Introduction: During the COVID-19 pandemic, clinical sites have closed their doors to student placements, leading to the implementation of remote rotations. The purpose was to determine best practices for distance preceptorship from the student's perspective. Methods: A survey was sent to the pharmacy students at the Leslie Dan Faculty of Pharmacy who have completed at least one remote rotation. Results: Forty-eight out of 121 students (39%) completed the survey. It was found that 83% of the students were motivated during the start of their rotations, while 48% remained motivated throughout. Students who remained motivated had clear expectations set from the beginning, felt comfortable communicating issues regarding their assigned work with their preceptor, had similar rapport with remote preceptors as with in-person preceptors, had a preceptor who is always available for questions, and had a work environment free of distractions. Discussion:There are numerous best practices students and preceptors can utilise during a remote rotation to help students remain motivated. Preceptors and students should work together so that students remain motivated throughout their rotation. Setting expectations, having good communication, getting to know their preceptor, and having a work environment free of distractions are key factors for conducting a remote rotation.

Objective: To evaluate if applicants selecting internet-based interviews (iMMI) have the same probability for admission as traditional on-site interviews (MMI). Methods: This was a retrospective cohort study of all applicants between 2014 and 2017 using routinely collected data. Logistic regression was used to compare the odds of admission and models were adjusted for potential confounders. Confounders which were significant in the univariate analysis were selected for the multivariate model. Analysis was performed using XLSTAT. Results: There were 238 applicants. Admission rate was not different between iMMI and MMI applicants. Eight-four percent (84%) of applicants in iMMI and 80% in MMI were admitted leading to a crude odds ratio (OR) of 1.4 (95% CI 0.7 - 2.7) and an adjusted OR of 1.2 (95% CI 0.5 - 2.8). Conclusions: This study demonstrated similar admission rates suggesting that iMMI may be a viable option for wider use. This process may improve admission procedures for hard-to-reach applicants in pharmacy programmes.

OBJECTIVE:To assess the feasibility of a medication sampling program involving community pharmacists.METHODS:A community pharmacy dispensed samples after receiving a voucher given to patients by prescribers. Surveys explored prescribers' and patients' views about sampling and patients' experiences with the program.KEY FINDINGS:Half of prescribers reported providing samples, yet 15 patients redeemed 18 vouchers over 1 year. Patients expressed favourable views towards sampling and pharmacist involvement, despite more than half (n = 8/15, 53%) feeling that visiting the pharmacy was less convenient.CONCLUSION:A voucher-based medication sampling program based in a community pharmacy is a model integrating pharmacist care.

PURPOSEThe published literature on medication reconciliation (MR) interventions, outcomes, and facilitators in ambulatory care settings is reviewed.METHODSA scoping review was conducted to characterize ambulatory care-based MR research in terms of study design, elements of interventions, and outcomes examined. English-language articles on comparative studies of MR programs targeting adults in ambulatory care settings were identified using data sources including MEDLINE, PreMEDLINE, EMBASE, and International Pharmaceutical Abstracts. For each study, steps undertaken in the MR process were extracted. The Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify types of interventions; taxonomies for reported outcomes and factors facilitating implementation of MR initiatives were developed by the authors.RESULTSFrom among 2062 publications screened, 15 were included in the review. In 13 studies, multiple data sources were used to compile a "best possible medication history" (BPMH); however, the BPMH was shared with external healthcare providers in only 4 studies and with patients in only 5 studies. Most reported MR interventions were classified into two EPOC domains: professional (predominantly educational outreach visits and patient reminders) and organizational (predominantly provider-oriented interventions). Process outcomes were reported in 12 studies, with correct performance of MR being the most commonly evaluated process outcome, and 9 studies identified factors that facilitated MR implementation.CONCLUSIONFew studies have examined clinical outcomes of MR in ambulatory care settings, with the majority of pertinent reports focusing instead on process outcomes. Facilitators of successful MR interventions have been identified at the patient, staff, and clinic setting levels.

On trouve plusieurs types de produits d'hormonothérapie en vente au Canada, qui contiennent différents oestrogènes et progestines. Ils sont proposés en diverses présentations, en différentes doses et en plusieurs voies d'administration. Il existe des différences importantes d'action pharmacologique entre les diverses hormones et de marqueurs substituts selon la voie d'administration. On peut obtenir le même résultat clinique global avec différentes molécules, mais étant donné l'importante variabilité inter- et intrapatient des produits, il faut personnaliser le traitement pour optimiser les résultats et la qualité de vie de la patiente. (Voir page 14.)

Across Canada, the provincial colleges of pharmacy issue licences to those meeting the registration requirements to practise pharmacy. But does one licence fit all? At a minimum, all pharmacists have an undergraduate degree, and many have additional formal training through a Canadian pharmacy residency program or a Doctor of Pharmacy program. All practising pharmacists are registered under the same licence category, even though they work in a wide variety of settings and provide vastly different services, including drug dispensing, patient counselling, adaptation of prescriptions, chronic disease clinics, therapeutic drug monitoring, delegated drug therapy management, medication reconciliation, participation in patient care rounds, interpretation of laboratory test results, and collaborative prescribing, all intended to achieve better patient outcomes. Not knowing what to expect from a pharmacist must be confusing for patients, physicians, and the rest of the health care team, not to mention the general public, health administrators, and ministries of health. When a health care profession proposes a change to its scope of practice and the corresponding legislation, broad consultation must take place with stakeholder groups such as other health care professionals and the public. Given our duty to protect the public, we must be able to demonstrate that our training provides adequate skills and competence to perform these new functions, and that our profession has a process for ongoing assessment of these competencies. Do I feel that our undergraduate training provides adequate skills and competence for advanced clinical practice? I’m afraid I don’t—if it did, we wouldn’t need advanced training programs such as residencies and graduate degrees. So I am not surprised when proposed legislative changes related to the scope of pharmacists’ practice meet resistance from physician groups across the country. On the other hand, do I feel that there are many excellent clinical pharmacists being held back by our single licence category? Absolutely. I believe the following are essential elements in defining an advanced practice pharmacist: graduation from an accredited experiential pharmacy training program such as a residency, clinical master’s program, or Doctor of Pharmacy program; ability to collaborate with the health care team in their clinical practice; ability to access and interpret comprehensive health information relevant to the patient’s care; ability to assess and monitor a patient’s signs, symptoms, and response to therapy; expectation to practice within the person’s scope of expertise; recognition of duty to incorporate evidence-based decisions and the patient’s goals and preferences into the care plan; recognition of duty to communicate interventions and plans to the rest of the care team; ability to monitor the outcomes of interventions; accountability to ensure appropriate follow-up; and responsibility for the patient’s care (Ensom RJ, Bachand R, Carr R, Corrigan S, de Lemos J, de Lemos M, et al. Advanced practice pharmacist overview. Unpublished discussion paper, prepared July 2009). Advanced practice pharmacists would have greater flexibility and authority granted under their scope of practice to be able to care for patients and help them achieve desirable health outcomes. Such outcomes might include relief of symptoms, reduction in shortor long-term risk, resolution of an acute medical condition, or stabilization of a chronic disease. To meet these goals, the advanced practice pharmacist would be involved in assessing the condition, monitoring the patient’s progress, and prescribing drug therapy if deemed appropriate for the patient’s care. He or she would help to improve the safety, effectiveness, efficiency, and timeliness of drug therapy and would need to practise under a model of clinical services going well beyond the usual Monday to Friday routine. The new practice model would incorporate direct hand-over of patient care from one clinician to another, and provision of services 7 days a week in acute care settings, similar to the physician model. We already have evidence supporting the need to go beyond patient counselling, provision of drug information, and provision of pharmacokinetic services, activities that do not affect patient mortality. By contrast, activities such as monitoring adverse drug reactions, obtaining histories on admission, managing drug protocols, and participating in medical rounds do correlate with reductions in mortality. In a recent Canadian comparison of advanced pharmacy practice with usual pharmacy care, indicators of quality of care were better and the frequency of re-admissions was lower at 3 months for patients receiving advanced practice care. Creating a separate licence category for advanced practice pharmacists would help by setting out clear expectations and accountability for qualifications, competencies, and patient care activities, both internally for our profession and externally for the teams with which we work and for the health care system more broadly. It is a necessary step of added quality assurance to satisfy stakeholder groups that the expanded scope of practice is being adopted with both the best interests and the safety of patients in mind. Pharmacists in Alberta are the first in North America to be granted independent prescribing privileges. Their regulatory model includes different categories of licensure and authorization for this privilege, which will ensure that the required competencies and quality assurances are met. POINT COUNTERPOINT

In 2005 the emergency contraception formulation of levonorgestrel (Plan B) became available in Ontario pharmacies without a prescription. We surveyed 239 pharmacies 1 month before the regulatory change and 14-17 months after the change to determine whether availability of the drug increased. The response rates were 79% and 70% before and after the change in status. The proportion of pharmacies that had an in-stock supply of Plan B increased from 78% to 92% (p < 0.001). After the regulatory change, 87% of the surveyed pharmacies (95% confidence interval 82%-92%) reported that they had the drug in stock and were willing to dispense it behind the counter. Availability was similar for urban and rural pharmacies, but rural pharmacies had more restricted hours (e.g., 15% closed on weekends). Thus, as a result of the regulatory change, emergency contraception is more widely available, but access in rural areas is still limited by restricted pharmacy hours.

OBJECTIVE:To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases.OUTCOMES:Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada.EVIDENCE:Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed.VALUES:The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.

Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada. Evidence: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed. Values: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.

Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada. Evidence: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed. Values: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.

The objective of this article was to describe the effectiveness of a multifocus recruitment strategy to a pilot project allowing direct provision of emergency contraception (EC) in a community pharmacy through collaborative agreements between pharmacists and physicians. The project recruited pharmacies through direct appeals to pharmacists, pharmacy managers and/orowners, and corporate pharmacy chains. The evaluation project was successful in recruiting sufficient numbers of pharmacies to warrant proceeding with the project. The most successful component of the recruitment strategy was reference to the opportunities that participation offered to expand the pharmacist’s role in patient-focused care. The importance of peer influence was also noted in terms of encouraging pharmacy involvement.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Introduction: Commonly known as “the morning-after pill,” hormonal emergency contraception or the emergency contraceptive pill (ECP) is most effective if used within 72 hours of unprotected sex. In this paper we review a pilot project in Toronto, Ontario, that aimed to increase accessibility by allowing pharmacists to dispense ECP through a pharmacist-physician collaborative agreement, using a predefined protocol. Participating pharmacists received training in the pilot protocol and about ECP. To evaluate whether participating pharmacists were following the project protocol (i.e., giving accurate information to women requesting ECP and dispensing ECP appropriately), and to determine the quality of the pharmacist-patient encounter, we sent “secret shoppers” to participating pharmacies. Method: Five trained “secret shoppers,” using one of two predefined scripts (Script One, where ECP was clearly appropriate, and Script Two, where ECP was not appropriate) visited 34 participating pharmacies to request ECP. At the end of the visit, the secret shopper filled in a questionnaire about the encounter and provided comments. Percentages were calculated for all variables. Results: For Script One encounters (n=17), most pharmacists followed the protocol correctly to dispense ECP. For Script Two encounters (n=17), 71.4% provided alternatives to ECP, but three pharmacists did not follow protocol and provided ECP. For Script One, 52.9% of pharmacists and for Script Two, 71.4%, provided a community referral for follow-up care. The majority of pharmacists (97%) treated the shopper with respect and 85% communicated clearly. Most of the shoppers' comments were positive and the main negative comment about the encounter was lack of privacy. Conclusions: The use of a secret shopper allowed the examination of the pharmacist-customer interaction to delineate issues of importance to the pilot project and provide feedback on areas that may require improvement in the pharmacy provision of emergency contraception, namely, dealing with women who do not qualify for ECP and providing women with community referrals for sexually transmitted infections or ongoing contraception.

OBJECTIVES:To determine the availability in Canada of different types of hormone replacement therapy (HRT) products, and to compare the availability of HRT products in Canada to their availability in other countries. METHODS:A systematic review was conducted of the availability of products indicated for treatment of menopausal symptoms in Canada, the United States (US), the United Kingdom (UK), Sweden, and Australia. Products indicated for the treatment of menopausal symptoms were determined for each country by using on-line drug product databases. Products administered by injection and androgen products, unless combined with estrogens, were excluded from the analysis. RESULTS:There were 111 different brands identified in the 5 countries examined, with Canada having the lowest number of brands and active ingredients (28 and 22, respectively) compared to the other countries (Sweden and UK at 67 and 47 brands and 39 and 40 active ingredients, respectively). Not available in Canada are 34 active ingredients (either alone or in combination products) and 5 different types of formulations of HRT. There was a significant difference between the number of combination brand products available in Canada and in the UK (5 versus 29, P <.001, respectively). CONCLUSIONS:Canadian women have comparatively few options available to them for the management of menopausal symptoms. The wide range of HRT products available in other developed countries provides alternatives for managing side

Much of the recent focus on emergency contraception (EC) has been on the need to increase the availability of EC without a prescription. Barriers to the wider accessibility of EC include the need to use the medication within a 72-hour window, cost, and knowledge about its availability. Concerns about the non-prescription accessibility of EC include missing the opportunity to see a physician, possible reduced use of barrier contraceptives and the resulting increase in sexually transmitted infections, and overuse of EC and underuse of regular contraception. As the wider availability of EC is a reality, and pressure to further increase its access is growing, it is timely that issues surrounding accessibility of EC be discussed. This paper explores the issues around making EC more accessible and the various models of obtaining EC, namely, prescription medication, pharmacist-physician collaboration, pharmacist-dispensed medication, schedule II (behind the counter) medication, or on-the-shelf medication. The ideal model will be the one that provides improved accessibility for adolescents, other low-income women, and indeed for all women. Increased accessibility of EC should also lead to cost savings for the health-care system because of fewer unwanted pregnancies.

Objectives: To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies.