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1.  A scoping review of research on the prescribing practice of Canadian pharmacists 
Canadian Pharmacists Journal : CPJ  2015;148(6):325-348.
Pharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature.
We conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information.
We identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing.
Canadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians’ services, overall patient safety and access to health care systems and economic implications for society.
A growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact.
PMCID: PMC4637852  PMID: 26600824
2.  What elements of the patient–pharmacist relationship are associated with patient satisfaction? 
Optimal medication management requires an effective relationship between the patient and health care professional. As pharmacists move from the traditional dispensing role to become more actively involved in patient care, factors influencing their relationship with patients need to be identified. A better understanding of these factors will facilitate more effective relationships.
To explore the effect of patient-perceived pharmacist expertise on relationship quality, self-efficacy, patient satisfaction, and relationship commitment.
This was a cross-sectional study conducted in five community pharmacies within the province of Alberta, Canada. A total of 500 patients were asked to complete a set of validated, self-administered questionnaires that measured perceived pharmacist expertise, relationship quality, self-efficacy, patient satisfaction, and relationship commitment. Hierarchical multiple regression was used to examine the associations between variables.
A total of 112 surveys were returned. Internal consistency ranged from 0.86–0.92, suggesting good reliability, except for the relationship commitment scale. There was a significant, positive correlation between patient-perceived pharmacist expertise and quality of the relationship (0.78; P < 0.001). There were also significant, positive correlations between perceived expertise and patient satisfaction (0.52; P < 0.001) and relationship commitment (0.47; P < 0.001). These associations remained significant but the magnitude of correlation decreased when relationship quality was taken into account (0.55; P < 0.001 and 0.56; P < 0.001, respectively). On the other hand, there was no significant association between either patient-perceived pharmacist expertise or relationship quality and medication self-efficacy (0.06; P = 0.517 and 0.10; P = 0.292, respectively).
Patient-perceived pharmacist expertise is an independent determinant of relationship quality, patient satisfaction, and relationship commitment. Relationship quality also appears to mediate the effect of perceived expertise on patient satisfaction and relationship commitment.
PMCID: PMC3461603  PMID: 23055699
relationship quality; pharmacist expertise; self-efficacy; relationship commitment; satisfaction
3.  Evaluation of Structured Patient Interactions: The Diabetes Check 
To evaluate a structured patient intervention, the Diabetes Check, in which pharmacy students ask patients with diabetes about 3 clinical targets: A1c, blood pressure, and low-density lipoprotein (LDL) cholesterol (ABC) levels. Specific objectives were to: (1) describe the effect of patients' reactions on pharmacy students; (2) describe pharmacy students' confidence and role beliefs; and (3) determine predictors of pharmacy students' intention to use the Diabetes Check in the future.
After training, pharmacy students were asked to perform 10 diabetes checks and complete an evaluation. Data from the evaluations described pharmacy students' reactions, role beliefs, and confidence. Linear regression was performed to predict intention of using the Diabetes Check in future.
One-hundred twenty-eight pharmacy students used the Diabetes Check tool with over 1000 patients. Most pharmacy students were encouraged by patients' reactions (56%). Pharmacy students' perceptions of patients' reaction and pharmacy students' role beliefs about monitoring ABCs significantly predicted pharmacy students' reported intention to use a Diabetes Check (r-squared = 0.52).
Pharmacy students' perceptions of patient reactions and role beliefs about the importance of monitoring predicted their reported intention of performing a Diabetes Check in the future.
PMCID: PMC1636955  PMID: 17136177
student pharmacist; diabetes; role beliefs; patient interaction; self-efficacy
4.  Pharmacists Connect and CARE 
Canadian Pharmacists Journal : CPJ  2014;147(3):149-153.
PMCID: PMC4025885  PMID: 24847366
5.  Factors influencing pharmacists’ adoption of prescribing: qualitative application of the diffusion of innovations theory 
In 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists’ adoption of prescribing using a model for the Diffusion of Innovations in healthcare services.
Pharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations.
Thirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists’ adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists’ decisions to apply for independent prescribing privileges.
Diffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists’ adoption of prescribing. The characteristics of the prescribing model itself which legitimized prior practices, the model of practice in a pharmacy setting, and relationships with physicians were prominent influences on pharmacists’ prescribing behaviours.
PMCID: PMC3847669  PMID: 24034176
6.  Patients’ blood pressure knowledge, perceptions and monitoring practices in community pharmacies 
Pharmacy Practice  2010;8(3):187-192.
Hypertension is a modifiable risk factor for cardiovascular disease. Despite this, patients often cannot or inaccurately estimate their risk factors.
In order to improve pharmacist interventions, we sought to: 1) find out patients’ knowledge about blood pressure (BP) and their self-monitoring behaviors and 2) identify the relationships between these two elements. Specifically, if evaluation of BP control were related to knowledge of one’s BP level and self-monitoring habits, and if knowledge of one’s target and BP level varied with monitoring habits.
Final year pharmacy students were trained and interviewed patients in community pharmacies as a required exercise in their pharmacy clerkship. Each student recruited a convenience sample of 5-10 patients who were on hypertension medication, and surveyed them regarding their BP targets, recent BP levels as well as monthly and home BP monitoring practices.
One third of the 449 patients interviewed were able to report a blood pressure target with 26% reporting a JNC 7 recognized target. Three quarters of patients who reported a blood pressure target were able to report a blood pressure level, with 12% being at their self-reported target. Roughly two thirds of patients perceived their BP to be “about right”, and slightly less than a third thought it to be “high”. Sixty percent of patients monitor their BP monthly, but less than 50% of patients practice home BP monitoring.
This study along with others before it point to the knowledge and self-management gaps in patients with chronic conditions. Furthermore, pharmacy students were able to use a brief intervention to screen patients during routine care. Pharmacists can help improve patient understanding and promote increased self-management through regular BP monitoring.
PMCID: PMC4127054  PMID: 25126139
Students; Pharmacy; Blood Pressure Monitoring; Ambulatory; Self Care; Hypertension; Canada
7.  Safety and Efficacy of High-Dose Interleukin-2 Therapy in Patients With Brain Metastases 
The authors determined the safety and efficacy of recombinant high-dose interleukin-2 administration in patients with brain metastases. This retrospective review included 1,069 patients with metastatic melanoma or renal cell carcinoma who received high-dose interleukin-2 alone or in combination with other immunotherapy or chemotherapy from July 1985–July 2000. All patients were evaluated for both toxicity and response. Only the first exposure to interleukin-2 was considered. Parameters evaluated among the groups included toxicity profiles, reasons for stopping treatment, number of interleukin-2 doses per cycle, and response to therapy. Three patient groups were compared. Group 1 (n = 27) comprised patients with previously treated brain metastases (surgery or radiation), group 2 (n = 37) comprised patients with untreated brain metastases, and group 3 (n = 1,005) comprised patients without brain metastases. For most comparisons between patients with brain metastases and those without, no significant differences were noted in toxicity profiles or reasons for stopping interleukin-2 therapy. Patients with previously treated brain metastases received fewer interleukin-2 doses per cycle (median, 6.5) than patients with previously untreated brain metastases (median, 7.5) or patients without brain metastases (median, 7.5). Patients with previously treated brain metastases demonstrated an 18.5% overall clinical response to interleukin-2 treatment. However, patients with evaluable (previously untreated) brain metastases had an overall 5.6% response rate, which was less than the 19.8% response rate of patients without brain metastases. Two of thirty-six patients with evaluable brain metastases demonstrated objective regression of intracranial and extracranial disease after receiving interleukin-2. Carefully selected patients with brain metastases can safely receive high-dose interleukin-2, and some can experience a response to treatment at intracranial and extracranial disease sites.
PMCID: PMC2424228  PMID: 11924913
Interleukin; 2; Melanoma; Brain metastases; Safety

Results 1-7 (7)