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Canadian Pharmacists Association
Canadian Pharmacists Association
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Live Links Archive March 2016

A review of pharmacy practice research from Canada and the world.

In this issue: 

Technology | Pharmacist Interventions | Pharmacy WorkforceCommunication | Education and Training | Models of Practice

Technology

The effect of electronic medical record system use on communication between pharmacists and prescribers

Studies examining the effect of electronic medical records (EMRs) on prescribing have shown an impact on prescribing practices and potential errors. This study aimed to determine the effect of a newly implemented EMR system on communication between pharmacists and primary care clinicians.

A retrospective chart analysis consisting of primary care EMR data was carried out. This analysis compared faxed pharmacy communications captured before and after the implementation of an EMR system at an academic family medicine clinic. Communication requests were classified into the various categories including refill accepted, clarification, incorrect dose, interaction, incorrect dose and new prescription requests.

The number and percentage of clarification requests, interaction notifications and incorrect dose notifications were lower after the EMR system implementation, indicating an improvement in prescribing safety. The number and percentage of refills accepted and new prescription requests increased after the implementation of the EMR system, indicating a change in prescription patterns. These results indicate that the EMR had a significant effect on the volume of communication between pharmacists and prescribers as well as helping establish the beneficial impact EMRs have on patient safety and efficiency.

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Pharmacist Interventions

Improving pharmaceutical care for athletes

Pharmacists may overlook athletes as patients who could benefit from pharmaceutical advice. Athletes will frequently seek any substance or strategy to enhance their performance such as anabolic steroids and visualization techniques, also referred to as ergogenic aids. The most relevant to pharmacists are the regulated pharmaceutical ergogenic aids, such as natural health products (NHPs) and supplements. Surveys show that as many as 42% of college athletes have used supplements within the past year. Due to product marketing overemphasizing the benefits and minimizing the risks, athletes will often choose NHP products based solely on testimonial evidence. Though pharmacists have a great opportunity to improve care using evidence-based recommendations to meet athletes’ specific needs, no studies exist in this area.

Barriers in providing pharmaceutical care to athletes include a lack of resources and reliable evidence, as well as a lack of confidence on the part of the pharmacists. While resources do exist, such as the Natural Standards Database, most are considered unconventional. One tool that can be used to address athletes’ questions is the WEIGHT$ acronym. WEIGHT$ stands for what’s the goal, exercise type, indicate who recommended the supplement, gather personal history and investment, how effective is the supplement, the risk of the supplement and cost-effectiveness. This allows pharmacists to collect key information while balancing the athlete’s personal desire to purchase a safe and effective product. It is important for pharmacists to develop a relationship with patients to help them with appropriate product selection, as most of these products are available over the counter.

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Pharmacy Workforce

Identifying relationships between the professional culture of pharmacy, pharmacists’ personality traits, and the provision of advanced pharmacy services

Legislative changes are giving pharmacists the opportunity to provide more advanced pharmacy services. However, many pharmacists have not yet been able to provide these services sustainably.

Research from implementation science suggests that before sustained change in pharmacy can be achieved an improved understanding of pharmacy context, through the professional culture of pharmacy and pharmacists’ personality traits, is required.

The primary objective of this study was to investigate possible relationships between cultural factors and personality traits, with the uptake of advanced practice opportunities by pharmacists in British Columbia. The study was carried out using a cross-sectional survey of registered and practicing pharmacists.  The survey gauged respondents’ characteristics, practice setting and provision of advanced pharmacy services. It also contained the Organizational Culture Profile (OCP), a measure of professional culture, as well as the Big Five Inventory (BFI), a measure of personality traits.

About 900 completed survey instruments were returned. A significant positive relationship was identified for respondents perceiving greater value in the OCP factors competitiveness and innovation, and number of advanced services provided. A positive relationship was observed for respondents scoring higher on the BFI traits extraversion and the immunizations provided, and agreeableness and openness, and medication reviews completed.

This work serves as a starting place from which to develop more detailed insight into how the professional culture of pharmacy and pharmacists’ personality traits may influence the adoption of advanced pharmacy services.

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Communication

Don’t assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy

Health literacy is defined as having the capacity to understand health information provided by the health care system. It encompasses numeracy skills, basic literacy skills and basic health-topics knowledge. This study aims to ascertain the barriers that individuals with low health literacy face with understanding medication therapy.

One-on-one semi-structured interviews were held consisting of a verbal health literacy assessment and open-ended questions focused on medication information. Interviews were then followed by a written health literacy assessment, which was later used to compare self-assessed health literacy to written health literacy scores. All interviews were audio-recorded, transcribed and analyzed using thematic analysis.

A flow chart that describes the low health literate population's pharmacy experience with medication information was developed to explain the cause and effect of challenges patients faced with current pharmacy medication information. Low health literacy levels were found in 75% of participants; however, self-assessed literacy levels were generally over-estimated. The major challenges patients faced were limited time with pharmacists, understanding medication information, forgetting to take medication, and concerns association with side effects and food–drug interactions. Future interventions targeted to improving pharmacy medication information for the low health literate population should focus on addressing these challenges.

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Education and Training

Pharmacists’ performance in a telephone-based simulated patient study after a mental health capacity-building program

More Than Meds is a program designed and developed using behaviour change techniques, based on behaviour change theory, to enhance community pharmacists’ care of patients with mental illness. This study aimed at evaluating pharmacists who participated in More Than Meds by means of a trained actor who telephoned both group of pharmacists, the intervention group and a control group, approximately six months following their training.

Pharmacists were scored on their assessment of the patient and problem, guidance provided on both pharmacological and nonpharmacological care, communications and overall quality. Sixty-three pharmacists were reached. Call duration was longer with intervention versus control group pharmacists. Sixty-seven percent and 100% of intervention versus control pharmacists, respectively, made medication recommendations. Intervention group pharmacists scored significantly higher on most components within communication and overall quality scores. Scores for assessing the patient, the problem, quality of sleep and medication supply were lower than expected for both groups.

More research is required regarding telephone consultations in practice; however, this study demonstrates that pharmacists with More than Meds training preformed better on several components.

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Models of Practice

A pharmacist telephone intervention to identify adherence barriers and improve adherence among nonadherent patients with comorbid hypertension and diabetes in a Medicare advantage plan

In the United States, poor medication adherence results in 33% to 69% of all medication-related hospital admissions, costing the system $100 billion annually. In patients with co-morbid hypertension (HTN) and diabetes mellitus (DM), the American Diabetes Association guidelines recommend angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for their documented benefit and efficacy in reducing macrovascular and microvascular complications of DM. This study aimed to examine the effect of a brief pharmacist telephone intervention in improving adherence to ACEI/ARB medications among non-adherent patients with co-morbid HTN and DM.

Patients who had a diagnosis of HTN and DM with at least two fills for ACEI or ARB therapy between January 2013 and October 2013 were included in addition to some non-adherent patients between October 1, 2013, and December 31, 2013. To be included, patients must have had a percentage of days covered (PDC) of less than 80% for their ACEI/ARB medication. In the intervention, pharmacists first used a standardized template, which was then followed by individualized recommendations. The pharmacist also contacted the patients’ physicians or pharmacies when possible to resolve the issues discussed with the patients.

The brief pharmacist telephone intervention resulted in significantly lower discontinuation rates as well as better PDCs during the six months following the intervention. The overall PDC rates in both the intervention and control groups were still lower than the recommended 80%, suggesting that perhaps incorporating motivational interviewing techniques with the phone calls may be more influential in forming sustainable behavioural change and enhancing medication adherence.

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