Patient perspectives on the British Columbia Biosimilars Initiative: a qualitative descriptive study.

In May 2019, the Government of British Columbia (BC) announced the implementation of the Biosimilars Initiative, mandating the switch of biologic (originator) drugs to biosimilars for certain patient populations in the hopes of optimizing public resources. Through this qualitative study, we aimed to identify patients' perspectives as they undergo this change. From October 2019 to July 2020, we conducted nine pre- and six post-switch to biosimilar interviews with BC, English speaking participants, who were 18 years or older, and were currently taking a biologic medication. Participants were interviewed pre- and post-switch to a biosimilar medication and interviews were audio-recorded and transcribed verbatim for qualitative analysis. Interviews were thematically analysed and major themes and sub-categories were elucidated. The themes derived from pre and post-switch interviews captured participants' anticipated or experienced barriers and enablers to the policy change. In general, the fears and apprehension of participants approaching the switch, including concerns surrounding the efficacy and safety of biosimilars, were addressed by their rheumatologist and social support circles. For the most part, participants were able to successfully manage their disease regardless of their baseline concerns about efficacy and safety. Experiences of changes in health delivery models were also observed secondary to the impact of the COVID-19 pandemic amongst participants. This study is the first of its kind to characterize the patient perspective regarding the BC Biosimilars Initiative. The incorporation of the patient perspective, including adequate provider-patient communication and shared decision-making can help to inform future non-medical switching policy changes.

Strategies Proposed by Students and Pharmacists for Virtual Experiential Patient Care Practicums.

Background: The University of British Columbia (UBC) Pharmacists Clinic (the Clinic) is a pharmacist-led patient care clinic serving as a practice site for experiential education in a team-based primary care practice. Given the unprecedented circumstances surrounding COVID-19, some pharmacy practice sites have permanently transitioned select experiential education activities to a virtual format. Currently, there is limited literature on teaching practices that are conducive to students' success in a virtual environment. Objective: To determine the factors that enable successful development of a virtual patient care practicum experience at a university clinic from the perspectives of student pharmacists and practice educators. Methods: A qualitative research methodology was used to gain the perspectives of student pharmacists, who did not have experience with virtual practicums, and practice educators, who had some experience with virtual practicums at the time of the study. Separate focus group interviews were conducted using a semi-structured approach and consisted of questions aimed at gathering insight into participant perspectives on virtual practicums. The focus group sessions were audio recorded with participant consent and transcribed. A thematic analysis was conducted to analyze the data. Results: Three pharmacist practice educators and three student pharmacists participated in their respective focus groups. Six major themes were developed based on the data: (1) technology optimization, (2) patient care related activities, (3) student-practice educator relationship, (4) student skill development, (5) student support, and (6) in-person vs virtual practicum preferences. Proposed strategies to mitigate the limitations of virtual practicums included setting communication guidelines, arranging enriching learning opportunities, and having reliable internet connection. Conclusion: The participants in this study provided insight on factors to support successful development and delivery of a virtual patient care practicum. The results from this study can be applied to other health disciplines and their approach to virtual practicums during and following the COVID-19 pandemic.

Pharmacy students' perspectives on involvement in workplace-based preventative health and wellness events.

INTRODUCTION: Canadian pharmacy students have varied exposure within their academic curricula and limited opportunities for hands-on preventative health experiences prior to practicums. We aimed to explore pharmacy student perceptions of readiness to engage in patient education and assessment activities in health promotion events. METHODS: Under licensed pharmacist supervision, volunteer pharmacy students delivered health promotion events to University of British Columbia staff and faculty between 2017 and 2020. Students attended a one-hour, group training session with a licensed pharmacist prior to participating in four hours of service delivery. Post-event, anonymous, electronic surveys were emailed to student participants to gauge perceived change(s) in knowledge and skill development as a result of participation. Data analysis was by descriptive statistics. RESULTS: Surveys were sent to 151 pharmacy student volunteers from 2017 to 2020. A total of 69 responses were received (response rate = 45.7%), 60 of which were complete (completion rate = 39.7%). Overall, students reported a shift from feeling competent to confident in the various domains assessed as a result of participation. The majority of students strongly agreed or agreed that they were well-prepared for the event and felt supported by pharmacist supervisors. CONCLUSIONS: Pharmacy students felt that participation in a brief preventative health and wellness intervention increased confidence in knowledge and patient care skills, regardless of year of study. Early exposure to health promotion activities may accelerate and enhance clinical abilities of pharmacy students while preparing them for expanding pharmacist roles.

Assessment of Burnout among Canadian Pharmacists Working in Team-based Primary Care Settings.

BACKGROUND: Burnout syndrome is well-documented among healthcare professionals across various practice settings. There has been recent expansion of Canadian pharmacists into team-based primary care and burnout in this setting has not been assessed. Our objective was to assess workplace burnout and to identify factors that play a role in perpetuating or diminishing it. METHOD: An online survey to assess burnout was developed using the Maslach Burnout Inventory (MBI) tool and questions regarding pharmacist background and practice. Invitations to complete the survey were sent to Canadian pharmacists working in team-based primary care settings on November 26, 2019 via a national primary healthcare listserv. RESULTS: A total of 31/433 completed responses were collected. The main analysis focused on the personal accomplishment (PA) domain as it had an adequate response rate. The PA domain had a median score of 5.0 (95% CI 4.69-5.22). We compared medians of the PA domain across different groups of each categorical variable. We found that the number of years working in primary care settings was positively associated with a higher PA domain score (p= 0.029). DISCUSSION: PA was higher in pharmacists who have been practicing in a primary care setting for longer; however, burnout rates could not be properly assessed due to the limited response rate. CONCLUSION: This is the first study to assess burnout among Canadian team-based primary care pharmacists. Personal accomplishment was higher in those who have been practicing in a primary care setting for longer. Future studies should consider alternate methods to evaluate burnout in this population.

"r/Thritis", Pregnancy, and Parenting: A Qualitative Descriptive Study of Reddit Forums to Explore Information Needs and Concerns of Women With Rheumatoid Arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) disproportionately affects more women than men, often striking during childbearing years. Because the Internet, particularly social media, is increasingly used by patients with chronic conditions seeking and sharing information, our objective was to conduct a qualitative descriptive study of threads on the social news website, Reddit, to understand the information needs and concerns of women with RA regarding pregnancy and parenting. METHODS: We searched threads (original posts and responses) on three subreddit sites, "r/Thritis," "r/Rheumatoid," and "r/BabyBumps," over a 10-year period between October 27, 2008, and October 27, 2018. All threads were reviewed, and those that specifically mentioned having RA and fertility/family planning, pregnancy/reproduction, and/or parenting/having children were included. We applied a thematic analysis to the threads, which involved initial line-by-line coding, clustering of codes into subcategories and categories, and abstraction into final themes. RESULTS: We identified 87 threads and included 59 for qualitative analysis. The thematic analysis led to the identification of five themes. Theme one (finding a community) captures motivations for seeking information online. Themes two (making decisions about pregnancy and having children) and three (worrying about the impacts of arthritis on pregnancy and parenting) capture women's concerns and thought processes. Themes four (information needs for managing arthritis throughout the perinatal period) and five (pregnancy information and resources for women with arthritis) describe the community's specific informational needs. CONCLUSION: A qualitative analysis of publicly available threads about the relationship between RA and issues of pregnancy and parenting identified areas of concern and further information need. These forums also provided an online community where women with RA sought social support and encouragement. Altogether, findings speak to the importance of supporting the information and care needs of women with RA who are pregnant or considering pregnancy.