Canadian Pharmacists Journal最新文献

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is highly effective at reducing the risk of acquiring HIV. PrEP is underused due, in part, to prescriber inaccessibility. The overall aim of this study was to evaluate the impact of pharmacist PrEP management (including prescribing and monitoring) on clinical and acceptance outcomes in patients who are at high risk for HIV exposure.

Methods: Pharmacist-led PrEP management was guided by a prescribing protocol and implemented at 10 community pharmacies in Nova Scotia over 6 months. Baseline and follow-up bloodwork determined HIV status, coinfection(s), and other eligibility criteria for initial and refill PrEP prescriptions. Patient acceptance was measured according to the theoretical framework for acceptability of health care interventions.

Results: Forty-five participants met eligibility criteria, and 37 remained for the study duration. Around half of the participants had never used PrEP before, and all identified as men who have sex with men or transgender women. Participants were highly accepting of the service and agreed that pharmacist-led PrEP management should always be available. Few reported privacy or stigma/discrimination concerns. All participants remained HIV-negative during study participation, and participants with coinfections were linked with care (n = 4).

Interpretation: The service was acceptable and effective for patients. Future work is required to reach underserved populations, particularly individuals with injection-related HIV risk factors.

Conclusions: Pharmacist-led PrEP management can provide an alternative way to obtain PrEP for higher-risk patients. This study resulted in a regulation change on July 1, 2024 that authorized pharmacists to prescribe PrEP in Nova Scotia.

Background: Chronic kidney disease (CKD) affects 1 in 10 Canadians. Medications cleared by the kidneys can be harmful if dosed improperly. Community pharmacists are well-positioned to optimize prescribing, but inconsistencies between medication resources can complicate dosing. This study developed and validated higher-risk medication toolkits, including decision support algorithms for community pharmacists managing people with CKD.

Methods: Fifty-one toolkits and algorithms were developed by team experts using Lynn's method (domain identification, item generation per domain, and instrument formation). Team experts followed by community pharmacists rated toolkit content and algorithm face validity using a 2-part questionnaire with Likert scales. Each toolkit was validated by 5 to 6 participants over 2 rounds. Content validity was computed using an item-level content validity index (I-CVI) and scale-level content validity index (S-CVI/Ave) per round. Face validity calculated percentages for level of agreement to 5 statements. Community pharmacist interviews were conducted after each round, data analyzed, and toolkit revisions were made between rounds.

Results: Twenty-two team experts validated 51 toolkits in 2 rounds between August and September 2024. Toolkit I-CVI, S-CVI/Ave, and face validity per algorithm ranged from 0.5 to 1, 0.87 to 1, and 49% to 100%, respectively. Thirteen toolkits were excluded from the community pharmacist validation. In 2 additional rounds, 23 community pharmacists, with 13.7 ± 9.1 years of experience, validated 38 medication toolkits between October and December 2024. Toolkit I-CVI and S-CVI/Ave and face validity per algorithm ranged from 0.83 to 1 and from 0.87 to 1, which met the content validity threshold of 0.83 to 1 (P < 0.05) for at least 5 to 6 participants per round. Participants' overall agreement for the face validity statements ranged from 75% to 100%, which was above the prespecified threshold of 70% for face validity consensus.

Conclusions: Thirty-eight toolkits achieved high content and face validity. Future research will integrate them into a digital tool and assess their effectiveness and safety in community pharmacy practice in people with CKD.

Contexte: Le Canada a longtemps figuré parmi les leaders mondiaux de la prise en charge de l'hypertension artérielle (HTA), mais ses taux de traitement et de maîtrise de l'HTA ont régressé ces dernières années. Le présent guide de pratique clinique vise à fournir des recommandations pragmatiques axées sur les soins de première ligne afin d'améliorer la prise en charge de l'HTA chez les adultes à l'échelle de la population.

Méthodes: Conformément aux normes de qualité et de présentation du guide AGREE II (Appraisal of Guidelines for Research and Evaluation), nous avons utilisé la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et le processus ADAPTE pour formuler des recommandations sur la prise en charge de l'HTA chez les adultes de 18 ans et plus. Nous avons ensuite intégré ces recommandations dans des algorithmes simplifiés, pragmatiques et fondés sur les données probantes en nous appuyant sur le guide technique HEARTS - un modèle de soins mis au point par l'Organisation mondiale de la Santé (OMS) afin d'améliorer la maîtrise de l'HTA et de réduire le fardeau des maladies cardiovasculaires (MCV). Le comité qui a préparé ce guide de pratique clinique se composait principalement de prestataires de soins de première ligne, mais aussi de patients et patientes, de spécialistes de la méthodologie et de spécialistes de l'HTA. Notre processus de gestion des intérêts concurrents a respecté les principes du Guidelines International Network.

Recommandations: Les 9 recommandations pour la prise en charge de l'HTA chez les adultes sont regroupées sous les rubriques « Diagnostic » et « Traitement ». Les recommandations diagnostiques comportent une méthode standardisée de mesure de la pression artérielle (PA) et de confirmation de l'HTA, ainsi qu'une définition uniforme de l'HTA, soit une PA ≥ 130/80 mm Hg. Les recommandations thérapeutiques comprennent l'établissement d'une cible de pression artérielle systolique (PAS) < 130 mm Hg, l'adoption de saines habitudes de vie, de même qu'une démarche par étapes pour guider un choix optimal de médicaments lorsqu'une pharmacothérapie est nécessaire.

Interprétation: Notre objectif consiste à améliorer la norme de soins de l'HTA en soins de première ligne au Canada. Un diagnostic exact et un traitement optimal de l'HTA peuvent réduire le nombre d'événements cardiovasculaires indésirables ainsi que le risque de décès.

Background: The pharmacist labour supply affects patient access to pharmacotherapy, immunization, and other primary health care services. There is little published evidence on the pharmacist labour supply in Canada, yet these data are needed for pharmacist workforce planning. We evaluated long-term trends in the number of pharmacists in Canada, their average hours worked, and how demographic and other factors affect hours worked. We also examined trends in community pharmacist productivity.

Methods: Data on the number of licensed pharmacists were obtained from pharmacist regulatory agencies. Statistics Canada's Labour Force Survey identified pharmacists' hours worked per week to be between 1987 and 2023. Regression models were used to estimate the impact of pharmacist demographic characteristics, worksite type, region of residence, and secular trends on hours worked. IQVIA data on community pharmacist prescription dispensing were used to examine productivity.

Results: The number of pharmacists relative to population doubled over the past 4 decades. This growth was partly offset by reductions in average hours worked per week. This appears to be driven by increases in the female share of the pharmacist workforce and the declining number of hours that male pharmacists work. On net, however, the total number of weekly hours worked-the average weekly hours worked per pharmacist times the number of pharmacists-has increased in both absolute and per capita terms. This expansion in the pharmacist labour supply was reinforced by an increase in pharmacist productivity, at least in the community pharmacy sector.

Interpretation: The pharmacist labour supply in Canada has expanded markedly over the past 4 decades; this has occurred despite a decline in the average weekly hours worked by male pharmacists. It is unclear, however, whether this increase is commensurate with the increased responsibilities and workloads being placed on pharmacists. Province-level data on the forecasted demand for pharmacist services and the pharmacist personnel needed to provide these services are required for pharmacist workforce planning. Can Pharm J (Ott) 2025;158:236-246.