Challenges & Priorities
RESEARCH REPORT
August 2008
Prepared for: Moving Forward: Pharmacy Human Resources for the Future Prepared by: Ascentum Inc.
The Moving Forwardinitiative is funded by the Government of Canada's Foreign Credential Recognition Program.
Challenges & Priorities
RESEARCH REPORT
August 2008
Prepared for:
Moving Forward: Pharmacy Human Resources for the Future
Prepared by:
The Moving Forwardpartners would like to express their appreciation to all the individuals whose participation in this research contributed to its success.Moving Forwardespecially wishes to thank the many people who kindly took the time to participate in surveys, focus groups, interviews and other facilitated consultations.
This research was conducted by the firm of Ascentum Inc., and its associates, as well as subject matter experts Dr. Derek Jorgenson and Dr. Neil MacKinnon. The research team was assisted by the Moving Forward
Management Committee (and their representative organizations), the Moving ForwardNational Advisory Committee, and numerous other expert advisors.
These individuals include: Management Committee Kevin Hall, Moving ForwardCo-Chair Fred Martin, Moving Forward Co-Chair
Zubin Austin, Association of Faculties of Pharmacy of Canada
Patty Brady, Human Resources and Social Development Canada
Janet Cooper, Canadian Pharmacists Association Tim Fleming, Canadian Association of Pharmacy Technicians
Dennis Gorecki, Association of Deans of Pharmacy of Canada
Ray Joubert, National Association of Pharmacy Regulatory Authorities
Paul Kuras, Canadian Pharmacists Association Allan Malek, Canadian Association of Chain Drug Stores
Linda Suveges, The Pharmacy Examining Board of Canada
Ken Wou, Canadian Society of Hospital Pharmacists
National Advisory Committee Sandra Aylward, Sobeys Pharmacy Group Danuta Bertram, Winnipeg Regional Health Authority
Paul Blanchard, New Brunswick Pharmacists Association
Anne Marie Burns, Ottawa Hospital Lynda Buske, Canadian Medical Association Jean-François Bussières, Hôpital Sainte Justine Nicolas Caprio, Shoppers Drug Mart
Deborah Cohen, Canadian Institute for Health Information
Omolayo Famuyide, Canadian Association of Pharmacy Students and Interns
Rock Folkman, Canadian Pharmacy Technician
Michael Gaucher, Canadian Agency for Drugs and Technologies in Health
Aline Johanns, New Brunswick Department of Health
Nadine Lacasse, Sebastien Aubin et Nadine Lacasse Pharmaciens
Manon Lambert, Ordre des pharmaciens du Québec Lisa Little, Canadian Nurses Association
Jonathan Mailman, Canadian Association of Pharmacy Students and Interns
Ron McKerrow, British Columbia Provincial Health Services Authority
Colleen Norris, Glebe Pharmasave Bonnie Palmer, Shoppers Drug Mart
Noman Qureshi, International Pharmacy Graduate Alumni Association
Michèle Roussel, New Brunswick Department of Health
Chris Schillemore, Ontario College of Pharmacists Brenda Schuster, Regina Qu’Appelle Health Region Jane Wong, Canadian Healthcare Association
Researchers and Subject Matter Experts Frank Abbott, Association of Deans/Association of Faculties of Pharmacy of Canada
Susanna Janowitz, Ascentum Inc.
Derek Jorgenson, Saskatoon Health Region Rob Mariani, Ascentum Inc.
Neil MacKinnon, Dalhousie University
John Pugsley, the Pharmacy Examining Board of Canada
Myrella Roy, Canadian Society of Hospital Pharmacists
Jennifer Smith, JLS Management Consulting Inc.
Glossary of Terms and Abbreviations
Overview of Moving Forward: Pharmacy Human Resources for the Future . . . 1
1. Introduction . . . . 2
1.1 A New Vision for the Pharmacy Workforce . . . 2
2. Pharmacy Thought Leaders . . . . 4
2.1 Research Approach . . . 4
2.1.1 Methodology . . . 6
2.1.2 Interview Topics . . . 6
2.2 Key Findings . . . 6
2.2.1 Reactions to the New Vision for Pharmacy . . . 6
2.2.2 New Models of Practice . . . 7
2.2.3 Critical Changes to the Pharmacy Workforce . . . 8
2.2.4 The Pharmacy Workforce of the Future . . . 8
2.2.5 Challenges/Barriers and Enablers . . . 10
2.2.6 Stakeholder Involvement in Achieving the New Vision . . . 12
3. Practising Pharmacists . . . . 14
3.1 Research Approach . . . 14
3.1.1 Methodology . . . 14
3.1.2 Online Consultation Tools . . . 15
3.2 Demographic Profile of Participating Pharmacists . . . 16
3.2.1 Age . . . 18
3.2.2 Gender . . . 18
3.2.3 Level of Education . . . 18
3.2.4 Additional Training . . . 19
3.2.5 Location of Completion of Entry-to-Practice Degree . . . 19
3.2.6 Primary Practice Setting . . . 20
3.2.7 Hours of Work . . . 21
3.2.8 Position or Employment Status . . . 22
3.2.9 Year in Practice . . . 22
3.2.10 Location of Practice . . . 23
3.3 Pharmacists’ Time Allocation and Job Satisfaction . . . 24
3.5 Workplace Implications of Expanded and Innovative Pharmacy Roles . . . 34
3.5.1 HR Implications of Innovative and Expanded Roles (By Role) . . . . 35
3.5.2 Broader Implications of Expanded and Innovative Pharmacy Roles (Comparative Analysis) . . . 39
3.6 Technology Requirements . . . 48
3.7 Challenges and Opportunities for Pharmacy . . . 54
3.8 Pre- and Post-Choicebook™ Attitudes . . . 55
4. Pharmacy Students . . . . 57
4.1 Research Approach . . . 57
4.2 Key Findings . . . 59
4.2.1 Education and Career Choice . . . 59
4.2.2 Perceptions of the Pharmacy Job Market . . . 60
4.2.3 Future Plans and Practice Expectations . . . 61
4.3 Final Comments . . . 65
5. Deans and Faculties of Pharmacy . . . . 67
5.1 Research Approach . . . 67 5.2 Key Findings . . . 68 5.2.1 Capacity . . . 68 5.2.2 Curriculum . . . 70 5.3 Final Comments . . . 72 6. Pharmacy Employers . . . . 73 6.1 Research Approach . . . 73 6.2 Key Findings . . . 73 6.2.1 Hospital Employers . . . 74
6.2.2 Chain Drug Store Representatives . . . 75
6.2.3 Community-based Independent Pharmacy Owners . . . 77
6.3 Final Comments . . . 78
ACE Angiotensin-converting enzyme ACW Awareness, compliance, wellness
ADPC Association of Deans of Pharmacy of Canada AFPC Association of Faculties of Pharmacy of Canada ASA Acetylsalicylic acid
CACDS Canadian Association of Chain Drug Stores
CADTH Canadian Agency for Drugs and Technologies in Health CAPSI Canadian Association of Pharmacy Students and Interns CAPT Canadian Association of Pharmacy Technicians
CCCEP Canadian Council on Continuing Education in Pharmacy CDE Certified Diabetes Educator
CEUs Continuing education units CHA Canadian Healthcare Association
CIHI Canadian Institute for Health Information CMA Canadian Medical Association
CNA Canadian Nurses Association CPhA Canadian Pharmacists Association
CPTEA Canadian Pharmacy Technician Educators Association CSHP Canadian Society of Hospital Pharmacists
HR Human resources
HRSDC Human Resources and Social Development Canada INR International Normalized Ratio
IPG International Pharmacy Graduate
NAPRA National Association of Pharmacy Regulatory Authorities OCP Ontario College of Pharmacists
OPQ L’Ordre des pharmaciens du Quebec OSCE Objective Structured Clinical Examination OTC Over-the-counter
PDA Personal digital assistant
PDW Professional Development Weekend (CAPSI’s conference) PEBC The Pharmacy Examining Board of Canada
UBC University of British Columbia UT University of Toronto
OVERVIEW OF
MOVING FORWARD:
PHARMACY HUMAN RESOURCES FOR THE FUTURE
One of the most urgent crises facing Canada’s health care system today is the appropriate management of health human resources –that is, ensuring that the right health care providers with the right skills are available in the right place at the right time. Pharmacists have been identified as a high priority health human resource with key roles to play in delivering health care both now and in the future.Many challenges surround the pharmacy sector’s efforts to optimize the management of its available human resources. Reports of difficulties in recruitment and retention are common. The role of the pharmacist and of the pharmacy technician in the delivery of health care is changing. International Pharmacy Graduates, a significant and growing workforce population, need to be better supported in their integration to professional practice in order to maximize the contribution they can make. A failure to address these human resources challenges will compromise the ability of the pharmacy workforce to provide quality, health outcomes-focused, patient care.
In order to understand the factors contributing to these human resource pressures and to strategize potential solutions, eight leading national pharmacy organizations partnered together in 2005 to carry out a human resources study of pharmacists and pharmacy technicians now known as Moving Forward: Pharmacy Human Resources for the Future. Funded by the Foreign Credential Recognition Program of Human Resources and Social Development Canada and managed by the Canadian Pharmacists Association, Moving Forwardhas completed a multi-pronged research program examining the factors contributing to pharmacy human resources challenges in Canada, and has developed a series of pharmacy human resources planning recommendations to ensure a strong pharmacy workforce prepared to meet the future health care needs of Canadians. The findings contained in this report represent the results of Moving Forward’s research stream entitled Pharmacy Human Resource Challenges and Priorities, which examined both qualitative and quantitative information from and about the practising pharmacist workforce, pharmacy students, pharmacy educators, pharmacy employers, leaders and other key stakeholders with a vested interest in planning and managing pharmacy human resources.
1.
INTRODUCTION
Pharmacists have been identified as a high priority health human resource with a key role to play in delivering health care both now and in the future. However, many challenges surround the health care system’s efforts to optimize the management of its available pharmacy human resources (HR). There is a need to understand the factors contributing to these HR pressures and strategize potential solutions.
This research study, Pharmacy Human Resources Challenges and Priorities, sought to investigate the HR implications of how pharmacy will be practised in the future. Participants provided key perspectives on the education, workload, recruitment and retention, training and career development of the pharmacy workforce both now and in the future. Consultation with participants involved key informant interviews, a national on-line consultation, focus groups, standard surveys and discussion forums. These processes allowed for the collection of quantitative and qualitative information from and about the pharmacy workforce in Canada in order to continue to provide quality patient care and pharmacy services to Canadians.
Stakeholders engaged throughout the Pharmacy Human Resources Challenges and Priorities research stream were:
• Thought leaders,experienced decision-makers in pharmacy from universities, regulatory authorities, private industry, professional associations and other leading figures in pharmacy practice;
• Practising pharmacistsacross Canada, in all types of practice settings;
• Pharmacy students, both undergraduates and graduates, currently enrolled in one of Canada’s 10 Faculties of Pharmacy;
• Deansof Canada’s 10 Faculties of Pharmacy; and
• Employersrepresenting hospital pharmacies, independent pharmacies, and drug store/grocery and mass merchandiser practice settings.
The research and engagement process, and resulting key findings from each stakeholder group are presented in the following sections. Limitations or considerations pursuant to the individual research methodology employed are presented in the appropriate section.
1.1 A New Vision for the Pharmacy Workforce
An investigation of the HR implications of how pharmacy will be practised in the future required an informed vision for the future of pharmacy in Canada. For this, Moving Forward turned to a landmark initiative known as the Blueprint for Pharmacy.1The Blueprint is developing a strategic action plan for the pharmacy profession in Canada, to strengthen its alignment with the health care needs of Canadians and to respond to the stresses on the health care system. The Blueprint is drafting a vision and mission for pharmacy based on
the enhanced roles it believes pharmacists and pharmacy technicians will need to play in the future. This draft vision and mission suggest that future pharmacy will include innovations and expansions to the pharmacist’s role in many areas.
Pharmacists are medication experts committed to patient-centred, outcomes-focused care. Pharmacists take increased accountability and responsibility for the safe and effective use of medications. Pharmacists promote wellness and disease prevention, and empower patients, in collaboration with other health professionals.
— Blueprint for Pharmacy, DRAFT, May 2007 Moving Forwardaccepts the work of the Blueprint and its draft vision for pharmacy. To carry out its Pharmacy Human Resources Challenges and Priorities study, Moving Forward adapted and presented, with permission, some core elements from the Blueprint as its expectation of the innovative and expanded pharmacy roles of the future:
• Drug therapy management:Pharmacists will spend more time managing drug therapy in collaboration with patients, physicians, and other health care providers;
• Public health outreach:Pharmacists will play a more prominent role in health promotion, disease prevention, and chronic disease management;
• Prescribing and monitoring authority:Pharmacists will have greater responsibility and authority for making prescribing decisions (including initiating and modifying drug therapy) and monitoring drug therapy outcomes (including ordering and performing tests) in collaboration with other health care providers;
• Self-care patient support:Pharmacists will continue to be accessible and available to support patient self-care; and
• Dispensing leadership:Pharmacists will focus on clinical tasks related to dispensing prescriptions including checking doses, drug interactions, contraindications, allergies, appropriateness of drug selection and patient counselling. Dispensing leadership also includes delegating technical aspects of dispensing to regulated pharmacy technicians. This vision for the future of pharmacy and the individual descriptions of anticipated
innovative and expanded roles for the pharmacy workforce were used throughout the Pharmacy Human Resources Challenges and Prioritiesresearch stream.
2.
PHARMACY THOUGHT LEADERS
As part of its research to support the Moving Forwardinitiative, Ascentum Inc. conducted a series of key informant interviews with thought leaders in the field. These interviews were designed to gather the perspectives of experienced leaders in pharmacy practice, pharmacy management, patient care, medicine and research.
The two primary objectives were to:
• Gather ideas about the future of pharmacy from leaders in the field, and
• Identify HR barriers and enablers that the profession and health care system face in making the innovative and expanded roles for pharmacy a reality.
This section of the report describes the main findings from the thought leaders interviews.
2.1 Research Approach
2.1.1 Methodology
A series of qualitative, semi-structured interviews was conducted with a sample of individuals representing a diverse range of expert perspectives on health care, pharmacy and patient safety. Interviews were conducted between September and October 2007. A purposive sample of thought leaders was developed in close coordination with the Moving Forwardproject team, Management and Advisory Committees. The list was carefully constructed to include representatives from major stakeholders, geographic regions, areas of pharmacy practice and other associated professions. Participants in the thought leader interviews represented a diverse range of expert perspectives on health care, pharmacy and patient safety, and were faculty members, administrators, practising pharmacists and physicians. Most had more than 20 years of experience in pharmacy, though interviewees also included a recent graduate and a newly practising pharmacist to add a younger perspective. A full list of thought leaders who participated in the interviews is shown on the next page. These names and perspectives are included for reference and to provide context for the key findings presented.
Thought Leader Interviewees
Name Perspective
Jean-François Bussières Director, Department of Pharmacy, CHU Sainte Justine Mother and Child University Hospital Centre
Della Croteau Deputy Registrar, Ontario College of Pharmacists
Lisa Dolovich Associate Professor, Department of Family Medicine, McMaster University Greg Eberhart Registrar, Alberta College of Pharmacists
David Malian Director, Government and Professional Affairs, Pfizer Canada Ray Murphy Owner, Murphy’s Pharmacies
Emily Musing Director of Pharmacy, University Health Network
Linda Poloway Patient Safety Coordinator, Health Services Quality Improvement, David Thompson Health Region
Adam Somers Associate, Shoppers Drug Mart
Ross Tsuyuki Director and Professor, COMPRIS/EPICORE Centre, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta
Once identified, participants were contacted by a letter or email signed by the project co-chairs. Respondents were then contacted by telephone or email to arrange an
appropriate interview time. Potential participants not responding in one week to the initial request were telephoned and/or sent a follow-up letter/email. Those still having not responded within another two weeks were sent a final letter/email.
To prepare for the key informant conversations, an interview protocol was developed. This short, accessible document contained a brief overview of Moving Forward, a description of the interview objectives and a list of structured questions to be covered during each
discussion. Thought leaders were presented with Moving Forward’s expected vision for the future of pharmacy (as adapted from the draft Blueprint for Pharmacy). This document was distributed to participants in advance of the interviews, to provide an opportunity for them to consider their responses in advance.
The interviews were conducted via telephone by an Ascentum Inc. researcher in either French or English. Detailed notes were taken of the conversation and participant responses. The interviewers’ post-interview field notes were summarized and emergent themes,
patterns and connections were identified and reviewed. Throughout this report, no specific comments or responses are attributed to individual thought leader interviewees. Instead, a summary of aggregate responses is provided.
2.1.2 Interview Topics
During each interview, participants were asked questions on a series of HR-related topics stemming from the new vision for pharmacy:
• Reactions to the new vision • Models of practice
• Changes in the profession • Future direction of pharmacy
• Barriers/challenges facing the new vision • Enablers supporting the new vision • Pharmacist readiness for change • Stakeholder perceptions
2.2 Key Findings
2.2.1 Reactions to the New Vision for Pharmacy
Thought leaders were asked if they agreed with the new vision for pharmacy and about potential threats to its implementation. Overall, participants expressed significant support for the direction and specific proposals in the new vision for pharmacy. Nevertheless, they identified some weaknesses and threats that may pose challenges to its realization.
Strengths
• Focus on patient safety: The patient is at the centre of the new vision, and the
innovative and expanded roles identify an integrated and comprehensive approach to provide better pharmacy care to patients.
• Supports pharmacy role in clinical care: A greater role for pharmacy in clinical care will lead to more effective drug treatment, more informed patients and, ultimately, improved health outcomes for patients.
Weaknesses
• Requires collaboration: The anticipated innovative and expanded roles in the new vision require support and collaboration from other key stakeholders in health care and pharmacy, from nurses and physicians to pharmacy employers.
• Not visionary enough: Alberta has already implemented many of the innovative and expanded pharmacy roles. Consequently, some suggested that the new vision does not look far enough into the future to set objectives for the profession’s
transformation.
• Complexity: There are indications that the new vision for pharmacy is too technical and too complex to be articulated effectively to patients and the general public.
Threats
• Capacity within the profession: The new vision requires that pharmacists have the required skills to perform expanded and innovative roles. Though many interviewees felt that pharmacists already possess these skills, they suggested that ongoing training and education were needed to ensure all members of the profession could continue to upgrade their skills.
• Lack of support within the profession: Even if pharmacists have the required skills, there is a risk that many will not support the new vision because of the real or imagined possibility that it would lead to increases in workload, stress and liability. • “Unfriendly” regulatory environment: Participants felt that the new vision can only be
realized with changes in the regulatory environment to facilitate pharmacists playing greater roles in prescribing and drug therapy management, and regulated pharmacy technicians performing dispensing roles.
• Lack of support from physicians: Physicians’ associations in Canada have not expressed support for greater prescribing authority for pharmacists. If a role in prescribing
authority is to be achieved, pharmacy will need to build support for this expanded and innovative role in the medical community.
• Need for new reimbursement models: Community-based pharmacies are for-profit businesses and the new vision will require changes to payment models to allow pharmacists to take on new roles while ensuring that pharmacies are still viable. • Requires support from employers: Pharmacists cannot make changes to the future of
the profession without building consensus and support among pharmacy owners and employers. The new vision will have to support their businesses and ensure that they are equally profitable in the future, as pharmacists take on new roles.
2.2.2 New Models of Practice
Interviewees were asked to describe the new models of practice that need to be considered and implemented in order to make the new vision for pharmacy viable. Instead of outlining specific models, participants depicted general principles that they felt needed to be reflected when new models of pharmacy practice are being developed. These principles were: • Models that encourage greater involvement with patient care: Pharmacists in a clinical
setting could prescribe as there is no bias; however, they should not prescribe in the pharmacy setting due to conflict of interest in the sale of, and profit from, medications. • Remove pharmacists from the drug distribution system: Participants suggested taking
the pharmacist away from the direct product/dispensing. Pharmacists can work in an integrated health team where the regulated pharmacy technician does the dispensing. • Utilization and regulation of pharmacy technicians: Pharmacists should focus on
patient counselling and clinical activities. Pharmacists can supervise, but should delegate dispensing tasks to regulated pharmacy technicians. Nevertheless, a pharmacist should always be on site.
• Better use of technology: Pharmacy practice should make greater use of technology, such as electronic health records and automated dispensing machines, to allow pharmacists to focus their energies on providing more clinical patient care.
2.2.3 Critical Changes to the Pharmacy Workforce
Thought leaders were asked for their views on the important changes to the pharmacy workforce that are required to support the new vision. Their responses highlighted a number of key HR changes that need to be realized. According to interviewed thought leaders:
• Regulation of pharmacy technicians: Pharmacy technicians are key actors in the new vision, but there is a need for these members of the pharmacy team to have the right skills and be a regulated profession in order to ensure the maintenance of standards. • Better use of technology: Pharmacists will need to have access to technologies that
support expanded and innovative roles, as well as the skills to use these technologies effectively. Some interviewees also raised the need for common technology platforms between pharmacies and other areas of the health care system, to facilitate
collaboration and information exchange.
• Additional education and training opportunities: Most pharmacists already have the required skills for the new vision, though interviewees commented that some pharmacists may require additional education and training courses to upgrade skills. • Education needs to place greater emphasis on clinical skills: Pharmacy education needs
to provide students with greater clinical skills and experience during their training, particularly prescribing and monitoring, and drug therapy management teaching. • Creation of new pharmacy models: New practice models will be required to ensure
pharmacists’ incomes are not adversely affected by assuming innovative and expanded roles, and that community-based pharmacies can continue to be profitable businesses. • Change in attitudes among pharmacists: There is a need to “reinstall” professionalism
within the profession, along with support among pharmacists for change and the adoption of innovative and expanded roles.
• Greater opportunities for international pharmacy graduates (IPGs): Some interviewees asserted that Canada is facing a future shortage of skilled pharmacists. Aside from increasing the number of spaces at Canadian universities for pharmacy, they advocated making greater use of IPGs and their skills.
2.2.4 The Pharmacy Workforce of the Future
Interviewees were asked to describe the pharmacy workforce of the future, based on the assumption that the new vision for pharmacy will be realized. They were asked to comment on the following HR management facets of future pharmacy workforce: • Key competencies
• Recruitment and retention
• Workforce composition and pharmacy staffing • Reimbursement
• Facilities and workspace • Technology
Key Competencies
• Overall, competencies will be greater: In the future, pharmacists will have a more diverse and expert skill set. Newer graduates will need to make a leap to this new future, developing greater clinical skills, as well as “soft” skills required to support patients and work in collaborative teams.
• Ability to work in health care teams: Pharmacists will need to develop the clinical skills required to work alongside physicians, nurses, nurse practitioners, dieticians and other members of inter-disciplinary health care teams. In addition, they will need to gain the skills to effectively communicate with these other health professionals.
• Organizational skills: Pharmacists in the future will need to develop considerable organizational and management abilities based on greater demands on their professional time. Increased periods outside pharmacy settings, the introduction of new technology, and time spent supervising pharmacy technicians will also require these abilities.
• Communication skills: Pharmacists will have a more clinical role in patient care, which will require skills to communicate with patients and other health care professionals about drug therapy management options and programs.
• Other soft skills: Some interviewees commented that pharmacists will need to develop greater soft skills to support their clinical skills, such as judgment, critical thinking and timely decision-making abilities.
• Experiential learning: During their education, pharmacy students will need to have more hands-on time in a clinical setting to ensure they have the required
competencies upon graduation.
Recruitment and Retention
• More opportunities for clinical activities: Employers will need to recognize that pharmacists will choose to work in environments where they can utilize their clinical skills.
• Greater job satisfaction: Pharmacists will gain greater job satisfaction when they have more opportunities to use their clinical skills. As such, retention strategies will involve a work environment that supports the new vision for pharmacy.
Workforce Composition and Pharmacy Staffing
• Pharmacy technicians will play a key role: Pharmacy technicians will play a central dispensing role to allow pharmacists to concentrate on clinical patient care. Within this context, pharmacists will need to supervise dispensing.
• Need for a pharmacist onsite: Most interviewees felt that, even with regulated pharmacy technicians and greater use of automated dispensing machines, there will always be a need for at least one pharmacist in a pharmacy setting – especially those based in the community. A pharmacist will need to be present to supervise dispensing and to provide clinical care to patients onsite.
• Ratio of pharmacists to pharmacy technicians: A ratio of one pharmacist for five to six pharmacy technicians was suggested during the interviews. Other interviewees did not want to suggest a specific ratio. They felt, instead, that staff ratios would depend on the particular client community served by a pharmacy. For example, a pharmacy serving a community with older residents would need more pharmacists than one serving a newer or suburban community where residents are younger.
Reimbursement
• Consensus on the need for new models: All interviewees agreed that the new vision will require new reimbursement approaches for pharmacists.
• Pharmacists support for new vision will depend on the adoption of new reimbursement models: Many commented that, for the new vision to be realized, pharmacists will need to support it, and to support it, pharmacists will need to know that their reimbursement will not be damaged as a result.
• Broad agreement on fee-for-service payment: There was broad agreement among thought leaders that pharmacists should continue to be paid on a fee-for-service basis. • More services need to be reimbursed: Within a fee-for-service structure, interviewees
agreed that more services will need to be covered as pharmacists perform innovative and expanded roles that are currently not reimbursed.
Facilities and Workspace
• Need for private counselling space: There was a broad consensus among thought leaders that, in the future, pharmacy workspaces will need to include private spaces for assessments and other aspects of clinical patient care.
• Creation of a virtual office environment: Interviewees believed that pharmacists will need more information technology in their work environments to access patient records, medication information on the Internet, and other patient care databases.
Technology
• Need for electronic health records: Thought leaders agreed that the most important technology tool in the future will be access to electronic health records.
• Other important technologies include: Automated dispensing machines, Internet access and personal computer, and telephone for drug compliance monitoring with patients.
2.2.5 Challenges/Barriers and Enablers
During the interviews, thought leaders were asked to identify the main barriers or challenges(HR or otherwise) facing the realization of the new vision for pharmacy. These are described below:
• Government policy and regulation: Interviewees agreed that the need for appropriate facilitating regulations is the primary challenge or barrier facing the new vision. However, others added that governments need to develop and implement health policy frameworks that support innovative and expanded pharmacy roles.
• Common understanding and support for new vision: Within the profession, there is a need for pharmacists to develop a common understanding of the innovative and expanded roles and, more importantly, support for the vision to be realized.
• Acceptance from employers: In order to support the new vision, employers and owners need economic models that will eliminate the conflict between patient and business needs, to allow pharmacists to perform innovative and expanded roles while ensuring businesses remain profitable.
• Acceptance from patients: Patients will need to understand the innovative and expanded roles of pharmacists and how they fit with the roles of other health care professionals, such as physicians and nurse practitioners, to provide better care. • Inter-professional collaboration: Pharmacists and other health care professionals will
need to learn how to work together more closely in clinical care settings. If close collaboration is not possible, pharmacists will not be able to provide the drug therapy management and prescribing authority roles they are capable of performing.
• Lack of technology: Technology tools, such as electronic health records and automated dispensing machines, are important enablers for the new vision. If these tools are not available it will be more difficult for pharmacists to perform innovative and expanded roles.
Interviewees were asked to describe the key enablers(HR or otherwise) that would facilitate the implementation of the new vision:
• Patient/client demand: Many interviewees suggested that client or patient demand for clinical care support from pharmacists was the most important enabler for the new vision. Some linked this demand with the larger issue of patient safety and suggested it would be beneficial to connect innovative and expanded pharmacy roles with this increasingly important policy issue.
• Pharmacist education: Having a pharmacy profession with the required clinical and non-clinical skills is vital for the new vision. Some suggested that making education and training opportunities widely available to current pharmacists would help create this enabler.
• Inter-professional collaboration: Several thought leaders indicated that the new vision will be realized when other health professionals agree to work collaboratively with pharmacists in health care teams. When this occurs, it will add significant momentum towards realizing the innovative and expanded roles.
• Technology: Once pharmacists have the technology tools required, such as access to electronic health records and automated dispensing machines, they will be better placed to provide drug therapy management and other clinical care, working in collaborative teams as they do so.
2.2.6 Stakeholder Involvement in Achieving the New Vision
Toward the end of each interview, thought leaders were asked to describe the activities each of the major pharmacy stakeholders needs to undertake to help realize the new vision. These stakeholders were:
• Employers • Pharmacists • Professional associations • Educators • Regulators Employers
• Need to understand the benefits of the new vision: While the patient care benefits may be evident to pharmacists, interviewees suggested that the business benefits also need to be made clear to pharmacy owners and employers.
• Employers are prepared to support innovative and expanded roles, but revenue is a concern: Many interviewees speculated that employers were ready to support innovative and expanded roles, as long as they could be provided with practice models that would continue to make their businesses financially viable.
Pharmacists
• Developing greater confidence in their skills: Almost all interviewees agreed that pharmacists already possess the required skills and abilities to perform the innovative and expanded roles of the new vision. However, they also suggested that pharmacists need to demonstrate greater confidence in their abilities to provide these roles. • Shifting attitudes: Achieving the new vision involves a shift in attitudes among
pharmacists. Instead of seeing themselves primarily as dispensers, pharmacists need to embrace changes in their practice settings and take on the expanded and innovative roles to make more effective use of their skills.
• Sharing good news stories: Interviewees felt that sharing success stories is a key tool to increase morale, professionalism and confidence within the profession.
Professional Associations
• Bringing other professions to the table: Interviewees commented that professional pharmacy advocacy associations, such as the Canadian Pharmacists Association (CPhA), have a key liaison function to play in working with other professional associations in the health care sector to build strategic support for innovative and expanded pharmacy roles.
• Advocacy on behalf of the new vision: Professional associations need to advocate on behalf of pharmacists and the new vision to key audiences, such as government and the public.
• Setting education standards: Some interviewees saw a role for CPhA in setting and perhaps enforcing education standards for pharmacy.
Educators
• Starting cultural change at the university level: An interviewee commented that educators can play a key role in supporting the cultural change within pharmacy towards a greater clinical role in care.
Regulators
• Change regulations to facilitate expanded and innovative roles: Interviewees agreed that government regulators need to take action to change regulatory regimes to facilitate the implementation of the expanded and innovative pharmacy roles, for example by granting pharmacists greater power to prescribe medications under certain conditions.
Interview participants were asked to comment on how implementation of the new vision would affect key stakeholders other than pharmacists themselves.
Physicians
• Make better use of physicians’ time: With drug therapy management support from pharmacists, physicians can reduce the time they spend with patients discussing medication issues. These conversations can be managed by pharmacists when prescriptions are filled.
• Improve quality of care for patients: Working with pharmacists will allow physicians to provide more comprehensive medication management support to their patients.
Governments
• Lower health costs in the long-term: Interviewees asserted that, although innovative and expanded roles may lead to a short-term increase in medication costs for
governments, the new vision will lead to a healthier population and lower health care costs for governments in the long-term.
Public
• Improve access to care that meets their needs: In the context of Canada’s physician shortage, the new vision will provide patients with easier access to expert advice and support on medications.
Thought leaders were asked, as leaders in the profession, what role they are currently playing or would like to play in shaping the future development of the pharmacy
workforce. Some indicated that they were acting as a “mentor, facilitator and enabler” when working with pharmacists and government to implement the changes necessary to realize the new vision. Others indicated that their primary role is conducting research, to
strengthen evidence-based research in pharmacy practice. Finally, many indicated that the most important role they could perform was advocacy.
3.
PRACTISING PHARMACISTS
A major component of the Pharmacy Human Resources Challenges and Prioritiesresearch study was the design and execution of an online consultation to reach practising
pharmacists across Canada. The engagement initiative used an online Choicebook™ and story/idea sharing tool to reach a number of participants. Overall, more than 1000 pharmacists from across Canada participated in the online consultation.
3.1 Research Approach
3.1.1 Methodology
For the online pharmacist consultation, a dedicated website was built and was accessible via the main Moving Forwardwebsite at www.pharmacyhr.ca/onlineconsultation. The consultation included a “How to Participate” page and two complementary engagement tools: The Online Choicebook™ and the Online Stories and Ideas Tool. (These tools are further described in Section 3.1.2.) The site was open during September and October 2007 andwas available in both French and English. The consultation process took approximately 30 minutes.
The online consultation process was tested by a panel of practising pharmacists and reviewed by an expert panel. Incentives for participation included accreditation by the Canadian Council on Continuing Education in Pharmacy (CCCEP) for 0.5 continuing education units (CEUs) and a participation prize draw. The online consultation was promoted by members of the Moving Forward Management Committee, National Advisory Committee, provincial pharmacy regulatory authorities and provincial advocacy
organizations through emails, web postings, faxes and presentations. In total 1003
individuals participated in the online Choicebook™ process and 741 participants completed each question in the consultation. Data submitted by users who did not complete the entire Choicebook™ process was still incorporated into the research findings. An additional 53 participants engaged using the Online Stories and Ideas Tool. This mixed-methods approach allowed for the collection and analysis of data, the integration of findings,
and a mechanism for understanding how the documented ideas and opinions can be linked to the subject’s own frame of reference or experiences.
The online consultation was informed by Moving Forward’s expected vision for the future of pharmacy (as adapted from the draft Blueprint for Pharmacy) and included questions in six (6) key areas: 1) demographics; 2) time spent on work activities and job satisfaction; 3) perception of HR implications of new roles for pharmacists; 4) introduction to expanded or innovative roles and responses to those roles; 5) technology use and needs;
6) challenges and opportunities facing pharmacy workforce.
SPSS software was used to conduct univariate and multivariate analysis, including
frequencies and crosstabs. For example, crosstabs for each of the main question sets in the online Choicebook™ were run. This was done to provide information about pharmacists’ attitudes and opinions based on key demographic features. The two main variables
selected for these standard crosstabs included primary practice setting and years in practice. These two variables provided important lenses to understand the data, based on
participants’ professional setting and their level of experience. The findings from these crosstab variables are included throughout this report where the results differ from the response profile of participants overall.
Figure 3-1: Screenshot of the How to Participate Page
3.1.2 Online Consultation Tools
The Online Choicebook™:TheMoving Forward: Pharmacist Choicebook™ was an online tool that provided pharmacists with an opportunity to learn more about the new vision for pharmacy and provide their feedback on the future HR challenges and priorities in an informed way. The Choicebook™ focused on the new roles for pharmacy and invited participants to provide feedback on the expanded activities and describe the biggest opportunities and challenges for making this new vision a reality. The Choicebook™ offered participants with a vehicle to express their views during a 20- to 30-minute experience by answering mostly closed-ended questions.
The Choicebook™ tool produces statistical data, based on participant responses to closed-ended questions.
The Online Stories and Ideas Tool: In addition to the Choicebook™, the site also invited participants to write about their own stories or ideas in an open-ended format. The stories and ideas tool provided the same broad range of online participants with space to answer more open-ended questions, and express their ideas and experiences in their own words. The tool also made it possible for participants to attach documents or type their responses and target them towards the consultation’s major themes.
When submitting their stories or ideas, this tool gave participants the option of posting their submission in the “story reading room” on the consultation site, where other participants could read it. This allowed participants to share their stories and ideas with the analysis team, as well as with other pharmacist participants. As part of the experience, participants could learn from each other’s points-of-view and react to previous submissions. This made for a more effective, engaging and deliberative experience.
Figure 3-2: Screenshots of the Online Choicebook™
3.2 Demographic Profile of Participating Pharmacists
The online consultation heard from a number of target audiences, including pharmacists working in a range of different practice settings. Specifically, pharmacists were asked to identify themselves as working in one of the following practice settings:• Independent pharmacies
• Chain pharmacy – drug store format
• Chain pharmacy – grocery and mass merchandiser • Hospital pharmacies
• Clinic/primary health care centre • Educational institution
• Research/pharmaceutical industry • Government
Overall, more than 1000 pharmacists from across Canada participated in the online consultation. A more detailed breakdown of participation is included in the following table.
Table 3-1: Pharmacists’ Participation in Elements of the Online Consultation
At the start of the Choicebook™, participants were invited to answer several demographic questions about themselves. These added important strategic information that was used to further analyze participant responses. They were asked to identify their:
• Age
• Gender
• Level of pharmacy education • Additional training
• Location of entry to practice degree • Primary practice setting
• Work hours • Employee type • Location of practice • Years in practice
• Size of city where practising
Consultation Elements Status
Choicebook™
Choicebook™ starts 1003 Choicebook™ completes 741 Choicebook™ completion rate 74% Stories and Ideas
Total stories/ideas 53
Stories 24
Tell us about an experience when you worked collaboratively with physicians and/or
other health care providers. 12
Tell us about an experience where you felt you helped a patient achieve a better health
outcome. 3
Tell us about your experience with one area of responsibility of the new role for
pharmacists. 7
Tell us about an experience where you felt you lacked the necessary training to carry
out your responsibilities. 2
Ideas 29
What do you think is required to get buy-in from pharmacists for an expanded role for
pharmacists? 11
What do you think is required to get buy-in from physicians for an expanded role for
pharmacists? 5
How should the reimbursement model change to ensure pharmacists are adequately
compensated in a new role? 3
What would need to change for you, in order to free up the time necessary to deliver
Answering each of these demographic questions was optional for participants. This explains variations in the number of responses(n values)for the following data sets. Available statistics regarding the practising pharmacy workforce are presented where available to allow for comparison. Please note that all figures may not sum to 100%. Each represents the percentage that selected each individual option.
3.2.1 Age
There was participation from a wide range of age groups, fairly evenly spread between the ages of 25 to 54. Younger pharmacists (34 and under) accounted for 33.5% of participants and more experienced pharmacists aged 35 and older accounted for 66.5% of participants. This provided a good mix of generational perspectives on the future of the profession. This is reasonably consistent with census data on the age distribution of pharmacists in Canada.2
Table 3-2: Age Distribution of Pharmacists Participating in the Online Consultation
3.2.2 Gender
There was a higher representation of women (60.5%) than men (39.5%), which is fairly representative of the gender balance in the larger pharmacist community in Canada.2
Table 3-3: Gender Distribution of Pharmacists Participating in the Online Consultation
3.2.3 Level of Education
A strong proportion of participants responded that they had a Bachelor of Science in Pharmacy (88.6%). Significantly fewer indicated that they held other types of higher education: Masters of Pharmacy was the second-most frequent selection (8.7%), followed by a post-baccalaureate PharmD (5.4%).
Furthermore, close to one in five participants indicated that they also held another type (i.e., non-pharmacy) of education or training. Responses under the “other” category included other non-pharmacy bachelors degrees (e.g., biology, commerce) and masters degrees (e.g., business administration or health administration). Others listed “hospital residency” in this category as well.
Age Percentage <25 6.0 25—34 27.5 35—44 28.5 45—54 26.5 55+ 11.5 n=930 Gender Percentage (%) Male 39.5 Female 60.5 n=942
Table 3-4: Level of Education of Pharmacists Participating in the Online Consultation
3.2.4 Additional Training
Just under half the participants (44.1%) indicated that they did not have additional pharmacy training beyond their pharmacy education. Of those who responded that they had additional training or certification, 10.0% had a specialty certification, 5.2% a
certification by the Pharmacy Board in the USA and 2.9% had completed a fellowship. “Other” responses in this category included clinical and practice management certifications.
Table 3-5: Additional Training of Pharmacists Participating in the Online Consultation
3.2.5 Location of Completion of Entry-to-Practice Degree
The online consultation asked pharmacists where they completed their entry-to-practice pharmacy degree. Looking at specific provinces, Ontario was the most frequent province with 20.2% of participants, followed by Saskatchewan (17.0%), Alberta (13.9%), Quebec (11.1%) and British Columbia (10.7%).
In addition, a small number of participants indicated they had completed their entry-to-practice degree in the USA (2.0%) or in another country (3.6%).
Level of pharmacy education completed Percentage (%)
Bachelor of Science in Pharmacy 88.6
Entry level PharmD 1.1
Masters of Pharmacy 8.7
Post-BSc PharmD 5.4
Post-BSc non-traditional PharmD 1.4
PhD 0.5
Other (non-pharmacy) 18.5
n=936
Additional training/certification Percentage (%)
None 44.1
Fellowship 2.9
Specialty certification 10.0
Pharmacy board certification (USA) 5.2
Other 8.5
Table 3-6: Location of Completion of Entry-to-Practice Degree of Pharmacists Participating in the Online Consultation
Please note there are currently no known faculties of pharmacy in the provinces of New Brunswick or Prince Edward Island.
3.2.6 Primary Practice Setting
Pharmacy is a diverse field, with pharmacists working in a wide range of work environments. To gain a sense of this environment and their associated perspective, participants were asked to identify their primary practice setting. Although pharmacists are active in each of the listed primary practice settings, participant responses showed that 83.7% work in one of four major settings:
1. Chain pharmacies – drug store format 2. Independent pharmacies
3. Chain pharmacies – grocery and mass merchandisers 4. Hospital pharmacies
Location of entry to practice degree Percentage (%)
British Columbia 10.7 Alberta 13.9 Saskatchewan 17.0 Manitoba 6.2 Ontario 20.2 Quebec 11.1 Nova Scotia 9.8 New Brunswick 1.1
Newfoundland and Labrador 4.0
Prince Edward Island 0.2
USA 2.0
Other country 3.6
Table 3-7: Primary Practice Setting of Pharmacists Participating in the Online Consultation
A comparison of these findings to the national pharmacists licensure statistics maintained by the National Association of Pharmacy Regulatory Authorities (NAPRA) indicates that this research study sample was likely under-represented in community pharmacy (46.7% compared to 72.5%) and likely over-represented in the categories of hospital pharmacy (37.0% compared to 16.2%) and other practice sites (6.2% compared to 11.2%).3However, it should be noted that the NAPRA statistics have a number of limitations (e.g., are not collected for every province, contain multiple entries where a pharmacist maintains a licence in more than one province).
3.2.7 Hours of Work
The large majority of participants are employed full-time (78.8%). Others indicated that they work part-time (16.8%), are not currently employed or work a more customized or flexible schedule.
Table 3-8: Hours of Work of Pharmacists Participating in the Online Consultation
Primary practice setting Percentage (%)
Chain pharmacies — drug store format 21.4
Independent pharmacies 19.6
Chain pharmacies — grocery and mass merchandisers 5.7
Hospital pharmacies 37.0
Consulting 1.6
Clinic/primary health centre 2.9
Educational institution 2.2
Pharmaceutical industry 1.3
Research .2
Government 1.1
Not currently employed 1.8
Other 5.1
n=919
Work hours Percentage (%)
Full-time: 35 or more hours/week 78.8
Part-time: less than 35 hours/week 16.8
Not currently employed 2.5
Other 1.9
n=916
3National Association of Pharmacy Regulatory Authorities. National Statistics. [Online] 2008 [cited March 2008];
3.2.8 Position or Employment Status
In addition to identifying their practice setting, participants were asked to describe their employment type. The majority responded that they were staff pharmacists (53.1%) while almost one-quarter (23%) indicated that they were a manager/director, and (10%) self-identified as pharmacy owners. According to available statistics reported by the
Canadian Institute of Health Information (CIHI), on average 61% of the workforce are staff pharmacists, 32.6% of the workforce are owners and managers.4
Table 3-9: Position or Employment Status of Pharmacists Participating in the Online Consultation
3.2.9 Years in Practice
Further to providing the age range they belong to, participants were asked to provide the number of years they had been in practice. This provided a generational lens, to identify the proportions of participants who are new and establishing themselves in pharmacy and those who are likely older and more established. The range of participants shows that pharmacy has a significant young and less-established cohort ready to staff the profession in the future: 20.0% have been in practice for less than five years and more than one-third (34.2%) have been in practice for less than 10 years. At the same time, pharmacy also maintains a more experienced and established cohort. More than 36% have been in practice between 20 and 39 years. While no comprehensive statistics exist on the years in practice of the pharmacy workforce, this pattern appears to be reasonably comparable to the age distribution of pharmacists reported by CIHI.4
Table 3-10: Years in Practice of Pharmacists Participating in the Online Consultation
4Canadian Institute for Health Information, Workforce Trends of Pharmacists for Selected Provinces and Territories in
Employee type Percentage (%)
Staff pharmacist 53.1
Manager/director 23.0
Owner 8.4
Self-employed 3.1
Not currently employed 2.4
Other 8.4
n=917
Years in practice Percentage (%)
<5 years 20.0 5–9 14.2 10–19 26.5 20–29 24.3 30–39 12.7 40+ years 2.3 n=887
3.2.10 Location of Practice
The online consultation heard from pharmacists practising in every province and territory in Canada: 28.2% of participants practise in Ontario, followed by Alberta (14.3%), Manitoba (12.2%), Saskatchewan (11.4%) and Quebec (10.9%). Together with representatives from other provinces and territories, the online consultation gathered views from a broad range of geographic locations across the country.
Table 3-11: Location of Practice of Pharmacists Participating in the Online Consultation
A comparison of these findings to the national pharmacists licensure statistics maintained by NAPRA indicates that this research study sample was likely significantly
under-represented in the provinces of British Columbia (5.6% compared to 13.6%), and Quebec (10.9% compared to 22.4%), somewhat under-represented in Ontario (28.2% compared to 35.6%) and likely significantly over-represented in the provinces of Manitoba (12.2% compared to 3.9%) and Saskatchewan (11.4% compared to 4.0%).5
3.2.11 Size of City Where Practising
To add an urban/rural lens to the demographic profile, participants were asked to estimate the size of the city in which they are practising. More than one-third of participants
reported they practised in a city with 100,000 to 999,999 residents.
Location of practice Percentage (%)
British Columbia 5.6 Alberta 14.3 Saskatchewan 11.4 Manitoba 12.2 Ontario 28.2 Quebec 10.9 Nova Scotia 4.6 New Brunswick 5.0
Newfoundland and Labrador 3.0
Prince Edward Island 1.7
Northwest Territories 0.2
Nunavut 0.1
Yukon 0.3
USA 0.1
Other country 0.8
Not currently employed 1.5
n=884
5National Association of Pharmacy Regulatory Authorities. National Statistics. [Online] 2008 [cited March 2008];
Table 3-12: Size of City of Practice of Pharmacists Participating in the Online Consultation
3.3 Pharmacists’ Time Allocation and Job Satisfaction
In the opening section of the online Choicebook™, before they learned about the new vision for pharmacy, participants were provided with a list of work-related activities, ranging from technical (non-clinical) dispensing to continuing education/professional development. Participants were asked to describe how much of their time is spent performing the various work activities, and their satisfaction level in performing each of these.Time Allocation
As shown in Table 3-13, participants spend differing proportions of their time performing a range of professional or work-related activities.
Size of city where practising Percentage (%)
Small centre/rural area 15.6
Small city (10,000-99,999) 21.4
City (100,000–999,999) 36.3
Large city (>1,000,000) (suburban) 12.7
Large city (>1,000,000) (core neighbourhood) 14.0
Table 3-13: Time Allocation of Pharmacists Participating in the Online Consultation
Key Observations
On average, about one-third of all participants indicated they spend half their time to almost all their time performing a small number of core work activities:
• Technical (non-clinical) tasks related to dispensing/distribution (35.5%)
• Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies) (34.7%)
On the other side of the spectrum, a large number of participants indicated they do not spend any time on other activities that go beyond day-to-day tasks:
• More than one-third of participants never perform third party payer/billing and related administrative matters (38.2%)
• About one-third never perform pharmacy staff supervision or managerial tasks (29.5%) • Almost half never perform research/quality improvement projects (48.4%)
• More than one-third never perform teaching/mentoring (34.5%)
• Just over one-tenth report they never perform (i.e., participate in) continuing education/professional development activities (14%)
% of Responding Pharmacists:
How much of your time is spent performing the following work related activities? Almost all About three quarters About half About one quarter Less than one quarter None Technical (non-clinical) tasks related
to dispensing/distribution 2.2 8.6 24.7 23.2 23.3 18.1
Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies)
3.6 9.1 22.0 37.0 16.4 12.0
Direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds)
1.9 4.9 11.2 20.3 41.5 20.1
Third party payer/billing and related
administrative matters 0.5 1.5 3.8 14.6 41.4 38.2
Communicating with or advising other
health professionals 2.4 3.2 6.8 24.9 58.2 4.5
Supervising pharmacy staff/
managerial tasks 2.5 4.0 8.3 15.8 39.3 29.9
Research/quality improvement
projects 0.9 1.5 2.3 8.7 38.1 48.4
Teaching/mentoring 1.0 0.6 2.6 10.7 50.8 34.3
[Participating in] continuing
education/professional development 0.9 0.7 3.4 9.7 72.0 13.3
Other: please specify 3.4 4.8 2.9 9.1 12.0 67.8
When time allocation responses were further analyzed based on primary practice setting and years in practice, there were a number of notable trends among participant responses: • Hospital pharmacists indicated they spent less time performing technical (non-clinical)
tasks related to dispensing/distribution, and clinical tasks related to dispensing, than pharmacists in other primary practice settings. Participants working in independent pharmacies spent the most time performing clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies) followed by participants in chain pharmacies – drug store format.
• Hospital pharmacists indicated they spend significantly more time providing direct patient care not related to dispensing than those working in other main primary practice settings: 30% of hospital pharmacists indicated they spend about half of their time or more providing this care, compared to less than 10% of those at independent pharmacies and less than 5% of those at chain pharmacies, both drug store and mass merchandiser.
• Hospital pharmacists indicated they were more likely to spend greater amounts of time communicating with or advising other health professionals, compared to pharmacists in other practice settings. Pharmacists with fewer years in practice were slightly more likely to spend time communicating with or advising other health professionals than those with more experience.
• Although all participants indicated that they do not spend significant amounts of time involved with third party payer/billing and related administrative matters, this was especially the case for hospital pharmacists, almost 70% of who indicated they do not spend any time performing this activity.
• Hospital pharmacists indicated they spent more time doing research/quality improvement projects than pharmacists in other practice settings, though still not greater than one-quarter of their time. Pharmacists in grocery and mass merchandisers rarely carry out this task: 82% do not spend any time performing this task, and the remaining 18% spend less than a quarter of their time doing so.
• Those with fewer years in practice were more likely to spend more time performing technical (non-clinical) tasks related to dispensing/distribution, and clinical tasks related to dispensing, in comparison to pharmacists with 10 or more years in practice. • Pharmacists with more than 30 years in practice are less likely to spend their time in
direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds) than those with less than 30 years experience. These less-experienced pharmacists were more likely to spend between one-half and one-quarter of their time performing this task.
• Pharmacists with less than five years in practice spent less time supervising pharmacy staff or on managerial tasks.
Satisfaction Level
Participant responses indicated that pharmacists derive different levels of satisfaction from their various work-related activities.
Table 3-14: Satisfaction Levels of Pharmacists Participating in the Online Consultation
Key Observations
More than half of all participants responded that they find the following clinical pharmacy aspects of pharmacy satisfying or very satisfying:
• Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies) (56.0%)
• Communicating with or advising other health professionals (54.7 %)
• Direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds) (53.4%)
Percentage (%) of Responding Participants:
Based on the amount of time you spend on each, how satisfied are you with performing the following activities?
N/A (Do not perform)
Very
Unsatisfied Unsatisfied Neutral Satisfied
Very Satisfied Technical (non-clinical) tasks related
to dispensing/distribution 18.8 16.8 26.9 21.3 10.4 5.7
Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies)
11.6 1.8 8.6 22.1 39.4 16.6
Direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds)
15.5 5.8 10.1 15.2 28.5 24.9
Third party payer/billing and related
administrative matters 35.8 34.0 15.6 7.3 3.4 3.9
Communicating with or advising other
health professionals 3.6 4.7 10.9 26.2 36.5 18.2
Supervising pharmacy staff/
managerial tasks 29.3 3.4 11.9 27.5 21.4 6.5
Research/quality improvement
projects 40.9 4.5 8.3 19.8 18.2 8.3
Teaching/mentoring 28.0 3.6 7.7 20.7 26.2 13.8
[Participating in] continuing
education/professional development 10.6 5.8 12.9 26.3 31.0 13.4
Other: please specify 65.4 4.8 5.3 4.3 9.6 10.6
One activity in particular received a low satisfaction rating from all participants:
• Third party payer/billing and related administrative matters (49.6% reported unsatisfied or very unsatisfied with this task).
When time allocation responses were further analyzed based on primary practice setting and years in practice, there were a number of notable trends among participant responses: • Pharmacists in chain pharmacies – grocery and mass merchandisers found the
technical (non-clinical) tasks related to dispensing/distribution less satisfying than pharmacists in other practice settings. More than 55% responded that they were either very unsatisfied or unsatisfied performing the activity.
• Participants who work in independent pharmacies felt that clinical tasks related to dispensing (e.g., patient counselling; screening for drug interactions, proper doses, contraindications, allergies) were more satisfying than those in other practice settings. In contrast, a disproportionate number of participants who work in chain pharmacies – grocery and mass merchandisers indicated that they find the activity either very unsatisfying or unsatisfying.
• Hospital pharmacists found patient care not related to dispensing significantly more satisfying than pharmacists in other practice settings. More than 65% indicated it was either satisfying or very satisfying compared to 32% of pharmacists in chain
pharmacies – grocery and mass merchandisers.
• Hospital pharmacists found communicating with or advising other health professionals more satisfying than did those in other practice settings, especially grocery and mass merchandisers. More than 74% of hospital pharmacists described this activity as very satisfying or satisfying, compared to 23% of those in chain pharmacies – grocery and mass merchandisers.
• Hospital pharmacists also found performing research/quality improvement tasks more satisfying than those in other practice settings. Thirty-seven percent described it as either very satisfying or satisfying compared to 12% in both chain pharmacies – grocery and mass merchandisers, and drug store format.
• Furthermore, hospital pharmacists indicated that teaching/mentoring was more satisfying than for participants in other practice settings. Forty-eight percent described the activity as either very satisfying or satisfying. The satisfaction level was significantly lower for other pharmacists, who also indicated they are likely to spend less time performing the task.
• In contrast to those with more years of experience, participants with less than five years experience found it less satisfying to communicate with or advise other health care professionals. Forty-three percent described it as either very satisfying or
3.4 Pharmacists’ Perceptions on the Future of
Pharmacy (Myths vs. Facts)
In the next section of the Choicebook™ participants were asked to respond to a series of statements about pharmacy that were presented as myths or facts. They could react to each of these statements using a scale from “strongly disagree” to “strongly agree.”
Overall, participants indicated that:
• There is an urgency for change in the profession;
• They are prepared for future pharmacy roles, especially younger graduates, but others are less confident about taking on these roles;
• They would be able to support the new vision for pharmacy if they could spend less time on technical dispensing tasks; and
• The new vision will require innovative and flexible funding models.
The following section examines participant responses to each statement presented. Where significant differences were observed by cross-referencing responses according to different participant demographic variables, these differences a
