Canadian Pharmacists Journal最新文献

Background: Two-Spirit Peoples face unique challenges in accessing and receiving health care in Canada due to health services, including community pharmacy services, being built on hetero- and cis-normative models that impede appropriate care for this group. Currently, there is limited published information on Two-Spirit Peoples' experiences accessing and receiving care in community pharmacy settings.

Methods: To address the lack of published information, 21 Two-Spirit individuals shared their experiences in a focus group setting. Four different focus groups were held across Canada, including 1 in Saskatoon, Vancouver, Edmonton, and Toronto. Informed by Indigenous methodologies, data were recorded via audio recording and notetaking, and the audio was transcribed and then analyzed for themes using the Voice-Centred Relational Method.

Results: Three major structural systems that affect the experiences of Two-Spirit Peoples in community pharmacies were identified: 1) white supremacy, 2) capitalism, and 3) heteronormativity. These 3 systemic issues presented themselves via racism, homophobia, transphobia, pharmacists' lack of knowledge about Two-Spirit individuals and their health and lack of time spent educating or building relationships with Two-Spirit Peoples. Participants provided suggestions for how community pharmacists can better serve the Two-Spirit community, such as using inclusive language, adding pronouns and preferred names to patient files, increasing knowledge about Two-Spirit health and advocating for Two-Spirit Peoples.

Discussion: The results suggest that dismantling current structures and ideologies in community pharmacy and society are required to overcome the identified issues.

Conclusion: Two-Spirit Peoples face barriers when it comes to accessing and receiving care in community pharmacies, resulting in many Two-Spirit individuals avoiding health care to save themselves from unsafe and uncomfortable interactions. Pre- and postlicensure pharmacy education about Two-Spirit Peoples is required to improve Two-Spirit Peoples' experiences accessing and receiving care in community pharmacies.

Background: The Canadian health sector's carbon footprint is among the highest in the world and is responsible for 4.6% of Canada's total greenhouse gas emissions, a quarter of which is linked to pharmaceuticals, with metered-dose inhalers (MDIs) contributing disproportionally high amounts.

Objectives: To describe MDI prescribing, dispensing, use and waste patterns at a Canadian tertiary care academic hospital.

Methods: In a retrospective point-prevalence cohort study, 100 consecutive patients discharged from medical and surgical services who were prescribed at least 1 MDI during their admission were included. Data were collected to describe patient demographics, MDI prescribing, dispensing, use and waste patterns. Use and waste data were applied to annual purchasing data to estimate annual usage and waste. Financial cost was computed using local purchasing estimates and carbon cost was calculated using published estimates.

Results: In 100 consecutively discharged patients, 315 MDIs were dispensed in total, of which 96 were unused. This represents 61,440 actuations dispensed, with 56,773 (92%) of doses unused or wasted. Waste data were applied to annual estimates, with a calculated annual carbon footprint of 315.8 tons of carbon dioxide equivalent (tCO2e). We estimate that a 20% waste reduction would result in carbon savings of 68.5 tCO2e. If 20% of salbutamol prescriptions were switched to the dry powder inhaler alternative, terbutaline, a 14% reduction in waste would be required to offset the additional monetary cost.

Conclusions: This study suggests that 92% of MDI doses are unused and wasted. Opportunities for waste reduction exist and would be associated with both financial and carbon savings.

Background: Climate change remains a significant challenge to global health. The health care system is a major contributor of greenhouse gas (GHG) emissions. While pharmacists are aware of climate change as an important societal issue, there is little known about the level of implementation of climate-conscious practices in community pharmacies throughout Ontario.

Methods: An interview-based system was developed to gather insights from pharmacists regarding their perspectives on climate change and identify strategies to involve them in sustainable practices. Convenience and snowball sampling techniques were used to recruit pharmacists. Interviews were conducted by phone or Zoom, and transcripts were developed and analyzed for common themes using a qualitative method.

Results and discussion: Twenty-four community pharmacists were interviewed. Three overarching themes emerged: 1) there is a knowledge and awareness gap in the pharmacy profession; 2) before pharmacists can prioritize sustainable practices, they must first address more immediate concerns in the pharmacy; 3) sustainable practice integration requires employment and regulatory changes as relying solely or extensively on the good intentions of frontline pharmacists is insufficient.

Conclusion: While pharmacists show concern about the environmental impacts of their work, sustainable practice integration is very limited in community pharmacies across Ontario. There are many challenges and barriers to address. This includes closing the knowledge and awareness gap by incorporating climate-related topics into pharmacy curricula and providing educational seminars and resources for practicing pharmacists. In addition, improving workflow, changing standard operating procedures at a corporate level and providing incentives for implementing eco-friendly practices are crucial steps to address time and financial limitations. To manage patient safety concerns, providing resources that consider climate considerations as a secondary objective, when clinically appropriate for the patient, is the right approach to engage pharmacists. Lastly, advocating for employment and regulatory changes will be necessary for large-scale, durable changes to pharmacy practice.