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Oral presentations • Day 1

Session 1: Institute for Clinical Evaluative Sciences (ICES) administrative data

1. A descriptive analysis of MedsCheck Annuals

Dolovich L, Consiglio G, Abrahamyan L, Bojarski E, MacKeigan L, Pechlivanoglou P, Pojskic N, Rac V, Su J, Krahn M, Cadarette S

A MedsCheck Annual consultation is a medication review service funded by the Ontario government for people taking three or more prescription medications for chronic conditions. Leveraging administrative data housed at Institute for Clinical Evaluative Sciences, we sought to describe the demographic and clinical characteristics of MedsCheck Annual service recipients in Ontario from April 1, 2007 to March 31, 2013. This project is the first of three investigating MedsCheck Annual medication reviews.

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2. Impact of pharmacists on influenza vaccination uptake in Ontario: A descriptive analysis using administrative claims data

Kwong J, Cadarette S, Schneider E, Campitelli M, Church D, Consiglio G, Pojskic N, Houle S, Waite N

Since the 2012–13 flu season, pharmacists in Ontario have been authorized to provide influenza vaccination as part of Ontario’s Universal Influenza Immunization Program. Health administrative databases are being leveraged to examine the impact that pharmacists have had on influenza vaccine uptake in Ontario. Preliminary results provide a comparison of the numbers and rates of physician-administered influenza vaccinations compared with pharmacist-administered vaccinations over time, and descriptive characteristics of patients who received influenza vaccination from a physician versus those who received influenza vaccination from a pharmacist.

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3. A descriptive analysis of Ontario’s Pharmaceutical Opinion Program

Dolovich L, Consiglio G, Bojarski E, MacKeigan L, MacCallum L, Pojskic N, Cadarette S

A Pharmaceutical Opinion occurs when the pharmacist makes a documented recommendation to the prescriber regarding the drug therapy. Based on consultation with the prescriber, the prescription may be dispensed as prescribed, may not be dispensed, or the prescription therapy may be adjusted. Leveraging administrative data housed at ICES, we sought to describe the demographic and clinical characteristics of Pharmaceutical Opinion recipients in Ontario from April 1, 2011 to March 31, 2013.

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4. Initial uptake of the Ontario Pharmacy Smoking Cessation Program: Descriptive analysis over two years

Wong L, Burden A, Liu Y, Tadrous M, Pojskic N, Dolovich L,  Calzavara A, Cadarette S

The Ontario Pharmacy Smoking Cessation Program was launched in September 2011. We used medical and pharmacy claims data in Ontario to describe public drug plan beneficiaries receiving and pharmacies providing smoking-cessation services between September 2011 and September 2013. These data were supplemented with publicly available data and grey literature to describe regional differences in program uptake. Patient characteristics were summarized, stratified by drug plan group: seniors (ages ≥65 years) or on social assistance. Trends over time were examined by plotting the number of services, unique patients and unique pharmacies by month. We also examined use of follow-up services, prescription smoking-cessation medications and quit status.

 

Session 2: Stakeholder perspectives

1. Capturing the perspectives of academics, policy makers, physicians and pharmacists about the evaluation of pharmacy — Preliminary results

Dolovich L, Akram S, Rietkoetter S, Slonim K, Nainifard A, MacKeigan L, Patel T, Waite N, Chang F, Farrell B

To inform the development of the pharmacy services evaluation framework, a series of key informant interviews were undertaken to capture expert perspectives on the critical structure, indicators and processes to be included in such a framework and to gain a better understanding of the potential barriers and facilitators to its development and uptake. Results of the thematic analysis of 19 interviews will be presented, highlighting emergent common themes, as well as areas of divergence among participants. This project has highlighted the importance of gathering input from diverse stakeholders in advance of creating an evaluation framework.

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2. Implementation of MedsCheck and Pharmaceutical Opinions: Preliminary findings from corporate pharmacy interviews

MacKeigan L, Bensimon C, Winterbottom M, Dolovich L, Pojskic N, Bojarski E, MacCallum L

To identify strategies used by Ontario pharmacies to enhance the uptake of MedsCheck (Annuals and Diabetes) and pharmaceutical opinions (POs), to ensure service quality, and/or to reach high-risk patients, semi-structured interviews were conducted with key informants from community pharmacy corporations, independent community pharmacies, Ontario professional pharmacy organizations, and the Ontario Ministry of Health and Long-Term Care. Descriptive content analysis was used to identify themes. According to the 13 corporate executive interviews, documentation and patient identification software plus pharmacist training were common implementation strategies for MedsCheck. Regarding POs, underbilling was a consensus theme; restricted patient eligibility and unclear service criteria were attributed causes.

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3. Pharmacists’ perspectives on pharmacists as immunizers

Schneider E, Wenger L, Pojskic N, Raman-Wilms L, Waite N

Although an important public health strategy, the provision of flu shots by pharmacists in Canada is still in its infancy. To understand the perceptions and experiences of pharmacists with this new service, the OPEN immunization team surveyed Ontario-based community pharmacists from August – September of 2014 (n=780, RR: 18%), including both those certified to administer and those who are not. Preliminary survey findings will be presented that provide valuable insight into past and future practices related to advertising and administration, perceived challenges and enablers to the provision and receipt of flu shots in a pharmacy setting, and ideas from pharmacists for engaging more patients in this service.

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4. Identification of challenges and opportunities for community pharmacists to manage chronic pain — dialogue exchange by chronic pain stakeholders

Chang F, Khan A, Patel T, Grindrod K, Aoki K, Chen K, Milic A, Mercer K, Sproule B

Chronic pain is a significant public health issue and affects many domains of life: physical and psychological. Community pharmacists have the opportunity to impact pain management, as they are highly visible and easily accessible to patients. The purpose was to identify and better understand the challenges and opportunities for community pharmacists to optimally manage chronic pain as perceived by patients, caregivers, advocacy groups and healthcare providers, in order to plan for patient-centred pharmacist interventions. The nominal group technique was used to gather and rank data collected. Participants identified numerous opportunities for pharmacists to meet needs of patients with chronic pain.

 

Session 3: Pharmacy practice data

1. Audit of community pharmacist–delivered MedsCheck and Pharmaceutical Opinions services in Ontario

Pojskic N, MacKeigan L, Dolovich L, MacCallum L

The goal of this project is to use community pharmacy records of MedsCheck Annual (MCA), MedsCheck Diabetes (MCD) and Pharmaceutical Opinion (PO) patient encounters to determine quality of services provided. Thirty-five community pharmacies from four regions in Ontario will be recruited for participation. Each pharmacy visit includes collection of a random sample of 16 of each of MCA, MCD and PO forms, which two expert reviewers will assess for comprehensiveness, pharmacist recommendations, and inappropriate medications using a structured form. Service documentation will be compared across regions, pharmacy ownership types and prescription volume levels. The audit is currently underway, with nine pharmacy visits completed to date. Full results are expected by the end of 2014.

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2. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified Delphi process

Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K

A modified Delphi approach was used to identify and gain consensus on prioritized medication classes that would benefit from development of an evidence-based deprescribing guideline. An expert panel meeting was followed by three rounds of surveys among a 65-member Canadian panel of geriatrics experts. Top five priorities were identified as well as nine other classes that participants identified as being in need of a deprescribing guideline. This session will demonstrate that overtreatment and the need for deprescribing guidelines occur throughout the spectrum of primary care and that practitioners identify multiple needs for deprescribing guidance.

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3. Deprescribing guideline development: methods and results of a proton-pump inhibitor deprescribing guideline

Thompson W, Farrell B, Pottie K, Rojas-Fernandez C, Walsh K, Welch V, Boghossian T, Rashid J, Pizzola L, Moayyedi P

Deprescribing guidelines are being developed with the aim of providing clinicians with practical, evidence-based tools they can use to reduce inappropriate medication use in older persons. The first of these guidelines is focused on proton-pump inhibitors. Development of an evidence-based deprescribing guideline is a complex and comprehensive process. Important steps include guideline team formation, development of research questions and scope, gathering and synthesis of evidence, assessment of strength and quality of evidence using GRADE, formulation of recommendations, consideration of patient preferences and costs, and dissemination of findings. This presentation will review the process of developing a deprescribing guideline for proton-pump inhibitors, and will provide a summary of key results and recommendations. A clinical algorithm being trialled in pilot sites will also be presented.

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4. Bias in pharmacist interactions with patients

Wenger L, Pearson-Sharpe J, Waite N

Among pharmacy’s strengths is the profession’s accessibility to patients. As part of the effort to ensure that this accessibility is as cognitively developed as it is spatially distributed, we conducted a scoping review of literature on bias within pharmacist practice. Although findings indicate that many pharmacists are engaging with a range of populations with respect and participating in broader conversations about the value of culturally competent healthcare, there are clear opportunities for improvement. This review highlights patterns in the literature related to deficits in pharmacists’ knowledge about marginalized groups, biased, stereotypical and stigmatizing perceptions of certain patient groups and related care, and constrained service provision, as well as gaps in the extant literature and related research opportunities.

 

Oral presentations • Day 2

Session 4: Research in progress

 

1. Developing deprescribing capacity through developmental evaluation

Conklin J, Farrell B, Raman-Wilms L, McCarthy L, Pizzola L, Irving H, Anderson L

Developmental evaluation (DE) is a qualitative technique for strengthening and improving new programs and innovations. The Deprescribing project is using DE to identify effective and ineffective aspects of the guideline development and implementation processes, to bring these findings to the attention of participants, and to make adjustments to our team processes. With DE, we will develop, define and disseminate an adaptable development and implementation process for deprescribing guidelines. This session presents DE results related to the first guideline development team. We will explain how we are using DE, what it has revealed, and how it has helped us to improve our process.

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2. Patient perspectives on pharmacists as immunizers

Wenger L, Sergeant O, Papastergiou J, Pearson-Sharpe J, Pojskic N, Raman-Wilms L, Schneider E,  Waite N

To ensure safe, effective and appropriate steps forward with pharmacist-administered immunizations, it is important to understand public opinion of this service. To that end, the OPEN immunization team has engaged a number of research projects, including a detailed scoping review of the literature on patient perspectives, attitudes, and knowledge regarding pharmacists as immunizers, surveys of public opinion, and secondary data analyses. This presentation will highlight some of this work, including the results of the scoping review and an overview of a recent survey of pharmacy patrons, and describe how the team is engaging a review and summary of existing data sources to identify gaps and inform research priorities.

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3. Pharmacist and chronic pain survey: Insight on your attitudes, perceptions and knowledge

Chang F, Patel T, Sproule B, Khan A, Coulston B, Jurcic-Vrataric J, Raman-Wilms L

As medication experts, pharmacists have a key role in medication management, providing patient-centred care to optimize safe, effective and appropriate drug therapy. The objectives of the survey research study are to conduct an environmental scan of community pharmacists’ attitudes and perceptions on chronic low back pain, painful diabetic neuropathy and headache disorders, therapeutic knowledge of treating these chronic conditions, and current practices associated with assessment and treatment of these disorders. These chronic ailments are significantly prevalent in our society and the treatment burden falls heavily upon community pharmacists. The results of the survey will guide the second phase of this project, the target of which is to develop and deliver educational modules to community and family health team pharmacists.

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4. Pharmacy students as immunizers: A scoping review of the literature

Johnson S, Church D, Raman-Wilms L, Waite N, Pearson-Sharpe J, Schneider E

In many jurisdictions pharmacy students are authorized to administer vaccines during their undergraduate pharmacy program. Using Arksey and O’Malley’s (2005) framework, we provide a broad overview of the literature on pharmacy students as immunizers. One hundred and seventy-three titles were identified and organized into the following themes: public-related outcomes, student-related outcomes, student perceptions, pharmacy-related outcomes, acceptance of pharmacy students as immunizers, and student training. North American literature suggests that student-run vaccination clinics, student involvement in health fairs, and community-based clinics during rotations or elective courses are beneficial to the public. Limitations include data collection bias and minimal Canadian data.

 

Session 5: Research in progress

1. Measuring self-efficacy for deprescribing tasks: Development of a scale and initial results

Farrell B, Sunstrum L, de Launay D, Conklin J, Raman-Wilms L

Clinicians often express a lack of confidence or ability in carrying out tasks related to deprescribing medications. Evidence-based deprescribing guidelines are intended to provide such support to facilitate deprescribing. No instruments exist to measure clinicians’ ability to deprescribe medications. We developed a survey aimed at measuring self-efficacy for carrying out the main domains of deprescribing tasks. The survey has been administered in our six practice sites before guideline implementation with plans to administer following each of the three guideline implementation periods. This session will cover the survey development process and initial results.

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2. Pharmacist immunization authority beyond influenza: A scoping review

Church D, Pojskic N, Schneider E, Houle S, Waite N

To protect Ontarians from vaccine-preventable disease beyond influenza, and to promote optimal use of pharmacy-based services, the Ontario Pharmacists Association sponsored the following applied health research question: Which non-influenza vaccines should be made available from pharmacists in Ontario pharmacies? A scoping review of the literature was performed using Arksey and O’Malley’s (2005) framework. One hundred and twenty-five articles were reviewed and 10 themes identified. Vaccines featured often in the literature include pneumococcal vaccine, travel vaccines and herpes zoster vaccine. Survey research, reviews and commentaries also occur frequently. A major gap is the lack of consistent measurement of pharmacist impact on non-influenza vaccination rates.

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3. Pharmacists’ authority to renew and adapt prescriptions: Project overview

McCarthy L, Bojarski E, Grindrod K, Dolovich L, Pojskic N, Waite N

This presentation will provide an overview of the project, examining the extent to which and how pharmacists use their authority to renew and adapt prescriptions in Ontario. We will discuss the design of a survey of Ontario pharmacists and plans for a substudy examining the experiences of educators, students, and recent graduates from Ontario’s pharmacy schools.

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4. Sex- and gender-based analysis in the pharmacy research literature

Chang F, Cook K, Cooke M, McCarthy L, Sproule B, Waite N

The Gender and Vulnerable Populations (GVP) team has a mandate to conduct a sex- and gender-based analysis (SGBA) within OPEN. The concept of “sex- and gender-based analysis” is not well defined. Therefore, the GVP team conducted a review of the pharmacy research literature to determine the ways in which sex and gender are analyzed, and the prevalence and definition of SGBA in this body of research. Findings suggest that there are a number of ways in which sex and gender are characterized and analyzed, and that SGBA is present, but not highly prevalent in the pharmacy literature. In this presentation, we will outline our literature review methodology, findings to date, and next steps.

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5. OPEN collaboration research: Experience and impact

Waite N, Dolovich L, Cook K, Cooke M, Grindrod K, Jennings B, Sproule B, Marshall S, Wenger L

OPEN is undertaking an internally focused examination of how team members experience the research collaboration, how they work in partnership on research and related activities, and how the activities of the OPEN network enable or constrain individual and project-wide research goals. Designed to support enhancements to the structure and functioning of the collaboration and help ensure sustainability, this mixed-methods review process involves a survey of team performance and engagement and semi-structured interviews organized to obtain a more detailed understanding of team members’ experiences. Engaged at the OPEN midpoint and at the completion of year 3, the first phase of this study is in process and will run through the end of October. This presentation will present research objectives and methods and provide an opportunity for questions.