Abstract
Objectives:
To review new approaches to enhancing the quality of pharmacy services, to identify pharmacists from across Canada who have developed innovative pharmacy practices and the facilitators and challenges they encountered, and to document details of these inovations, in order to assist others in their practice innovations.
Methods:
A literature survey was conducted to determine innovative practices documented in the peer-reviewed literature and Canadian trade publications, as well as innovations cited on the international scene, with specific attention to the United Kingdom, USA, Australia, New Zealand and Germany. Key leaders in the Canadian pharmacy organizations (academic, regulatory, various pharmacy practices) were contacted to identify innovative pharmacy practices aimed at enhancing the quality of health care devoted to medication use. Fifty innovative pharmacy practice models were documented, as well as an additional 45 pharmacists practising in a primary care team. One of the goals of primary care reform is to integrate key health care professionals into a cohesive team to provide better access and a sustainable and efficient health care system. Descriptive data were prepared for each innovative practice, including services provided, the role of the pharmacist, resources required, benefits, challenges and evaluations undertaken.
The innovations were classified into 8 categories: collaborative primary health-care teams; chronic disease management; expanded prescribing authority; health promotion and disease prevention; continuity of care and medication reconciliation; consulting and cognitive services; new technologies (information storage, communication and medication delivery); and delegation of technical duties.
Results:
Pharmacists consistently identified communication skills, enhanced training and clinical experience in collaborative practice methods and increased awareness among other health care providers of pharmacists' training and capabilities as fundamental for the implementation and maintenance of pharmacy practice innovations. The research highlighted many innovative pharmacists focusing their practices to specific groups of patients. Some pharmacists identified in this study reported heavy involvement in the health promotion role. These practitioners often counsel seniors or previously diagnosed patients in order to manage symptoms or actively promote lifestyle changes for particular risks. In pharmacies where the technical aspects of dispensing were centralized and/or delegated to qualified pharmacy technicians, the pharmacists were free to pursue clinical, patient-oriented activities. In each of the innovative practices identified, the senior population represented a significant component of that practice and each identified new approaches to assuming effective, efficient, accessible and timely, patient-centred, equitable and safe pharmacy care.
Conclusion:
The compilation of the current Canadian innovative pharmacy practices will serve as an important resource to move the profession forward. There is a need to focus on key enablers to further practice change. It is our view that pharmacy practitioners working within a primary care team represent a fundamental model of innovative practice, and we expect that in the future a significant proportion of the pharmacy workforce will be practising in that environment. There is a high level of cooperation across this group of Canadian practitioners, who exchange ideas and experiences to further their innovative practices.
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