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Setting priorities for physical examination in pharmacy education: A Delphi study 确定药学教育中体格检查的优先事项:德尔菲研究
Pub Date : 2024-02-05 DOI: 10.1177/17151635241228259
Marie-Laurence Tremblay, Marc-Antoine Guay, Alexandre Lafleur
As the scope of pharmacy practice is expanding, a growing number of pharmacists perform physical examination (PE) to gather additional information to monitor the effectiveness and safety of their patients’ therapy. This professional activity calls for the development of comprehensive and valuable PE training. We sought to determine by consensus which PE tests should be given teaching priority in pharmacy education. Using existing PE literature in pharmacy, we conducted an online Delphi survey from December 2021 to April 2022 with 16 pharmacists who practise in a variety of settings and/or who are considered experts in PE. After 2 Delphi rounds, consensus was reached to either include or exclude 27 PE tests in entry-to-practice programs. One last round allowed prioritizing the agreed-upon PE tests in terms of educational needs. Clinicians agreed that measuring blood pressure is indispensable and should be given teaching priority, followed by pulse rate, weight and blood glucose measurements. Endocrine system and head and neck examinations should be included in pharmacy programs, but their clinical usefulness was considered less important. We compared our results with PE literature in other health care disciplines. We found that only a few PE tests truly influence drug therapy management, that some examinations can be quite difficult to perform accurately and that without proper training and opportunities to retrain, skill decay can lead to dangerous misinterpretations. Pharmacy programs should consider focusing on teaching PE tests supported by evidence as having an impact on drug therapy management. Can Pharm J (Ott) 2024;157:xx-xx.
随着药学实践范围的不断扩大,越来越多的药剂师通过进行体格检查(PE)来收集更多信息,以监测患者治疗的有效性和安全性。这项专业活动要求开展全面而有价值的 PE 培训。我们试图通过共识来确定哪些 PE 检查应在药学教育中列为教学重点。利用现有的药学 PE 文献,我们在 2021 年 12 月至 2022 年 4 月期间进行了一次在线德尔菲调查,调查对象是 16 位在不同环境中执业的药剂师和/或被认为是 PE 专家的药剂师。经过两轮德尔菲调查后,我们就 27 项 PE 测试是否纳入执业准入计划达成了共识。在最后一轮讨论中,根据教育需求对商定的 PE 检查项目进行了优先排序。临床医生一致认为,测量血压是不可或缺的,应在教学中优先考虑,其次是脉搏、体重和血糖测量。内分泌系统和头颈部检查应纳入药学课程,但其临床实用性被认为不太重要。我们将研究结果与其他医疗学科的 PE 文献进行了比较。我们发现,只有少数 PE 检查能真正影响药物治疗管理,有些检查很难准确进行,而且如果没有适当的培训和再培训机会,技能衰退会导致危险的误判。药剂学课程应考虑重点教授有证据支持的、对药物治疗管理有影响的 PE 检查。Can Pharm J (Ott) 2024;157:xx-xx.
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引用次数: 0
Setting priorities for physical examination in pharmacy education: A Delphi study 确定药学教育中体格检查的优先事项:德尔菲研究
Pub Date : 2024-02-05 DOI: 10.1177/17151635241228259
Marie-Laurence Tremblay, Marc-Antoine Guay, Alexandre Lafleur
As the scope of pharmacy practice is expanding, a growing number of pharmacists perform physical examination (PE) to gather additional information to monitor the effectiveness and safety of their patients’ therapy. This professional activity calls for the development of comprehensive and valuable PE training. We sought to determine by consensus which PE tests should be given teaching priority in pharmacy education. Using existing PE literature in pharmacy, we conducted an online Delphi survey from December 2021 to April 2022 with 16 pharmacists who practise in a variety of settings and/or who are considered experts in PE. After 2 Delphi rounds, consensus was reached to either include or exclude 27 PE tests in entry-to-practice programs. One last round allowed prioritizing the agreed-upon PE tests in terms of educational needs. Clinicians agreed that measuring blood pressure is indispensable and should be given teaching priority, followed by pulse rate, weight and blood glucose measurements. Endocrine system and head and neck examinations should be included in pharmacy programs, but their clinical usefulness was considered less important. We compared our results with PE literature in other health care disciplines. We found that only a few PE tests truly influence drug therapy management, that some examinations can be quite difficult to perform accurately and that without proper training and opportunities to retrain, skill decay can lead to dangerous misinterpretations. Pharmacy programs should consider focusing on teaching PE tests supported by evidence as having an impact on drug therapy management. Can Pharm J (Ott) 2024;157:xx-xx.
随着药学实践范围的不断扩大,越来越多的药剂师通过进行体格检查(PE)来收集更多信息,以监测患者治疗的有效性和安全性。这项专业活动要求开展全面而有价值的 PE 培训。我们试图通过共识来确定哪些 PE 检查应在药学教育中列为教学重点。利用现有的药学 PE 文献,我们在 2021 年 12 月至 2022 年 4 月期间进行了一次在线德尔菲调查,调查对象是 16 位在各种环境中执业的药剂师和/或被认为是 PE 专家的药剂师。经过两轮德尔菲调查后,我们就 27 项 PE 测试是否纳入执业准入计划达成了共识。在最后一轮讨论中,根据教育需求对商定的 PE 检查项目进行了优先排序。临床医生一致认为,测量血压是不可或缺的,应在教学中优先考虑,其次是脉搏、体重和血糖测量。内分泌系统和头颈部检查应纳入药学课程,但其临床实用性被认为不太重要。我们将研究结果与其他医疗学科的 PE 文献进行了比较。我们发现,只有少数 PE 检查能真正影响药物治疗管理,有些检查很难准确进行,如果没有适当的培训和再培训机会,技能衰退会导致危险的误判。药剂学课程应考虑重点教授有证据支持的、对药物治疗管理有影响的 PE 检查。Can Pharm J (Ott) 2024;157:xx-xx.
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引用次数: 0
The quality of pharmacist-led community warfarin management across 2 provinces in Canada: A cross-sectional observational study 加拿大两省药剂师领导的社区华法林管理质量:横断面观察研究
Pub Date : 2024-02-05 DOI: 10.1177/17151635241228228
Laura Morrison, Jeff Nagge
Guidelines for anticoagulation management services recommend personnel be specially trained in warfarin management and suggest using tools such as decision-support software. To date, there have been no Canadian studies documenting the quality of warfarin management using a similar guideline recommended approach. A cross-sectional, retrospective observational study was conducted to measure the quality of pharmacist-led warfarin management using point-of-care international normalized ratio (INR) testing and decision-support software in various ambulatory settings in Canada. Settings included 4 family health teams in Ontario and 40 community pharmacies across Nova Scotia. Quality was measured using time in therapeutic range (TTR) and was reported in 3 manners: mean TTR, median TTR and time-weighted mean TTR. The primary outcome included 963 patients. The combined mean and median TTR for the 2019 Ontario family health teams and Nova Scotia pharmacies was 74.2% and 77.3% (interquartile range 64%-87.9%), respectively. The time-weighted mean TTR was 76.3%. To the best of our knowledge, the TTR achieved by this model of care is the highest reported in Canadian general practice. Since Thrombosis Canada defines good-quality warfarin management as a TTR of 60% or greater, and many studies have reported an association between higher TTR values and lower rates of thrombosis and hemorrhage, this model of care may have significant benefits for patients. This study demonstrates the high quality of anticoagulation management provided by specially trained pharmacists using point-of-care INR testing and decision-support software. These results support expanded access to this service for all Canadians. Can Pharm J (Ott) 2024;157:xx–xx.
抗凝管理服务指南建议对工作人员进行华法林管理方面的专门培训,并建议使用决策支持软件等工具。迄今为止,加拿大还没有任何研究记录了使用类似指南推荐方法进行华法林管理的质量。我们开展了一项横断面回顾性观察研究,在加拿大不同的门诊环境中使用床旁国际正常化比值(INR)检测和决策支持软件来衡量药剂师主导的华法林管理质量。研究地点包括安大略省的 4 个家庭保健团队和新斯科舍省的 40 个社区药房。质量用治疗范围内时间(TTR)来衡量,并以三种方式报告:平均 TTR、中位数 TTR 和时间加权平均 TTR。主要结果包括 963 名患者。2019 年安大略省家庭健康团队和新斯科舍省药房的综合平均治疗率和中位治疗率分别为 74.2% 和 77.3%(四分位距为 64%-87.9% )。时间加权平均 TTR 为 76.3%。据我们所知,这种护理模式达到的 TTR 是加拿大全科实践中报告的最高值。由于加拿大血栓形成协会将高质量的华法林管理定义为 60% 或更高的 TTR,而且许多研究都报道了较高的 TTR 值与较低的血栓形成率和出血率之间的关联,因此这种护理模式可能会给患者带来显著的益处。这项研究表明,经过专门培训的药剂师利用床旁 INR 检测和决策支持软件提供的抗凝管理质量很高。这些结果支持扩大这项服务的覆盖面,让所有加拿大人都能享受到这项服务。Can Pharm J (Ott) 2024;157:xx-xx.
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引用次数: 0
The quality of pharmacist-led community warfarin management across 2 provinces in Canada: A cross-sectional observational study 加拿大两省药剂师领导的社区华法林管理质量:横断面观察研究
Pub Date : 2024-02-05 DOI: 10.1177/17151635241228228
Laura Morrison, Jeff Nagge
Guidelines for anticoagulation management services recommend personnel be specially trained in warfarin management and suggest using tools such as decision-support software. To date, there have been no Canadian studies documenting the quality of warfarin management using a similar guideline recommended approach. A cross-sectional, retrospective observational study was conducted to measure the quality of pharmacist-led warfarin management using point-of-care international normalized ratio (INR) testing and decision-support software in various ambulatory settings in Canada. Settings included 4 family health teams in Ontario and 40 community pharmacies across Nova Scotia. Quality was measured using time in therapeutic range (TTR) and was reported in 3 manners: mean TTR, median TTR and time-weighted mean TTR. The primary outcome included 963 patients. The combined mean and median TTR for the 2019 Ontario family health teams and Nova Scotia pharmacies was 74.2% and 77.3% (interquartile range 64%-87.9%), respectively. The time-weighted mean TTR was 76.3%. To the best of our knowledge, the TTR achieved by this model of care is the highest reported in Canadian general practice. Since Thrombosis Canada defines good-quality warfarin management as a TTR of 60% or greater, and many studies have reported an association between higher TTR values and lower rates of thrombosis and hemorrhage, this model of care may have significant benefits for patients. This study demonstrates the high quality of anticoagulation management provided by specially trained pharmacists using point-of-care INR testing and decision-support software. These results support expanded access to this service for all Canadians. Can Pharm J (Ott) 2024;157:xx–xx.
抗凝管理服务指南建议对工作人员进行华法林管理方面的专门培训,并建议使用决策支持软件等工具。迄今为止,加拿大还没有任何研究记录了使用类似指南推荐方法进行华法林管理的质量。我们开展了一项横断面回顾性观察研究,在加拿大不同的门诊环境中使用床旁国际正常化比值(INR)检测和决策支持软件来衡量药剂师主导的华法林管理质量。研究地点包括安大略省的 4 个家庭保健团队和新斯科舍省的 40 个社区药房。质量用治疗范围内时间(TTR)来衡量,并以三种方式报告:平均 TTR、中位数 TTR 和时间加权平均 TTR。主要结果包括 963 名患者。2019 年安大略省家庭健康团队和新斯科舍省药房的综合平均治疗率和中位治疗率分别为 74.2% 和 77.3%(四分位距为 64%-87.9% )。时间加权平均 TTR 为 76.3%。据我们所知,这种护理模式达到的 TTR 是加拿大全科实践中报告的最高值。由于加拿大血栓形成协会将高质量的华法林管理定义为 60% 或更高的 TTR,而且许多研究都报道了较高的 TTR 值与较低的血栓形成率和出血率之间的关联,因此这种护理模式可能会给患者带来显著的益处。这项研究表明,经过专门培训的药剂师利用床旁 INR 检测和决策支持软件提供的抗凝管理质量很高。这些结果支持扩大这项服务的覆盖面,让所有加拿大人都能享受到这项服务。Can Pharm J (Ott) 2024;157:xx-xx.
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引用次数: 0
The pharmacist primary care clinic: The evolution of pharmacy practice? 药剂师初级保健诊所:药学实践的演变?
Pub Date : 2024-02-01 DOI: 10.1177/17151635241229059
Stephanie C. Gysel, Ross T. Tsuyuki
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引用次数: 0
The pharmacist primary care clinic: The evolution of pharmacy practice? 药剂师初级保健诊所:药学实践的演变?
Pub Date : 2024-02-01 DOI: 10.1177/17151635241229059
Stephanie C. Gysel, Ross T. Tsuyuki
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引用次数: 0
OPEN Summit 2023 Abstracts–Poster and Oral Presentations 2023 年开放峰会摘要--海报和口头报告
Pub Date : 2023-12-18 DOI: 10.1177/17151635231219546
Yasmin Abdul Aziz, Vivian Ng, Diya Srinivasan, Julie Vo, Laura Desveaux, Kevin Schwartz, Z. Rosenberg-Yunger, Erin Berenbaum, Lindsay Friedman, Bradley Langford, Valerie Leung, Emily Angl, Nardine Nakhla, Mina Tadrous, Barbara Farrell, Mathew DeMarco, Nancy Waite, Lisa Dolovich, Mansur Mehdi, Jon Jones, Humayra Tasnim, Mhd Wasem, E. Alsabbagh, Kelly Neiterman, Grindrod, Kristy Scarfone, Shaleesa Ledlie, D. Shearer, Tara Gomes
BACKGROUND: Expanding pharmacists' scope of practice to include prescribing for thirteen minor ailments, including infectious diseases, in the community pharmacy setting began January 2023. This expansion presents opportunities to improve patients’ access to timely care and harness pharmacists’ expertise to increase appropriate prescribing. Identifying key facilitators and barriers for the effective implementation of pharmacist prescribing is crucial to proactively support this evolution. OBJECTIVE : To identify facilitators and barriers for the effective implementation of pharmacists prescribing medications for selected minor ailments and infectious diseases METHODS : Virtual interviews and online surveys were utilized to gather pharmacists’ perspectives on service provision across Ontario prior to the launch. Virtual focus group discussions were conducted with primary care physicians and patients separately. Focus groups and interviews were audio recorded, transcribed verbatim and thematically analyzed. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework
背景:从 2023 年 1 月起,药剂师的执业范围将扩大到包括在社区药房开具十三种轻微疾病(包括传染病)的处方。这一扩展为改善患者获得及时护理的机会,以及利用药剂师的专业知识增加适当处方提供了机遇。确定有效实施药剂师处方的关键促进因素和障碍对于积极支持这一演变至关重要。目的:确定有效实施药剂师为特定轻微疾病和传染病开处方的促进因素和障碍 方法 :采用虚拟访谈和在线调查的方式,收集药剂师对安大略省各地在启动之前所提供服务的看法。分别与初级保健医生和患者进行了虚拟焦点小组讨论。对焦点小组和访谈进行了录音、逐字记录和主题分析。数据分析以实施研究综合框架 (CFIR) 和理论领域框架为指导
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引用次数: 0
Why we need to incorporate obesity medicine into community pharmacies 为什么我们需要将肥胖症医学纳入社区药房?
Pub Date : 2023-12-08 DOI: 10.1177/17151635231217196
Daniel Burton, Stephanie Gysel, Ross T. Tsuyuki
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引用次数: 0
Social prescribing in pharmacies: What is it, does it work and what does it mean for Canadian pharmacies? 药房的社会处方:社会处方是什么、是否有效、对加拿大药房意味着什么?
Pub Date : 2023-12-08 DOI: 10.1177/17151635231216119
Tarek Hussein, Nia Cartright, Jenny Kirschner, Arun Nadarasa, A. Rathbone, Laura Lindsey
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引用次数: 0
A practice tool for initiating and managing combined hormonal contraceptives for contraception: Assessment, decision-making and monitoring 启动和管理复方激素避孕药避孕的实践工具:评估、决策和监测
Pub Date : 2023-12-08 DOI: 10.1177/17151635231215061
N. Yuksel, Anne Marie Whelan
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引用次数: 0
期刊
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada
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