November 18, 2020
By Julie Gould
There are several barriers that do not allow pharmacy professionals to work to their full scope, including professional collaboration, professional identity, and adequate training, according to a study in Research in Social and Administrative Pharmacy.
“As pharmacy evolves, pharmacy professionals continue to struggle to practice to their full scope,” the researchers of the study wrote.
To better understand the study, we spoke with Rand Hussein, RPh, PhD candidate at the School of Pharmacy, University of Waterloo, and study author. She discusses how pharmacists can benefit from establishing collaborative relationships with other prescribers, and why the development of a secure instant messaging application to utilize open communication any time will help build these relationships and maximize patient safety.
What existing data led you and your co-investigators to conduct this research?
As the role of pharmacy professionals in care provision evolves, pharmacy professionals continue to struggle to practice to their full scope. More research is showing that the rate of adoption of the full scope of practice among Canadian pharmacists and pharmacy technicians is much slower than expected despite supporting regulations. Evidence suggests barriers to the effective delivery of such services, including lack of confidence and reluctance to adopt new practices. Hence, there is a crucial need to continue to develop and refine creative and effective behavior change interventions to support pharmacy professionals in learning how to deliver care that can improve patient outcomes.
To address this, Dr. Kelly Grindrod developed the Pharmacy5in5.ca platform in 2018. It is a computer-based educational platform that aims to help pharmacists build their knowledge and skills in short 5-minute lessons. While the current version of Pharmacy5in5 has been well received by pharmacists and appears to improve user knowledge, we want to add other features specifically to address behavior change. To do that, we used the Theoretical Domains Framework, a comprehensive framework of 33 behavior theories, to guide us in talking with pharmacy professionals to identify behavior change strategies that could be used in Pharmacy5in5.ca to specifically target the adoption of the full scope of practice.
Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?
In order to identify barriers of and facilitators to the adoption of the full scope of practice among pharmacists/technicians, we distributed a survey and conducted telephone interviews with pharmacists and technicians. We wanted to identify which behavior areas we should focus on when improving the design of Pharmacy5in such as knowledge, skills, or confidence. The use of a theoretical lens in this study helped us uncover additional barriers absent from the literature, shedding light on barriers on both individual and organizational level.
One of our key findings was how pharmacists benefited from establishing collaborative relationships with other prescribers. In particular, with neighboring clinics before providing a new service to avoid conflicts. Pharmacists also felt less confident adapting or initiating prescriptions for unsupportive prescribers. Technicians had similar feelings about pharmacists and pharmacy managers, as they discussed how lack of support from managers and pharmacists hindered them from fully embracing their expanded role and instead pushed them toward taking on a pharmacy assistant role. One particularly surprising finding was that organizations imposed their authority to limit technicians’ role by restricting employment opportunities and working hours. Technicians reported how some pharmacy managers prefer to hire pharmacy assistants rather than technicians due to their lower wages. Moreover, technicians cited examples of getting paid as technicians for a few hours per day and as assistants for the rest of the day.
Another key finding was how the current pharmacy environments and workflows hamper practice change. One particularly surprising finding was that organizations imposed their authority to limit technicians’ role by restricting employment opportunities and working hours. Technicians reported how some pharmacy managers prefer to hire pharmacy assistants rather than technicians due to their lower wages. Moreover, technicians cited examples of getting paid as technicians for a few hours per day and as assistants for the rest of the day. From pharmacists' perspective, in addition to lack of time and staff, a number of additional environmental barriers to the provision of full scope services were mentioned. In particular, access to patient medical records, and availability of appropriate communication channels with prescribers were reported by pharmacists as crucial to practice to their full scope.
What are the possible real-world applications of these findings in clinical practice?
Pharmacists would really benefit from the development of a secure instant messaging application to reach out to prescribers any time to build collaborative relationships and maximize patient safety. There is also an urgent need to support technicians through the adjustment of payment models and employment opportunities to maximize their ability to support pharmacists.
For continuing professional developers, the study highlighted a number of useful behavior change strategies that should be considered when for future development activities for pharmacy professionals. First, practice and rehearsal of a full scope service helps master skills and build confidence. Pharmacy professionals felt uncomfortable and anxious when they had to acquire their skills through practicing in real settings without an opportunity to practice in a safe environment first. Second, clear instructions on how to perform full scope services including detailed steps to follow was found to be useful in translating knowledge into practice. Third, demonstration of full scope services by other pharmacy professionals was also found useful.
Do you and your co-investigators intend to expand upon this research?
The findings of this study will be implemented through the pharmacy5in5.com platform. We are currently doing research on strategies to boost users’ engagement and to optimize videos. The Identified behavior change strategies will be translated into new features in the platform, such as new videos demonstrating other pharmacists or health care providers advocating for full scope services. Future studies will focus on assessing the effect of newly added features on pharmacists/technicians behaviors and practice change.
Is there anything else pertaining to your research and findings that you would like to add?
As a pharmacist myself, I really enjoyed working closely with pharmacists and technicians across Canada. Talking to pharmacists practicing outside Ontario helped me understand current barriers to full scope services that we don’t have in Ontario yet. These barriers can be anticipated as a future barrier in Ontario, and learning about them now can help us be proactive to support pharmacists and technicians by providing needed infrastructure and training prior to changing regulations.
About Ms Hussein
Rand Hussein is a PhD candidate at the School of Pharmacy, University of Waterloo, working under the supervision of Dr. Kelly Grindrod, the lead behind Pharmacy5in5 and an Associate Professor at the University of Waterloo School Pharmacy. She is also a licensed and practicing pharmacist in Ontario and received her master’s degree in clinical pharmacy from the University of Jordan in 2010 and I am a board-certified pharmacotherapy specialist (BCPS) since 2012.
Her research focuses on the development of digital technologies to influence pharmacists’ behavior in health care systems to minimize drug-related problems and medication errors. Ms Hussein served as a lecturer of pharmacy practice at several academic institutions in the Middle East, and also worked as a clinical pharmacist in critical care units at the Hospital of Jordan University. Currently, she works part-time in a team-based community health centre where she collaborates with a team of health care professionals to provide the best care for complicated patients from vulnerable populations.
Hussein R, Whaley CRJ, Lin ECJ, Grindrod K. Identifying barriers, facilitators and behaviour change techniques to the adoption of the full scope of pharmacy practice among pharmacy professionals: Using the Theoretical Domains Framework [published online October 20, 2020]. Res Social Adm Pharm. doi: https://doi.org/10.1016/j.sapharm.2020.10.003