Canadian Pharmacists Journal最新文献

Background: Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, and additional people who identify as part of sexual and gender diverse communities (2SLGBTQ+) experience worse health outcomes than cisgender heterosexual counterparts. This is attributable to structural oppression within the health care system, which manifests as health care providers' lack of knowledge and training in 2SLGBTQ+ health.

Methods: This cross-sectional, mixed-methods survey targeted 2SLGBTQ+ community members 14 and older in British Columbia to understand aspects of pharmacy care in the province. The survey asked participants about their experiences with the pharmacy environment, the pharmacist, and the competencies they thought were most important for pharmacists to provide inclusive care. The survey was disseminated online and live from October 24 to December 18, 2022.

Results: After eligibility and exclusions, 195 records were included and analyzed. Some (46.2%) participants found the pharmacy environment inclusive. Half (51.8%) felt their needs as 2SLGBTQ+ people were met by the pharmacist. The most important pharmacist competencies identified were respect, knowledge of 2SLGBTQ+ health, and inclusive language. Participants also shared examples of their pharmacy experiences in free-text comments.

Discussion: Despite increasing focus on equity, diversity, and inclusion in health care, there is still a significant gap in pharmacy care related to pharmacist competency, yet there is little progress in systematically training pharmacists on 2SLGBTQ+ competencies. Implementing 2SLGBTQ+ content into pharmacy programs is one approach to ensuring pharmacists are well-prepared to serve 2SLGBTQ+ communities.

Conclusion: Findings highlighted 2SLGBTQ+ community-identified needs and served to inform curricular reform, professional development opportunities, and priorities of professional governing bodies as the pharmacy profession works towards more equitable health care for 2SLGBTQ+ communities. Can Pharm J (Ott) 2025;158:xx-xx.

Background: Pharmacist-led interventions have demonstrated benefits across various medical conditions; however, their impact on atrial fibrillation (AF) remains unexplored. This study aims to synthesize the available evidence regarding the pharmacist's role in AF management.

Methods: A systematic review with searches in PubMed, Scopus, and Web of Science was performed (PROSPERO: CRD42025647848). Randomized and non-randomized trials, as well as cohort studies reporting clinical, process, and humanistic outcomes, were included. Findings were pooled through pairwise meta-analyses. Dichotomous outcomes were reported as risk ratios (RRs) and continuous variables as standardized mean differences (SMDs) with 95% confidence intervals (CIs). The quality of the randomized and non-randomized studies was assessed using RoB 2.0 and ROBINS-I tools, respectively. Evidence was graded using the GRADE approach.

Results: Seventeen studies (n = 11,428 participants) published between 2008 and 2024, predominantly as non-randomized trials/cohorts (77%), were included. Pharmacist-led interventions varied widely in scope, including anticoagulation management services, medication therapy management, and prescribing. Meta-analyses showed that pharmacists improved time in therapeutic range (SMD 0.35; 95% CI, 0.13-0.56) and reduced major bleeding events (RR 0.76; 95% CI, 0.61-0.95) and strokes (RR 0.65; 95% CI, 0.44-0.94) compared with usual care. Pharmacist care also increased appropriate prescription rates (RR 1.36, 95% CI, 1.18-1.56). No significant differences were found for other outcomes. Evidence was of low-to-moderate certainty.

Interpretation: Pharmacist-led interventions have been shown to improve certain clinical and process outcomes in AF.

Conclusions: High-quality randomized studies with well-defined interventions are still needed to better refine the pharmacist's role in AF care and to identify the most effective intervention in practice (see Graphical Abstract). Can Pharm J (Ott) 2025;158:xx-xx.

Background: Quality indicators (QIs) are measures used to evaluate quality of services but are often underused in pharmacy practice. This study examines trends in 2 established QIs in community pharmacy.

Methods: We conducted a repeated cross-sectional study in Ontario using administrative data collected between 2013 and 2023. We measured 2 QIs designed for pharmacy practice annually: (1) percentage of newly dispensed opioid prescriptions exceeding 50 morphine milligram equivalents (MME), and (2) percentage of eligible patients receiving pharmacist medication reviews within 7 days of hospital discharge. Regional differences were summarized using variance calculations, while temporal trends were analyzed using Mann-Kendall tests.

Results: The opioid indicator demonstrated a consistent decline in the percentage of newly dispensed opioid prescriptions exceeding 50 MME across Ontario, with an absolute reduction of 10.5% from 2013 (25.6%) to 2023 (15.1%). High-dose opioid initiation ranged from 12.8% (Central) to 16.7% (West) in 2023 (range 3.9%, variance 2.3%). Significant time trends were found for all regions, with the largest reductions observed in urban regions. For the medication review indicator, provincial trends declined by 7.6%, from 16.7% in 2013 to 9.1% in 2017, followed by a modest recovery to 12.5% by 2023. Regionally, rates of medication reviews varied, with rural areas maintaining higher uptake rates compared with urban centres. Rates ranged from 7.8% (Toronto) to 16.2% (North) in 2023 (range 8.4%, variance 10.0%). A significant time trend was found only in Eastern Ontario.

Conclusion: Significant declines in high-dose opioid initiation but inconsistent uptake of reviews across regions indicate opportunities for improvement in pharmacy practice.