Canadian Pharmacists Journal最新文献

{"title":"Advocacy as a professional responsibility.","authors":"Caitlin Olatunbosun, Kyle John Wilby","doi":"10.1177/17151635221125782","DOIUrl":"https://doi.org/10.1177/17151635221125782","url":null,"abstract":"Background Health inequalities in Canada exist, are persistent and are growing. These gaps in health present as predisposition to disease, disease severity, complications, mortality, preventive screening, adherence and access to care. Many of these gaps are the result of social, political and economic disparities. They are seen with respect to race, ethnic group, immigrant status, ability, sexual orientation, gender identity, rurality and socioeconomic status. In this era of heightened awareness of the impact of public policy on health outcomes, health inequalities are running rampant. In the 19th century, Rudolf Virchow was one of the first to make a case for social origins of illness, public health reform and political engagement. He famously stated, “Physicians are natural attorneys of the poor and social problems should largely be solved by them.” This call to advocacy came first to physicians, but as pharmacists increase their presence in direct patient care, the responsibility has extended loudly to us. Advocacy is defined as speaking on behalf of another, to plead their cause. The American Pharmacists Association states that pharmacists must advocate for “changes that improve patient care” as well as “justice in the distribution of health resources.” The American Society of Hospital Pharmacists believes it is both a moral and an ethical professional obligation to advocate for these changes. This is to say that being an excellent clinician alone is insufficient. In Canada, the National Association of Pharmacy Regulatory Authorities (NAPRA) has incorporated advocacy in their recently released standards for professionalism. This includes advocating for safe and effective medication for patients as well as helping patients navigate the health system. This professional principle calls for pharmacists to uphold “fair and equitable access to health care so that patient characteristics (e.g., finances, culture, language, ethnicity, gender identity, sexual orientation) do not serve as barriers to receiving quality care.” The concept of advocacy has transcended into pharmacy education, as the Association of Faculties of Pharmacy of Canada (AFPC) has “health advocate” as a key competency for pharmacy graduates. AFPC calls on pharmacy graduates to be health advocates by demonstrating care, understanding health needs and advancing the health and well-being of others not just for individuals but also for communities and populations. AFPC extends the role of advocating for individuals’ health needs beyond the patient care environment and calls for social accountability to effect system-level change. Health advocacy includes a broad number of activities and applications. Hubinette et al. developed a Health Advocacy Framework to outline different types and approaches to advocacy and serve as a common pathway across health disciplines, as well as a teaching tool. They describe advocacy activities as 2 different types: agency and activism.","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"155 6","pages":"298-301"},"PeriodicalIF":1.5,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647394/pdf/10.1177_17151635221125782.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problems with professional identity.","authors":"Natalie Borden","doi":"10.1177/17151635221129797","DOIUrl":"https://doi.org/10.1177/17151635221129797","url":null,"abstract":"","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"155 6","pages":"297"},"PeriodicalIF":1.5,"publicationDate":"2022-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647396/pdf/10.1177_17151635221129797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-delivered HIV point-of-care testing in Ontario: Lessons learned from the GetaTest pilot.","authors":"Steven Winkelman, Gauri Inamdar, Maya Kesler, Deborah V Kelly, Zahid Somani, Justin Ho, Taslim Somani, Ben Gunter, Lisa Tran, Ken English, Alexandra Musten","doi":"10.1177/17151635221128001","DOIUrl":"https://doi.org/10.1177/17151635221128001","url":null,"abstract":"Introduction Approximately 89% of people living with HIV in Ontario have been diagnosed, leaving 11% who are living with HIV but unaware of their status. Adopting innovative HIV testing approaches to reach these individuals is a priority, not only to ensure timely linkage to care and rapid initiation of antiretroviral therapy (ART) but also to share education and HIV prevention services such as pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) for those with negative test results. Individuals in Ontario can currently receive HIV testing through lab-based (blood-draw) testing, point-of-care testing (POCT) and HIV self-testing. However, access to HIV testing remains inconsistent across populations and geography. Barriers include concerns about confidentiality, low perceived risk of infection and discomfort discussing testing with clinicians as well as lack of testing opportunities outside of regular business hours and outside of clinical facilities. To address some of these barriers to HIV testing, the Ontario HIV Treatment Network (OHTN) partnered with The Village Pharmacy in Toronto and Shoppers Drug Mart, Gladstone and Bank location in Ottawa to pilot pharmacydelivered HIV POCT. The goals of this initiative were to improve HIV-testing uptake and increase the number of Ontarians who know their HIV status. Pharmacists are an integral and often underutilized resource in Ontario, with a rapidly expanding scope of practice. In recent years, pharmacists’ role in health care provision has expanded to include providing vaccinations, extending and adapting prescribed medications and prescribing certain medications. Pharmacists have also proven their efficacy in HIV care, working to reduce pill burden and dosing frequency, enhancing ART adherence, prescribing PrEP, increasing rates of viral suppression, increasing CD4 counts and reducing medication errors. This article details the implementation and impact of Ontario’s first pharmacist-delivered HIV POCT pilot in Ottawa and Toronto and will outline recommendations and next steps for pharmacy-based HIV testing.","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"155 6","pages":"309-314"},"PeriodicalIF":1.5,"publicationDate":"2022-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647395/pdf/10.1177_17151635221128001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40479421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 vaccination in high-risk communities: Case study of Brampton, Ontario.","authors":"Manmohit Gill,&nbsp;Dhruv Datta,&nbsp;Paul Gregory,&nbsp;Zubin Austin","doi":"10.1177/17151635221123042","DOIUrl":"https://doi.org/10.1177/17151635221123042","url":null,"abstract":"<p><strong>Background: </strong>The Peel region in Southern Ontario is among the most ethnoculturally diverse and fastest growing areas in Canada. During the COVID-19 pandemic, the multicultural community of Brampton suffered one of the highest infection rates in Canada, in part because of the demographic and socioeconomic characteristics of the community. The role of pharmacists in supporting vaccine uptake in this linguistically, ethnically and religiously diverse community has not been adequately characterized.</p><p><strong>Methods: </strong>A qualitative case study approach was used, focusing on one of the major communities in Peel (Brampton). Interviews with community pharmacists and pharmacy staff directly involved in COVID-19 vaccine administration during the pandemic were undertaken to identify common experiences and trends related to providing care and support to this high-risk community. Constant comparative coding was used to identify common themes that can inform ongoing public health supports in future pandemics.</p><p><strong>Results: </strong>A total of 29 interviews were completed. Key themes that emerged included 1) the impact of operational, organizational and logistical issues on vaccine uptake in the community; 2) the negative influence of inconsistent messaging from public health and other experts during the pandemic; and 3) the identification of an emerging typology of \"vaccine hesitancies\" describing different reasons/motivations for avoiding COVID-19 vaccination and approaches taken by pharmacy staff to address these within a multicultural, multilingual practice context.</p><p><strong>Discussion: </strong>The COVID-19 vaccination campaign was unprecedented in its size, scope and speed, and community pharmacists were integral in this effort. The unique needs of ethnoculturally, linguistically and socioeconomically diverse communities like Brampton require further studies to examine ways in which the pharmacy profession can positively influence greater vaccine uptake, by increasing understanding of the diverse proliferation of vaccine hesitancies that emerged.</p>","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"155 6","pages":"345-351"},"PeriodicalIF":1.5,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647403/pdf/10.1177_17151635221123042.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DOAC drug interactions management resource.","authors":"Ayush Chadha,&nbsp;Micheal Guirguis,&nbsp;Tammy J Bungard","doi":"10.1177/17151635221116100","DOIUrl":"https://doi.org/10.1177/17151635221116100","url":null,"abstract":"Background Over the past decade, direct oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban and rivaroxaban) have offered many advantages over traditional therapy with warfarin ± low-molecular-weight heparins (LMWHs). The DOACs have established dosing without the need for coagulation monitoring as well as a quick onset (C max at 1-4 hours) and offset (half-lives ranging from 9-14 hours for patients with normal renal function), thereby eliminating the need for bridging with LMWHs (Figure 1). Moreover, DOACs have fewer drugdrug interactions (DDIs) relative to warfarin; however, as the use of DOACs continues to increase in clinical practice, more information surrounding DOAC DDIs is necessary to make timely clinical decisions. Pathways relevant to DOAC DDIs encompass the cytochrome P450 system (focusing on 3A4), as well as the Pglycoprotein (P-gp) transport system. Rivaroxaban and apixaban are substrates for P-gp and (in part) metabolized by CYP 3A4. Subsequently, rivaroxaban and apixaban DDIs must strongly affect both P-gp and CYP 3A4; the clinician should ensure a patient is not on 2 concomitant drugs that affect CYP 3A4 and P-gp separately, as these combined DDIs could cause significant changes in DOAC concentrations. In contrast, dabigatran and edoxaban are affected only by strong inhibitors/ inducers of P-gp, as they lack metabolism by the CYP enzyme. The P-gp impact is within the gastrointestinal tract; hence, to minimize the P-gp DDI, dabigatran or edoxaban may be administered 2 hours prior to the interacting agent. Notably, all DOACs have a component of renal elimination (dabigatran &gt; edoxaban &gt; rivaroxaban &gt; apixaban), and while progressive renal dysfunction will result in elevated DOAC concentrations, this elimination is not a direct mechanism of DDIs. At this time, there is limited clinical pharmacokinetic (PK)/ pharmacodynamic (PD) data to quantify the clinical impact of specific DOAC DDIs. DDIs of this nature (i.e., P-gp or CYP 450) are highly variable because of the timing of the induction/ inhibition turnover as well as the strength (mild, moderate or strong) of the interaction. In addition, there is inherent intersubject variability of 30% for concentrations of dabigatran, edoxaban and apixaban, with rivaroxaban reaching 40% for PK parameters. In addition, reported ranges of DOAC concentrations assessed in subgroups of clinical trials demonstrate variability in peak/trough ratios of nearly 1.6-fold. With this in mind, DDIs that alter DOAC concentrations of 30% to 40% often still result in DOAC concentrations falling within these reported concentration ranges. Subsequently, when regulators consider providing advice surrounding DDIs, within the context of high PK/PD variability, general recommendations are often to avoid these combinations; specifically, regulators contraindicate DOACs for DDIs with inducing agents (for fear of thrombotic events) and recommend use with caution and assess other factors that may warrant avoidance ","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"155 6","pages":"315-325"},"PeriodicalIF":1.5,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pharmacist's guide to human papillomavirus (HPV).","authors":"Cheryl E Cable,&nbsp;Cert Prosth,&nbsp;Maxillofacial Prosth,&nbsp;Ian Vandermeer,&nbsp;Adrian Poon,&nbsp;Ross T Tsuyuki","doi":"10.1177/17151635221116342","DOIUrl":"https://doi.org/10.1177/17151635221116342","url":null,"abstract":"","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":" ","pages":"242-243"},"PeriodicalIF":1.5,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking glass ceilings: A student perspective on national advocacy and leadership.","authors":"Sara Habib,&nbsp;Lynn D'Souza","doi":"10.1177/17151635221120043","DOIUrl":"https://doi.org/10.1177/17151635221120043","url":null,"abstract":"","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":" ","pages":"247-248"},"PeriodicalIF":1.5,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445503/pdf/10.1177_17151635221120043.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic distribution of Ontario pharmacists: A focus on rural and northern communities.","authors":"Patrick Timony,&nbsp;Sherilyn K D Houle,&nbsp;Alain Gauthier,&nbsp;Nancy M Waite","doi":"10.1177/17151635221115411","DOIUrl":"https://doi.org/10.1177/17151635221115411","url":null,"abstract":"<p><strong>Introduction: </strong>Canadians living in rural and northern communities face particular health needs and challenges in accessing primary care services. Ontario pharmacists are increasingly able to optimize patient care with a broadening scope of practice; this was highlighted during the COVID-19 pandemic. This study explores the geographic distribution of pharmacists to evaluate their potential to deliver health care in rural and northern Ontario communities.</p><p><strong>Methods: </strong>A secondary analysis of the Ontario College of Pharmacists' registry data was undertaken, with all Part A pharmacists who had at least 1 patient care practice site included in the analysis. Full-time equivalent (FTE) hours worked at each practice site were calculated and compared with the population distribution. Ratios of FTEs per 1000 residents by census subdivision (which represents communities) were calculated and compared by geography, north vs south and urban vs rural (further subdivided by metropolitan-influenced zones).</p><p><strong>Results: </strong>The greatest availability of pharmacist FTEs was found in urban communities (with slightly better availability in the north), whereas the lowest availability was found in the most rural communities. A more granular observation revealed that northern communities were more likely to have no local pharmacist access (72%) compared with southern communities (24%).</p><p><strong>Discussion: </strong>Rural and northern communities are underserved. Novel approaches to overcoming the rural pharmacist care gap include rural practice incentives, targeted enrollment of rural students, increased rural exposure in pharmacy schools and the utilization of new technologies such as telepharmacy and drone medication deliveries.</p>","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":" ","pages":"267-276"},"PeriodicalIF":1.5,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario.","authors":"Sherilyn K D Houle,&nbsp;Patrick Timony,&nbsp;Nancy M Waite,&nbsp;Alain Gauthier","doi":"10.1177/17151635221115183","DOIUrl":"https://doi.org/10.1177/17151635221115183","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacist-administered immunizations have been associated with improved vaccination rates; however, little is known about whether areas with little to no access to this service (\"vaccination deserts\") exist. The objective of this work is to determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario.</p><p><strong>Methods: </strong>Ontario College of Pharmacists registry data were used to identify patient care-providing pharmacists in community pharmacies and their ability to administer injections. Their number of hours worked was converted into full-time equivalents (FTEs), assuming 40 hours per week represents 1 FTE. Practice site(s) were mapped by postal code and presented by Public Health Unit (PHU) area. Communities within PHUs were further categorized as urban or rural and northern or southern, with ratios of FTEs per 1000 population calculated for both injection-trained and non-injection-trained pharmacists.</p><p><strong>Results: </strong>In total, 74.6% of Ontario's practising community pharmacists are authorized to provide injections. Northern PHUs had slightly better access to pharmacist injectors (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41 FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist immunizers, while PHUs with greater land area were more likely to not have any immunizing pharmacists present (<i>p</i> < 0.001 for all).</p><p><strong>Discussion: </strong>As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-based immunizations and collaboration with public health and primary care providers to address them (e.g., through mobile vaccination clinics) will be required to ensure equitable access. <i>Can Pharm J (Ott)</i> 2022;155:xx-xx.</p>","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":" ","pages":"258-266"},"PeriodicalIF":1.5,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a leadership specialty rotation for undergraduate pharmacy students.","authors":"Christine Lee,&nbsp;Zack Dumont,&nbsp;Kelly Babcock","doi":"10.1177/17151635221114088","DOIUrl":"https://doi.org/10.1177/17151635221114088","url":null,"abstract":"","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":" ","pages":"244-246"},"PeriodicalIF":1.5,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445506/pdf/10.1177_17151635221114088.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}