RxCELLENCE June 2024

Pharmacists’ Role in Primary Care

“There is a need now, more than ever, for pharmacists to practice at their full scope in primary care. ”

Canada is currently facing a shortage crisis of family doctors. People are struggling to find a family doctor accepting new patients or to get in to see their usual family doctor in a timely manner, with wait times for appointments of four to six weeks. Pharmacists play a vital role in filling this gap in primary care, as trusted and accessible primary care providers

To meet our patients’ primary care needs, there is a need now, more than ever, for pharmacists to practice at their full scope What does this look like?

First, “pharmacist primary care clinics” have started to open across the country, allowing pharmacists to practice at their full scope to deliver primary health care. For more information on this topic, click here.

Second, we are developing “care pathways” - these are guideline and evidence-based electronic algorithms which can help you to assess, treat, educate patients and document your care. We will bundle this with a practical education program on how to provide these services We plan to roll these out to pharmacists this summer - the first area will be cardiovascular risk reduction.

Read below for more (see the PRxOACT Trial)

May Measurement Month

Hypertension is one of the leading risk factors for death and disability worldwide and approximately 50% of individuals with hypertension are unaware they have the condition. Active clinical screening of asymptomatic patients reduces lead time between diagnosis and treatment. BP screening and control remains a major challenge in primary care; innovative interventions to improve screening and control are needed.

May Measurement Month (MMM) is an annual global blood pressure (BP) screening awareness campaign launched in 2017; more than 100 countries have participated. This campaign builds on the World Hypertension League’s annual World Hypertension Day on May 17th. The MMM campaign runs from May 1 to July 31 of each year. Canadian health professionals have previously participated, however MMM had never been completed in Canadian community pharmacies until 2023.

Community pharmacies are highly accessible to the public and are well positioned to engage in BP screening. For most people, it is far easier to see and speak to a pharmacist than a physician. Clinical trial evidence has demonstrated the advantages of pharmacist intervention in hypertension including education, consultation, and/or prescribing. Pharmacists in every province can provide hypertension screening.

Participating in MMM is very easy! Pharmacists and pharmacy personnel must complete a short 30-minute training module on proper blood pressure measuring technique. Participating patients complete a short questionnaire and have their blood pressure taken by pharmacy personnel.

If you are a pharmacy professional interested in participating in MMM 2024, please email sgysel@ualberta.ca.

Implementation of Pharmacist Case Finding and Intervention for Vascular Prevention: PR OACT Study

We are seeking pharmacists to participate in this new study. In this study, we are developing electronic tools to assist pharmacists in their assessment and care of patients at high cardiovascular risk. We are looking for pharmacists working in primary care clinics or who are already delivering advanced clinical services. x

Cardiovascular disease is still one of the leading causes of death in Canada, even though most of its cases and deaths are caused by well-known modifiable risk factors Guidelines recommend using cardiovascular (CV) risk assessment to guide the treatment and prevention of cardiovascular disease and its risk factors However, such assessment has not been integrated into clinicians’ daily routine

Pharmacists are frontline primary healthcare providers who see patients with chronic conditions frequently Their interventions in patients with such conditions have been demonstrated to improve outcomes and are associated with very high levels of patient satisfaction and significant cost savings While there is strong evidence for the impact of pharmacist care in cardiovascular disease, implementation of this evidence is lacking Such lack of implementation, combined with the family physician crisis in Canada, highlights the need for creative implementation initiatives for this excellent evidence

Primary objective: To determine the impact of a pharmacist care pathway on patients’ estimated risk for major cardiovascular events

Methods

Design: Randomized controlled trial with the patient as the unit of randomization

Setting: Pharmacist primary care clinics

Intervention: Patient assessment, lab assessment, individualized CV risk calculation and education about this risk Using EPI RxISK™ (https://www.epicore.ualberta.ca/epirxisk/), adherence assessment, shared decision making, treatment initiation/adjustment and lifestyle adjustment based on co-designed treatment plan, regular follow-up.

What this study adds: This initiative builds on well-studied interventions and will not only improve Albertans access to CV care, but it will also enhance their knowledge and understanding of their CV risk and risk factors Moreover, the proposed project meets the recommendations of the latest proposals and calls for modernizing Alberta’s primary health Care system (MAPS) as it will be the first project to evaluate CVD services at the pharmacist primary care clinics which will ensure “sufficient research and evaluation capacity built into all early actions to facilitate both accountability and improvement" and will use the online interactive EPI RxISK™ CV calculator which will embrace “technology-enabled care as a foundation” that was identified as a major driver for transformation.

If you are interested in joining please contact: yazid.alhamarneh@ualberta.ca & shania.liu@ualberta.ca

R OC-IT: A Pharmacist-Led Obesity Care Intervention x

***Seeking CDE and/or CBE Pharmacists in Alberta***

Objectives:

To develop the first pharmacist-led obesity management clinics in Canada. Determine the benefit of a pharmacist-led weight management program in patients struggling with overweight and obesity.

Background:

Overweight and obesity is associated with stigma and can also affect the social, economic, and mental wellbeing of those who experience it. We need to find better ways for people who have overweight and obesity to access health care services that help them improve their health. In Alberta, pharmacists have the broadest scope of practice in Canada. They have the ability to prescribe medications and order laboratory tests thus are well positioned to increase access to comprehensive, collaborative care and follow-up for patients living with overweight and obesity in Alberta.

Design:

Prospective before and after study design. With one core community pharmacy-led clinic (Apothecare Pharmacy) and three satellite pharmacy-led clinics across Alberta. The initial step involved creating a core pharmacist-led obesity clinic to establish a benchmark – complete. Satellite pharmacies and pharmacist trainees will be determined and provided standardized training based on Obesity Canada’s clinical practice guidelines and via experiential learning.

We are seeking pharmacists/pharmacies with the following criteria below that would be interested in participating:

Independent community pharmacy/pharmacists outside of Calgary, AB. Have sufficient staffing/overlap.

Pharmacists must have APA, and a PRAC-ID to order lab work.

Practice as a Certified Diabetes Educator® and/or Certified Bariatric Educator®.

If you are interested in participating please send an email to dan@apothecarerx.ca.

Studies: Call for Ideas

Have you noticed something interesting, or had a question come up in practice and thought that would make a great research question? Are you currently recruiting participants for an ongoing study?

We are always looking for ways that we can help YOU turn your questions into research studies or provide you with assistance with your ongoing endeavors. Please email us at rxexcell@ualberta.ca with any ideas or requests, and we’ll work with you to make it a reality!

www.epicore.ualberta.ca/home/rxcellence

rxexcell@ualberta.ca