Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial.

BACKGROUND: Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES: ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS: The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL: The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS: A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).

Role of Indigenous health workers in the delivery of comprehensive primary health care in Canada, Australia, and New Zealand: a scoping review protocol.

OBJECTIVE: The aim of this review is to identify and describe Indigenous health workers' roles, functions, activities, and involvement in decision-making in the provision of primary health care for Indigenous peoples and communities in Canada, Australia, and New Zealand. INTRODUCTION: The Indigenous health worker workforce is the cornerstone to providing culturally safe, primary health care for Indigenous peoples and communities. Yet, wide-ranging role variation has created a general lack of understanding of who Indigenous health workers are, what Indigenous health workers do, and how to best coordinate their roles and skills with other care providers to further improve the health care experience and outcomes for Indigenous peoples and communities. INCLUSION CRITERIA: This review will consider full text, peer-reviewed publications and gray literature that include Indigenous health workers who identify as belonging to, and are recognized as such by their communities, any First Peoples group in Canada (First Nations, Inuit, Métis), Australia (Aboriginal, Torres Strait Islander), and New Zealand (Maori); and who describe their role as the provision of primary health care to Indigenous peoples and communities, in clinical and non-clinical settings, in both mainstream health systems and within community-controlled primary health care sectors. METHODS: MEDLINE, CINAHL, Scopus, Embase, Informit (Indigenous Collection, New Zealand Collection, Rural and Remote Health Database, APAIS-ATSIS, Aboriginal and Torres Strait Islander health bibliography), Sociological Abstracts, and Australian Indigenous HealthInfoNet will be searched for studies. Additional sources of unpublished literature, including government websites and community-controlled health organization websites in Canada, Australia, and New Zealand, will also be searched. Articles in English and French will be included, with no set date restrictions. Screening and selection will follow JBI methodology and findings will be summarized in tabular form accompanied by narrative text.

Distributing Publicly-Funded Influenza Vaccine-Community Pharmacies' Perspectives on Acquiring Vaccines from Public Health and from Private Distributors in Ontario, Canada.

OBJECTIVES: To explore community pharmacies' experience with two models of distribution for publicly-funded influenza vaccines in Ontario, Canada-one being publicly-managed (2015-2016 influenza season) and one involving private pharmaceutical distributors (2016-2017 season). METHODS: Online surveys were distributed to community pharmacies across Ontario during the 2015-2016 and 2016-2017 influenza seasons with sampling proportional to Ontario Public Health Unit catchment populations. Quantitative data were analyzed descriptively and inferentially and qualitative data were summarized for additional context. RESULTS: Order fulfillment appeared more responsive with the addition of private distributors in 2016-2017, as more pharmacies reported shorter order fulfillment times (p < 0.01); however, pharmacies reported significantly more days with zero on-hand inventory in 2016-2017 (p < 0.01), as well as more instances of patients being turned away due to vaccine unavailability (p < 0.05). In both seasons, a similar proportion of pharmacies reported slower order fulfillment and limited order quantities early in the season. Improved availability early in the season when patient demand is highest, more vaccines in a pre-filled syringe format, and better communication from distributors on product availability dates were recommended in qualitative responses. CONCLUSIONS: Introducing private distributors for the management and fulfillment of pharmacies' orders for the publicly funded influenza vaccine appeared to have mixed results. While key concerns surrounding the frequency, responsiveness, and method of delivery were addressed by this change, challenges remain-in particular, acquiring sufficient vaccine early in the season to meet patient demand. As pharmacies become more prominent as vaccination sites, there are several opportunities to ensure that patient demand is met in this setting.

Pharmacy students' perceived willingness and ability to negotiate for paid co-operative education positions.

Background: Evidence of a gender wage gap has been identified across many professions, with some evidence in pharmacy. Negotiation is one potential strategy to address this gap and it is underutilized, especially among women. No studies to date have examined pharmacy student perceptions of negotiation when applying for co-operative education positions - a potential sign of willingness to negotiate for entry-level positions upon graduation. Objectives: To examine pharmacy students' comfort with and ability to engage employers in negotiation over wage and other work-related considerations for mandatory and paid co-operative education work terms at the University of Waterloo (Waterloo, Ontario, Canada). Methods: Two focus groups, one for female and one for male students, were performed with students who had completed at least one co-operative education placement. Focus groups aimed to elucidate students perceived ability to negotiate with potential employers, to identify strategies that educators can employ to better support students through the hiring and negotiation process, and to elicit student perceptions on the gender wage gap in pharmacy. Focus groups were audio recorded and transcribed verbatim, and data were coded inductively by two independent reviewers, employing thematic analysis. Results: Three major and two minor themes were identified: Preservation of the relationship; Power differential and perceived ability to negotiate; Institutional support and training; Negative experience with negotiation and wage gaps; and the presence of a gendered approach to negotiation. Pharmacy students rarely engage in negotiation during co-operative hiring processes at the University of Waterloo, with some female students expressing hesitation to negotiate due to concerns about being perceived as "bossy". Students of both genders felt poorly equipped to engage in negotiation with a potential employer, and lacked confidence in initiating such a conversation. Conclusions: Students identified a number of factors which influence their ability and desire to negotiate wages during co-op placement, including the requirements and logistics of placements, the perceived power imbalance between students and potential employers, and a concern that any wage negotiation may overshadow the value placed by students on the opportunities to provide patient care. Educators can play a role in equipping students, especially female students, with tools to enter into conversations on wages with potential employers.

Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies - An implementation method.

INTRODUCTION: Community pharmacists' optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties. PROJECT AIMS: To build community pharmacies' capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting. METHODS: Community pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process. INTENDED OUTCOMES: To assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.

Exploring influenza vaccine hesitancy in community pharmacies: Knowledge, attitudes and practices of community pharmacists in Ontario, Canada.

BACKGROUND: Vaccine hesitancy (VH) remains a prime contributor to poor influenza vaccine uptake. This study explores the knowledge, attitudes and practices of community pharmacists toward influenza VH, including their personal influenza immunization attitudes and behaviours. METHODS: A web-based cross-sectional survey questionnaire was administered to community pharmacists practising in Ontario, Canada. A 38-question survey tool explored 5 domains, including pharmacists' personal attitudes and behaviour toward influenza immunization, their self-reported knowledge of influenza, its vaccine and vaccine hesitancy, and their attitudes, practices and experiences with influenza VH at the community pharmacy. The data were analyzed descriptively. RESULTS: A total of 5530 survey invitations were e-mailed, and 885 responses were collected (response rate 16%). Two-thirds (n = 568, 65.7%) of the respondents reported receiving the influenza vaccine in the preceding season. The most frequent reasons for personal influenza immunization were prevention of disease transmission to patients, friends and family, and contribution to herd immunity. In addition to their confidence and perceived ability to identify and address influenza VH, respondents' self-reported knowledge across a 15-item Likert questionnaire was high. Respondents reported coming across an average of 16 (SD 28) individuals hesitant to receive the influenza vaccine each week. Regular workload (n = 419, 65.6%) and insufficient time (n = 406, 65.3%) were reported as the most limiting barriers to engagement in influenza vaccine conversations. CONCLUSION: Facilitating optimal practice scope for pharmacists, and capitalizing on the convenience and accessibility of the community pharmacy setting, presents a promising means to address influenza VH. However, barriers to pharmacist-initiated engagement on influenza vaccine must be explored and addressed. Can Pharm J (Ott) 2020;153:xx-xx.

Shades of gray in vaccination decisions - Understanding community pharmacists' perspectives of, and experiences with, influenza vaccine hesitancy in Ontario, Canada.

BACKGROUND AND OBJECTIVES: Vaccine hesitancy (VH) has been increasingly recognized as a global threat to public health. Yet, limited research exists exploring healthcare providers' experience of this phenomenon. Our study aims to understand community pharmacists' attitudes towards, and experiences with, influenza VH, and explore factors impacting their engagement with patients on the influenza vaccine. METHODS: A semi-structured interview guide was developed, and interviews were conducted to saturation with community pharmacists practicing in Ontario, Canada. Interview data was transcribed verbatim and analyzed using a thematic content analysis framework. The analysis yielded 110 unique codes, which were merged into five major themes and 15 sub-themes. RESULTS: A total of 22 pharmacists were interviewed to achieve saturation. Most pharmacists were authorized to administer injections (n = 20, 90.9%) and practiced for >20 years (n = 16, 72.7%). Pharmacists' engagement with patients on the influenza vaccine was found to be modulated by a complex and mutually reinforcing constellation of attitudes and behaviours which include: a binary (pro-vaccine or anti-vaccine) perception of patient vaccination decisions; a conflation of those expressing hesitancy with those who are anti-vaccine; and a passive approach to patient engagement, wherein patients were found to be the primary initiators of vaccine conversations. Although pharmacists recognized the importance of educating patients and addressing their vaccine-related concerns, barriers such as limited time, inadequate staffing, and poor remuneration were found to restrict optimal patient engagement on influenza vaccinations. CONCLUSION: While pharmacists hold the potential to effectively address influenza VH within their communities, future interventions must aim to break the loop of passive patient engagement and enable proactive pharmacist-patient interactions on influenza vaccinations in this setting.

The International Pharmacists-as-Immunizers Partnership (IPIP)-Advancing Research on Pharmacist-Administered Immunizations Worldwide.

This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada to discuss published and in-progress research on the topic, identify gaps and priorities for future research, and share implementation strategies used in different jurisdictions. Twelve researchers from five countries attended this initial meeting, identified from both personal networks and from authorship lists from published research. Small- and large-group discussions addressed a number of themes, including: clinical, economic and educational outcomes of the service; the perspectives of pharmacists, patients, and other health professionals; operational and policy factors influencing uptake; safety; and the immunizing pharmacist's role in disaster preparedness. Feedback on our first meeting and outcomes achieved were evaluated on the basis of participant feedback. Key components of the meeting that were considered successful and important lessons learned are summarized, so that other like-minded researchers with a shared pharmacy practice research interest could consider leveraging funding opportunities to establish other international pharmacy practice research networks.

Cost-utility analysis of offering a novel remunerated community pharmacist consultation service on influenza vaccination for seniors in Ontario, Canada.

BACKGROUND: Despite the availability of free and accessible influenza vaccine to all Ontarians, uptake has remained suboptimal. Although reasons to not receive the vaccine vary widely, health care provider recommendations remain the most effective strategy to positively influence vaccination decisions. OBJECTIVES: This study aimed to predict the relative quality of life, costs, and cost-effectiveness of introducing a remunerated community pharmacist consultation service on influenza vaccination for Ontarians aged ≥ 65 years. METHODS: A cost-utility analysis was performed from a third-party public payer perspective over 1 year. The delivery of consultation services by community pharmacists on influenza vaccination, billable at CAD $15 was compared with current standard practices (absence of remunerated consultations). Model inputs were derived primarily from existing literature. The impact of parameter uncertainties was assessed through deterministic and probabilistic sensitivity analyses. RESULTS: The provision of influenza vaccine consultation services was predicted to prevent 2407 cases of mild influenza and 3 influenza-related deaths at an additional cost of CAD $2.03 per person over current practices. The incremental costs per quality-adjusted life-year (QALY) gained for the enhanced care strategy compared with standard care was CAD $2087. The interpretation of the base-case result was found to be robust across all sensitivity analyses. The projected additional costs of implementing pharmacist consultations in Ontario was estimated at CAD $1.15 million per year, and the anticipated benefits included a gain of 507 QALY per year. CONCLUSION: Pharmacist-delivered consultation services on influenza vaccination are cost-effective and lead to improved clinical outcomes for Ontario seniors. Introduction of such services offers a promising strategy to address challenges related to poor vaccine uptake in this group.

Vaccine hesitancy and Web 2.0: Exploring how attitudes and beliefs about influenza vaccination are exchanged in online threaded user comments.

The growth of Web 2.0 has been particularly impactful in shaping information assessment in decision-making with regards to vaccination. The aim of the present study was to explore how attitudes and beliefs about influenza vaccination are exchanged in Web 2.0 through an analysis of user comment threads in response to related news reports on the Canadian Broadcasting Corporation national news website (average of 5.8 million unique visitors per month). User comments (n = 2042) were extracted using a Google Chrome data mining extension, from 33 articles reporting on the seasonal influenza vaccine between September 2015 and October 2016. User comments were analyzed using thematic discourse analysis to identify themes within the data, and also identify how information is exchanged, including identifying the rhetorical devices and tactics used. Mostly unrelated to article content, user comments were extremely polarized with only those with strong positions at either end of the vaccination spectrum (for or against) engaging actively in online debates. Observed exchanges, and the use of rhetorical devices and tactics employed by users are identified as furthering or reinforcing polarization. In addition to exchanging information, forums served as 'echo chambers' where individuals connect with likeminded users and collect additional information to reinforce pre-existing beliefs, rather than encouraging the enrichment of user knowledge. Our data lead us to question existing calls for public health engagement in such online forums, as doing so may actually reduce the intention to vaccinate among individuals against vaccination. Rather, we identify a greater need to observe online platforms to better understand the social mechanisms that may contribute to, or reinforce, attitudes and beliefs related to influenza vaccine refusal. Further research may also explore the effect that such dialogue has on the attitudes and beliefs of passively observing individuals who have yet to decide whether to receive the flu vaccine.