Endocrine Reviews

Background: Pharmacists are essential to team-based care, contributing knowledge and expertise that positively impact patient care. However, it is less clear how interprofessional collaboration is enacted by pharmacists in single-disciplinary outpatient practice environments. Methods: We recruited pharmacists from 3 university-affiliated, pharmacist-led primary care clinics in Canada. Employing a social network analysis approach, the data collection encounter explored the nature and composition of collaboration in patient care. We conducted semistructured interviews, including participant drawings (sociograms), to illustrate their network experiences caring for specific patients. Transcripts from the data collection encounters were systematically coded and analyzed in an iterative process. Initial codes were generated inductively and broader categories refined through constant comparison and finalized by author discussion. Results: Eleven (78%) pharmacists were interviewed and drew 28 sociograms. Pharmacist networks encompassed a wide array of health professionals and patient family members. Despite the physical distribution of interprofessional members, pharmacists formed and maintained relationships to support patient care through conscientious communication and medication management decision-making. Network relationships and system factors influenced collaboration and patient care, often resulting in practice paralysis and/or the need to re-emphasize patient self-advocacy. Interpretation and conclusion: Our findings underscore the dynamic nature of pharmacist networks and how they are navigated to support pharmacist-led medication management. Primary care pharmacists attempt to overcome encountered barriers to implementing patient care plans through various strategies, including leveraging new and existing network relationships. System obstacles impeding effective and efficient patient care could in part be overcome through pharmacist scope of practice expansion.

Background: Patient–provider language discordances can negatively affect the availability, accessibility, acceptability, and quality (AAAQ) of pharmacy services as described by the AAAQ framework. With nearly 600,000 residents of Ontario identifying French as their mother tongue, the active offer (AO) of French language pharmacy services should be provided, yet little is known about pharmacists’ familiarity and use of AO. Methods: Ontario pharmacists completed an online survey measuring their knowledge, attitudes, and behaviours (KAB) regarding the AO for French language services (FLS). Demographics, including ability to converse in French, were collected. KAB AO scores were calculated and compared using descriptive and inferential statistics. Results: A total of 360 pharmacists completed the survey. The majority (65.1%) practiced in a primary care setting, 21.1% spoke French, and 71.8% lived in an area where less than 10% of the population were Francophone. Overall, AO scores were highest for attitude (3.8/5) and lowest for behaviours (2/5) and knowledge (1.8/5). Most pharmacists (62.8%) indicated an interest in AO training. Discussion: Gaps in KAB regarding AO for FLS by Ontario pharmacists resemble those observed throughout the health care system. Further training is suggested to address the lack of knowledge regarding AO, particularly its proactive nature, as well as strategies for its implementation. Conclusion: Although most participating pharmacists demonstrated gaps in AO knowledge and behaviour, many had favourable attitudes toward the importance of AO in the pharmacy setting and agreed that further training would be needed to improve their KAB. Further, the AO can address all 4 elements of the AAAQ framework.

Purpose: As the scope of practice continues to evolve for pharmacists, professional abstinence is being observed by students in workplaces and practicums. Professional abstinence is defined as “consciously choosing not to provide the full scope of patient care activities”. Exposure of students to professional abstinence may cause cognitive dissonance, as they are challenged by practices that do not match what they are taught in school. This study explores pharmacy student perspectives on professional abstinence in community practice settings and their thoughts on how it could be addressed. Methods: Pharmacy students enrolled at an accredited Canadian pharmacy school with previous experience at a community practice site were invited to participate via email and social media. Data were collected between March and November 2021 through virtual individual interviews using a semistructured guide and the Zoom platform. Recordings were transcribed verbatim, and data were analyzed using cognitive dissonance theory to guide the inductive coding and interpretation of results. Results: Twenty students representing 6 pharmacy schools were recruited. Themes identified regarding students’ experiences with professional abstinence were “introspection and reflection” and “the system”, with the subthemes of emotion, excuses, professional identity and infrastructure, and inertia/disengagement, respectively. Regarding how to address professional abstinence, the themes “self as professional” and “empowering professionals” emerged. Self as professional included the subthemes of continuous learning, role modelling/mentorship, and internal drive/initiative, while empowering professionals included improved logistics, self-care, and advocacy. Conclusion: Students’ experiences with professional abstinence led to mixed feelings and influences on their professional identity. Pharmacy schools should be made aware of the phenomenon of professional abstinence and its effect on students, as they can potentially help manage learners’ cognitive dissonance and best prepare them for their future full-scope practices.

Background: Pharmacists, being one of the more readily accessible primary health care professionals, must ensure accessibility. With growing internationalization, those in Japanese community pharmacies increasingly interact with non-Japanese speakers. This study aimed to understand how Japanese pharmacies can fulfill accessibility needs by accounting for patients’ native language and culture. Methods: A cross-sectional survey of community pharmacies in 2 Japanese municipalities (Hirakata and Suma) was conducted between September and October, 2022. The survey questionnaire included questions on “interaction with non-native Japanese speakers”, “impressions during dialogue”, and “characteristics and preparedness of pharmacies”. The responses were analyzed using descriptive statistics. Results: The response rate was 30.9% (46/149) in Hirakata and 50.0% (29/58) in Suma. The frequency of contact with non-native Japanese speakers at least once a month was 47.8% (22/46) in Hirakata and 55.2% (16/29) in Suma. The main purpose of the visits was to obtain prescription medicines. English was the most commonly used language, as seen on the website, patient forms, medicine bags, informational materials, and staff language skills. However, fewer than half of the stores offered this service. Chinese, Korean, and Vietnamese were even less common. Discussion: Pharmacists, often recognized for their accessibility among primary health care providers, demonstrated limited readiness to serve non-native Japanese speakers in the surveyed regions. To enhance service to diverse pharmacy visitors, improved preparedness for linguistic and cultural differences and cultural competence education are recommended. Conclusion: Japanese pharmacies face barriers in providing language-aligned care to service visitors with diverse linguistic and cultural backgrounds. By preparing for linguistic differences and providing cultural competency education, pharmacies can improve accessibility to effectively serve diverse populations.

Objective: This qualitative study aimed to describe patients’ experiences of a community pharmacy (CP)–based medication therapy management program (MTM). Methods: Qualitative, semistructured, face-to-face interviews were conducted with a purposive sample of patients with uncontrolled diabetes who received care at a CP-based MTM clinic. Interviews were conducted in the MTM clinic of Health Kingdom CP in Riyadh City, Kingdom of Saudi Arabia by a research pharmacist using an interview guide. Data collection was continued until data saturation. All interviews were audiorecorded, transcribed verbatim, and analyzed thematically. Key findings: A total of 16 patients, of whom more than half were male, were interviewed between October 2021 and March 2022. The mean ± standard deviation age of the patients was 52.0 ± 8.9 years, whereas the mean number of years since the first diagnosis of diabetes was 11.2 ± 7.3 years. Three main themes emerged from the interviews: perceived benefits and outcomes of the program, factors driving positive patient experiences, and challenges and recommendations for enhancing MTM service. Generally, patients were satisfied with the quality of advanced care that they received at the clinic and recognized the importance of the pharmacist’s role. Furthermore, the program was perceived by patients as an opportunity to transition to a healthier lifestyle. Patients also highlighted a few barriers related to follow-up, such as accessibility, and issues with the service, such as long waiting times. Finally, there were some suggestions for patient improvement. These include expanding the clinic space, initiating educational and follow-up messages, and cooperating with other specialists as required. Conclusions: Patients received the MTM program very positively with noticeable health benefits. Barriers to effective follow-up and care should be addressed before implementing this service in wider community pharmacies in Saudi Arabia and beyond.

Background: Despite the shift towards direct-acting anticoagulants, warfarin remains widely used in Canada and is traditionally managed by family physicians through laboratory-based international normalized ratio (INR) testing. The Community Pharmacy Anticoagulation Management Service (CPAMS) in Nova Scotia represents an innovative approach, enabling community pharmacists to conduct point-of-care (POC) INR testing and manage warfarin therapy. A potential benefit of this approach is the opportunity to identify non-warfarin medication therapy problems (nwMTPs) during routine visits. Method: We conducted a prospective, multicentre, observational study across 40 community pharmacies in Nova Scotia, part of CPAMS’s second phase. Pharmacists documented nwMTPs identified in patients with atrial fibrillation during routine POC INR visits using the Qualtrics Insight Platform, categorizing them by indication, effectiveness, safety, or adherence, alongside corresponding interventions. Results: Over 6 months, 43 nwMTPs were submitted from 13 unique pharmacies. There were 3404 POC INR tests in patients with atrial fibrillation, yielding an estimated nwMTP detection rate of 1.26 (95% CI, 0.69 to 2.32) per 100 INR tests. The most common nwMTP category was “Indication,” primarily requiring additional therapy. Pharmacists frequently intervened by recommending medication adjustments or providing patient education. Discussion: The findings highlight a modest, yet potentially significant role of pharmacists in detecting and managing diverse MTPs during focused warfarin management assessments. The predominance of indication-related problems underscores unmet therapeutic needs in patients on warfarin. Conclusion: This study illustrates the potential of pharmacist-led POC INR testing in community settings to identify and address nwMTPs, contributing to comprehensive patient care.