Module 8: The Evolving Role of Pharmacy in Primary Care

Question 1

Given our place within the community, pharmacists are well positioned to assume a larger primary care role - how so? (2)

Answer 1

1. Highly accessible for those seeking care
2. Many already have an established relationship with a particular pharmacy

Question 2

Pharmacy scope of practice is expanding, and the evidence supports a significant role for pharmacists in: (3)

Answer 2

1. Chronic disease management
2. Treatment of self-limiting conditions
3. Providing immunizations

Question 3

Ordering lab tests in SK. Yay or nay?

Answer 3

“Within the pharmacist’s scope of practice; but…
…not enabled outside public health institutions due to limitations in The Medical Laboratory Licensing Act and Regulations and other system issues.”

Question 4

January 29th, 2024: new SCPP bylaws came into
effect granting new level 1 prescriptive authority. Changes include: (3)

Answer 4

1. Ability to provide emergency supply when interruption in drug therapy will result in imminent harm
2. Altering dose or regiment in situations of imminent harm, obvious error, and to assist with antibiotic and opioid stewardship
3. Administrative prescribing to obtain third party drug coverage or support MofH formulary management.

Question 5

“PAS expects the Ministry to support pharmacist expanded scope of practice by adequately compensating for these (new) services…but? (2)

Answer 5

1. No public funding at this time
2. The responsibility for payment would fall on the patient, until public funding is available

Question 6

What is an issue regarding clarifying the pharmacist’s role?

Answer 6

While there is broad and growing support to expand the role and scope of practice of community pharmacists (primary care), role ambiguity (the lack of a clear patient care role) has meant many pharmacists continue to identify with the dispensing or drug distribution role.

Question 7

Researchers point to a general hesitancy among some pharmacists to take on more responsibility for patient care. One paper suggests it is due to: (9)

Answer 7

Traits common among pharmacists that manifest as:
1. Lack of confidence
2. Fear of repercussions
3. Paralysis in the face of ambiguity
4. Need for approval
5. Risk aversion
6. Feelings of caution
7. Perceived competency
8. Role uncertainty
9. Perceived risk

Question 8

In looking at giving a larger role to community pharmacists in patient care, an Alberta study by Donald et al. (2017) reported physicians expressing concerns around: (2)

Answer 8

1. Accountability and liability, and mixed messaging.
2. Duplication of services leading to the wasting of already scarce resources

Question 9

Clarity of roles and effective communication through a _______ ______ ______ were seen as essential to addressing these issues, and in building trust and mutual respect

Answer 9

shared health record

Question 10

Most community pharmacists work apart from family physicians and other primary care providers. What does that lead to? (2)

Answer 10

1. Effective communication and connectivity is less likely
   - Interactions are usually reactive and limited to one-way communication via phone or fax.
2. Contributes to fragmented care resulting in poorer health outcomes and patient experiences

Question 11

Interprofessional collaboration, particularly between physicians and pharmacists can: (4)

Answer 11

1. Enhance quality of care
2. Increase patient engagement
3. Improve patient safety
4. Improve provider satisfaction and retention, as well as provider perceptions of empowerment and recognition

Question 12

Mercer et al. (2020) interviewed physicians and pharmacists on how they communicate and work with one another. They found: (2)

Answer 12

1. Both groups often found traditional community practice challenging to establishing a working relationship.
2. Co-location allows physicians to gain appreciation for the possible roles of a pharmacist and to develop one-on-one relationships built of trust

Question 13

What are some issues and challenges with pharmacist-led clinics? (5)

Answer 13

1. Scope of practice:
   - Insufficient in many jurisdictions.
2. Access to medical charts and lab results:
   - Most community pharmacists lack access to the medical charts and lab results needed to make a proper assessment.
3. Funding models:
   - Need to cover infrastructure, logistics and staffing support (clinic overhead), with less reliance on OOP payment models.
4. Physical assessment skills:
   -Many pharmacists lack the skills needed to assess common ailments and chronic diseases.
5. Practice standards/guidelines
   - Lack of established national guidelines