Oral presentation abstracts • Day 1
Session 1: Pharmacy Services Research
1. A mixed-methods evaluation of MedsCheck and Pharmaceutical Opinion Programs in Ontario
Linda MacKeigan, Lisa Dolovich, Nedzad Pojskic, Lori MacCallum, Giulia Consiglio, Lusine Abrahamyan, Petros Pechlivanoglou, Suzanne Cadarette, Nadine Ijaz, Bojana Petrovic, Valeria Rac, Elizabeth Bojarski
In 2007 Ontario implemented MedsChecks (MC). MC Diabetes followed in 2010 and Pharmaceutical Opinions (PO) in 2012. This three-year mixed-methods study characterizes providers and recipients of these services, identifies determinants of service uptake, and assesses service quality and clinical significance. Provision of the services grew over time, though MC Annual recipients became less complex. Patients with a prior MC, new drug, or recent hospitalization were more likely to receive a MC; those with multiple or inappropriate medications were less likely. MC Annual documentation was insufficient to assess quality. Half of POs were ineligible; for 67% of the eligible POs, the perceived clinical impact was moderate to major.
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2. Pharmacists prescribing: Present and future
Lisa McCarthy, Elizabeth Bojarski, Nancy Waite, Lisa Dolovich, Ida-Maisie Famiyeh, Kelly Grindrod, Nedzad Pojskic
Independent prescribing by Ontario pharmacists was a key component of scope of practice expansion in 2012. It includes the authority to renew chronic medications, adapt the dose, regimen, route or formulation of a prescription and initiate therapy for smoking cessation. As part of OPEN, our team has conducted a series of studies to understand the uptake and impact of this prescriptive authority on patients, pharmacists and other stakeholders. In this presentation, we will highlight selected findings from these studies. We will also discuss additional research gathering stakeholders’ and patients’ views about opportunities for further expansion of prescriptive authority in Ontario.
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3. Pharmacists as immunizers: What has been the uptake and impact of community pharmacist–administered influenza vaccinations?
Nancy Waite, Sherilyn Houle, Wasem Alsabbagh, Dana Church, Jeff Kwong, John Papastergiou, Nedzad Pojskic, Eric Schneider, Lalitha Raman-Wilms
Members of OPEN’s Immunization team continue to assess the uptake of community pharmacist–administered influenza vaccinations in Ontario since 2012 and have found a net increase of 468,666 influenza vaccinations has been realized through pharmacist-administered vaccinations. Ontarians vaccinated by pharmacists differ from those vaccinated by physicians, and consistently report high levels of satisfaction. Both patients and pharmacists tend to support the expansion of pharmacists’ immunization authority. Going forward, the team will work to determine the return on investment for pharmacist-administered influenza immunizations; design a typology of community pharmacy influenza vaccination service seekers and avoiders; and develop methods to evaluate the uptake of pharmacist-administered travel vaccines.
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4. Ontario Pharmacy Smoking Cessation Program: An updated descriptive analysis by Local Health Integration Network, 2011–2015
Suzanne Cadarette, Giulia Consiglio, Michael Chaiton, Lisa Dolovich, Sarah Guilcher, Zahava Rosenberg-Yunger, Beth Sproule, Lindsay Wong
The Pharmacy Smoking Cessation Program was launched on September 1, 2011 to provide reimbursement to community pharmacists for smoking cessation assessments and follow-up visits. The results from our prior applied health research question described patients receiving and pharmacies offering smoking cessation services over the first two years of the program (Can J Pharm 2015; 148(1):29–40). We updated our original analysis with two more years of data and have compared characteristics of initial program recipients (2011/09 to 2013/08) to more recent program enrollees (2013/09 to 2015/03), and examined repeat service use, adherence to pharmacotherapy and regional differences in uptake by Local Health Integration Network.
Session 5: Current Pharmacy Practice and Models
1. Development of an evaluation framework for pharmacy services
Lisa Dolovich, Nancy Waite, Barbara Farrell, Linda MacKeigan, Feng Chang, Beth Sproule, Tejal Patel, Nancy Winslade
The framework will contain a set of comparative indicators to provide evaluators and decision-makers with critical guidance on the structure, process, and expected outcomes of pharmacist-led patient services. A scoping literature review was undertaken, as well as stakeholder interviews and consultation with representatives from pan-Canadian jurisdictions to identify evaluation framework content, as well as barriers and facilitators. 1500+ relevant quality indicators (QI) and 30+ QI domains were identified. Two consensus-based processes will help to determine which domains and QIs are appropriate, important and feasible.
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2. Determining the perspectives of stakeholders on priorities for economics analyses of billable pharmacy services in Ontario
Jilan Yang, Sherilyn Houle
The aim of this study is to solicit stakeholder perspectives to provide direction on economic analyses that should be undertaken and for which services, and to consider priorities and measurement issues related to performing the desired analysis on the service(s) identified as a priority. Semi-structured interviews were conducted by phone with 16 stakeholders from government, research academia, pharmacy industry/association, and insurance companies. All interviews were audiotaped. The transcriptions were analyzed by NVivo. It is well recognized that economic evaluation of pharmacy services is valuable, useful and important across all stakeholders, but existing economic research on pharmacy service in Canada is scarce and not well designed. MedsCheck is considered as the top priority for economic evaluation. Selecting appropriate research topics depends highly on the availability of data, funding and stakeholder interests.
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3. ‘Moving the mountain’ — A shift in focus
The Ontario College of Pharmacists’ mandate is to both serve and protect the public. Traditionally, the College has focused on its responsibility to protect by ensuring pharmacy processes and procedures comply with relevant legislation, policies and guidelines. Although this remains an important component of pharmacy visits, the introduction of the new practice assessment has shifted focus to our responsibility to ‘serve’ our patients by including an evaluation of individual practitioners’ adherence to standards of practice and code of ethics. Preliminary data shared in this presentation will illustrate how, through coaching and mentoring, the College is supporting enhancements to practice to optimize health outcomes for patients.
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4. Pharmacy services — Patients’ perspective
The presentation will highlight methodology and findings of customer research conducted with patients of a retail pharmacy organization. The research focuses on medication reviews and minor ailment assessments conducted in various provinces across Canada. Implications of patients’ views and key benefits to future policy decisions will be discussed.
Oral presentation abstracts • Day 2
Session 8: Caring for the Vulnerable
1. Sex/gender and vulnerable populations in OPEN research
Nancy Waite, Martin Cooke, Emily Milne, Katie Cook, Feng Chang, Lisa McCarthy, Beth Sproule
Funders now frequently require that sex and gender are considered in research programs, but provide little guidance about how this can be accomplished. OPEN adopted a sex, gender and vulnerable population (GVP) model to promote incorporation of sex, gender and other dimensions of vulnerability across research projects. This presentation (a) addresses why the consideration of GVP matters to pharmacy practice and medication management research, and (b) provides a synthesis of GVP activities, outputs and feedback. The experience of OPEN suggests that a cross-project structure can help integrate these considerations into a large and complex research program. The next generation GVP model will be proposed.
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2. Mapping health geography data and pharmacy access
Nancy Waite, Wasem Alsabbagh, Suzanne Cadarette, Katie Cook, Martin Cooke, Susan Elliott, Peter Johnson, Emily Milne
Community pharmacists are among the most accessible healthcare providers, delivering a range of services including immunizations, smoking cessation support and chronic disease medication management. The ease of access to these services may be particularly important for vulnerable or high-risk populations such as people with low income, older adults, Aboriginal people, people with disabilities, newcomers, racial minorities and individuals in rural or remote communities. This project is investigating the degree to which the geographic distribution of community pharmacies is aligned with the residential concentrations of these groups to better understand how to improve access to existing pharmacy services and to identify opportunities to use pharmacies to deliver additional preventive services to these populations. Understanding geographic determinants of access to pharmacy services among vulnerable population may provide a way to address disparities and ensure that those at highest risk are able to access appropriate primary, secondary and tertiary preventive measures.
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3. Evaluation of the impact of an expanded immunization program
Vaccines have the ability to decrease infectious diseases and reduce disease morbidity. Pharmacists are one of the most accessible health care providers and as such can positively affect immunization rates, while relieving additional pressures on healthcare resources. The Ontario Pharmacists Association explored whether a business case exists to support education and access to immunizations administered by pharmacists for the following vaccinations: pertussis, pneumococcal diseases and herpes zoster.
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4. The Banting & Best Diabetes Centre: Supporting pharmacists to improve patient outcomes
Diabetes affects approximately three million Canadians, and this figure is expected to reach 3.7 million by 2018/2019. It also costs the Canadian healthcare system $11.7 billion annually. Empowering pharmacists is vital to improving outcomes for diabetes patients, as these patients see a pharmacist more often than any other healthcare provider. To support pharmacists, the Banting & Best Diabetes Centre at the University of Toronto launched the Guidebook for Pharmacists on Diabetes Management and established a national Diabetes Pharmacists Network. The most recent initiative is an online interactive learning program. Together, these initiatives foster the expansion of the pharmacist’s role through disseminating knowledge, sharing best practices, and engaging pharmacists on challenging topics in diabetes management.
Session 9: Implementation Research
1. Developing, implementing and evaluating “deprescribing” guidelines for the elderly: A mixed-methods approach
Barbara Farrell, James Conklin, Hannah Irving, Lalitha Raman-Wilms, Lisa McCarthy, Carlos Rojas-Fernandez, Kevin Pottie, Lise Bjerre
Polypharmacy and inappropriate medication use are growing problems for the elderly. This project developed, implemented and evaluated three evidence-based deprescribing guidelines to assist clinicians in discontinuing medications that may no longer be indicated or may be causing harm. A modified Delphi approach identified guideline priorities. Cochrane methods were followed to develop the guidelines, which were implemented into six practice sites. Observational data and interviews collected information on barriers and facilitators to guideline development and implementation and self-efficacy surveys assessed changes to provider confidence in deprescribing. This presentation will provide an overview of the methods and results of the project.
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2. Identification and pharmacist follow up of actionable atrial fibrillation using an integrated cardiovascular screening approach in community pharmacies
Karla Lancaster, Lisa Dolovich
In 2014–2015, the Program for Identification of Actionable Atrial Fibrillation (PIAAF) was implemented in 20 community pharmacies in Hamilton and Edmonton. The program incorporated session coordinators, community volunteers and pharmacists. It screened 1,131 elderly community members for atrial fibrillation, type II diabetes and hypertension. The prevalence of actionable atrial fibrillation was 2.4%, prevalence of uncontrolled blood pressure was 38.4%, and a high risk of diabetes was identified in 18.5% of participants. A second phase of this study will look at the data collected by the PIAAF, and pharmacy profiles of participants, to describe the use of pharmacy services in PIAAF participants. It will analyze whether high-risk patients received more services than low-risk patients, and a budget impact analysis will analyze cost-effectiveness. A survey of pharmacists participating in the PIAAF will describe their opinions on the success and feasibility of the trial.
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3. Teaching the masses through an online pharmacy game
Pharmacy 5in5 in a new learning platform that gamifies the expanding scope of pharmacy practice in Ontario. This session will include a live demo and audience members will get a chance to test the website and generate their own ideas for new topics.
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4. Examining the potential for a community pharmacist relationship with Health Links in Ontario
Nicole Mittmann, Katie Dainty, Shazia Hassan, Carmine Stumpo, Zahava Rosenberg-Yunger, Allan Malek, Lisa Dolovich
To determine how best to define, identify and trigger pharmacy services for complex patients using community pharmacy framework and infrastructure, qualitative interviews with key informants were used to collect data. Potential interviewees were approached by the lead investigator and interviews were conducted by a trained qualitative researcher. Participants indicated that “complex patients” are already defined by Ministry data. It was more important to include a dedicated pharmacist in a Health Link and as part of the primary care team of complex patients. Further exploration on how to include a formal system for triggering pharmacy services for complex patients is necessary.
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5. Promoting knowledge translation through a stakeholder advisory committee: Factors that facilitate or impede an advisory committee’s work
James Conklin, Karen Chun
Advisory committees (ACs) are often used in Canadian health research projects, but little work has been done to help us understand the impact of these committees. This project investigated OPEN’s Research AC using a qualitative case study approach to understand how a stakeholder AC can help to move research findings into practice. Our findings generated insights into factors that facilitate and impede an AC’s knowledge translation role. Our results show how an AC influences research in positive ways, and can create linkages between scientists, practitioners, and policy makers. Our findings will help researchers create high-performing ACs that improve the impact of research.