Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

With the epidemic of diabetes in our population, pharmacists must become more actively involved in the management of this chronic illness. This study was designed to examine the relationship between diabetes-specific training and pharmacists' activities in and attitudes toward diabetes management.

This was a cross-sectional survey of licensed pharmacists in Alberta. Respondents were grouped according to diabetes-specific training: Certified Diabetes Educator, completion of one or more diabetes-specific continuing education courses or no diabetes-specific training. A list of 67 activities related to diabetes management was generated through a review of the literature describing activities related to pharmacist involvement in diabetes management, national guideline recommendations, indicators for best practice and discussions with pharmacists specializing in diabetes management. Survey respondents were asked how frequently they provided each of these activities. Attitudes were measured using the Diabetes Attitude Scale.

Certified Diabetes Educators reported conducting significantly more activities related to diabetes management, especially in the areas of patient education in self-monitoring of blood glucose, hypoglycemia management, sick-day management, diabetes drug therapy and management of comorbid diseases. Pharmacists who had completed diabetes-specific continuing education courses and pharmacists with no diabetes-specific training reported similar levels of activities. There was a significant and graded relationship between attitudes and diabetes-specific training.

Pharmacists with more advanced, experiential-based training and national certification consistently reported providing more activities related to diabetes practice and generally held more positive attitudes toward the disease and its management, compared to other pharmacists.

To provide and measure the effects of having a resource pharmacist committed to the front store for his or her work shift. Clients could use this service to access individualized, timely, professionally provided information to guide them in their health choices.

A resource pharmacist was scheduled to be located in the front of the store for his or her whole shift. An immediate record of interventions was kept in a pocket notebook, with more in-depth recording done later on a standardized form. Clients were greeted by the pharmacist and counted, with a goal of showcasing pharmacists' accessibility. Clients who required counselling were counted separately and categorized. Our highest number day had 82 clients greeted and 32 counselled — a total of 114 clients; our lowest had 15 greeted and 10 counselled — a total of 25 clients. Promotion, signage and mailout were done to increase awareness of the new service. The key message promoted was of the benefits of a one-on-one consult with the resource pharmacist on the client's health concerns and counselling for over-the-counter medication.

This has proven to be a successful professional service that can be easily implemented into any community pharmacy. Professional satisfaction with the process was high. The dispensing pharmacist could focus on prescriptions, while the resource pharmacist was able to provide a patient-centred and individualized service. The clients had ready access to information that clarified their choices; gave them immediate, individualized health information; and sometimes ended with a referral to other health care providers. An example of some of the health issues addressed were cancer, suicide, depression and various chronic illnesses. The resource pharmacist was able to provide a service that will increase the efficiency of the health care system by empowering clients to take charge of their health and making professionally advised decisions.

Strong evidence supports the benefits of pharmacist intervention and chronic disease management (CDM) for patients, yet most pharmacists are not providing such services. The purpose of this study was to better understand pharmacists' perceptions of CDM and potential remuneration models.

We developed and tested a web-based survey based on the issues identified in a series of focus groups involving pharmacists: current practice setting, education, remuneration models, current practice environment and implementation. An invitation to complete the survey was e-mailed to registered pharmacists and was included in a weekly newsletter to Alberta pharmacists in January 2008, with 3 subsequent reminders to complete the survey.

Responses from 140 pharmacists were included. Pharmacists were most interested in providing CDM for diabetes (79%), although only 49% were presently comfortable with managing diabetes. The top enablers for provision of CDM included pharmacists' desire to change their scope of practice, a supportive work environment and patient demand. The top barriers included a lack of time to engage in CDM, lack of remuneration and staffing issues. Interestingly, relatively few identified pharmacists' resistance to change and difficulty finding eligible patients (38% and 25%, respectively) as important barriers. The majority of pharmacists agreed that payment should be shared between the pharmacy and the pharmacist as a fee-for-service. The average amount pharmacists expected for this model was $44.23/service.

Pharmacists showed interest but may lack the confidence to provide CDM services to patients. Many of the facilitators and barriers point toward the need for a sustainable remuneration model for pharmacists' clinical care. We plan to use these results to help develop such a model.

To compare the efficacy and pharmacologic, pharmacokinetic, drug interaction and adverse effect profiles of duloxetine and venlafaxine.

A systematic review of the literature pertaining to duloxetine and venlafaxine was conducted using a computer-aided search of MEDLINE and EMBASE for the period January 1988 to May 2008 with the following search terms: venlafaxine and duloxetine and depression, clinical studies, pharmacology, drug interactions, pharmacokinetics, adverse effects, safety, case reports and review articles.

Duloxetine and venlafaxine have comparable efficacy and share similar pharmacologic profiles but differ somewhat in their pharmacokinetic profiles, drug interactions and adverse effects. Both agents block the reuptake of serotonin and norepinephrine and both are substrates for the cytochrome P450 2D6 isoenzyme; however, duloxetine inhibits these enzymes to a moderate extent, whereas venlafaxine is only a weak inhibitor. Furthermore, duloxetine is more extensively bound to protein than venlafaxine. Venlafaxine is more likely to elevate blood pressure in a dose-related manner. Both duloxetine and venlafaxine have the potential to cause hepatic injury.

Although venlafaxine and duloxetine have similar efficacy in the treatment of depression, differences in their adverse effects and pharmacokinetic profiles suggest that one agent may be preferred over the other in certain patient groups.