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4.  Collaborative Cardiovascular Risk Reduction in Primary Care II (CCARP II) 
Canadian Pharmacists Journal : CPJ  2013;146(5):284-292.
Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors.
This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors.
Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed.
Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention.
Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
PMCID: PMC3785192  PMID: 24093040
7.  Pharmacist educators in family medicine residency programs: A qualitative analysis 
BMC Medical Education  2012;12:74.
25-29% of North American family medicine residency programs utilize a pharmacist to teach residents. Little is known about the impact that these pharmacist educators have on residency training. The purpose of this study was to examine the experiences of residents, residency directors and pharmacists within Canadian family medicine residency programs that employ a pharmacist educator to better understand the impact of the role.
Recruitment from three cohorts (residents, residency directors, pharmacists) within family medicine residency programs across Canada for one-on-one semi-structured interviews followed by thematic analysis of anonymized transcript data.
11 residents, 6 residency directors and 17 pharmacist educators participated in interviews. Data themes were: (1) strong value of the teaching with respect to improved resident knowledge, confidence and patient care delivery; (2) lack of a formal pharmacotherapy curriculum; (3) desire for expansion of pharmacist teaching; (4) impact of teaching on collaboration; (5) impact of teaching on residency program faculty; and (6) lack of criticism of the role.
The pharmacist educator role is valued within residency programs across Canada and the role has a positive impact on several important aspects of family medicine resident training. Suggestions for improvement focused on expanding the teaching role and on implementing a formal curriculum for pharmacist educators to follow.
PMCID: PMC3494584  PMID: 22883928
10.  Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies 
BMC Family Practice  2012;13:27.
Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services.
Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada.
Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains.
Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role.
PMCID: PMC3372430  PMID: 22455482
Primary health care; Pharmacy; Pharmacists; Competencies; Scope of practice
11.  Pharmacists teaching in family medicine residency programs 
Canadian Family Physician  2011;57(9):e341-e346.
To determine the percentage of family medicine residency programs that have pharmacists directly involved in teaching residents, the types and extent of teaching provided by pharmacists in family medicine residency programs, and the primary source of funding for the pharmacists.
Web-based survey.
One hundred fifty-eight resident training sites within the 17 family medicine residency programs in Canada.
One hundred residency program directors who were responsible for overseeing the training sites within the residency programs were contacted to determine the percentage of training sites in which pharmacists were directly involved in teaching. Pharmacists who were identified by the residency directors were invited to participate in the Web-based survey.
Main outcome measures
The percentage of training sites for family medicine residency that have pharmacists directly involved in teaching residents. The types and the extent of teaching performed by the pharmacists who teach in the residency programs. The primary source of funding that supports the pharmacists’ salaries.
More than a quarter (25.3%) of family medicine residency training sites include direct involvement of pharmacist teachers. Pharmacist teachers reported that they spend a substantial amount of their time teaching residents using a range of teaching modalities and topics, but have no formal pharmacotherapy curriculums. Nearly a quarter (22.6%) of the pharmacists reported that their salaries were primarily funded by the residency programs.
Pharmacists have a role in training family medicine residents. This is a good opportunity for family medicine residents to learn about issues related to pharmacotherapy; however, the role of pharmacists as educators might be optimized if standardized teaching methods, curriculums, and evaluation plans were in place.
PMCID: PMC3173442  PMID: 21918131
13.  Pharmacist and physician collaborative prescribing 
Canadian Family Physician  2009;55(12):e86-e91.
To determine if there is improvement in medication management when pharmacists and family physicians collaborate to prescribe medication renewals requested by fax.
Prospective, non-randomized controlled trial.
W est Winds Primary Health Centre, an interdisciplinary health centre that includes an academic family medicine practice, located in Saskatoon, Sask.
All patients whose pharmacies faxed the health centre requesting prescription renewals between October 2007 and February 2008 were selected to participate in the study.
Medication renewal requests were forwarded to the pharmacist (who works in the clinic part-time) on days when he was working (intervention group). The pharmacist assessed drug-therapy issues that might preclude safe and effective prescribing of the medication. The pharmacist and physician then made a collaborative decision to authorize the requested medication or to request additional interventions first (eg, perform laboratory tests). When the pharmacist was not working, the physicians managed the renewal requests independently (control group).
Medication renewals authorized with no recommendations, medication-related problems identified, new monitoring tests ordered, and new appointments scheduled with health providers.
A total of 181 renewal requests were included (94 in the control group and 87 in the intervention group). The control group had significantly more requests authorized with no recommendations (75.5% vs 52.9%, P = .001). Those in the intervention group had significantly more medication-related problems identified (26 vs 10, P = .031); medication changes made (24 vs 10, P = .044); and new appointments scheduled with their family physicians (31 vs 21, P = .049).
There is an improvement in medication management when a pharmacist collaborates with family physicians to prescribe medication renewals. The collaborative model created significantly more activity with each renewal request (ie, identification of medication-related problems, medication changes, and new appointments), which reflects an improvement in the process of care.
PMCID: PMC2793207  PMID: 20008583
14.  Examining asthma quality of care using a population-based approach 
Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators.
We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting β-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the χ2 test for proportions and generalized linear modelling techniques.
In 2002/03, there were 24 616 people aged 5–54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6–9 years and females aged 20–44 years. Males and those in adult age groups (predominantly 20–44 years) had worse quality of care for 4 indicators examined.
Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting β-agonist medications as recommended by consensus guidelines.
PMCID: PMC2276554  PMID: 18390944

Results 1-14 (14)