Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Over the past decade, there has been a sharp rise in the approval of orally administered anti-cancer agents for disease control. The increase in the use of oral anti-cancer agents (OAAs) raises concerns that community pharmacists may not have the training to safely dispense these agents and provide effective patient care. In order to identify the needs of community pharmacists with respect to oral anti-cancer therapy, a survey was conducted in the province of Newfoundland and Labrador.

A structured electronic mailing strategy was used. Standardized data collection forms with a cover letter were electronically mailed to 560 practising pharmacists. Survey items included questions related to demographic information, practice setting, current knowledge related to cancer therapy, education needs, access to resources, patient education, patient and pharmacist safety and required elements of an OAA prescription.

The response rate was 39%. Only 9.6% of respondents felt that they had received adequate oncology education at the undergraduate level and approximately 31% had attended a continuing education event related to oncology in the past 2 years. Just 17% of respondents stated that they used protective equipment when dispensing OAAs. Only 28% of the pharmacists who responded were familiar with the common doses of OAAs and approximately 25% felt comfortable educating patients on these medications.

A substantial portion of community pharmacists in Newfoundland and Labrador do not have a solid understanding of oral anti-cancer therapy. These educational gaps must be addressed to ensure patient safety as well as the safe handling and dispensing of OAAs by community pharmacists.

Previous research has shown that community pharmacists describe their role mostly in product-focused rather than patient-centred terms. We wondered if pharmacy faculty members think similarly, which might influence how students, and subsequently, new pharmacists think. The objective of this study was to examine how pharmacy faculty members describe the health care role of pharmacists.

We telephoned 101 randomly selected Canadian pharmacy faculty members. The surveyor posed as a sociology student studying the use of language. We asked a single question: “What does a pharmacist do?,” asking respondents to answer in a few short phrases that were recorded verbatim. Responses were analyzed by content and categories were established from previous studies, coded as “patient-centred,” “product-focused (dispensing),” “research” or “business-related.”

Ninety-four faculty members (71% were pharmacists) provided 200 responses. Of the responses, 40% were categorized as patient-centred, 32.5% were product-focused and 5% were research- or business-related. Evaluating participants' first responses, faculty members who were pharmacists offered a patient-centred description in 59% of responses, while non-pharmacists provided a more pro duct-focused description. The most frequently used terms to describe a pharmacist's role were: patient, medication, educate, dispense, responsible, safety and ensure.

Pharmacy faculty members' perception of the role of pharmacists may influence the culture of the profession. We found that faculty members were more idealistic about patient-centred roles for pharmacists than community or hospital pharmacists, but a large proportion (mainly nonpharmacist faculty members) still describe a product-focused role.

As of January 2009, pharmacists in British Columbia (BC) have been able to adapt prescriptions to provide renewals; change the dosage, formulation or regimen; and substitute therapeutically equivalent therapies for reasons of cost or continuity of care.

To describe and characterize pharmacy manager and owner perceptions of pharmacy adaptation services in BC.

Over a 1-month period, pharmacy owners, dispensary managers and regional managers from “high-adapter” pharmacies (>60 adaptations/month) and “low-adapter” pharmacies (<10 adaptations/month) were interviewed. During the semi-structured interviews, participants were asked to comment on uptake, cost, revenue and general perceptions of adaptation services. All data were assessed using content analysis.

Very few capital costs were incurred. Those costs included additional human resource costs (training and staff), updating computer software to produce physician notification forms, fax machine upgrades, additional physical storage and paper. The other emerging themes from the interviews included sustainability, patient and physician knowledge of the program, perceived benefits of the program, suggested changes to the program, high-adapting pharmacies as being champions of pharmacy adaptation services and potential barriers to adoption within a pharmacy.

In general, few changes were made as a result of the adaptation program and minimal capital costs were incurred. The documentation stage was the most labour-intensive aspect of adapting prescriptions. Perceived benefits related to providing the patient with continuity of care. Most of the suggested changes involved reducing restrictions on the program and providing greater opportunities for pharmacists to exercise their clinical judgment.

Although pharmacists have been granted prescribing privileges in Alberta since 2007 and most other Canadian provinces have granted or put forward similar legislation since then, there is a lack of Canadian data exploring pharmacists' understanding and adoption of prescribing practice. Therefore, our goal is to investigate pharmacists' perceptions of prescribing, the extent to which prescribing has been incorporated into pharmacists' practices and the factors that have influenced its uptake.

We are conducting a mixed-methods evaluation of pharmacist prescribing in Alberta and Ontario consisting of 3 consecutive stages: 1) semi-structured interviews with a small cohort of pharmacists in Alberta and Ontario; 2) development of a survey guided by responses identified in Stage 1; and 3) a mixed-methods survey of a large random sample of pharmacists in Alberta.

When complete, this study will inform researchers, policy-makers and educators about Ontario pharmacists' attitudes towards prescribing and the initial uptake of prescribing practice in Alberta. This will allow for a greater understanding of pharmacists' perceptions of prescribing; the extent to which prescribing has been incorporated into pharmacy practice; and the factors facilitating its uptake.