Benzodiazepine use in medical cannabis authorization adult patients from 2013 to 2021: Alberta, Canada.

BACKGROUND: Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential "sparing effects" of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada. METHODS: A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis. RESULTS: Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (- 0.08 DDE, 95% CI: - 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, - 0.04 DDE, 95% CI: - 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: - 0.009 to 0.12) per patient was noted. CONCLUSIONS: This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use. HIGHLIGHTS: • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication.

A longitudinal qualitative study examining the impact of Check-In, a novel learning activity on burnout for pharmacy students.

INTRODUCTION: Burnout is a phenomenon that can occur in any occupation, but pharmacists may be more prone to its effects. Because of its relevance to the pharmacy profession, the University of Waterloo School of Pharmacy incorporated an active learning activity to teach pharmacy students about healthcare provider burnout. This activity, named Check-In, was launched in March 2020 and consisted of one-on-one check-ins between pharmacy students and staff. As the first learning activity of its kind, the researchers wished to investigate the ongoing impact of Check-In. METHODS: This qualitative, descriptive study was composed of telephone interviews with 13 students that partook in Check-In. These interviews were held at two different timepoints: six and 18 months post-activity. Participants were recruited until data saturation, and transcripts underwent thematic analysis. RESULTS: Four themes were identified from the interviews: (1) Check-In was a valuable learning activity; (2) students performed some form of checking in post-activity; (3) burnout could be recognized and defined by students; (4) Check-In's place in the pharmacy curriculum still needs to be determined. CONCLUSIONS: Check-In is an innovative learning activity to teach pharmacy learners about healthcare provider burnout. It can be utilized by pharmacy institutions to incorporate wellness and student mental health into curriculum.

From student to tutor: A journey in problem-based learning.

PURPOSE: Problem-based learning (PBL) is an active learning method that allows for students to self-identify their learning needs and work together in small groups to achieve their learning objectives. These small groups are facilitated by a tutor. The tutor has a vital role to the student experience in PBL that is explored in this article. DESCRIPTION: This reflection uses my personal experience in PBL with two roles: student and tutor. In my fourth-year of pharmacy school I was a student in PBL for the final pharmacotherapeutic course. After graduation and licensure, I returned to pharmacy school for graduate work and became a tutor for the same course I had taken a year ago. ANALYSIS: Having experienced both sides of PBL, I was able to understand the importance of what happened in my time as a student and how it was shaped by my tutor. Using the past as a guide, I improved the learning experience by being the tutor I wish I could have had as a student. CONCLUSIONS: Tutors are a crucial element to the success of PBL and their role should not be overlooked. Pharmacy programs looking to implement PBL in their curriculum should pay attention to these skills that tutors should exemplify. IMPLICATIONS: PBL can have a rewarding impact on students and tutors. It is imperative that all tutors have these appropriate skills and care for the needs of their group in order to make PBL a great learning experience for all students.

Check-In: An Educational Activity to Address Well-Being and Burnout among Pharmacy Students.

Background: Chronic workplace stress that has not been adequately managed can result in burnout. Healthcare providers; including pharmacists, may be particularly susceptible to this phenomenon, prompting the School of Pharmacy at the University of Waterloo to develop an active-learning activity to teach and reflect on healthcare provider burnout, called Check-In. Methods: Check-In was comprised of a 20 min online lecture on healthcare provider burnout, two pre-readings that highlighted burnout among physicians, and an optional one-on-one session between individual students and a faculty or staff member. A reflection guide was also shared among students and facilitators where students had to rate their current mental health on a 10-point scale and reflect on questions focusing on energy expenditure, self-care, and self-compassion within the past, present, and future. Results: Check-In was rewarding and overall positive for students and faculty. The personal connection with members from the school and the strategic timing of the activity within the curriculum notably contributed to the success of the activity. The short duration of individual sessions was the key criticism of the activity. Further research at the University of Waterloo School of Pharmacy will be explored to assess the long-term impact of Check-In on student well-being.

Travel Medicine Curricula across Canadian Pharmacy Programs and Alignment with Scope of Practice.

Limited research exists on pharmacy students' training in travel medicine, and how this aligns with scope of practice. This research aimed to detail travel medicine education across pharmacy programs in Canada and map this against the scope of practice for pharmacists in each university's jurisdiction. A survey based on the International Society of Travel Medicine's Body of Knowledge was developed and distributed to all Canadian undergraduate pharmacy schools to identify topic areas taught, teaching modalities utilized, and knowledge assessment performed. Educational data was collected and analyzed descriptively, and compared to pharmacists' scope of practice in the province in which each university is located. Training provided to students varied significantly across universities and topic areas, with topics amenable to self-care (e.g., traveller's diarrhea and insect bite prevention) or also encountered outside of the travel context (e.g., sexually transmitted infections) taught more regularly than travel-specific topics (e.g., dengue and altitude illness). No apparent relationship was observed between a program's curriculum and their provincial scope of practice. For example, training in vaccine-preventable diseases did not necessarily align with scope related to vaccine administration. Alignment of education to current and future scope will best equip new practitioners to provide care to travelling patients.

Development and Testing of a Clinical Practice Framework for Pharmacists to Assess Patients' Travel-Related Risks: The 5W Approach to Travel Risk Identification.

Objective: To assist with identifying patients who may be managed by pharmacists without additional travel medicine training, versus those who may benefit from referral, we developed and validated a clinical practice framework. This framework was then piloted in eight pharmacies in Ontario, Canada, from March to August 2019. Methods: A panel of experts, comprised of physicians and pharmacists from Ontario, Canada, holding a Certificate in Travel HealthTM from the International Society of Travel Medicine was recruited. This panel participated electronically in the development of the framework in three stages: (1) Sharing their current approach when performing information gathering and assessing risk in a traveling patient; (2) judging of items collated from all panellists on the basis of how essential they are to a risk assessment; and (3) validation of items deemed essential by the panel using the Item and Average Content Validity Index. The framework was then released to community pharmacies, where pharmacists that self-identified as beginners to travel medicine completed pre- and post-test phase surveys to determine the utility of the framework. Key Findings: A total of 64 items for consideration were deemed essential enough to proceed to content validation, organized into 5 'W' domains: Who, What, Where, When, and Why. Each item was ranked by the experts according to its relevancy, resulting in an Average-Content Validity Index of 0.91. The resulting framework was titled "The 5W Approach to Travel Risk Identification." This clinical practice framework is the first published assessment tool for travel medicine tailored for pharmacy's scope of practice that has been content validated. Pharmacists reported that the framework is simple to use and provides structure for interactions with travelling patients. However, it may not be as beneficial for those with a higher level of travel medicine expertise than the average pharmacist. Conclusion: The 5W Approach tool allows pharmacists inexperienced in travel medicine to collect information when required to use their professional judgement when assessing traveling patients as either high-risk (requiring a referral to a travel medicine specialist) or low-risk. With the aim of supporting pharmacists to be more confident in caring for traveling patients and increasing their involvement in travel medicine, future research will test this framework for feasibility in Canadian community pharmacy practice.

Uptake of Travel Health Services by Community Pharmacies and Patients Following Pharmacist Immunization Scope Expansion in Ontario, Canada.

In December 2016, pharmacists in Ontario, Canada with authorization to administer injections saw an expansion in their scope from a restriction to the influenza vaccination only to now including an additional 13 vaccine-preventable diseases, largely those related to travel. It was uncertain whether this change in scope would see sufficient uptake, or translate to a corresponding expansion in other travel health service offerings from community pharmacies. In October/November 2017 a survey was conducted of all licensed community pharmacists in Ontario, followed by semi-structured interviews with 6 survey respondents in June 2018. A web-based survey of members of the public from a single region of the province was also conducted in September 2018 to assess uptake of expanded vaccination services. Broad variability in uptake of these services was noted, ranging from the dispensing of travel-related medications and vaccinations only through to vaccine administration and prescribing under medical directive; however, uptake was generally at the lower end of this spectrum. This was evidenced by 94% of pharmacists reporting administering fewer than 10 travel vaccinations per month, fewer than 10% of patients reporting receiving a travel vaccine administered by a pharmacist, and a maximum of 30 pharmacies (of nearly 6000 in the province) designated to provide yellow fever vaccinations. Fewer than 1 in 3 pharmacists reported performing some form of pre-travel consultation in their practice, often limited to low-risk cases only. Barriers and facilitators reported were similar for these services as they were for other non-dispensing services, including insufficient time to integrate the service into their workload, perceived lack of knowledge and confidence in travel health, and low patient awareness of these new services available to them through community pharmacies.