Building practice-informed indigenous health curricula: A systematic review of pharmacy services for indigenous peoples.

BACKGROUND: An increased need is recognized to improve Indigenous cultural safety curriculum. This review aimed to inform curriculum development by identifying and categorizing challenges and opportunities that underlie existing practices. This entails policies, pharmacy services, and health workers' perspectives associated with pharmacy services for Indigenous peoples of Australia, Canada, New Zealand, and the United States. METHODS: Four academic databases were screened including PubMed, Embase, CINAHL, and Web of Science. This search was complemented by grey literature database searches. Thematic analysis by NVivo, version 12 (QSR International) was utilized to analyze qualitative data, and a narrative strategy guided common theme consolidation. This approach was prefaced and supplemented using Endnote X9 (Clarivate) and SUMARI 2019 (JBI) and according to the Joanna Briggs Institute's guidelines. An Indigenous Curriculum Advisory Committee at the University of British Columbia Pharmaceutical Sciences was queried for suggestions, potential cross-cultural interpretation, and guidance for explicit content in the context of pharmacy service delivery in Indigenous communities. RESULTS: Fourteen studies were included and classified into three categories: (1) Indigenous patients', pharmacists', and health care providers' perspectives, (2) policies and practices, (3) pharmacy-based programs. Thematic analysis portrayed several themes with overlapping presentation of challenges and opportunities. It is important to utilize evidence-based strategies for improving the effectiveness of culturally-safe pharmacy services for Indigenous populations and for optimizing education and practice-informed curriculum development. IMPLICATIONS: This information can inform pharmacists, educators, and faculty members in understanding and delivering optimal care and education engaging Indigenous insights and perspectives at systems and curricular levels.

Risk of air and surface contamination of SARS-CoV-2 in isolation wards and its relationship with patient and environmental characteristics.

Air and surface contamination of the SARS-CoV-2 have been reported by multiple studies. However, the evidence is limited for the change of environmental contamination of this virus in the surrounding of patients with COVID-19 at different time points during the course of disease and under different conditions of the patients. Therefore, this study aims to understand the risk factors associated with the appearance of SARS-CoV-2 through the period when the patients were staying in the isolation wards. In this study, COVID-19 patients admitted to the isolation wards were followed up for up to 10 days for daily collection of air and surface samples in their surroundings. The positivity rate of the environmental samples at different locations was plotted, and multiple multi-level mixed-effect logistic regressions were used to examine the association between the positivity of environmental samples and their daily health conditions and environmental factors. It found 6.6 % of surface samples (133/2031 samples) and 2.1 % of air samples (22/1075 samples) were positive, and the positivity rate reached to peak during 2-3 days after admission to the ward. The virus was more likely to present at bedrail, patients' personal items and medical equipment, while less likely to be detected in the air outside the range of 2 m from the patients. It also revealed that higher positivity rate is associated with lower environmental temperature, fever and cough at the day of sampling, lower Ct values of latest test for respiratory tract samples, and pre-existing respiratory or cardiovascular conditions. The finding can be used to guide the hospital infection control strategies by identifying high-risk areas and patients. Extra personal hygiene precautions and equipment for continuously environmental disinfection can be used for these high-risk areas and patients to reduce the risk of hospital infection.

An Indigenous health elective - Perspectives of pharmacy undergraduate students and alumni.

BACKGROUND AND PURPOSE: Health professional programs, including pharmacy, have increased Indigenization efforts through cultural safety learning. The objective of this paper is to describe student and alumni interest, impact, and perceptions for improvement of an undergraduate elective course on Indigenous health. EDUCATIONAL ACTIVITY AND SETTING: A three-credit elective course was developed with an Indigenous advisory committee and a two-phase mixed-methods design incorporating pre- and post-course surveys and interviews for pharmacy students was implemented from 2013 to 2016. In 2019, all previous students enrolled in the course, now alumni and practicing pharmacists were invited to participate in an online survey and follow-up interview. FINDINGS: A total of 87 students and 21 alumni participated. The course appeared to have considerable impact on students' interest in course topics, specifically Canadian history of colonialism and impact on health. The course generated an increased interest in both Indigenous-oriented practicums and future practice setting. Self-perceived efficacy in providing care to Indigenous patients increased post-course and was sustained in alumni. Three major themes emerged: course should be mandatory and/or more widely available to all students, incorporate more experiential learning (such as educational field trips), and understanding of Indigenous history and impact on health care was a key learning outcome. SUMMARY: A lecture-based elective course increased interest in Indigenous health topics, changed current perspectives on Indigenous health needs, and improved self-perceived efficacy in providing care. Students and alumni felt course content should be more widely available and highlighted the importance of increased experiential learning opportunities.

Assessing Indigenous Cultural Safety Learning using Modified Reflexive Visual Arts.

Objective: Assessing Indigenous cultural safety learning in pharmacy students using modified reflexive visual arts Innovation: Traditional quantitative assessment methods are often ineffective and impractical for the evaluation of Indigenous cultural safety learning. Existing qualitative assessment methods have shown potential in small-class and experiential environments, but evidence to guide the scalability and use in a large lecture format is sparse. An innovative, visual arts-based qualitative assessment of cultural safety learning was developed and deployed to 223 first-year pharmacy students. The assessment was deployed in a pre- and post-term style in a foundational pharmacy module that included content on Indigenous health and cultural safety. The pre-term assessment included two activities for students: 1) a visual art self-reflection requiring students to use any visual art medium to depict what they think it means to practice as a pharmacist with cultural safety, accompanied by a brief written description and (2) an in-class session with a brief lecture component, small and large group sharing of reflections, debrief of experiences, and student peer review of the visual reflections. The post-term portion included a similar self-reflection activity and an in-class session that now asked students in their small groups to: 1) compare their pre/post reflections, and 2) collectively create a new summative visual that depicts the entire group's thoughts. Surveys and a focus group were used as an additional source of data. Critical Analysis: Survey responses (n=215) indicated that feedback for the assessment was highly positive, with 77% of students recommending the activity for future first-year pharmacy students. Students also validated the utility of the assessment, with 70% strongly or somewhat agreeing that the activity was valuable for their learning, 80% strongly or somewhat agreeing that the activity stimulated their thinking, and 81% strongly or somewhat agreeing the activity accurately reflected their true feelings on practicing cross-culturally.

Pharmacist-led cardiovascular risk prevention in Western Canada: a qualitative study.

OBJECTIVES: Preventing cardiovascular diseases (CVD) is a public health and policy priority, including for employers. A novel CVD risk management programme that included medication management was delivered by pharmacists to employees of a Canadian university. This qualitative study describes the experiences and perceptions of participants who received individual health consultations in this programme. METHODS: A qualitative study design using free-text responses was adopted. Data (5658 words) came from evaluation surveys completed by 119 programme participants were iteratively coded and thematically analysed. KEY FINDINGS: We identified four themes characterising participant experiences of pharmacist-led CVD prevention. Theme one was labelled self-efficacy because personalised health information and advice on CVD risk factor management empowered participants to make improvements for their health. Participants expressed a range of positive responses about the longer consultations, supportive communication and safe setting of their pharmacist-led encounters; hence, Theme two is labelled pharmacists' interpersonal skills. The wider context of the programme included a number of enabling factors (Theme three) that either supported or limited participant engagement in the programme. A number of changes to behaviour and health measures were identified and participant suggestions to expand and continue the programme further contributed to perceptions of positive programme impact (Theme four). CONCLUSIONS: This study raises questions about how external resources and broader determinants might enable, or hinder, future programme success and sustainability. It also highlights the need for greater understanding and communication of the importance of primary prevention and the role of pharmacists in CVD risk reduction and workplace health promotion.

Family physician perceptions of barriers and enablers to integrating a co-located clinical pharmacist in a medical clinic: A qualitative study.

OBJECTIVE: Pharmacists from The University of British Columbia Pharmacists Clinic provide comprehensive medication management services once to twice a month through the co-location model at multiple general practice clinics beginning from 2014 and consistently since 2016. For some of the clinics, this was the first experience with a co-located allied health professional. The objective of this study was to examine the perspectives of physicians who had a relatively long-standing relationship with a co-located pharmacist to identify barriers and facilitators to integrating a clinical pharmacist. METHODS: A qualitative research methodology was used to gain the perspectives of physicians. Data were collected through convenience sampling and one-on-one semistructured interviews. In-person or telephone interviews were conducted from August 12, 2019, to September 10, 2019, and audio was recorded with the participants' consent. The recorded interviews were transcribed, and a thematic analysis with an inductive approach was used to analyze the data. RESULTS: Eight physicians from 4 general practice clinics were interviewed. Analysis of the interviews identified 6 themes that contained barriers or enablers to the integration of a co-located pharmacist: (1) electronic medical record (EMR) use, (2) identifying patients and the referral process, (3) workload and logistics, (4) patients' willingness, (5) impact of in-person communication, and (6) shifting physicians' perspectives. The enablers included the use of an EMR to proactively identify patient referrals, a dedicated pharmacist workspace, a physician champion, and intentional scheduling of in-person physician-pharmacist case conferences. The barriers included identifying patients for referral, the lack of EMR interoperability, pharmacist availability, physician colleagues who were less committed to team-based care, and financial implications despite externally funded pharmacists. CONCLUSION: The physician participants perceived several barriers and enablers to the integration of a pharmacist into their practice. The themes identified can be used to inform physicians and pharmacists on the integration process for team-based primary care.

Creating a pharmacy elective course in Indigenous health.

BACKGROUND AND PURPOSE: There is a critical need for greater Indigenous health education and cultural safety training for pharmacists. The objective of this paper is to describe the creation, development, and impact of Canada's first offering of an undergraduate elective course specific to pharmaceutical care in Indigenous health. EDUCATIONAL ACTIVITY AND SETTING: A three-credit elective course was developed and offered to bachelor of science pharmacy students at the University of British Columbia. A variety of pedagogical approaches including reflection, educational trips, video conferencing with Indigenous communities, and Indigenous community-based projects were used. Evaluation of student learning impact included quantitative and qualitative post-course survey data, student enrollment, and student work. FINDINGS: From course inception in 2012 to 2017, 101 students participated. Survey respondents rated an average of 4.7 out of 5 on the five core elements of the curriculum design and pedagogical practice (i.e. learning objectives, instructional methods, assessments, organization, and workload). Thematic analysis identified three themes: 1) the qualities of the course instructors, 2) the unique curriculum design and pedagogical practices, and 3) significant personal and professional impact on students. SUMMARY: This course is one of few opportunities for pharmacy students to learn about cultural safety as it relates to the pharmaceutical care of Indigenous peoples. Extensive engagement with stakeholders and utilization of various teaching and assessment techniques were beyond the expected requirements of course offerings. Students highly rated this course as having personal and professional impact. This course plays a critical role in the overall Indigenization of pharmacy curricula.

Navigating Allyship through Indigenization, Decolonization, and Reconciliation: Perspectives from Non-Indigenous Pharmacy Educators.

As pharmacy schools across Canada and North America work towards authentic and meaningful curriculum and learning opportunities in Indigenous health and cultural safety, the conversation of "why" we need to do this has become clearer, but the task of "how" we do this remains challenging. This curricular transformation can be increasingly more complex to navigate as a non-Indigenous ally and pharmacy educator. Defining your role as an ally is deeply personal and critically important, as it can transform based on the collaborative work undertaken with Indigenous partners and communities. The purpose of this article is to share perspectives gained over years of experience and practical applications of allyship through the lens of three key separate, but interconnected concepts - indigenization, decolonization, and reconciliation.