663693
editorial2016
CPHXXX10.1177/1715163516663693C P J / R P CC P J / R P C
LISA DOLOVICH, BSCPHM, PHARMD, MSC ROSS T. TSUYUKI, BSC(PHARM), PHARMD, MSC, FCSHP, FACC
EDITORIAL
Pharmacy practice research produces findings that inform how pharmacists contribute to optimal drug therapy outcomes for Canadians You know that life as a pharmacist is busy. So many different activities to juggle—often all at the same time. There are multiple prescriptions to review and assess. There are medication reviews, immunizations, blood pressure or other services to organize, prioritize and provide. Patients or their family members want answers to questions about medications or health. Other health care providers need answers to medication questions that they have sent by phone, text or email. There are care plans to develop and case conferences to participate in. And this is just a partial list. How do you make sense of it all? Meanwhile, society needs high-quality accessible primary health care. Pharmacists are highly accessible and an important part of our primary care system. But we are not often recognized for our primary health role in terms of scope of practice and remuneration. How do we change this? The answer to the above questions is pharmacy practice research. Pharmacy practice research is intended to help answer the questions that pharmacists face every day, such as: •• •• •• •• ••
Is it better if I practise in this way? Why should I practise in this way? How should I do this as part of my practice? How do I implement a new service? What is going on in my practice? (patient demographics, services I provide and outcomes, etc.) •• How best should I interact with others on the health care team? When answers to these questions are generated using highquality scientific methods, this can result in changes to pharmacy practice and health policy. In 2006, the Canadian Pharmacy Practice Research Group defined pharmacy practice research as a component of health services research that focuses on the assessment and evaluation of pharmacy practice. It includes studies that evaluate
pharmacists’ roles in a variety of capacities. These studies include systems research, patient-centred research and community-based research that encompasses a variety of determinants of health and their influence on patient outcomes and population health. Pharmacy practice research methods are used to evaluate expanded professional pharmacist services or new pharmacy programs. For example, how do we know that a medication review such as a Standard Medication Management Assessment in Alberta or a MedsCheck in Ontario is helpful for recipients? And how do we know whether this activity is the best use of the pharmacist’s time? Canada benefits from a robust program of pharmacy practice research. The findings from pharmacy practice research help people learn how to get healthier from the use (or not) of medications. Health care policy-makers learn more about how to organize the health care system. Pharmacists learn more about how to practise better, safer and faster. Pharmacy practice research has informed: 1. The consideration of expanding immunization authorization to students in Ontario1 2. Refinements to the MedsCheck medication review processes in Ontario in 20162 3. Health care stakeholders about the benefits of pharmacists’ independent prescribing and care in diabetes, hypertension, cardiovascular risk and dyslipidemia3-6 4. National guidelines for hypertension screening in Canada and the United States, with a focus on screening in pharmacies7-9 5. Health care stakeholders about the benefits of pharmacists’ detection of previously unknown chronic kidney disease through expanded scope of practice activities, such as screening and ordering laboratory tests10 6. Our understanding of the challenges faced by pharmacists to provide mental illness and addictions care11 © The Author(s) 2016 DOI: 10.1177/1715163516663693
CPJ/RPC • september/october 2016 • VOL 149, NO 5
261
EDITORIAL 7. The decision to include pharmacists as providers within primary care group practices in Ontario and Saskatchewan12,13 8. Our understanding that lack of confidence or unwillingness to take responsibility are key barriers to advanced pharmacist practice14 9. Our understanding that pharmacist renewals in British Columbia are happening less frequently than expected and that many renewals are completed for conditions not set out in the new regulatory policy15 10. The development of continuing pharmacist education for numerous topics, including pain management16,17 The profession of pharmacy in Canada and around the world needs a strong foundation in pharmacy practice research to achieve its vision and mission. The mission of the Canadian Pharmacists Association (CPhA) is “advancing the health and well-being of Canadians through excellence in pharmacist care.” The answers generated by pharmacy practice research efforts are central to Canadian pharmacists’ knowing how to achieve this mission. The Blueprint for Pharmacy initiative, a long-term, multistakeholder strategy designed in 2005 to catalyze, coordinate and facilitate changes to align pharmacy practice with the health care needs of Canadians, agreed that the vision for pharmacy is “optimal drug therapy outcomes for Canadians through patient-centred care.”18 Building on the efforts of the Blueprint for Pharmacy, the 2016 Pharmacy Thought Leadership Summit held at the recent CPhA conference in Calgary identified evidence-generating research as 1 of the 3 priority areas, along with technology and workplace environments and payer and policy-maker issues, as the foci of the emerging pan-Canadian Pharmacy Thought Leadership and Practice Advancement Initiative.19 It is meaningful that research was recognized as an essential driver of change. Research was judged to be helpful in informing which pharmacy programs or care processes would be most effective, including the best use of technology. Research was thought to be helpful in informing pharmacy and broader health services policy. Research was considered to be valuable in identifying the most advantageous business models for the patient, health care system and pharmacist. Research was also believed to be helpful in informing how patients can use or not use medications effectively and safely. Participating in pharmacy practice research activities is not an everyday part of a pharmacist’s job, despite Canadian successes in conducting a number of well-regarded research studies. Pharmacist participation in research networks is not well organized at a provincial, national or corporate level. Formal research networks could be used as a mechanism for both research and continuous quality improvement (CQI) activities. Research networks can be used to collect data at regular intervals and in an organized manner so that the data can be easily generated and fed back to individual practices for CQI purposes and to understand care at the population level. An 262
example of pharmacy practice research in Quebec has shown some initial success with audit and feedback in pharmacies.20 The Canadian Primary Care Sentinel Surveillance Network21 is a particularly successful research network of primary care practices that Canadian pharmacy care learn from. There are many ways forward to increase pharmacy practice research capacity and output in Canada. What we need to do is: •• Build the profession a business case for everyday participation in pharmacy practice research •• Encourage a professional culture in which research is seen as valuable and there is an expectation to participate in pharmacy practice research as an everyday regular part of practising pharmacy •• Develop provincial and national platforms for the routine collection of data, including quality indicators and research data to support each pharmacist in their own quality improvement and program evaluation activities, which can also support research across a number of pharmacies •• Champion pharmacy practice research in professional associations and schools of pharmacy to build awareness, training and capacity •• Encourage fundraising for pharmacy practice research through professional associations and schools of pharmacy, including the allotment of a portion of pharmacist registration or membership fees toward pharmacy practice research •• Promote the value of pharmacy practice research to research funders as a mechanism to support improved health outcomes and health service utilization through better medication management •• Continue strong support for the Canadian Pharmacists Journal as the home of published Canadian pharmacy practice research results. It is the voice of pharmacy practice research in Canada, as it focuses on the evidence for pharmacist care •• Ensure Canadian pharmacy practice research is also published worldwide so that our work can inform pharmacy practice around the world The only thing that is constant is change. Those words written by the ancient Greek philosopher Heraclitus ring true when we try to figure out how a pharmacist can practise pharmacy in a way that will be best for the patient, best for the health care system and best for that pharmacist all at the same time. Each pharmacist faces this challenge every single day. Pharmacy practice research is essential, feasible and can change pharmacy practice and health policy. We use evidence to decide on drug therapy, why not for our own practice? Canadians will get more benefit and less harm from their medications if the pharmacy profession expands its pharmacy practice research organization, capacity and output.■ CPJ/RPC • september/october 2016 • VOL 149, NO 5
EDITORIAL
References 1. Church D, Johnson S, Raman-Wilms L, et al. A literature review of the impact of pharmacy students in immunization initiatives. Can Pharm J (Ott) 2016;149:153-65. 2. Dolovich L, Consiglio G, MacKeigan L, et al. Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013. Can Pharm J (Ott) 2016;149:293-302. 3. Al Hamarneh Y, Charrois T, Lewanczuk R, Tsuyuki RT. Pharmacist intervention for glycemic control in the community (the RxING study). BMJ Open 2013;3:e003154. 4. Tsuyuki RT, Houle SK, Charrois TL, et al. Randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta Clinical Trial In Optimizing Hypertension (RxACTION). Circulation 2015;132:93-100. 5. Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. The effectiveness of community pharmacist prescribing and care on cardiovascular risk: the multicenter randomized controlled RxEACH trial. J Am Coll Cardiol 2016;67(24):2846-54. 6. Tsuyuki RT, Rosenthal MM, Pearson GJ. A randomized trial of a communitybased approach to dyslipidemia management: Pharmacist Prescribing to Achieve Cholesterol Targets (RxACT study). Can Pharm J (Ott) 2016;149:283-92. 7. Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health PAwareness program (CHAP). BMJ 2011;342:d442. 8. Lindsay P, Connor Gorber A, Joffres M, et al. Recommendations on screening for high blood pressure in Canadian adults. Can Fam Physician 2013;59:927-33. 9. U.S. Preventive Services Task Force. Hypertension in adults: screening and home monitoring. November 2015. Available: www.uspreventiveservices taskforce.org/Page/Document/RecommendationStatementFinal/high-bloodpressure-in-adults-screening (accessed Jul. 18, 2016). 10. Al Hamarneh YN, Hemmelgarn B, Curtis C, et al. Community pharmacist targeted screening for chronic kidney disease. Can Pharm J (Ott) 2016;149:13-7.
CPJ/RPC • september/october 2016 • VOL 149, NO 5
11. Murphy AL, Phelan H, Haslam S, et al. Community pharmacists’ experiences in mental illness and addictions care: a qualitative study. Subst Abuse Treat Prev Policy 2016;11(6). 12. Dolovich L, Pottie K, Kaczorowski J, et al. Integrating family medicine and pharmacy to advance primary care therapeutics. Clin Pharmacol Ther 2008;83:913-7. 13. Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract 2014;22:292-9. 14. Frankel GE, Austin Z. Responsibility and confidence: identifying barriers to advanced pharmacy practice. Can Pharm J (Ott) 2013;146:155-61. 15. Law MR, Cheng L, Kratzer J, et al. Impact of allowing pharmacists to independently renew prescriptions: a population-based study. J Am Pharm Assoc 2015;55:398-404. 16. Lalonde L, Leroux-Lapointe V, Choinière M, et al. Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: a Canadian survey of physicians and pharmacists. Pain Res Manag 2014;19:241-50. 17. Patel T, Chang F, Mohammed HT, et al. Knowledge, perceptions and attitudes toward chronic pain and its management: a crosssectional survey of frontline pharmacists in Ontario, Canada. PLoS One 2016;11(6):e0157151. 18. Canadian Pharmacists Association. Blueprint for Pharmacy. Available: https://www.pharmacists.ca/pharmacy-in-canada/blueprint-for-pharmacy/ (accessed Jul. 19, 2016). 19. Canadian Pharmacists Association. Pharmacy thought leadership initiative. Available: www.pharmacists.ca/pharmacy-in-canada/pharmacy-thought -leadership-initiative (accessed Jul. 18, 2016). 20. Winslade N, Eguale T, Tamblyn R. Optimising the changing role of the community pharmacist: a randomised trial of the impact of audit and feedback. BMJ Open 2016;6:e010865. 21. Canadian Primary Care Sentinel Surveillance Network. Available: http:// cpcssn.ca (accessed Jul. 18, 2016).
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editorial2016
CPHXXX10.1177/1715163516663693C P J / R P CC P J / R P C
LISA DOLOVICH, BSCPHM, PHARMD, MSC ROSS T. TSUYUKI, BSC(PHARM), PHARMD, MSC, FCSHP, FACC
EDITORIAL
Pharmacy practice research produces findings that inform how pharmacists contribute to optimal drug therapy outcomes for Canadians You know that life as a pharmacist is busy. So many different activities to juggle—often all at the same time. There are multiple prescriptions to review and assess. There are medication reviews, immunizations, blood pressure or other services to organize, prioritize and provide. Patients or their family members want answers to questions about medications or health. Other health care providers need answers to medication questions that they have sent by phone, text or email. There are care plans to develop and case conferences to participate in. And this is just a partial list. How do you make sense of it all? Meanwhile, society needs high-quality accessible primary health care. Pharmacists are highly accessible and an important part of our primary care system. But we are not often recognized for our primary health role in terms of scope of practice and remuneration. How do we change this? The answer to the above questions is pharmacy practice research. Pharmacy practice research is intended to help answer the questions that pharmacists face every day, such as: •• •• •• •• ••
Is it better if I practise in this way? Why should I practise in this way? How should I do this as part of my practice? How do I implement a new service? What is going on in my practice? (patient demographics, services I provide and outcomes, etc.) •• How best should I interact with others on the health care team? When answers to these questions are generated using highquality scientific methods, this can result in changes to pharmacy practice and health policy. In 2006, the Canadian Pharmacy Practice Research Group defined pharmacy practice research as a component of health services research that focuses on the assessment and evaluation of pharmacy practice. It includes studies that evaluate
pharmacists’ roles in a variety of capacities. These studies include systems research, patient-centred research and community-based research that encompasses a variety of determinants of health and their influence on patient outcomes and population health. Pharmacy practice research methods are used to evaluate expanded professional pharmacist services or new pharmacy programs. For example, how do we know that a medication review such as a Standard Medication Management Assessment in Alberta or a MedsCheck in Ontario is helpful for recipients? And how do we know whether this activity is the best use of the pharmacist’s time? Canada benefits from a robust program of pharmacy practice research. The findings from pharmacy practice research help people learn how to get healthier from the use (or not) of medications. Health care policy-makers learn more about how to organize the health care system. Pharmacists learn more about how to practise better, safer and faster. Pharmacy practice research has informed: 1. The consideration of expanding immunization authorization to students in Ontario1 2. Refinements to the MedsCheck medication review processes in Ontario in 20162 3. Health care stakeholders about the benefits of pharmacists’ independent prescribing and care in diabetes, hypertension, cardiovascular risk and dyslipidemia3-6 4. National guidelines for hypertension screening in Canada and the United States, with a focus on screening in pharmacies7-9 5. Health care stakeholders about the benefits of pharmacists’ detection of previously unknown chronic kidney disease through expanded scope of practice activities, such as screening and ordering laboratory tests10 6. Our understanding of the challenges faced by pharmacists to provide mental illness and addictions care11 © The Author(s) 2016 DOI: 10.1177/1715163516663693
CPJ/RPC • september/october 2016 • VOL 149, NO 5
261
EDITORIAL 7. The decision to include pharmacists as providers within primary care group practices in Ontario and Saskatchewan12,13 8. Our understanding that lack of confidence or unwillingness to take responsibility are key barriers to advanced pharmacist practice14 9. Our understanding that pharmacist renewals in British Columbia are happening less frequently than expected and that many renewals are completed for conditions not set out in the new regulatory policy15 10. The development of continuing pharmacist education for numerous topics, including pain management16,17 The profession of pharmacy in Canada and around the world needs a strong foundation in pharmacy practice research to achieve its vision and mission. The mission of the Canadian Pharmacists Association (CPhA) is “advancing the health and well-being of Canadians through excellence in pharmacist care.” The answers generated by pharmacy practice research efforts are central to Canadian pharmacists’ knowing how to achieve this mission. The Blueprint for Pharmacy initiative, a long-term, multistakeholder strategy designed in 2005 to catalyze, coordinate and facilitate changes to align pharmacy practice with the health care needs of Canadians, agreed that the vision for pharmacy is “optimal drug therapy outcomes for Canadians through patient-centred care.”18 Building on the efforts of the Blueprint for Pharmacy, the 2016 Pharmacy Thought Leadership Summit held at the recent CPhA conference in Calgary identified evidence-generating research as 1 of the 3 priority areas, along with technology and workplace environments and payer and policy-maker issues, as the foci of the emerging pan-Canadian Pharmacy Thought Leadership and Practice Advancement Initiative.19 It is meaningful that research was recognized as an essential driver of change. Research was judged to be helpful in informing which pharmacy programs or care processes would be most effective, including the best use of technology. Research was thought to be helpful in informing pharmacy and broader health services policy. Research was considered to be valuable in identifying the most advantageous business models for the patient, health care system and pharmacist. Research was also believed to be helpful in informing how patients can use or not use medications effectively and safely. Participating in pharmacy practice research activities is not an everyday part of a pharmacist’s job, despite Canadian successes in conducting a number of well-regarded research studies. Pharmacist participation in research networks is not well organized at a provincial, national or corporate level. Formal research networks could be used as a mechanism for both research and continuous quality improvement (CQI) activities. Research networks can be used to collect data at regular intervals and in an organized manner so that the data can be easily generated and fed back to individual practices for CQI purposes and to understand care at the population level. An 262
example of pharmacy practice research in Quebec has shown some initial success with audit and feedback in pharmacies.20 The Canadian Primary Care Sentinel Surveillance Network21 is a particularly successful research network of primary care practices that Canadian pharmacy care learn from. There are many ways forward to increase pharmacy practice research capacity and output in Canada. What we need to do is: •• Build the profession a business case for everyday participation in pharmacy practice research •• Encourage a professional culture in which research is seen as valuable and there is an expectation to participate in pharmacy practice research as an everyday regular part of practising pharmacy •• Develop provincial and national platforms for the routine collection of data, including quality indicators and research data to support each pharmacist in their own quality improvement and program evaluation activities, which can also support research across a number of pharmacies •• Champion pharmacy practice research in professional associations and schools of pharmacy to build awareness, training and capacity •• Encourage fundraising for pharmacy practice research through professional associations and schools of pharmacy, including the allotment of a portion of pharmacist registration or membership fees toward pharmacy practice research •• Promote the value of pharmacy practice research to research funders as a mechanism to support improved health outcomes and health service utilization through better medication management •• Continue strong support for the Canadian Pharmacists Journal as the home of published Canadian pharmacy practice research results. It is the voice of pharmacy practice research in Canada, as it focuses on the evidence for pharmacist care •• Ensure Canadian pharmacy practice research is also published worldwide so that our work can inform pharmacy practice around the world The only thing that is constant is change. Those words written by the ancient Greek philosopher Heraclitus ring true when we try to figure out how a pharmacist can practise pharmacy in a way that will be best for the patient, best for the health care system and best for that pharmacist all at the same time. Each pharmacist faces this challenge every single day. Pharmacy practice research is essential, feasible and can change pharmacy practice and health policy. We use evidence to decide on drug therapy, why not for our own practice? Canadians will get more benefit and less harm from their medications if the pharmacy profession expands its pharmacy practice research organization, capacity and output.■ CPJ/RPC • september/october 2016 • VOL 149, NO 5
EDITORIAL
References 1. Church D, Johnson S, Raman-Wilms L, et al. A literature review of the impact of pharmacy students in immunization initiatives. Can Pharm J (Ott) 2016;149:153-65. 2. Dolovich L, Consiglio G, MacKeigan L, et al. Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013. Can Pharm J (Ott) 2016;149:293-302. 3. Al Hamarneh Y, Charrois T, Lewanczuk R, Tsuyuki RT. Pharmacist intervention for glycemic control in the community (the RxING study). BMJ Open 2013;3:e003154. 4. Tsuyuki RT, Houle SK, Charrois TL, et al. Randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta Clinical Trial In Optimizing Hypertension (RxACTION). Circulation 2015;132:93-100. 5. Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. The effectiveness of community pharmacist prescribing and care on cardiovascular risk: the multicenter randomized controlled RxEACH trial. J Am Coll Cardiol 2016;67(24):2846-54. 6. Tsuyuki RT, Rosenthal MM, Pearson GJ. A randomized trial of a communitybased approach to dyslipidemia management: Pharmacist Prescribing to Achieve Cholesterol Targets (RxACT study). Can Pharm J (Ott) 2016;149:283-92. 7. Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health PAwareness program (CHAP). BMJ 2011;342:d442. 8. Lindsay P, Connor Gorber A, Joffres M, et al. Recommendations on screening for high blood pressure in Canadian adults. Can Fam Physician 2013;59:927-33. 9. U.S. Preventive Services Task Force. Hypertension in adults: screening and home monitoring. November 2015. Available: www.uspreventiveservices taskforce.org/Page/Document/RecommendationStatementFinal/high-bloodpressure-in-adults-screening (accessed Jul. 18, 2016). 10. Al Hamarneh YN, Hemmelgarn B, Curtis C, et al. Community pharmacist targeted screening for chronic kidney disease. Can Pharm J (Ott) 2016;149:13-7.
CPJ/RPC • september/october 2016 • VOL 149, NO 5
11. Murphy AL, Phelan H, Haslam S, et al. Community pharmacists’ experiences in mental illness and addictions care: a qualitative study. Subst Abuse Treat Prev Policy 2016;11(6). 12. Dolovich L, Pottie K, Kaczorowski J, et al. Integrating family medicine and pharmacy to advance primary care therapeutics. Clin Pharmacol Ther 2008;83:913-7. 13. Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract 2014;22:292-9. 14. Frankel GE, Austin Z. Responsibility and confidence: identifying barriers to advanced pharmacy practice. Can Pharm J (Ott) 2013;146:155-61. 15. Law MR, Cheng L, Kratzer J, et al. Impact of allowing pharmacists to independently renew prescriptions: a population-based study. J Am Pharm Assoc 2015;55:398-404. 16. Lalonde L, Leroux-Lapointe V, Choinière M, et al. Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: a Canadian survey of physicians and pharmacists. Pain Res Manag 2014;19:241-50. 17. Patel T, Chang F, Mohammed HT, et al. Knowledge, perceptions and attitudes toward chronic pain and its management: a crosssectional survey of frontline pharmacists in Ontario, Canada. PLoS One 2016;11(6):e0157151. 18. Canadian Pharmacists Association. Blueprint for Pharmacy. Available: https://www.pharmacists.ca/pharmacy-in-canada/blueprint-for-pharmacy/ (accessed Jul. 19, 2016). 19. Canadian Pharmacists Association. Pharmacy thought leadership initiative. Available: www.pharmacists.ca/pharmacy-in-canada/pharmacy-thought -leadership-initiative (accessed Jul. 18, 2016). 20. Winslade N, Eguale T, Tamblyn R. Optimising the changing role of the community pharmacist: a randomised trial of the impact of audit and feedback. BMJ Open 2016;6:e010865. 21. Canadian Primary Care Sentinel Surveillance Network. Available: http:// cpcssn.ca (accessed Jul. 18, 2016).
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