Positioning pharmacists’ roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada

Abstract Background A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists’ roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences. Methods Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists’ Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists’ roles were constructed in communications about the Compensation Plan. Results In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists’ changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists’ roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists’ changing roles were positioned in alignment with the aims of primary health care. Conclusions Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists’ changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists

Lessons Learned: A Pilot Program to Cultivate a Clinical Role for Pharmacy Students

INTRODUCTION For many years, first-, second-, and third-year pharmacy students were hired into technical roles for summer employment within the pharmacy department at Capital Health in Edmonton, Alberta. A pilot program to cultivate a clinical role for summer pharmacy students as members of the pharmacy patient care team was undertaken in 2004 by the clinical coordinators (including MLA) at Capital Health. This pilot program was designed to develop a rewarding professional development experience for pharmacy students, to offer meaningful contributions to the pharmacy clinical teams, to positively affect pharmacy students’ views of hospital practice, and to encourage careers in hospital pharmacy. In addition, integrating patient care and professional activities into student positions held promise to initiate change within the department’s culture with respect to students. The role developed for the pilot program was based on clinical pharmacy technician models from the literature, in which the clinical technician provided clinical services support, such as collecting laboratory data, screening patients, taking medication histories, and tracking outcomes, so as to redirect clerical workload and focus pharmacists’ time on direct patient care activities.1-4 These models involved extensive training for specific roles according to established protocols and other clinical tools, as well as assessment of decisionmaking competence for screening tasks.2,4 These previously reported experiences inspired development of a targeted clinical training program at our own institution. In addition, it was felt that a clearly defined role and expectations, supported by targeted training in clinical patient care activities, would promote acceptance of students on the pharmacy clinical team. Capital Health is a regional health authority serving a population of approximately one million. It consists of 13 facilities with a total of more than 2500 beds, in addition to outpatient clinics and public health services. Capital Health provides academic training for the health care professional programs of the University of Alberta. Regional Pharmacy Services, through its nearly 100 pharmacists and more than 65 technicians, provides clinical and distribution services for the health region. In this report we describe our experiences with this pilot program and outline the lessons learned

Reflective Practice: Co-Creating Reflective Activities for Pharmacy Students

Reflective practice is important in pharmacy education to support skill development for decision-making, critical thinking, problem-solving, and in continuing professional development and beyond. Despite the importance of reflective practice in higher education and professional practice, reflection assignments are not universally embraced by students. This project was initiated due to recent interest in the co-creation of pharmacy curriculum by students and faculty. The purpose of this project was to develop reflection assignments for pharmacy students. The principles of the analysis, design, development, implementation, evaluation (ADDIE) instructional design framework guided the development of reflection assignment templates for three focus areas: personal development, professional development, and professional identity formation. Templates included background and definitions for these specific focus areas as well as objectives, instructions, guiding questions, assessment methods, and submission requirements. A previously tested assessment rubric was adopted for reflection assignments. Development involved target audience and expert reviews and a trial implementation was held in a year 3 patient care skills course. The co-creation process enriched the experiences of students and faculty involved in it. Future co-creation projects including groups of students, formal evaluation of outcomes, and impact on the program will further support integration of reflective practice in the pharmacy curriculum

Positioning pharmacists’ roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada

Background: A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists’ roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences. Methods: Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists’ Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists’ roles were constructed in communications about the Compensation Plan. Results: In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists’ changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists’ roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists’ changing roles were positioned in alignment with the aims of primary health care. Conclusions: Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists’ changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.Arts, Faculty ofNon UBCLibrary, Archival and Information Studies (SLAIS), School ofReviewedFacult

Experience of Patients with COPD of Pharmacists’ Provided Care: A Qualitative Study

Chronic obstructive pulmonary disease (COPD) is associated with high global morbidity and mortality. Pharmacists are uniquely positioned to provide services which may reduce the burden of this disease on the health system, patients, and their families. The study aimed to understand the perceptions and experiences of patients living with COPD with pharmacists’ provided care in COPD diagnosis and management. The study was guided by qualitative description methodology and reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. We conducted semi-structured interviews with 12 participants who were recruited from community pharmacies, seniors’ centres, a general practice clinic, and a pulmonary rehabilitation centre. Using qualitative content analysis, we identified categories that revealed great variation in participants’ experience of pharmacy care based on the depth of patient–pharmacist engagement. Participants who regarded their pharmacists as an essential member of their healthcare team and those who did not, had contrasting experiences with education, communication, and ability to form connections with their pharmacists. For patients with COPD, it is important that the pharmacist is proactive in engaging patients through effective communication, education/provision of relevant information, identification of patient needs, and consistent provision of care with empathy

Hospital Pharmacists’ Experiences with Medical Assistance in Dying: A Qualitative Study

Background: Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists’ involvement, little is known about how they experience MAiD practice. Objective: To study how pharmacists experience the practice of caring for patients who seek MAiD. Methods: This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison. Results: Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists’ experiences were personal, relational, emotional, and dynamic. Conclusions: Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists’ roles in MAiD. RÉSUMÉ Contexte : Les pharmaciens de nombreux pays participent depuis longtemps à certains aspects de l’aide médicale à mourir (AMM). Depuis que le Canada a adopté une loi l’autorisant en 2016, le nombre de patients qui demandent l’intervention a augmenté chaque année. Malgré la nature mondiale de l’implication des pharmaciens, on sait peu de choses sur la façon dont ils vivent la pratique de l’AMM. Objectif : Étudier comment les pharmaciens vivent la pratique de la prise en charge des patients qui sollicitent l’AMM. Méthodes : Cette étude qualitative a utilisé des entretiens semi-structurés avec des pharmaciens qui avaient pris en charge des patients ayant fait une demande d’AMM. Un enregistrement sonore des entretiens, menés entre juin 2019 et octobre 2020, a été effectué et ils ont été transcrits mot à mot. Les données ont été examinées en adoptant une approche d’analyse du cadre modifié. Les données ont été codées et triées à l’aide des logiciels Quirkos et Microsoft Excel. Les thèmes ont été définis par un processus itératif impliquant une comparaison constante. Résultats : Dix-neuf pharmaciens d’hôpitaux représentant un éventail de milieux de pratique en Alberta ont participé à l’étude. L’expérience de la prise en charge de patients cherchant à recevoir l’aide médicale à mourir a mis en lumière 3 thèmes : trouver sa place dans le processus; jouer un rôle de proche aidant; et supporter des charges émotionnelles. Les expériences des pharmaciens étaient personnelles, relationnelles, émotionnelles et dynamiques. Conclusions : Chaque pharmacien a vécu la pratique de l’AMM d’une manière unique. Bien que leurs rôles dans l’AMM étaient principalement axés sur la médication, leurs expériences ont mis en évidence la centralité des choix, de l’autonomie et des besoins des patients. Les résultats de cette étude informeront les pharmaciens (y compris ceux qui ne sont pas encore engagés dans la pratique de l’AMM) sur le rôle. Ils seront également précieux pour les organismes pharmaceutiques et les éducateurs cherchant à soutenir les pharmaciens et la profession, ainsi que pour les décideurs politiques qui cherchent à élargir les rôles de pharmaciens dans l’AMM

Learning and Networking: Utilization of a Primary Care Listserv by Pharmacists

BACKGROUND: Expanding into new types of practice, such as family health teams, presents challenges for practising pharmacists. The Primary Care Pharmacy Specialty Network (PC-PSN) was established in 2007 to support collaboration among pharmacists working in primary care. The PC-PSN offers to its members a listserv (also referred to as an electronic mailing list) jointly hosted by the Canadian Society of Hospital Pharmacists and the Canadian Pharmacists Association. OBJECTIVES: To characterize PC-PSN membership and participation in the listserv and to examine how the listserv is used by analyzing questions posted, concerns raised, and issues discussed. METHODS: Qualitative content analysis was used to examine 1 year of archived PC-PSN listserv posts from the year 2010. Two coders used NVivo software to classify the content of posts. Research team members reviewed and discussed the coding reports to confirm themes emerging from the data. RESULTS: Overall, 129 people (52.9% of the 244 listserv members registered at the end of the calendar year) posted to the listserv during the study period. These participants worked in various practice settings, with over half residing in Ontario (68/129 [52.7%]). A total of 623 posts were coded. Agreement between coders, for a sample of posts from 10 users, was acceptable (kappa = 0.78). The listserv was used to share information on a diverse set of topics, to support decision-making and acquire solutions for complex problems, and as a forum for mentorship. CONCLUSIONS: The qualitative content analysis of the PC-PSN listserv posts for the year 2010 showed that the listserv was a medium for information-sharing and for providing and receiving support, through mentorship from colleagues. Apparent learning needs included effective question-posing skills and application of evidence to individual patients

Learning and Networking: Utilization of a Primary Care Listserv by Pharmacists

ABSTRACTBackground: Expanding into new types of practice, such as family health teams, presents challenges for practising pharmacists. The Primary Care Pharmacy Specialty Network (PC-PSN) was established in 2007 to support collaboration among pharmacists working in primary care. The PC-PSN offers to its members a listserv (also referred to as an electronic mailing list) jointly hosted by the Canadian Society of Hospital Pharmacists and the Canadian Pharmacists Association.Objectives: To characterize PC-PSN membership and participation in the listserv and to examine how the listserv is used by analyzing questions posted, concerns raised, and issues discussed.Methods: Qualitative content analysis was used to examine 1 year of archived PC-PSN listserv posts from the year 2010. Two coders used NVivo software to classify the content of posts. Research team members reviewed and discussed the coding reports to confirm themes emerging from the data.Results: Overall, 129 people (52.9% of the 244 listserv members registered at the end of the calendar year) posted to the listserv during the study period. These participants worked in various practice settings, with over half residing in Ontario (68/129 [52.7%]). A total of 623 posts were coded. Agreement between coders, for a sample of posts from 10 users, was acceptable (kappa = 0.78). The listserv was used to share information on a diverse set of topics, to support decision-making and acquire solutions for complex problems, and as a forum for mentorship.Conclusions: The qualitative content analysis of the PC-PSN listserv posts for the year 2010 showed that the listserv was a medium for information-sharing and for providing and receiving support, through mentorship from colleagues. Apparent learning needs included effective question-posing skills and application of evidence to individual patients.RÉSUMÉContexte : Passer à de nouveaux types de pratiques, comme les groupes de médecine de famille, présente différents défis pour les pharmaciens en exercice. Le Réseau de spécialistes en pharmacie (RSP) en soins de santé primaires a été mis sur pied en 2007 dans le but de favoriser la collaboration entre pharmaciens oeuvrant en soins de santé primaires. Le RSP en soins de santé primaires offre à ses membres un gestionnaire de liste de diffusion (listserv) sous l’égide conjoint de la Société canadienne des pharmaciens d’hôpitaux et de l’Association des pharmaciens du Canada.Objectifs : Offrir un portrait des effectifs du RSP en soins de santé primaires et de la participation des membres au forum de discussion, et étudier comment le gestionnaire de liste de diffusion est utilisé à l’aide d’une analyse des questions publiées, des préoccupations soulevées et des problèmes abordés.Méthodes : Une analyse qualitative du contenu a servi à étudier l’ensemble des messages archivés dans le gestionnaire de liste de diffusion de l’année 2010. Deux codeurs ont utilisé le logiciel NVivo pour classer le contenu des messages publiés. Les résultats de l’encodage ont été examinés par les membres de l’équipe de recherche afin d’identifier les thèmes se dégageant des données.Résultats : Dans l’ensemble, 129 personnes (52,9 % des 244 membres inscrits au gestionnaire de liste de diffusion à la fin de l’année civile) ont publié des messages durant la période à l’étude. Les participants travaillaient dans différents milieux et plus de la moitié habitaient en Ontario (68/129 [52,7 %]). Au total, 623 messages ont été encodés et la concordance entre les résultats des deux codeurs était satisfaisante pour un échantillon de messages provenant de 10 usagers (indice kappa = 0,78). Le gestionnaire de liste de diffusion a servi à partager de l’information sur une gamme de sujets, à appuyer des prises de décision et à trouver des solutions à des problèmes complexes. Il a aussi servi de forum de mentorat.Conclusions : L’analyse qualitative du contenu des messages publiés en 2010 dans le gestionnaire de liste de diffusion par les membres du RSP en soins de santé primaires a montré que le gestionnaire est un média d’échange d’information et qu’il permet d’offrir et de recevoir du soutien grâce au mentorat entre collègues. Parmi les besoins identifiés, on compte la capacité à bien formuler des questions et l’application des données probantes pour le traitement individuel des patients