Expanding the Scope of Community Pharmacy Practice in Nova Scotia: Impacts on Provincial COVID-19 Response

Nova Scotia has expanded the scope of practice for community pharmacists by allowing, among other changes, pharmacist prescribing under specific circumstances (2011) and administration of drugs by injection (2013), thereby alleviating stress on the health system. Due to these progressive expansions in community pharmacy scope of practice, Nova Scotia community pharmacy personnel (about 1,500 pharmacists and 246 technicians working in 315 pharmacies) were rapidly able to play key roles in the province’s response to the COVID-19 pandemic. Community pharmacies provided medicines, medical devices, personal protective equipment, hand hygiene solutions, thermometers, and pulse oximeters to patients and the public. In addition, they have responded to patients’ COVID-19-related needs by treating symptoms; providing referrals; discussing the benefits and risks of COVID-19 vaccines and administering them; making nirmatrelvir/ritonavir assessments; and addressing vaccine hesitancy and the spread of misinformation about COVID-19. Moreover, as in some other provinces, community pharmacists in Nova Scotia have played a leading role in delivering COVID-19 vaccines from almost the start of the vaccination campaign in December 2020. Their role expanded further in May 2022, when pharmacists were granted prescribing authority for inhaled budesonide in accordance with the provincial protocol to treat mild SARS-CoV-2 respiratory symptoms. La Nouvelle-Écosse a élargi le champ d’exercice des pharmaciens communautaires en autorisant, entre autres, la prescription par un pharmacien dans des circonstances spécifiques (2011) et l’administration de médicaments par injection (2013), soulageant ainsi le système de santé. Grâce à ces élargissements progressifs du champ d’exercice des pharmacies communautaires, le personnel des pharmacies communautaires de Nouvelle-Écosse (environ 1 500 pharmaciens et 246 techniciens travaillant dans 315 pharmacies) a pu contribuer de manière cruciale et rapide à la réponse de la province à la pandémie de COVID-19. Les pharmacies communautaires ont fourni des médicaments, des dispositifs médicaux, des équipements de protection individuelle, des solutions pour l’hygiène des mains, des thermomètres et des oxymètres de pouls aux patients et au public. En outre, elles ont répondu aux besoins des patients liés à la COVID-19 en traitant les symptômes, en orientant les patients, en discutant des avantages et des risques des vaccins contre la COVID-19 et de leur administration, en évaluant la pertinence de traiter certains patients au nirmatrelvir/ritonavir et en répondant à l’hésitation vaccinale et à la diffusion d’informations erronées sur la COVID-19. De plus, les pharmaciens communautaires de Nouvelle-Écosse, comme ceux d’autres provinces, ont joué un rôle de premier plan dans l’administration des vaccins contre la COVID-19 dès le début de la campagne de vaccination en décembre 2020. Leur rôle s’est encore élargi en mai 2022, lorsque les pharmaciens ont été autorisés à prescrire du budésonide inhalé, conformément au protocole provincial, pour traiter les symptômes respiratoires légers du SRAS-CoV-2

Expanding the Scope of Community Pharmacy Practice in Nova Scotia: Impacts on Provincial COVID-19 Response

Nova Scotia has expanded the scope of practice for community pharmacists by allowing, among other changes, pharmacist prescribing under specific circumstances (2011) and administration of drugs by injection (2013), thereby alleviating stress on the health system. Due to these progressive expansions in community pharmacy scope of practice, Nova Scotia community pharmacy personnel (about 1,500 pharmacists and 246 technicians working in 315 pharmacies) were rapidly able to play key roles in the province’s response to the COVID-19 pandemic. Community pharmacies provided medicines, medical devices, personal protective equipment, hand hygiene solutions, thermometers, and pulse oximeters to patients and the public. In addition, they have responded to patients’ COVID-19-related needs by treating symptoms; providing referrals; discussing the benefits and risks of COVID-19 vaccines and administering them; making nirmatrelvir/ritonavir assessments; and addressing vaccine hesitancy and the spread of misinformation about COVID-19. Moreover, as in some other provinces, community pharmacists in Nova Scotia have played a leading role in delivering COVID-19 vaccines from almost the start of the vaccination campaign in December 2020. Their role expanded further in May 2022, when pharmacists were granted prescribing authority for inhaled budesonide in accordance with the provincial protocol to treat mild SARS-CoV-2 respiratory symptoms. La Nouvelle-Écosse a élargi le champ d’exercice des pharmaciens communautaires en autorisant, entre autres, la prescription par un pharmacien dans des circonstances spécifiques (2011) et l’administration de médicaments par injection (2013), soulageant ainsi le système de santé. Grâce à ces élargissements progressifs du champ d’exercice des pharmacies communautaires, le personnel des pharmacies communautaires de Nouvelle-Écosse (environ 1 500 pharmaciens et 246 techniciens travaillant dans 315 pharmacies) a pu contribuer de manière cruciale et rapide à la réponse de la province à la pandémie de COVID-19. Les pharmacies communautaires ont fourni des médicaments, des dispositifs médicaux, des équipements de protection individuelle, des solutions pour l’hygiène des mains, des thermomètres et des oxymètres de pouls aux patients et au public. En outre, elles ont répondu aux besoins des patients liés à la COVID-19 en traitant les symptômes, en orientant les patients, en discutant des avantages et des risques des vaccins contre la COVID-19 et de leur administration, en évaluant la pertinence de traiter certains patients au nirmatrelvir/ritonavir et en répondant à l’hésitation vaccinale et à la diffusion d’informations erronées sur la COVID-19. De plus, les pharmaciens communautaires de Nouvelle-Écosse, comme ceux d’autres provinces, ont joué un rôle de premier plan dans l’administration des vaccins contre la COVID-19 dès le début de la campagne de vaccination en décembre 2020. Leur rôle s’est encore élargi en mai 2022, lorsque les pharmaciens ont été autorisés à prescrire du budésonide inhalé, conformément au protocole provincial, pour traiter les symptômes respiratoires légers du SRAS-CoV-2

Prevalance and determinants of antidepressant use among canadian forces members experiencing major depressive episodes

Backgroun

Economic evaluations of eHealth technologies: A systematic review

<div><p>Background</p><p>Innovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults.</p><p>Methods</p><p>We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement.</p><p>Results</p><p>Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors.</p><p>Conclusions</p><p>This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.</p></div

Characteristics of the included studies.

<p>Characteristics of the included studies.</p

CHEERS statement quality results.

<p>Items: (1) Title, (2) Abstract, (3) Background and Objectives, (4) Target population and subgroups, (5) Setting and Location, (6) Study perspective, (7) Comparators, (8) Time horizon, (9) Discount rate, (10) Choice of health outcomes, (11) Effectiveness, (12) Preference valuation, (13) Estimate resources and costs, (14) Currency, price date, conversion, (15) Choice of model, (16) Assumptions, (17) Analytical methods, (18) Study parameters, (19) Incremental costs and outcomes, (20) Uncertainty—single study or model based, (21) Heterogeneity, (22) Study findings/limitations/generalizability/current knowledge, (23) Source of funding, (24) Conflict of interest.</p

Coping Strategies Used by Patients Infected with Hepatitis C Virus Who Are Facing Medication Costs

ABSTRACTBackground: The prevalence of infection with hepatitis C virus (HCV) is increasing worldwide. Antiviral therapy, prescription and nonprescription medications, and nondrug therapies to treat HCV infection and to manage associated adverse effects are costly.Objective: To determine whether individuals infected with HCV attending a hepatology clinic were negatively affected by the costs of prescription medications, and if so, to determine coping strategies they adopted.Methods: Patients infected with HCV attending Hepatology Services, a clinic within the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, were interviewed as part of an exploratory study (April 2 to July 8, 2008). The interview was based on a validated survey adapted for Nova Scotia. Information collected included demographic characteristics; types of prescription, nonprescription, and complementary medications used by patients; and strategies patients adopted to pay their medication costs.Results: Fifty patients (age 33-64 years) participated in the interviewer-administered survey, including 35 (70%) men and 19 people (38%) with household income less than $30 000. Frequently used medications were antidepressants (19 patients [38$. Les m&eacute;dicaments couramment utilis&eacute;s &eacute;taient les antid&eacute;presseurs (19 patients [38 %]), les antihypertenseurs (12 [24 %]), anxiolytiques (10 [20 %]) et les antiinflammatoires non st&eacute;ro&iuml;diens (10 [20 %]). Plus de la moiti&eacute; des participants (29 [58 %]) &eacute;taient inquiets de ne pas avoir suffisamment d'argent pour payer leurs m&eacute;dicaments. Les strat&eacute;gies utilis&eacute;es pour s'adapter aux co&ucirc;ts des m&eacute;dicaments d'ordonnance &eacute;taient entreprises par les patients eux-m&ecirc;mes ou en collaboration avec les m&eacute;decins ou d'autres professionnels de la sant&eacute;. Des r&eacute;pondants, 16 (32 %) ont dit croire que les m&eacute;decins ne tenaient g&eacute;n&eacute;ralement pas compte des pr&eacute;occupations des patients &agrave; propos de l'abordabilit&eacute; lorsqu'ils leur prescrivaient des m&eacute;dicaments. Sept patients (14 %) ont mentionn&eacute; qu'ils demanderaient l'aide d'un pharmacien pour acheter des substituts &agrave; prix inf&eacute;rieurs.Conclusion : Cette &eacute;tude met en lumi&egrave;re des strat&eacute;gies d'adaptation qui ont &eacute;t&eacute; adopt&eacute;es par des patients infect&eacute;s par le VHC en r&eacute;ponse au co&ucirc;t des m&eacute;dicaments. Elle souligne la possibilit&eacute; que le co&ucirc;t limite l'acc&egrave;s &agrave; des m&eacute;dicaments essentiels dans cette population de patients, m&ecirc;me dans un syst&egrave;me de soins de sant&eacute; universel. Certaines des strat&eacute;gies d'adaptation utilis&eacute;es pourraient nuire &agrave; la poursuite et &agrave; l'observance du traitement, ce qui pourrait entra&icirc;ner des r&eacute;sultats cliniques ind&eacute;sirables. Les pharmaciens communautaires et hospitaliers doivent &ecirc;tre conscients des difficult&eacute;s auxquelles se heurtent les patients pour payer leurs m&eacute;dicaments et envisager des r&eacute;ponses proactives &eacute;ventuelles pour redresser des strat&eacute;gies d'adaptation potentiellement pr&eacute;judiciables

Study selection and identification flowchart.

<p>Study selection and identification flowchart.</p

Quality assessment of included studies using CHEERS statement.

<p>Quality assessment of included studies using CHEERS statement.</p