted worldwide through immunization. To improve vaccination coverage, pharmacists have been increasingly involved in immunization roles in their communities—as advocates, educators, and immunizers. Community pharmacy-based vaccination services have increased both in the number of immunization providers and the number of sites where patients can receive immunizations. In Canada, health care is under provincial legislation—and so, there are distinct differences in scope of pharmacist practice across the country. Prior to the COVID-19 outbreak in early 2020, in Québec, Canada’s second-largest province, pharmacists did not have the authority to administer vaccines. To help prepare pharmacists in Québec to become immunizers, we developed and deployed a series of accredited workshops. In these facilitated workshops, pharmacists were able to share best practices that may lead to providing effective vaccination services, identify common competency gaps, discuss effective patient communication skills, and determine how to target the most vulnerable population groups. Participants were also asked to evaluate the workshop. Our results indicate the evaluation was very reliable in measuring participant satisfaction (Cronbach’s α = 0.94) and pharmacists commented that the workshops’ learning outcomes exceeded their expectations, and the topics covered were relevant and applicable. The evaluation also asked participants to identify weaknesses of training, so future educational interventions can be planned accordingly. We believe this work will contribute to the continual growth and advancement of the pharmacy profession in Canada.

Medicaid reimbursement for pharmacist services: A strategy for the pharmacy profession.

Reimbursement for pharmacist services is complex due to a different set of rules for each payer. State legislatures, regulators, and professional licensing bodies have expanded the scope of practice for pharmacists in many states, representing a significant opportunity for third-party payers, including the Centers for Medicare and Medicaid Services, to enable and expand patient access to, and receipt of, care from pharmacists. This paper will introduce the term "other licensed practitioner" and describe how a state Medicaid program may include covered services provided by a pharmacist practitioner using the Medicaid state plan amendment process. In recent years, states have made great strides in training and educating high-quality pharmacist practitioners, expanding the scope of practice in all states, incorporating a credentialing and privileging process, and expanding the use of collaborative practice agreements with physicians and nurse practitioners. Pharmacists are well-positioned, essential members of the healthcare team, providing a spectrum of clinical and prevention services that increase access to care and improve health outcomes. A broad coalition of stakeholders including states, the federal government, pharmacy organizations, and other parts of the health ecosystem, working together, can better address the health needs of a state and its Medicaid beneficiaries. Pharmacist practitioners across different settings of care can augment public health efforts, as well as primary and specialty care practices. State efforts should include enrollment and reimbursement of pharmacist practitioners as Medicaid providers for pertinent Medicaid-covered services.

Travel Medicine Curricula across Canadian Pharmacy Programs and Alignment with Scope of Practice.

Limited research exists on pharmacy students’ training in travel medicine, and how this aligns with scope of practice. This research aimed to detail travel medicine education across pharmacy programs in Canada and map this against the scope of practice for pharmacists in each university’s jurisdiction. A survey based on the International Society of Travel Medicine’s Body of Knowledge was developed and distributed to all Canadian undergraduate pharmacy schools to identify topic areas taught, teaching modalities utilized, and knowledge assessment performed. Educational data was collected and analyzed descriptively, and compared to pharmacists’ scope of practice in the province in which each university is located. Training provided to students varied significantly across universities and topic areas, with topics amenable to self-care (e.g., traveller’s diarrhea and insect bite prevention) or also encountered outside of the travel context (e.g., sexually transmitted infections) taught more regularly than travel-specific topics (e.g., dengue and altitude illness). No apparent relationship was observed between a program’s curriculum and their provincial scope of practice. For example, training in vaccine-preventable diseases did not necessarily align with scope related to vaccine administration. Alignment of education to current and future scope will best equip new practitioners to provide care to travelling patients.

Competence and confidence with prescribing in pharmacy and medicine: a scoping review.

Prescribing is a growing scope of practice for pharmacists. The objective of this scoping review is to explore themes within the literature related to prescribing competence and confidence in the disciplines of pharmacy and medicine. Online databases MEDLINE, EMBASE and Global Health were used to identify articles from inception to October 2018. Articles describing either the competence or confidence of physician, pharmacist or student prescribing, including inappropriate prescribing and prescribing errors were included. After applying the inclusion and exclusion criteria, 33 eligible articles remained. Many studies demonstrate that medical students and junior doctors are not competent in prescribing when they enter practice, and their perceived confidence is often higher than their assessed competence. There were fewer studies about pharmacist competence and confidence with prescribing; however, they described pharmacists that felt competent to prescribe but lacked confidence. Themes from the review included self-awareness, lack of education and educational improvements, prescribing errors and resources, prescribing culture and barriers to prescribing, gender differences and benefits to prescribing. There is little consensus from the outcomes of these studies related to prescribing competence or confidence. While some reflect positively on prescribing competence and confidence, others show major deficits in competence and lack of confidence. Further research needs to be done to evaluate pharmacist competence and confidence with respect to prescribing.

Gagné’s 9 Events of Instruction With Active Learning: Teaching Student Pharmacists How to Measure Blood Pressure

As the scope of practice for pharmacists expands to include rendering physical assessment procedures, colleges and schools of pharmacy are increasingly incorporating various assessment skills into the curriculum. Pharmacy practice faculty are increasingly tasked with teaching and assessing learners on professional competency in entrustable professional activities and skills such as manual blood pressure measurement. Manual measurement using a sphygmomanometer and a stethoscope is considered the gold standard with regard to evaluating blood pressure. As pharmacy faculty begin to develop courses on physical assessment, a step-by-step, evidence-based andragogic/pedagogic method for designing, planning, instructing, and assessing learner proficiency is essential. The principles and techniques of active learning are frequently discussed and increasingly incorporated into the curricular and teaching philosophies of colleges and schools of pharmacy. However, the practical application of andragogic/pedagogic principles toward lesson planning and curation of active learning is infrequently discussed. In this article, we aim to illustrate a deliberate approach to designing and operationalizing active learning for auscultatory manual blood pressure measurement within the framework of Gagné’s 9 events of instruction. For each design and instruction step, we propose user-friendly, high-impact operational practices derived empirically from education science, experience, and observations. Schematically, the approach described is intended to also facilitate instructor metacognition and knowledge building of applied andragogy/pedagogy through pre hoc, ad hoc, and post hoc reflection. Pragmatically, the approach accommodates active learning lesson planning, promotes transparency of teaching and learning, and is generalizable and applicable toward the instruction of various physical assessment procedures within the health professions.

Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion

In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.

Facilitators and barriers to implementing pharmacist-prescribed hormonal contraception in California independent pharmacies

ABSTRACTIn 2013, California passed legislation to expand the scope of pharmacist practice, including authorizing pharmacists to prescribe hormonal contraception. Pharmacist-prescribed contraception was largely unavailable across the state in 2017. This study aimed to identify barriers and facilitators to offering this service in California independent pharmacies. To do so, we thematically analyzed qualitative data from structured interviews with 36 pharmacists working in independent pharmacies in 2016–17. We found that pharmacists anticipated general benefits from expanding their roles to prescribe contraception, including increasing health care access and decreasing costs. In contrast, described barriers were concrete, including lack of financial incentives and business risks for independent pharmacies. Specific barriers to prescribing hormonal contraception included time required to screen and counsel women about contraception and concerns that pharmacist-prescribed contraception would increase liability and lead to patients seeking health care less frequently. This study suggests that incentives and barriers identified by the respondents are likely to have varied and unequal impacts, with immediate barriers being potentially prohibitive for pharmacists to prescribe contraception. For independent pharmacies, perceived business risks and lack of insurance reimbursement may outweigh professional support for prescribing contraception, limiting the public health impact of legislation that should increase contraceptive access.

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.