Abstract Background: Hypertension control remains suboptimal, contributing to preventable cardiovascular disease events, particularly among patients with limited access to primary care. While pharmacist-led care has demonstrated benefit in primary care settings, its impact in urgent care is not well-studied. This study aimed to evaluate patient-centred outcomes of pharmacist-led interventions for hypertension management in urgent care. Methods: A pilot project was designed to integrate a pharmacist into a team-based care model to evaluate and intervene on hypertension and other cardiovascular risk factors among patients presenting to urgent care without a primary care provider and with hypertension (blood pressure ≥140/90 mmHg). The project was performed at the Metrotown Urgent and Primary Care Centre in British Columbia. A retrospective chart review was performed to evaluate the effectiveness of this project. Results: A total of 62 patients were included (mean age 56 years; 56.5% male). Mean (standard deviation [SD]) baseline systolic/diastolic blood pressure was 178.4 (SD 21.7)/101.2 (SD 14.7) mmHg and decreased to 124.1 (SD 12.0)/77.4 (SD 9.9) mmHg following pharmacist-led care, representing a mean reduction (SD) of 54.3 (SD 19.7)/23.8 (SD 15.0) mmHg. Overall, 82% of patients were discharged from the program after achieving Hypertension Canada guideline-recommended blood pressure targets. Conclusion: In an urgent care setting, pharmacist-led interventions achieved substantial reductions in blood pressure and high rates of guideline-recommended control, supporting this model as a strategy to address gaps in hypertension care for patients without primary care access.
Background: Scientific publication by pharmacists enhances professional practices, disseminates knowledge, and fosters academic development. The main objective was to describe a 10-year analysis of scientific publications by hospital pharmacists from Quebec. Methods: Eligible publications included articles in indexed or non-indexed journals, abstracts presented at conferences, and books. The publications were identified through various sources, such as the directors of pharmacy departments and a provincial website. Publications were described according to various parameters, and trends per year were evaluated. A Student's t-test was used for comparison. Results: A total of 2656 publications were identified, consisting of 1349 articles, 1260 abstracts, and 47 books. Two-thirds (836/1349) of publications were published in indexed journals. Most publications were from a university-affiliated institution (94.7%; 2515/2656) and conducted in a hospital setting (89.0%; 950/1068). Most consisted of evaluative research (66.6%; 1769/2656). Infectious diseases were the most frequent theme (20.6%; 323/1569). The mean number of authors per publication increased from 5.1 ± 3.2 to 7.3 ± 4.5 and was higher in indexed journals (7.4 ± 5.1) compared with non-indexed journals (4.3 ± 3.1) (p < 0.0001). The total number of publications per year was constant. Discussion: Most publications were affiliated with a university and relevant to a hospital setting. Future work will be done to facilitate the identification of publications by pharmacists in other settings. Conclusion: This structured longitudinal review of publications by pharmacists in Quebec revealed that publication activity remained constant over a 10-year period. Hospital pharmacy practice research needs to be further facilitated outside of an academic setting.
Abstract Background: The COVID-19 pandemic was a time of tremendous uncertainty, with rapidly changing guidelines and health policies that posed challenges for community pharmacist practice. Newfoundland and Labrador pharmacists looked to federal and provincial governments and pharmacy organizations for clarification about their roles and responsibilities during the pandemic. The objective of this document analysis was to identify the proposed roles of community pharmacists during the COVID-19 pandemic as well as policy instruments that informed these roles. Method: General and targeted search strategies were used to identify documents released by federal and provincial governments and pharmacy organizations from January 2020 to August 2022. Proposed roles for community pharmacies were determined using conventional content analysis and matched to predefined pandemic stages. The type of policy instrument informing each role was determined according to the 5 types used in health policy contexts: do nothing, exhortation, regulation, expenditure, and public ownership. Results: In total, 140 official documents met the inclusion criteria, and 11 distinct pandemic-related community pharmacist roles were identified. The documents described roles such as maintaining continuity of care, providing virtual care, staying informed about COVID-19 updates, prescribing COVID-19 treatment, and vaccinating against influenza and COVID-19. Exhortation, expenditure, and regulation policy instruments informed these roles. No public ownership policies were identified. Conclusion: Community pharmacists played essential roles during the pandemic, which were informed by various policy instruments. The lack of public ownership policies was a notable finding that may have presented challenges for pharmacists in enacting their roles.
Regulators have in recent years focused on the business aspects of Canada's community pharmacy sector. Despite the regulatory attention, there is limited published evidence on the community pharmacy business landscape in Canada. To add to the evidential basis for policy-making, in this paper and in a companion paper we investigate the economics of the community pharmacy sector in Canada.In this paper, we describe national community pharmacy revenues, by source, review the strategies that pharmacies use to compete, and describe the different pharmacy ownership models. We then use detailed pharmacy-level data from Ontario to compare the competitive strategies-such as scale, hours, prices, and location-used by corporate and non-corporate pharmacies.We find that pharmacies derive most revenues from dispensing medications. Corporate pharmacies-which comprise about 30% of all pharmacies-operate at a much larger scale than non-corporate pharmacies. They are about twice the size, on average, as measured by the number of pharmacists employed. They are also more likely to employ pharmacy technicians. Corporate pharmacies are open about 20-40 more hours per week than non-corporates, depending on the format. Patient foot traffic is markedly higher.Corporate and non-corporate pharmacies also differ in their locational choices. About 22% of banner and independent pharmacies share retail space with a medical clinic; the numbers were generally lower for corporates. Non-corporate pharmacies were much more likely to locate in rural areas. Finally, we find that non-corporate pharmacies are more likely to offer specialized compounding services. In the companion paper, we integrate these findings with other evidence, including the grey literature, to describe the structure of corporate and non-corporate pharmacies and their competitive strategies. Can Pharm J (Ott) 2026;159:1-23.
Background: Community pharmacists (CPs) are well-positioned to address the threat of antimicrobial resistance (AMR) by encouraging appropriate antimicrobial use. Understanding the individual and contextual determinants of CPs' involvement in antimicrobial stewardship (AMS) helps select sustainable strategies. Our objective was to identify and classify the barriers and facilitators to CPs' involvement in AMS.Methods: We conducted a systematic review of studies that evaluated the determinants of CP recommending, prescribing, or counselling on appropriate antibiotic use. We searched 5 databases (Ovid Medline, Embase, International Pharmaceutical Abstracts, PsycINFO, and Ebsco CINAHL) from inception to April 24, 2024, using search concepts of community pharmacy and AMS. Title and abstract, as well as full-text screening, were performed by 2 reviewers. Risk of bias was assessed using a modified Critical Appraisal Skills Programme tool. We extracted study details, with barriers and facilitators categorized according to the Theoretical Domains Framework and Consolidated Framework for Implementation Research.Results: Of the 2429 studies screened, 40 were included. High-income countries constituted 26 studies while 14 were in low-middle-income countries. Nine evaluated a specific AMS initiative. Key barriers included lack of time to participate in AMS, lack of collaboration with physicians, and lack of access to patient records. Facilitators included financial incentives and reimbursement for service, specialized training opportunities, and guidelines for AMS practice.Conclusion: This review identified key barriers and facilitators to antimicrobial stewardship in community pharmacy. These determinants can form the basis for selecting impactful community pharmacy AMS strategies to reduce the burden of AMR.
In the first paper in this series, we reviewed the basic economics of community pharmacy in Canada. In this paper, we describe the structure of corporate and non-corporate pharmacies and their competitive strategies.We find that corporate pharmacies generate much larger sales volumes than non-corporate pharmacies. To do so, they typically offer loyalty points on purchases of their large array of front-store products. The corporate chain pharmacies tend to be located in high-visibility areas and offer the longest operating hours. They strive for uniformity in pharmacy look and feel and engage the most heavily in marketing. Dispensing fees are relatively high. With their large sales volumes, corporate pharmacies can exploit scale economies that reduce the average cost per prescription dispensed below that faced by most non-corporates.The corporate model also owes its success to the centralization and standardization of pharmacy operations at the corporate head office. To encourage manager effort, the head office uses financial incentives that reward the attainment of profit targets and penalize underperformance.The scale at which corporate pharmacies operate limits their spread, creating opportunities for smaller non-corporates. Each corporate pharmacy requires a large catchment area to generate sufficient patient volumes and sales revenues to cover fixed costs. Moreover, there are relatively few commercial areas zoned to accommodate a large-footprint pharmacy. Both factors limit their geographic density. Pharmacist-owned pharmacies, being smaller, require a smaller patient volume to cover fixed costs and have more commercial locations to choose from.To compete, non-corporates offer services not routinely offered by the corporates. Many are located adjacent to, and sometimes within, medical clinics. Others have developed strong reputations in ethnic communities. To reduce costs, most pharmacist-owned pharmacies have joined banners and other consortia to share the marketing costs and inventory management and exploit bulk purchasing advantages. There is emerging evidence that non-corporate pharmacies apply less pressure on professional staff to achieve volume targets.
Background: Scientific publication by pharmacists enhances professional practices, disseminates knowledge, and fosters academic development. The main objective was to describe a 10-year analysis of scientific publications by hospital pharmacists from Quebec. Methods: Eligible publications included articles in indexed or non-indexed journals, abstracts presented at conferences, and books. The publications were identified through various sources, such as the directors of pharmacy departments and a provincial website. Publications were described according to various parameters, and trends per year were evaluated. A Student's t-test was used for comparison. Results: A total of 2656 publications were identified, consisting of 1349 articles, 1260 abstracts, and 47 books. Two-thirds (836/1349) of publications were published in indexed journals. Most publications were from a university-affiliated institution (94.7%; 2515/2656) and conducted in a hospital setting (89.0%; 950/1068). Most consisted of evaluative research (66.6%; 1769/2656). Infectious diseases were the most frequent theme (20.6%; 323/1569). The mean number of authors per publication increased from 5.1 +/- 3.2 to 7.3 +/- 4.5 and was higher in indexed journals (7.4 +/- 5.1) compared with non-indexed journals (4.3 +/- 3.1) (p < 0.0001). The total number of publications per year was constant. Discussion: Most publications were affiliated with a university and relevant to a hospital setting. Future work will be done to facilitate the identification of publications by pharmacists in other settings. Conclusion: This structured longitudinal review of publications by pharmacists in Quebec revealed that publication activity remained constant over a 10-year period. Hospital pharmacy practice research needs to be further facilitated outside of an academic setting.
Background: Members of Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and those who identify with other terms related to sexual and gender diversity (2SLGBTQ+) communities face worse health outcomes and receive lower quality of care compared to the general population, attributable to lack of training in health care professionals, including pharmacists. Further understanding of 2SLGBTQ+ pharmacy care in British Columbia is needed for targeted approaches to improve care. Methods: This cross-sectional, mixed-methods survey was conducted in British Columbia, targeting registered pharmacists and student pharmacists, asking participants to assess the inclusivity of their practice and their pharmacy, to rank the most important pharmacist competencies for providing inclusive care, and to comment on facilitators and barriers they experience in providing care to 2SLGBTQ+ communities. The survey was disseminated online from October 24 to December 18, 2022. Results: Four hundred ninety-five responses were included. Two-thirds of participants were comfortable interacting with 2SLGBTQ+ patients, and one-third said their pharmacy is a welcoming space for 2SLGBTQ+ patients. Facilitators for inclusive care included showing inclusivity through language and physical displays. A key barrier cited was the lack of training. The most important competencies identified were creating an inclusive space, using inclusive language, and providing culturally safe care. Discussion: Although participants report being comfortable caring for 2SLGBTQ+ communities, many do not have the skills to do so. This gap between the care pharmacists want to provide and the competencies they possess may be bridged by systematically integrating 2SLGBTQ+ competencies longitudinally throughout pharmacy school curricula. Conclusion: This study highlighted gaps in inclusive care from the pharmacist's perspective. Findings may guide curricular change and continuing education opportunities, as well as inform strategic planning of pharmacy professional bodies as the pharmacy profession evolves to take a more active role in the dignified care of 2SLGBTQ+ communities.
Background: Community pharmacy care clinics were established to improve access to clinical pharmacy services and help address the primary care crisis. This study reports characteristics of people who accessed the first clinic to open in Alberta (AB) and services they sought during the first 7 months of operation. Methods: This cross-sectional study examined information collected from self-reported intake forms submitted when individuals visited the clinic in Lethbridge, AB. Individuals seeking services between June 24, 2022 and January 31, 2023 were eligible for inclusion. Results: A total of 3305 people visited the clinic 4962 times and submitted 3831 intake forms with 4917 reasons for seeking care. Mean age was 32 years (range 0 to 96) and 62% were female. Almost 1 in 3 (32%) reported not having a family physician and 9% reported they usually access medical care in an emergency department (ED) or walk-in clinic. Assessment of an acute common ailment (e.g., pharyngitis, sinus symptoms, urinary tract infections) was the most common reason (80%) for visiting the clinic, followed by chronic disease management (e.g., review of medications, mental health, hypertension) (14%), and point-of-care testing or immunization (3%). Individuals who did not have a family physician were more likely to have >= 2 clinic visits (p < 0.01) and seek care for chronic disease management (p < 0.01). Of those who usually access care in an ED or walk-in clinic, 67% of the reasons to visit the clinic were for common ailments and 26% were for chronic disease management. Conclusions: The community pharmacy care clinic has improved access to a wide variety of individuals who visited the clinic with a broad range of complaints.
