Pharmacists have been encouraged to enhance their role on primary healthcare teams; but, the profession has yet to be involved to the degree in which a substantial impact can be made. The objective of this study was to provide guidance on how to integrate a pharmacist into an already established primary healthcare team. Using action research, a panel of established primary healthcare pharmacists identified clinical activities for a primary healthcare pharmacist tailored for the project site. The results were presented to the primary healthcare team, who then collaborated with the pharmacist and researchers to define the role of the pharmacist. Once an agreement was reached, a pharmacist provided eight weeks of full-time clinical services. Upon completion, focus groups were used to evaluate the pharmacist's clinical services. The focus group data, along with the pharmacist's suggestions, formed a step-wise guide for integration. The template consists of eight steps which highlight the importance of selecting a collaborative process and team, defining the role of the pharmacist, determining the logistics of providing care, establishing credibility, re-evaluating the role as it evolves, and obtaining patient feedback. Pharmacists desiring to be involved in primary healthcare teams can follow this template to assist them with integration.
Objective To compare the effects of pharmacist consultation versus a decision aid on women's decisional conflict regarding use of hormone replacement therapy (HRT) and subsequent satisfaction with the decision‐making process. Setting A family medicine clinic in Canada. Method The study was a prospective, randomised comparative trial. Peri‐ and post‐menopausal female patients aged 48 to 52 years were invited to participate. Volunteers (n=128) received either a private consultation with a pharmacist or a take‐home decision aid. Data collection was undertaken prior to the intervention and again following an appointment with a physician to discuss HRT. Outcome measures included: perception of being informed about HRT, decisional conflict, satisfaction with the education and the decision made regarding HRT, and adherence to HRT if prescribed. Telephone follow‐up occurred three and 12 months after the physician appointment. Key findings After discussing HRT with their physicians, 35 of 91 women (38.5%) chose HRT, 15 (16.5%) declined it and 41 (45.1%) opted to delay their decision. Both interventions significantly increased women's perception of being informed about this form of therapy and decreased decisional conflict. Satisfaction with the education and with the HRT decision was high. More postmenopausal women in the pharmacist group reached a yes/no decision than in the decision aid group. Of those initiating HRT during the study (n =18), 16.7% had discontinued it at 12 months. Conclusion Consultation with a pharmacist and use of a decision aid are both effective methods for decreasing decisional conflict in peri‐ and post‐menopausal women considering HRT.
Emergency contraceptive pills (ECPs; levonorgestrel or combination oral contraceptives) are used in unique regimens soon after failed contraception or unprotected intercourse to prevent pregnancy. Prompt access to these products is important, as efficacy diminishes with time since intercourse. The availability of EC from pharmacists (either as prescribed Schedule F products or via a rescheduling to Schedule II pharmacist-supervised sale) would greatly increase access. In Saskatchewan, pharmacists have received independent prescribing authority for ECPs. This article describes the process for assessing competency to prescribe EC in that province. A faculty of pharmacy developed a workshop to educate pharmacists about emergency contraceptive products, their mechanism of action, the necessary assessment and documentation processes, ethical issues related to emergency contraception, and counselling techniques. It also offered participants an opportunity to explore a variety of clinical cases in small groups. Participants completed a test before and after the training and were required to attain a score of 80% or greater on the latter test to become certified to prescribe. The average scores on the pre- and post-training tests were 14.4/25 (57.6%) and 22.1/26 (85.0%), respectively (p < 0.05). Over a series of three workshops, 17.2% of Saskatchewan's 1182 pharmacists became certified to prescribe ECPs. The workshop was offered again in June and September 2003, in anticipation of the September 1, 2003, legislative changes.
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