• Abstract and Figures
• Public Full-text

u McMaster Health Forum Evidence >> Insight >> Action McMaster Healt Forum Evidence Brief: Exploring Models for Pharmacist Prescribing in Primary and Community Care Settings in Ontario 16 June 2015 1 Evidence >> Insight >> Action McMaster Health Forum McMaster Health Forum For concerned citizens and influential thinkers and doers, the McMaster Health Forum strives to be a leading hub for improving health outcomes through collective problem solving. Operating at regional/provincial levels and at national levels, the Forum harnesses information, convenes stakeholders, and prepares action-oriented leaders to meet pressing health issues creatively. The Forum acts as an agent of change by empowering stakeholders to set agendas, take well-considered actions, and communicate the rationale for actions effectively. Authors François-Pierre Gauvin, PhD, Scientific Lead, Evidence Synthesis and Francophone Outreach, McMaster Health Forum John N. Lavis, MD PhD, Director, McMaster Health Forum, and Professor, McMaster University Lisa McCarthy, PharmD M.Sc., Pharmacy Scientist, Women’s College Research Institute at Women’s College Hospital, and Assistant Professor (status), Leslie Dan Faculty of Pharmacy, University of Toronto Funding The evidence brief and the stakeholder dialogue it was prepared to inform were funded by the Government of Ontario through two Health System Research Fund grants: 1) “Fostering innovation and evaluating the effectiveness of Ontario pharmacist-led medication management programs,” an interdisciplinary multi-site research program known as OPEN – the Ontario Pharmacy Research Collaboration – based at the University of Waterloo; and 2) “Harnessing evidence and values for health system excellence,” an interdisciplinary research and knowledge-translation program at McMaster University. The McMaster Health Forum receives both financial and in-kind support from McMaster University. The views expressed in the evidence brief are the views of the authors and should not be taken to represent the views of the Government of Ontario or McMaster University. Conflict of interest The authors declare that they have no professional or commercial interests relevant to the evidence brief. The funders played no role in the identification, selection, assessment, synthesis or presentation of the research evidence profiled in the evidence brief. Merit review The evidence brief was reviewed by a small number of policymakers, stakeholders and researchers in order to ensure its scientific rigour and system relevance. Acknowledgements The authors wish to thank Aunima Bhuiya, Tony Jin Shicheng, and Arnav Agarwal for assistance with reviewing the research evidence about the problem and options. We are grateful to Steering Committee members and merit reviewers for providing feedback on previous drafts of the brief. The views expressed in the evidence brief should not be taken to represent the views of these individuals. We are especially grateful to Elizabeth Bojarksi, Lisa Dolovich, Brent Fraser, Lisa Guirguis, Allan Malek, Nedzad Pojskic, Anne Resnick, Zahava Rosenberg-Yunger, Jeff Taylor and Nancy M. Waite for their insightful comments and suggestions. Citation Gauvin FP, Lavis JN, McCarthy L. Evidence Brief: Exploring Models for Pharmacist Prescribing in Primary and Community Care Settings in Ontario. Hamilton, Canada: McMaster Health Forum, 16 June 2015. Product registration numbers ISSN 1925-2242 (print) ISSN 1925-2250 (online) 2 Evidence >> Insight >> Action Exploring Models for Pharmacist Prescribing in Primary and Community Care Settings in Ontario Table of Contents KEY MESSAGES .............................................................................................................................................................. 5 REPORT .............................................................................................................................................................................. 7 Key definitions ..................................................................................................................................................... 8 Possible rationales for pharmacist prescribing .............................................................................................. 10 Context for pharmacist prescribing in Ontario ............................................................................................. 11 Key features of current pharmacist-prescribing models in Ontario .......................................................... 12 Key features of pharmacist-prescribing models in select jurisdictions in Canada and abroad .............. 14 THE PROBLEM ......................................................................................................................................................... 17 Primary-care providers are delivering care for a wide range of conditions, which results in a significant burden on their shoulders and gaps in services ......................................................................... 17 Current health-system arrangements may limit capacity to improve the situation ................................. 19 Some courses of action have not yet been fully implemented ................................................................... 21 Additional equity-related observations about the problem ......................................................................... 22 THREE OPTIONS FOR ADDRESSING THE PROBLEM ........................................................................... 24 Option 1 – Facilitate the system-wide adoption of collaborative prescribing agreements in primary and community care settings ............................................................................................................. 25 Option 2 – Establish a pharmacist-prescribing program for minor ailments .......................................... 29 Option 3 – Establish an advanced practice pharmacist model .................................................................. 32 Additional equity-related observations about the three options ................................................................ 34 IMPLEMENTATION CONSIDERATIONS ...................................................................................................... 35 REFERENCES................................................................................................................................................................. 39 APPENDICES ................................................................................................................................................................. 47 3 Evidence >> Insight >> Action McMaster Health Forum 4 Evidence >> Insight >> Action Exploring Models for Pharmacist Prescribing in Primary and Community Care Settings in Ontario KEY MESSAGES What’s the problem? Documents prepared by the Government of Ontario articulate a commitment to improving access to care, connecting services, supporting patients, and protecting our universal public-health system. Reconfiguring the scopes of practice of healthcare professionals (in this case, allowing pharmacists to prescribe) and developing new models of care (in this case, positioning pharmacists as members of primary and community care teams) have been suggested as possible ways to achieve these goals. The challenges in meeting these health-system goals can be understood by considering three aspects of, or contributors to, the problem: o primary-care providers are delivering care for patients with a wide range of conditions, many of whom live with multimorbidity, and this results in a significant burden on their shoulders and gaps in services (e.g., caring for minor ailments puts pressure on busy clinics and emergency departments, polypharmacy not being effectively managed, and high immunization rates not being achieved); o current health-system arrangements limit capacity to improve the situation (e.g., a lack of comprehensive information and communication technology infrastructure, a lack of interprofessional collaboration in terms of both what’s happening on the ground and what’s permitted by law); and o some courses of action have not been fully implemented (e.g., recommendation to allow pharmacists to prescribe drugs to treat minor ailments). What do we know (from systematic reviews) about three viable options to address the problem? Option 1 – Facilitate the system-wide adoption of collaborative prescribing agreements in primary and community care settings o We found no systematic review examining formal collaborative prescribing agreements, but a few examined pharmacist services delivered in primary-care clinics (with or without activities delivered collaboratively with family physicians). These reviews found several benefits for interprofessional collaboration (e.g., improved access to care, process of care, and patient outcomes in various areas of chronic disease management, and improved prescribing practices). Option 2 – Establish a pharmacist-prescribing program for minor ailments o There is evidence that pharmacy-based minor ailments programs are suitable alternatives to primary- care consultations (e.g., high symptom-resolution rates, low re-consultation rates, and a decline of the total number of consultations and prescribing for minor ailments in primary-care clinics). Option 3 – Establish an advanced practice pharmacist model o We found no systematic review examining advanced practice pharmacist models, however, there is a growing body of individual studies.

Load more

  70

Copy Link