MONTREAL, December 20, 2016 – Bill 41, which came into force on June 20, 2015, allows pharmacists to make a greater contribution to improving the health care system through new professional activities. Researchers at the CHU Sainte-Justine Research Center were seeking to get the opinion of physicians on the matter. A study recently published in the International Journal of Pharmacy Practice presents the results of a survey of 421 pediatric, emergency and family physicians in Quebec, on their level of agreement with expanding the professional activities of pharmacists, specifically concerning ten roles in the management of asthmatic patients.
For example, Bill 41 allows pharmacists to extend a physician's prescription, write a prescription for certain minor ailments, and adjust a prescription by modifying the format, or posology, or by adapting the dosage. These new activities could prove to be beneficial in that they provide for a more thorough management of asthmatic patients and ensure continuity in their care.
According to the results of the survey, Quebec physicians were strongly in favour of the expansion of pharmacists' professional activities with regards to the pharmacist-physician interdisciplinary management of patients with asthma, especially for 7 of the 10 activities surveyed (high agreement: 61% to 97%). In addition to those listed above, these included prescribing a holding chamber, providing a written action plan to the patient according to the physician’s prescription or monitoring the patients’ medication use with regards to effectiveness, safety and adherence, while keeping the physician informed. The strong endorsement of these seven activities is a strong guarantee of their success.
Despite a high agreement obtained in 45 to 55% of physicians, they appear to have some reservations with regard to three more complex activities: adjusting the dose of prescribed asthma medication to achieve a therapeutic target, suggesting an action plan to the physician in the context of a pharmaceutical opinion, and access to spirometry testing in pharmacies. Emergency doctors and the new generation of physicians were generally more in favour of pharmacists performing these three activities than others. Reasons for these reservations must be explored.
Impact on public health
Asthma control remains suboptimal among most Canadian asthmatics, and frequent visits to the emergency greatly reduce their quality of life. This represents a major socio-economic burden. However, the interdisciplinary control of asthma with the pharmacist was proven to be effective in improving adherence to the treatment prescribed by physicians, as well as asthma control and patients' quality of life.
A way forward
Currently, there is a world movement to expand the professional activities of pharmacists beyond the distribution and monitoring of drugs, particularly in Australia, Finland and the Netherlands. The new professional activities of pharmacists, highly supported by all Quebec physicians surveyed, are recognized as allowing for better control of asthma. The pharmacist-physician interdisciplinary approach is therefore a way forward in contributing to improving the treatment of asthma in Canadian children and adults.
About the study
The article entitled Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma was featured in the International Journal of Pharmacy Practice on October 24, 2016.
Dr Francine Ducharme is a Pediatrician and Researcher at CHU Sainte-Justine. She is also Director of the Clinical Research and Knowledge Transfer Unit on Childhood Asthma at CHU Sainte-Justine and Professor for Department of Pediatrics and Department of Social and Preventive Medicine at Université de Montréal. Audrey Tilly-Gratton is a medical student and member of the Clinical Research and Knowledge Transfer Unit on Childhood Asthma at CHU Sainte-Justine.
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About the CHU Sainte-Justine Research Center
CHU Sainte-Justine Research Center is a leading mother-child research institution affiliated with Université de Montréal. It brings together more than 200 research investigators, including over 90 clinician-scientists, as well as 385 graduate and postgraduate students focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine. The Center is part of CHU Sainte-Justine, which is the largest mother-child center in Canada and second pediatric center in North America. More on research.chusj.org