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 Pharmacists' Scope of Practice to Include Immunization in Nova Scotia

On 10 December 2010 An Act to Amend Chapter 36 of the Acts of 2001, the Pharmacy Act (Bill 7) received Royal Assent in Nova Scotia, including an amendment that enabled an expanded scope of pharmacy practice.  Expanding pharmacists' scope of practice came about from recommendations by various federal and provincial government bodies as an attempt to improve accessibility to health care and decrease costs. In 2013, pharmacists in Nova Scotia began administering the influenza vaccine as part of the publicly funded program in attempts to improve vaccine coverage rates. Preliminary evaluation in Nova Scotia has shown an increase in influenza vaccination coverage. Although pharmacist administration of influenza vaccination may improve vaccination coverage and reduce demand on physician time, there may be tension created among the professions, which needs to be addressed and managed.  La modification des lois qui concernent les professions de santé réglementées, An Act to Amend Chapter 36 of the Acts of 2001, the Pharmacy Act (Loi 7), a été sanctionée en Nouvelle-Écosse le 10 Décembre, 2010. Un de ces changements législatif avait pu renforcer l’élargissement du practique des pharmaciens en Nouvelle-Écosse. Grâce a la conseil de plusieurs groupes gouvernementale, Fédérale et Provinciale, cette élargissement de practique essaient a diminuer le coût et ameliorer l’accessibilité du système de santé. En 2013, les pharmaciens en Nouvelle-Écosse ont commencé d’administrer le vaccin antigrippal gratuitement au public, pour augmenter le taux d’immunisation contre la grippe dans le province. Une évaluation préliminaire a démontré l’augmentation des taux d’immunisation en Nouvelle-Ecosse. Bien que l’administration du vaccin contre la grippe pourrait améliorer la couvrage vaccinale et reduire le temps des médecins, il pourrait aussi crée des tensions entre les professions medicaux, qui doit être addresser et gérer.

Expanding Pharmacists' Scope of Practice to Include Immunization in Nova Scotia

On 10 December 2010 An Act to Amend Chapter 36 of the Acts of 2001, the Pharmacy Act (Bill 7) received Royal Assent in Nova Scotia, including an amendment that enabled an expanded scope of pharmacy practice.  Expanding pharmacists' scope of practice came about from recommendations by various federal and provincial government bodies as an attempt to improve accessibility to health care and decrease costs. In 2013, pharmacists in Nova Scotia began administering the influenza vaccine as part of the publicly funded program in attempts to improve vaccine coverage rates. Preliminary evaluation in Nova Scotia has shown an increase in influenza vaccination coverage. Although pharmacist administration of influenza vaccination may improve vaccination coverage and reduce demand on physician time, there may be tension created among the professions, which needs to be addressed and managed. La modification des lois qui concernent les professions de santé réglementées, An Act to Amend Chapter 36 of the Acts of 2001, the Pharmacy Act (Loi 7), a été sanctionée en Nouvelle-Écosse le 10 Décembre, 2010. Un de ces changements législatif avait pu renforcer l’élargissement du practique des pharmaciens en Nouvelle-Écosse. Grâce a la conseil de plusieurs groupes gouvernementale, Fédérale et Provinciale, cette élargissement de practique essaient a diminuer le coût et ameliorer l’accessibilité du système de santé. En 2013, les pharmaciens en Nouvelle-Écosse ont commencé d’administrer le vaccin antigrippal gratuitement au public, pour augmenter le taux d’immunisation contre la grippe dans le province. Une évaluation préliminaire a démontré l’augmentation des taux d’immunisation en Nouvelle-Ecosse. Bien que l’administration du vaccin contre la grippe pourrait améliorer la couvrage vaccinale et reduire le temps des médecins, il pourrait aussi crée des tensions entre les professions medicaux, qui doit être addresser et gérer.

Evaluation of the impact of immunization policies, including the addition of pharmacists as immunizers, on influenza vaccination coverage in Nova Scotia, Canada: 2006 to 2016

Abstract Background Influenza is a serious public health concern, resulting in morbidity, mortality and significant expense to healthcare systems worldwide. Annual vaccination is the most effective way to prevent influenza. The National Advisory Committee on Immunization in Canada recommends that everyone six months of age and older without contraindications should be vaccinated. The Canadian province of Nova Scotia implemented a publicly-funded universal influenza vaccination program in the 2010–2011 influenza season. In 2013, pharmacists in Nova Scotia gained the authority to provide a variety of vaccinations, including the publicly-funded influenza vaccine. This study aimed to investigate any changes in influenza vaccine coverage following the implementation of each policy change: 1) universal publicly-funded program and 2) universal publicly-funded program with the addition of pharmacists. Methods Influenza seasons evaluated were from 2006-2007 to 2015–2016. Coverage was estimated by examining Nova Scotia census data with aggregate immunization administration data, including the total number of vaccinations administered according to vaccine provider (physician, public health or pharmacist), geographic region, vaccine recipient age and year. Results The analysis showed an increase in influenza vaccine coverage immediately following the implementation of the two studied policy changes. Vaccine coverage increased from 36.4 to 38% following the implementation of the universally funded vaccine policy. Following the implementation of pharmacists as immunizers, coverage increased from 35.7 to 41.7%. Vaccine coverage was highest in those 65 years of age and older during all years evaluated. Physicians provided the highest proportion of vaccines during all study periods, however a decreasing trend through all periods was observed. Physicians proportionately provided more vaccines in urban areas; whereas pharmacist and public health immunization providers in rural areas provided proportionately more vaccinations than their urban counterparts. Conclusions The addition of a universally funded vaccination policy and the addition of pharmacists as providers of the influenza vaccine resulted in increases in vaccine coverage initially. Additional research is needed to determine the long-term impacts of the policy changes on vaccination coverage and to identify other important factors affecting vaccine uptake

Patient experiences with influenza immunizations administered by pharmacists

Influenza vaccination is the most effective way to reduce influenza infection and related complications. Unfortunately, vaccination coverage remains suboptimal. The addition of pharmacists as immunizers may assist in improving vaccine coverage. The experiences of patients who have received influenza vaccines from pharmacists is an important consideration for jurisdictions considering the addition of pharmacists as immunizers. We describe the reported experiences of recipients of influenza vaccinations by pharmacists in the community pharmacy setting in Nova Scotia, Canada. During the 2013–2014 influenza season, a paper-based quality assurance questionnaire was provided to interested vaccine recipients to assess their previous vaccination experiences and current experience at the pharmacy. More than 6,500 vaccine recipients completed questionnaires. The majority of respondents cited convenience as a main reason for receiving the vaccine in the pharmacy, with 50% indicating the service was better in the pharmacy and another 40% that the service was as good as elsewhere. Respondents also reported a positive environment in the pharmacy (e.g., less stressful, less exposure to sick people) as well as professionalism and knowledge of the pharmacists. Areas for improvement identified included better communication around the paperwork required (e.g., consent forms) and the wait time post-vaccination. This evaluation demonstrated that people who chose to be vaccinated by community pharmacists reported positive experiences and convenience was the primary factor for selecting a pharmacy as the site for vaccination

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

Barriers and Facilitators Related to Delivery of Hospital Pharmacy Services to Women, Children, and Their Families during a Pandemic: A Qualitative Study

Background: When the COVID-19 pandemic was declared in March 2020, health care professionals were challenged to adapt quickly and efficiently to change their work practices. However, an evidence-informed approach has not yet been used to systematically gather data on barriers and facilitators related to delivery of hospital pharmacy services in Canada. Objectives: The primary objective was to identify and describe barriers and facilitators related to the delivery of hospital pharmacy services to women, children, and their families during the COVID-19 pandemic. The secondary objective was to provide recommendations for improvement in delivery of pharmacy services to enhance patient care during pandemics. Methods: This qualitative study involved semistructured virtual interviews with pharmacists who worked in direct or nondirect patient care throughout the pandemic (since March 2020) at women’s and/or children’s hospitals in Canada. Individual interviews were completed virtually using conferencing software. An interview guide mapped to the Theoretical Domains Framework version 2 (TDFV2) was used to facilitate the interviews. Interviews were audio-recorded and transcribed verbatim by the principal investigator. Transcribed interviews were coded, mapped to the TDFV2, and analyzed using thematic analysis. Results: Interviews were completed with 21 pharmacists in 7 provinces across Canada. Barriers and facilitators coded to the TDFV2 were grouped into 4 main themes: communication and collaboration, adaptability, health and well-being, and preparedness. Conclusions: Participants highlighted a significant number of barriers that they experienced during the COVID-19 pandemic; overall, however, participants reported that they felt prepared for subsequent waves of the COVID-19 pandemic and future pandemics RÉSUMÉ Contexte : Lors de la déclaration de la pandémie de COVID-19 en mars 2020, les professionnels de la santé ont été mis au défi de s’adapter rapidement et efficacement à la situation en changeant leurs pratiques professionnelles. Cependant, une approche fondée sur des données probantes pour recueillir systématiquement des données sur les obstacles à la prestation des services de pharmacie hospitalière au Canada et les éléments facilitant celle-ci n’a pas encore été utilisée de manière systématique. Objectifs : L’objectif principal consistait à identifier et à décrire les obstacles à la prestation de services de pharmacie hospitalière aux femmes, aux enfants et à leur famille et les éléments facilitant celle-ci pendant la pandémie de COVID-19. L’objectif secondaire consistait, quant à lui, à fournir des recommandations pour améliorer la prestation de services de pharmacie afin d’améliorer les soins aux patients pendant une pandémie. Méthodes : Cette étude qualitative comprenait des entrevues virtuelles semi-structurées avec des pharmaciens ayant travaillé dans le domaine des soins directs ou non directs aux patients tout au long de la pandémie (depuis mars 2020) dans des hôpitaux pour femmes et/ou enfants au Canada. Les entretiens individuels ont été réalisés virtuellement à l’aide d’un logiciel de conférence. Un guide d’entretien adapté de la 2e version du cadre des domaines théoriques (TDFV2) [Theoretical Domains Framework] a été utilisé pour faciliter les entretiens. Ceux-ci ont été enregistrés sur bande audio et retranscrits textuellement par le chercheur principal. Les entretiens ainsi retranscrits ont été codés, reportés sur le TDFV2 et analysés par thème. Résultats : Des entrevues ont été réalisées auprès de 21 pharmaciens dans 7 provinces du Canada. Les obstacles et les éléments facilitateurs codés selon le TDFV2 ont été regroupés en 4 grands thèmes : communication et collaboration; adaptabilité; santé et bien-être; et état de préparation. Conclusions : Les participants ont mentionné un nombre important d’obstacles qu’ils ont rencontrés pendant la pandémie de COVID-19; dans l’ensemble, cependant, les participants ont déclaré qu’ils se sentaient préparés aux vagues ultérieures de la pandémie de COVID-19 et aux futures pandémies

Pharmacists’ immunization experiences, beliefs, and attitudes in New Brunswick, Canada

Background: The expansion of pharmacist scope of practice to include provision of immunizations has occurred or is being considered in various countries. There are limited data evaluating the experiences of Canadian pharmacists in their role as immunizers. Objective: To describe the experiences of pharmacists in the Canadian province of New Brunswick as immunizers, including vaccines administered and perceived barriers and facilitators to providing immunizations. Methods: An anonymous, self-administered, web-based questionnaire was offered via email by the New Brunswick Pharmacists’ Association to all its members. The survey tool was adapted, with permission, from a tool previously used by the American Pharmacists Association and validated using content validity and test-retest reproducibility. Pharmacist reported immunization activities and perceived facilitators and barriers to providing immunization services were assessed. Results: Responses from 168 (response rate of 26%) were evaluable. Approximately 90% of respondents worked in community practice full time, 65% were female and 44% were practicing for 20 or more years. Greater than 75% reported administering: hepatitis A and B, influenza, and zoster vaccines. The majority of respondents felt fully accepted (agreed or strongly agreed) as immunization providers by patients, local physicians, and the provincial health department (97%, 70%, and 78%, respectively). Most commonly reported barriers were: lack of a universally funded influenza immunization program, insufficient staffing and space, and concerns around reimbursement for services.  Conclusions: Pharmacists in New Brunswick, Canada are actively participating in the provision of a variety of immunizations and felt fully supported by patients and other healthcare providers. Barriers identified may provide insight to other jurisdictions considering expanding the role of pharmacists as immunizers

Point Prevalence Survey of Benzodiazepine and Sedative-Hypnotic Drug Use in Hospitalized Adult Patients

 ABSTRACTBackground: Benzodiazepines and sedative-hypnotic drugs (BZD/ SHDs), such as zopiclone and the antidepressant trazodone, pose risks such as falls, fractures, and confusion, especially for older adults. Use of these drugs in the acute care setting is poorly understood.Objectives: To determine the point prevalence and characteristics of use of BZD/SHDs in hospitals in Nova Scotia, Canada.Methods: A point prevalence survey was conducted for adults admitted to all hospitals with at least 30 acute care beds between May and August 2016. Drugs administered intravenously, patients in long-term care, and patients receiving mental health services, addiction treatment, or critical care were excluded. The proportion of included patients who had received a BZD/SHD within the 24 h before the start of the survey was determined. A descriptive statistical analysis was performed.Results: Overall BZD/SHD prevalence was 34.6% (487/1409) across the 16 eligible hospitals. The average age was 70.3 years, and 150 (30.8%) of the patients were 80 years or older. Among the 585 prescriptions for these patients, commonly used drugs were zopiclone (32.0%), lorazepam (21.9%), and trazodone (21.9%). The most common indications for use were bedtime/daytime sedation (60.0%) and anxiety (12.5%). More than half of the prescriptions (55.7%) had been initiated at home, 37.6% were started in hospital, and the place of initiation was unknown for 6.7%. Benzodiazepines were prescribed more frequently to patients under 65 years than those 80 years or older (41.3% versus 22.2%, p < 0.001) whereas trazodone was more frequently prescribed to the older of these 2 age groups (52.7% versus 14.3%, p < 0.001).Conclusions: BZD/SHDs were frequently used by hospitalized adult patients in Nova Scotia. Trazodone appears to have been substituted for benzodiazepines in the oldest age group. Pharmacists should direct their efforts toward preventing inappropriate initiation of BZD/SHDs in hospital, particularly for elderly patients.RÉSUMÉContexte : Les benzodiazépines et les médicaments sédatifs-hypnotiques (BZD/MSH), comme la zopiclone et l’antidépresseur trazodone, comportent des risques de chute, de fracture et de confusion, particulièrement chez les personnes âgées. Il existe une mauvaise compréhension de l’utilisation de ces médicaments dans un contexte de soins intensifs.Objectifs : Déterminer la prévalence ponctuelle et les caractéristiques de l’utilisation des BZD/MSH dans des hôpitaux en Nouvelle-Écosse, au Canada.Méthodes : Une enquête sur la prévalence ponctuelle a été menée entre mai et août 2016 auprès d’adultes admis dans les hôpitaux comptant au moins 30 lits en soins intensifs. Les patients recevant ces medicaments par voie intraveineuse, ceux en établissement de soins de longue durée, ceux recevant des services en santé mentale ou un traitement pour la toxicomanie ou encore ceux des soins intensifs ont été exclus de l’enquête. La détermination de la proportion des patients inclus dans l’étude portait sur ceux qui avaient reçu des BZD/MSH au cours des 24 h précédant le début de l’enquête, et elle a été suivie d’une analyse statistique descriptive.Résultats :De manière générale, l’usage des BZD/MSH s’élevait à 34,6 % (487/1409) dans les 16 hôpitaux participants. L’âge moyen des patients était de 70,3 ans et 150 (30,8 %) étaient âgés d’au moins 80 ans. Parmi les 585 prescriptions pour ces patients, les médicaments communément utilisés étaient la zopiclone (32,0 %), le lorazepam (21,9 %) et le trazodone (21,9 %). Les indications d’utilisation les plus répandues concernaient la sédation au coucher et en cours de journée (60 %) et l’anxiété (12,5 %). Plus de la moitié des prescriptions (55,7 %) ont commencé à domicile, 37,6 % ont commencé à l’hôpital, et le lieu du début de la prise de ces médicaments était inconnu dans 6,7 % des cas. La prescription des benzodiazépines s’adressait plus souvent aux patients de moins de 65 ans qu’à ceux d’au moins 80 ans (41,3 % par rapport à 22,2 %, p < 0,001), tandis que la prescription de trazodone s’adressait plus souvent aux personnes de la tranche d’âge plus avancée (52,7 % par rapport à 14,3 %, p < 0,001).Conclusions : Les BZD/MSH étaient fréquemment utilisés par les patients adultes hospitalisés en Nouvelle-Écosse. La trazodone semble avoir remplacé les benzodiazépines dans le groupe plus âgé. Les pharmaciens devraient orienter leurs efforts sur la prévention de la prise inappropriée des BZD/MSH en hôpital, particulièrement par les patients plus âgés

A Behavioral analysis of nurses’ and pharmacists’ role in addressing vaccine hesitancy: scoping review

The purpose of this review was to identify, characterize, and map the existing knowledge on a) nurses’ and pharmacists’ perceived barriers and enablers to addressing vaccine hesitancy among patients; and b) strategies or interventions for nurses and pharmacists to address vaccine hesitancy in their practice. Our comprehensive search strategy targeted peer-reviewed and grey literature. Two independent reviewers screened papers and extracted data. We coded narrative descriptions of barriers and enablers and interventions using the Behavior Change Wheel. Sixty-six records were included in our review. Reported barriers (n = 9) and facilitators (n = 6) were identified in the capability, opportunity and motivation components. The majority of the reported interventions were categorized as education (n = 47) and training (n = 26). This current scoping review offers a detailed behavioral analysis of known barriers and enablers for nurses and pharmacists to address vaccine hesitancy and interventions mapped onto these behavioral determinants