pharmaceutical care worldwide

PHARMACEUTICAL CARE WORLDWIDE

Pharmaceutical Care in Community Pharmacies: Practice and Research in Canada Erika JM Jones, Neil J MacKinnon, and Ross T Tsuyuki

OBJECTIVE:

To discuss the provision of pharmaceutical care in community pharmacies in Canada including the following topics: organization and delivery of health services, health service policy, methods of payment, types of pharmacy services provided, types of cognitive pharmacy services, research in community pharmacy, and future plans for community pharmacy services. DATA SYNTHESIS: The implementation of pharmaceutical care in Canadian community pharmacies continues to become more widespread. However, barriers to the provision of pharmaceutical care still exist, including the current shortage of pharmacists and lack of reimbursement systems for cognitive services. Evidence of the value of pharmaceutical care in Canadian community pharmacies has been supported by several pharmacy practice research projects. The pharmacist’s role in patient care is expected to continue to expand. CONCLUSIONS:

Although Canadian pharmacists’ capabilities are not yet universally recognized and applied to their full potential, there is reason to be optimistic about the future of pharmaceutical care in the community setting in Canada.

KEY WORDS: Canada, community pharmacy services.

Ann Pharmacother 2005;39:1527-33. Published Online, 12 Jul 2005, www.theannals.com, DOI 10.1345/aph.1E456

he rules and regulations regarding the operation and T ownership of community pharmacies vary across Canada’s 10 provinces and 3 territories. At the most basic level, all jurisdictions require that a license to operate as a pharmacy be obtained based on compliance with the provinces’ applicable standards or regulations. Beyond that, the regulations differ considerably. For example, in the Yukon territory, a community pharmacy must obtain a business license and have a licensed pharmacist dispensing drugs, with no additional restrictions pertaining to the ownership or location of the pharmacy. In contrast, pharmacies in the province of Québec are under the tightest restriction, requiring pharmacist ownership. Several other provinces, including Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Ontario, permit anyone to own a pharmacy provided it is under pharmacist management.

Author information provided at the end of the text.

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In recent years, there has been an increase in the number of community pharmacies. As of October 2003, there were 7522 community pharmacies in Canada.1 This increase has occurred primarily in the food and department store industry, accounting for 18% of pharmacies in 2003,1 while the number of independent pharmacies continues to decrease.2 Relative to the Canadian population, there are 4176 people per community pharmacy, a slight change from 4337 in 20011 and 4435 in 1999.3 There were 1534 people per community pharmacist in 2003.1

See also page 1539, DOI 10.1345/aph.1G049.

In recent years, there has been an apparent pharmacist shortage in Canada.4 In 2000, the number of practicing pharmacists decreased slightly from the previous year, even with the increase in the number of pharmacies and prescriptions filled.5 Since that time, many of the faculties

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of pharmacy in Canada have increased enrollment numbers. An average Canadian pharmacy, open 68 hours per week, now employs 1.8 full-time staff pharmacists, 1.7 part-time pharmacists, 2.2 full-time technicians, and 2.1 part-time technicians.1 The average annual prescription volume per pharmacy in 2002 was 43 339, with franchise pharmacies filling the most prescriptions (average 73 157/ y), while food/mass store pharmacies averaged only 32 939 prescriptions per year. Community pharmacy remains a profitable business in Canada. Pharmacy sales have been increasing in recent years, with average annual sales of $2.7 million (CDN $) in 2002. Additionally, the average net profit of $191 200 represents a gain of >60% since the mid-1990s. The dispensary accounts for 69% of pharmacy sales and, in 2002, the average prescription volume was reported to be 43 339 per year, an increase of >20% from 1995.1 In contrast, frontshop and nonprescription drugs represent 47% of the sales share in foodstore pharmacies. The overall pharmacy store average gross margin is 33%.6 Organization and Delivery of Health Services The responsibility for delivery of health services lies primarily with the provincial and territorial governments of Canada. The Canada Health Act mandates that every Canadian has access to a “publicly funded and publicly administered universal health plan that insures physician services and funds general hospital care.”7 These national standards must be met by the provinces and territories to receive federal healthcare funding. This funding is used in combination with provincial/territorial revenue and other federal transfers for the delivery of health services. Canada spends a relatively high proportion of its health budget on pharmaceuticals in relation to other Organisation for Economic Cooperation and Development (OECD) countries. Among OECD countries that spend the highest portion of their budget on health care, Canada is second only to France in spending on pharmaceuticals.8 The ratio of total health expenditures to Gross Domestic Product was forecast to be 10% in 2003, with drug expenditures accounting for 16.2% of total health expenditures ($19.6 billion/y).9 After hospital costs, pharmaceuticals are the second largest category of health expenditures.

Office for Health Technology Assessment), adverse drug reaction reporting, and control of drug prices via the Patented Medicine Prices Review Board (an independent, quasi-judicial body). Every province and territory provides some form of publicly funded prescription drug payment assistance,10 as will be discussed. Public access to drugs differs notably across Canada.11,12 Gregoire et al.11 studied 148 new prescription drugs launched in Canada between 1991 and 1998 and found wide variation in terms of drugs listed on provincial formularies, even among provinces listing a similar proportion of new drugs. Drug coverage is provided through public and private funds. Most public funding for prescribed drugs comes through provincial/territorial government health programs, but also from the federal sector and social security funds. The private sector (which includes out-of-pocket expenditures made by individuals, as well as private insurance) accounted for 52.8% of Canadian prescription drug expenditures in 2003, which totaled $16 billion.10 The public sector’s share of prescription drug coverage is increasing, rising from 42.5% in 1995 to 47.2% in 2003. The private sector is responsible for $3.6 billion in expenditures for nonprescription drugs (which are generally not covered by provincial drug plans). Figure 1 presents a breakdown of provincial and territorial drug expenditure per capita. Patients’ eligibility for coverage, copayments, and extent of coverage provided depend on the province of residence and the insurance plan. For example, individuals in Nova Scotia qualifying for the public seniors Pharmacare13 program who are not receiving the Guaranteed Income Supplement (GIS) (which provides additional money to low-income seniors living in Canada) pay premiums of up

Health Service Policy in Canada Drug policy development is primarily a provincial responsibility, although some notable exceptions exist. Federal involvement in drug policy is generally limited to areas such as regulatory approval (Health Canada), health technology assessment (the Common Drug Review as part of the Canadian Coordinating 1528

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Figure 1. Total drug expenditure per capita by source of finance by province/territory of Canada, 2001. AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland; NS = Nova Scotia; NT = Northwest Territories; NU = Nunavut; ON = Ontario; PE = Prince Edward Island; QC = Québec; SK = Saskatchewan; YT = Yukon Territories. Adapted from Drug Expenditure in Canada 1985–2003.49


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Community Pharmacy in Canada

to $390 per year and a 33% copay to a maximum of $30 per prescription. Nova Scotia seniors receiving the GIS pay the 33% copay to a maximum of $30 per prescription. The maximum copayment per year by all participants is $350. Private programs vary with each insurance company and employer. Ten percent of Canadians do not have drug coverage or have insurance only for yearly expenses exceeding $1000.14 Prescription medications are distributed through a variety of channels including wholesalers, pharmaceutical manufacturers, and franchise distribution centers. While direct orders from manufacturers accounted for 27% of deliveries in 1999, this number decreased to 14% in 2003.1 According to a survey of pharmacy owners and managers, wholesalers are now the most important venue through which pharmacies receive drugs. Other methods of outpatient drug distribution include physician samples, clinical studies, and mail-order and Internet pharmacies. Community Pharmacy Services

packaging to smoking cessation management to health professional education. A major development supporting reimbursement for cognitive services is the recognition of pharmacists as medical practitioners by the Canada Customs & Revenue Agency’s income tax directorate.19 As of December 2003, pharmacist services are considered taxdeductible expenses (previously the only recognized legitimate expense was the professional fee). TYPES OF PHARMACY SERVICES PROVIDED

Basic steps performed by a community pharmacy upon dispensing new prescriptions to patients include provision of written information accompanied by a counseling session. Each prescription that goes through the pharmacy undergoes a prospective drug utilization review. Table 1 contains a list of commonly provided pharmacy services and the percentage of pharmacies that provide them as reported by Canadian pharmacy owners and managers.1 A limitation of these data is that the frequency of provision of these services is not defined.

METHODS OF PAYMENT

Typically, reimbursement to the pharmacy is based on cost of the drug sold plus a small mark-up and a professional fee. Most programs pay for the lowest priced interchangeable product. The professional fee has remained constant over the last 10 years, maintaining an average of $8.70.1 The mark-up and professional fee are determined by the pharmacy, but are influenced by amounts that government, private plans, and employers are willing to pay. For example, in an effort to reduce prescription costs, some third-party payers form preferred provider organizations, wherein the plan members must go to certain pharmacies to have their prescriptions filled and the pharmacies offer a reduced professional fee. Cognitive services by pharmacists have become more frequently provided as community pharmacists begin to follow the pharmaceutical care practice model.15,16 Payment for the provision of these services occurs in some private insurance plans, several public insurance plans, and patients’ out-of-pocket expenses; however, overall, the majority of these services are provided without charge by the pharmacist. A 2003 telephone survey found that the majority (64%) of consumers considered private therapy consultations to be an extra service provided by their pharmacist and would expect to pay $17.20 for a half-hour consultation. Conversely, 82% of consumers viewed thorough medication reviews as a basic service expected of their pharmacist.17 The Ontario Pharmacists Association created a Suggested Fee Guide for Pharmacy Services18 to serve as a tool for pharmacists interested in reimbursement for cognitive services. While we could find no formal assessments of its use in practice, the guide contains a comprehensive list of cognitive pharmacy services that could be offered by pharmacies, a detailed description of each service, and a suggested fee for the service. Recommendations are given for services ranging from compliance aid www.theannals.com

TYPES OF COGNITIVE PHARMACY SERVICES

Public drug plans have gradually been introducing reimbursement programs for cognitive pharmacy services. Since 1978, Québec’s provincial drug plan, Régie de l’Assurance-Maladie du Québec, has provided reimbursement to pharmacists for pharmaceutical opinion (where a written notice is sent to the physician suggesting changes in a patient’s therapy) and refusal to dispense (where a pharmacist judges that a prescription might threaten the health of the patient if filled). In 1996, interventions were billed for 0.07% of prescriptions. The apparent underutilization of this program has been attributed to several factors, including lack of time and lack of personal financial gain.20 The Trial Prescription Program in Saskatchewan, along with similar programs in Alberta, British Columbia, and Ontario, is a benefit of the government drug plan. It encourages pharmacists to dispense a 7- or 10-day supply of a

Table 1. Types of Professional Services Offered by Canadian Community Pharmacies in 200350 Service

%

Home delivery of prescriptions

82

In-store BP monitoring device

78

In-store screening/risk assessments

67

Patient library

64

In-store educational seminars/programs

51

Trial prescriptions

49

Patient call-back system

43

In-store disease management

36

Home visits

24

Out-of-store educational seminars/programs

23

Documented care plans

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new prescription initially to monitor the effect on the patient. A survey of established trial prescription programs in Canada was conducted in 1997, and the researchers implemented a year-long demonstration project in Ontario.21 Findings suggested that trial prescription programs are acceptable to patients and have the potential to reduce drug wastage. More work is necessary before definite conclusions can be reached. To date, money saved in the form of reduced medication wastage from the program in Saskatchewan has far surpassed the amount spent on cognitive fees to the pharmacists, resulting in healthcare savings.22 In 2000, the Drug Evaluation Alliance of Nova Scotia introduced a provincial program to promote the conversion from wet to dry delivery methods for inhaled medications. Pharmacists were compensated for providing education on the effectiveness of spacer devices as a method of delivery, ensuring proper technique, and providing cleaning and replacement instructions.23 In a survey of 297 pharmacists in Nova Scotia, the self-reported participation with the various components of this initiative ranged from 34% to 58%, with a complex and time-intensive billing process being reported as the major barrier to participation.24 There is a significant body of evidence from Canadian pharmacists and researchers on the benefits of enhanced pharmacist care.25-28 For example, the 675-patient SCRIP (Study of Cardiovascular Risk Intervention by Pharmacists) was stopped before target enrollment was reached due to overwhelming evidence of benefit in the intervention group compared with the usual care group.28 Using 54 community pharmacy sites in the provinces of Alberta and Saskatchewan, investigators demonstrated the value of pharmacists in the largest randomized community-based intervention study to date. The primary endpoint (a composite measure of process of cholesterol risk management, consisting of measurement of a fasting cholesterol level by the primary care physician or prescription of a new cholesterol-lowering medication or an increase in dosage of a cholesterol-lowering drug) was achieved in 57% of intervention patients versus 31% of control patients. The British Columbia community pharmacy asthma study demonstrated the positive impact of pharmaceutical care on economic, clinical, and quality-of-life outcomes in patients with asthma.26 Specially trained pharmacists provided enhanced care to a group of patients. In the enhanced care group, significant improvements were noted with respect to symptom scores, patient knowledge, β-agonist use, quality of life, emergency department visits, and visits to the physician. Pharmacists providing expanded services such as these report increased job satisfaction.26,29 Quality control systems for cognitive pharmacy services in Canada range from formalized evaluations with experimental design to random audit checks to no quality control checks. The National Association of Pharmacy Regulatory Authorities developed a regulatory framework in May 2003 for recognizing and certifying pharmacist specialists in Canada.30 The PHARMALearn programs at the University of Alberta (www.pharmalearn.com) are Web-based 1530

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training programs aimed at providing practitioners with advanced skills to improve patient outcomes.31 Research in Community Pharmacy Research in community pharmacy in Canada is primarily based in the nation’s 9 faculties of pharmacy. These faculties all offer a Bachelor of Science in Pharmacy degree program with a total of approximately 950 graduates.32 The University of Toronto and the University of British Columbia offer post-BS PharmD, and several faculties are in the process of implementing an entry-level PharmD program. There are >200 students enrolled in graduate studies (Masters, PhD) in pharmacy faculties across Canada and many more completing hospital, industrial, and community pharmacy residencies. Of the 9 pharmacy schools in Canada, most have at least one researcher in pharmacy administration (social and behavioral pharmacy) and/or pharmacy practice who is actively involved in community practice research, and some pharmacy practice researchers are based within medical schools. Universities with entire research units in this area include the Centre for Community Pharmacy Research and Interdisciplinary Strategies at the University of Alberta; Initiative for Medication Management, Policy Analysis, Research & Training at Dalhousie University; and the University of British Columbia Collaboration for Outcomes Research and Evaluation. The Canadian Pharmacy Practice Research Group of the Canadian Pharmacists Association (CPhA) is the only organization in Canada that is solely dedicated to advocacy for pharmacy practice–based research.33 Community pharmacy researchers in Canada currently have research funded by national peer-reviewed healthcare research bodies including the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and the Canadian Health Services Research Foundation. Funding can also be provided by disease-specific research and advocacy bodies, such as the Heart & Stroke Foundation. Provincial pharmacy organizations and health research bodies, the pharmaceutical industry, and the Canadian Foundation for Pharmacy also are contributors to pharmacy practice research. Presently, there is no funding agency specifically for pharmacy practice research. The role of professional associations in promoting research in community pharmacy typically involves dissemination of research findings to health policy makers. For example, the CPhA’s submission to the Romanow Commission on the Future of Health Care in Canada included research findings from Canadian community pharmacy researchers.34 Sokar-Todd and Einarson35 summarized pharmacy practice research in Canada from 1970 to 2001 in a systematic review. Of the qualifying studies included in their review, the top 2 research categories during the past 5 years have been pharmacists’ attitudes, perceptions, willingness, and program implementation and evaluation, with all other categories far behind. There was a notable increase in the


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number of publications over the time period. The 127year-old Canadian Pharmaceutical Journal has just begun a renewal process to become a major pharmacy practice research journal. Future Plans for Community Pharmacy Services In November 2002, the Romanow Report was released by the Commission on the Future of Health Care in Canada (commissioned by the Prime Minister of Canada in 2001).36 This in-depth review of the healthcare system strongly advocated an increased role for pharmacists in a number of areas. The report stated, “pharmacists can play an increasingly important role as part of the primary health care team, working with patients to ensure they are using medications appropriately and providing information to both physicians and patients about the effectiveness and appropriateness of certain drugs for certain conditions.” This report initiated a healthcare renewal accord to improve access of quality care in February 2003 and a hope for pharmacists that the knowledge and skills they possess will be increasingly valued and recognized as changes are made to the health plan. The CPhA released Pharmacists and Primary Health Care in May 200437 and held a national pharmacy forum on the role of the pharmacist in primary health care in 2003.38 Seamless care, defined as “the desirable continuity of care delivered to a patient across the spectrum of caregivers and their environments,”39 is a concept that complements pharmaceutical care practice and requires community pharmacist involvement. A need for patient care such as this has been identified in Canada,40 and several seamless care initiatives have taken place across the country. Key barriers to seamless care include lack of time, insufficient human resources, lack of information, lack of therapeutic knowledge, difficulty in communicating with the patients’ physicians, concerns about patient confidentiality, patients’ use of multiple community pharmacies, and lack of funding.41 Despite this, hospital and community pharmacists are finding solutions for overcoming these barriers. For example, while patient privacy and confidentiality is a key concern, various approaches exist for pharmacists to exchange patient information.42 The provinces of Alberta43 and British Columbia44 are implementing healthcare initiatives allowing province-wide health professional access to complete electronic medical records, giving pharmacists access to patient information that could prove critical in changing the way they practice. Varying degrees of prescribing privileges have been given to pharmacists in several provinces and are expected to increase in years to come. These privileges include minor prescription changes (Québec), provision of interim or refill supplies (Manitoba, Québec), therapeutic modification based on protocols (Nova Scotia, Québec), and collaborative or dependent prescribing arrangements with physicians (Manitoba, Newfoundland and Labrador, Nunavut).45 With the Internet as its principal venue, the cross-border prescription drug trade in Canada is estimated to have www.theannals.com

reached a volume of $566 million, more than double the 2002 estimate.46 From Canadian Internet pharmacy sites, US residents can have their prescription drugs delivered to them for a fraction of the cost of what they pay in their own country’s pharmacies, while violating US federal laws. The CPhA is opposed to the cross-border prescription drug trade, stating that the “export of prescriptions is not consistent with its vision of contemporary and future pharmacy practice.”47 Some of the concerns include a possible rise in drug prices in Canada, a shortage of prescription drugs for the Canadian market, perpetuation of the current pharmacist shortage, decreased ability to monitor drug therapy, and compromised pharmacist–patient professional relationship. The National Assocation of Pharmacy Regulatory Authorities in Canada and the National Association of Boards of Pharmacy in the US agree that importation of prescription drugs into the US is potentially unsafe and raises ethical and legal issues.48 Summary Since the introduction of the pharmaceutical care model of practice in the early 1990s, the scope of practice of Canadian community pharmacists has greatly expanded. While the dramatic rise in pharmaceutical-related expenditures is a concern for Canadian healthcare decision-makers, it also affords an opportunity for community pharmacists to advocate their role in helping to optimize drug therapy and reduce preventable drug-related morbidity. Despite some formidable barriers, many Canadian pharmacists offer their patients a variety of services that have been shown to improve patient outcomes. Erika JM Jones, Research Assistant, College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada Neil J MacKinnon PhD, Director for Research and Associate Professor, College of Pharmacy, Dalhousie University Ross T Tsuyuki BSc (Pharm) PharmD MSc FCSHP FACC, Professor of Medicine (Cardiology), University of Alberta, Edmonton, Alberta, Canada Reprints: Dr. MacKinnon, College of Pharmacy, Dalhousie University, 5968 College St., Halifax B3H 3T5, NS, Canada, fax 902/4941396, [email protected] We acknowledge the contributions of BE (Bev) Allen BSP, Dale Dodge BScPharm, Dawn M Frail BSc (Pharm), J Patrick King MBA CAE, John J Ryan PhC LLD (Hon), and Susan Pierce BScPharm.

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33. Canadian Pharmacy Practice Research Group. Canadian Pharmacists Association. 2004. www.pharmacists.ca/content/hcp/resource_centre/ pharmacy_practice_research/research_group.cfm (accessed 2004 Aug 13). 34. Canadian Pharmacists’ Association. Submission to the Romanow Commission on the Future of Health Care in Canada. October 2001. www.pharmacists.ca/content/about_cpha/whats_happening/government_af fairs/ pdf/romanow.pdf (accessed 2004 Aug 13). 35. Sokar-Todd HB, Einarson TR. Community pharmacy practice research: a systematic review of the past 32 years. Can Pharm J 2003;136:26-38. 36. Commission on the Future of Health Care in Canada. Building on values: the future of health care in Canada. Final report. Government of Canada, Ottawa, Ontario, November 2002. 37. Pharmacists and primary health care. Canadian Pharmacists Association. May 2004. www.pharmacists.ca/content/about_cpha/whats_happening/ cpha_in_action/pdf/primaryhealth2a.pdf (accessed 2004 Aug 5). 38. Proceedings of the CPhA–CSHP National Pharmacy Forum. The role of the pharmacist in primary health care, May 31, 2003. Vancouver, BC. Canadian Society of Hospital Pharmacists and Canadian Pharmacists Association, 2003. www.pharmacists.ca/content/about_cpha/whats_happening/ cpha_in_action/pdf/ProceedingsCPhA_CSHPNationalPharmacyForum. pdf (accessed 2004 Aug 5). 39. Proceedings of the Seamless Care Workshop. A joint initiative of CSHP and CPhA; October 30 to November 1, 1998; Toronto, ON. Ottawa; ON: Canadian Society of Hospital Pharmacists and Canadian Pharmacists Association, 1998. 40. Forster AJ, Clark HD, Menard AM, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ 2004;170:345-9. 41. Dossa A. Overcoming barriers to seamless care. In: MacKinnon NJ, ed. Seamless care: a pharmacist’s guide to providing continuous care programs. Ottawa, ON: Canadian Pharmacists Association, 2003:19-29. 42. Saulnier L, Roberts N. Hospital pharmacy administrator’s perspective. In: MacKinnon NJ, ed. Seamless care: a pharmacist’s guide to providing continuous care programs. Ottawa, ON: Canadian Pharmacists Association, 2003:31-6. 43. Alberta WellNet. Electronic health record. Government of Alberta. 2003. www.albertawellnet.org/default_ehr.asp (accessed 2004 Jun 25). 44. A framework for an electronic health record for British Columbians. Health Chief Information Officer Council. 2003. http://healthnet.hnet. bc.ca/pub_reports/ehr_framework.pdf (accessed 2004 Jun 25). 45. Douma SL. Pharmacist prescriber privileges. Can Pharm J 2004;137:21. 46. Retail prescriptions grow at record level in 2003. IMS HEALTH Canada. 2004. www.imshealthcanada.com/htmen/4_2_1_49.htm (accessed 2004 Aug 11). 47. Canadian Pharmacists Association. Position statement on cross-border prescription drug trade. February 2004. www.pharmacists.ca/content/ about_cpha/whats_happening/cpha_in_action/pdf/Crossborderprescriptiondrugtrade. pdf (accessed 2004 Jul 21). 48. National Association of Pharmacy Regulatory Authorities (NAPRA). National Association of Boards of Pharmacy (NABP). National Association of Pharmacy Regulatory Authorities and National Association of Boards of Pharmacy Agreement. 2003. www.napra.ca/pdfs/news/ CrossBorderPressRelease.pdf (accessed 2004 Jul 22). 49. Drug Expenditure in Canada 1985–2003. Ottawa, ON: Canadian Institute for Health Information, 2004. 50. Pharmacy trends report 2003/Pharmacy post survey of owners and managers. Rogers Media, Toronto, Ontario, 2003:25.

EXTRACTO

Discutir la prestación de atención farmacéutica en las farmacias de comunidad de Canadá, incluyendo los siguientes temas: la farmacia de comunidad de Canadá, organización y ofrecimiento de servicios de salud, política de salud, métodos de pago, tipos de servicios farmacéuticos que se ofrecen, tipos de servicios farmacéuticos cognitivos, investigación en la farmacia de comunidad, y planes futuros para los servicios de farmacias de comunidad. HALLAZGOS: La implementación de atención farmacéutica en las farmacias de comunidad de Canadá continúa expandiéndose. Sin embargo, todavía existen barreras para la prestación de atención farmacéutica, incluyendo la escasez actual de farmacéuticos y la falta de mecanismos de reembolso por concepto de servicios cognitivos. OBJETIVO:


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Varios proyectos de investigación de la práctica de farmacia han documentado el valor de la atención farmacéutica en las farmacias de comunidad de Canadá. Se espera que el papel del farmacéutico en la atención de pacientes continúe expandiéndose. CONCLUSIONES: Aunque las capacidades de los farmacéuticos canadienses aún no han sido reconocidas universalmente y aplicadas en su mayor potencial, existen razones para mantener el optimismo acerca del futuro de la atención farmacéutica en el escenario de farmacia de comunidad en Canadá. DISCUSIÓN:

Homero A Monsanto RÉSUMÉ

Discuter de la prestation de soins pharmaceutiques dans les pharmacies communautaires au Canada en abordant les thèmes suivants: la pharmacie communautaire au Canada, l’organisation et distribution des soins de santé, les politiques de santé, les modalités de paiement, le type de services pharmaceutiques offerts, le type de services cognitifs

OBJECTIF:

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offerts, la recherche en pharmacie communautaire, et finalement, le développement futur des services en pharmacie communautaire. RÉSULTATS: Le recours aux soins pharmaceutiques dans les pharmacies communautaires du Canada continue à prendre de l’ampleur. Cependant, il existe toujours des barrières à la prestation des soins pharmaceutiques, notamment la pénurie de pharmaciens ainsi que le manque de systèmes de remboursement pour services cognitifs. DISCUSSION: La valeur et l’importance des soins pharmaceutiques au sein des pharmacies communautaires du Canada sont supportées par plusieurs projets de recherche. Le rôle du pharmacien dans la dispensation de soins de santé prend de l’importance et continuera de s’élargir. CONCLUSIONS: Bien que les habiletés des pharmaciens communautaires ne soient pas encore pleinement reconnues et ne soient pas utilisées à leur plein potentiel, il existe plusieurs raisons d’être optimiste relativement au futur des soins pharmaceutiques en pratique communautaire au Canada.


Marc M Perreault

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