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Poster presentations

1. Implementation of programs and services by community pharmacists: Barriers, facilitators and operational requirements (review)

Khan A, Vuong V, Iftikhar N, Patel T, Chang F

A literature review of barriers, facilitators of change, and operational requirements involved in the implementation of a pharmacy program in a community pharmacy setting was completed. We completed a literature review of OVID, Embase, Scopus, PubMed and IPA from January 2008 to July 2014. Truncation, Boolean operators, and keyword searching was used to yield relevant resources. A total of 293 articles were retrieved, of which 16 full-text articles were included. Pharmacy layout, lack of documentation and lack of time were commonly identified barriers in implementing new and existing pharmacy services. Facilitators such as relationship with physicians, relationship with patients, remuneration, patient expectation, manpower/staff, communication/teamwork, external support, program training, readiness, re-evaluation of roles and responsibilities, awareness and/or confidence of individual actions and understanding of workflow processes assisted in program implementation. Access to a computer, private counselling area, access to internet, access to published research, and electronic tools are preferred operational requirements of a community pharmacy.

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2. Emerging chronic disease prevention or management programs by community pharmacists (systematic review)

Chang F, Khan A, Wong K, Patel T

Building and expanding on previous literature, this systematic review aims to identify and describe recent chronic disease prevention or management programs delivered by community pharmacists. Programs were implemented for 14 conditions that were prevalent, underdiagnosed and associated with high healthcare costs. Main program components included administering screening tools, referral to other providers, health promotion, and creating and implementing care plans. Results suggested community pharmacists were able to improve clinical and lifestyle outcomes for patients. Programs varied in complexity and design, but both pharmacists and patients shared a high level of satisfaction for interventions delivered in a community pharmacy setting.

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3. Key findings from the overview on pharmacist-led interventions to aid deprescribing and optimizing prescribing in the community-based elderly population

Dolovich L, Rietkoetter S, Lancaster K, Di Nardo L, Nainifard A

Many seniors seen by community-based specialized geriatric services at home and in emergency departments have medication-related issues that are contributing to problems such as cognitive impairment, falls, weight loss and urinary incontinence. These problems often lead to hospitalization and premature avoidable deterioration, concomitantly placing an unnecessary strain on limited health system resources. This poster presents the preliminary results of an overview of systematic reviews aimed at understanding the implementation and impact of community pharmacist-led interventions on prescribing practices among the elderly, and associated patient health outcomes. The results will be applied in developing an Ontario-specific approach to pharmacist consultation for strategic deprescribing in the elderly.

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4. Development of patient questionnaires for evaluating the quality of MedsCheck Annual and MedsCheck Diabetes in Ontario

Lin J, MacCallum L, MacKeigan L

This project sought to develop patient questionnaires for MedsCheck Annuals and MedsCheck Diabetes to measure perceived pharmacist activities, service satisfaction, and change in self-efficacy for medication management or diabetes management. A literature search identified 11 relevant patient satisfaction questionnaires covering patient centredness, medication management, explanation/education, patient empowerment, and patient impact. Items were selected from these domains using pre-established criteria. Additional items were written for perceived activity, and self-efficacy scales for medication management and diabetes management were identified from the literature. Draft questionnaires for MedsCheck Annuals and MedsCheck Diabetes were compiled and reviewed for content validity. After another review to reduce length, a pilot test will be conducted.

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5. Developing the methods for a pharmacy record audit to evaluate MedsCheck Annuals and Diabetes: A pilot study

Pietrobon S, Pojskic N, MacKeigan L

This pilot study sought to determine the format, filing system and comprehensiveness of MedsCheck documentation to inform procedures and quality measures for an audit of MedsCheck Annual and MedsCheck Diabetes assessments in Ontario community pharmacies. Four pharmacies of different ownership types were visited and a sample of seven MedsCheck Annual and five MedsCheck Diabetes records were obtained from each. Documented information was categorized and found to be both variable across and within pharmacies, and limited in scope. Thus, the clinical significance of drug-related problem recommendations could not be assessed. The study results led to many recommendations for the pharmacy audit procedures.

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6. Deprescribing guidelines: Knowledge-to-action process

Pizzola L, Raman-Wilms L, Farrell B, Conklin J, Pottie K, McCarthy L, Rojas-Fernandez C, Bjerre L

The knowledge-to-action process (KTA) is the use of knowledge by practitioners, policymakers, patients and the public. The Deprescribing project has employed a collaborative or integrative knowledge translation approach, engaging stakeholders and knowledge users throughout the entire KTA process to produce relevant and practical findings for end users. Input from visiting knowledge users on process will be sought. This poster presents how the Deprescribing project has employed the KTA framework outlined by Graham et al. in his paper “Lost in knowledge translation: Time for a map?”

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7. Developing, implementing and evaluating “deprescribing” guidelines for the elderly: A mixed-methods approach

Farrell B, Conklin J, Ward N, Irving H, Raman-Wilms L, McCarthy L, Rojas-Fernandez C, Pottie K, Eisener-Parsche P, Sunstrum L

Polypharmacy and inappropriate medication use are growing problems for the elderly. This project aims to develop, implement and evaluate three deprescribing guidelines to assist clinicians in discontinuing medications that may no longer be indicated or may be causing side effects. This poster illustrates our mixed-methods approach to gain consensus on deprescribing priorities, develop and implement guidelines (in six practice sites) and evaluate our processes using developmental evaluation. The project will provide an enhanced understanding of the way in which deprescribing guidelines, along with the processes of creating and implementing them, can influence behaviour change in clinical settings.

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8. Evaluating the development of “deprescribing” guidelines for the elderly: A qualitative approach

Anderson L, Farrell B, Conklin J, Pizzola L, Raman-Wilms L, McCarthy L

Developmental evaluation, through use of ethnographic methods such as interviews, field notes and document analysis, is being used to strengthen the Deprescribing team’s capacity to create and implement guidelines. In this poster, we present the initial outcomes of the evaluation of the process used in creating our first proton-pump inhibitor deprescribing guideline. Recommendations from this analysis have guided choices for team leadership, composition and processes for preparation of the second guideline.

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9. Do stakeholder advisory committees help to promote the uptake and use of new research findings?

Conklin J, Grindrod K, Chun K, Cadieux, M-A, Mercer K

Advisory committees (ACs) are used in numerous Canadian health services research projects, but minimal work has been done to help us understand the potential impact of these committees. This investigation uses a case study approach to understand how a stakeholder AC can ensure that research knowledge is relevant and useful for policy makers, managers, administrators and users. This poster presents early results of a qualitative inquiry that focuses on OPEN’s AC. We will present the results of our literature review of ACs, findings from our initial interviews with committee members, observations at one AC meeting, and our preliminary document analysis.

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10. Program logic model to evaluate MedsCheck in Ontario

Sylvestre A, MacKeigan L, Pojskic N, Dolovich L

A program logic model (PLM) was created to guide the development of a research protocol to evaluate Ontario’s MedsCheck program. Searching electronic databases (Medline, Embase, IPA, CINAHL) and reference lists of retrieved articles was performed to identify methods and measures used in evaluative studies of medication reviews. Based on an existing framework and the MedsCheck program goals and requirements, a PLM was created. Thirty-six relevant studies were identified. The PLM contained the program components of design, service planning, patient recruitment, medication history, patient education, medication assessment and intervention, as well as implementation objectives/measures and short- and long-term objectives/outcomes. The PLM guided development of a population-level research protocol.

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11. Pharmacist and pharmacy student immunization authority: A jurisdictional review

Church D, Johnson S, Pojskic N, Raman-Wilms L, Schneider E, Houle S, Pearson-Sharpe J, Waite N

No comprehensive regulatory review is available that indicates which vaccines pharmacists can administer, restrictions regarding eligible patients, required pharmacist training, and whether pharmacy students are given similar authority. Legislation was manually searched and key informants contacted for Canada, the United States, the UK, Australia, and New Zealand. Pharmacists in Ontario and New Zealand are restricted to administering influenza vaccine, and pilot projects are underway in Australia for pharmacy-based influenza vaccination. Across Canada, the US, and the UK, pharmacists can administer a broad range of vaccines. All jurisdictions require similar training. Pharmacy student legislation is similar although not identical to pharmacist authority.

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12. Developing and implementing inclusive survey questions in pharmacy practice research

Chang F, Cook K, Cooke M, McCarthy L, Sproule B, Waite N

To encourage inclusion of vulnerable population needs and perspectives in OPEN research, the Gender and Vulnerable Populations team developed and distributed a list of suggested survey questions. This poster will present these “best practice” examples, the supporting literature, the rationale for their development, and how these questions have been used to date in OPEN research.

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13. OPENing doors to learning: An overview of capacity building

Waite N, Sproule B, Jennings B, MacKeigan L, Dolovich L, Schneider E, Austin Z, Blay J

The OPEN Capacity Building team will present the planning and framework used to underpin its work done to date. Existing capacity building projects will be described, as will ideas for capacity activities and endeavors. Summit participants will also have an opportunity to contribute thoughts and ideas for possible capacity building activities and topics.