Pharmacy Human Resources Challenges & Priorities

Transcription

1 Pharmacy Human Resources Challenges & Priorities RESEARCH REPORT August 2008 Prepared for: Moving Forward: Pharmacy Human Resources for the Future Prepared by: Ascentum Inc. Funded by the Government of Canada s Foreign Credential Recognition Program

2 How to cite this document: Management Committee, Moving Forward: Pharmacy Human Resources for the Future. Pharmacy Resources Challenges and Priorities: Research Report. Ottawa (ON). Canadian Pharmacists Association; (2008)

3 Pharmacy Human Resources Challenges & Priorities RESEARCH REPORT August 2008 Prepared for: Moving Forward: Pharmacy Human Resources for the Future Prepared by: Ascentum Inc. The Moving Forward initiative is funded by the Government of Canada's Foreign Credential Recognition Program. The opinions expressed in this publication are those of the author and do not necessarily reflect those of the Government of Canada.

4 ACKNOWLEDGEMENTS The Moving Forward partners would like to express their appreciation to all the individuals whose participation in this research contributed to its success. Moving Forward especially 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 Forward National Advisory Committee, and numerous other expert advisors. These individuals include: Management Committee Kevin Hall, Moving Forward Co-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 Educators Association Anne Marie Ford, Ford s Apothecary 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. Project Staff Heather Mohr, Project Manager Kelly Hogan, Research Coordinator

5 TABLE OF CONTENTS Glossary of Terms and Abbreviations Overview of Moving Forward: Pharmacy Human Resources for the Future Introduction A New Vision for the Pharmacy Workforce Pharmacy Thought Leaders Research Approach Methodology Interview Topics Key Findings Reactions to the New Vision for Pharmacy New Models of Practice Critical Changes to the Pharmacy Workforce The Pharmacy Workforce of the Future Challenges/Barriers and Enablers Stakeholder Involvement in Achieving the New Vision Practising Pharmacists Research Approach Methodology Online Consultation Tools Demographic Profile of Participating Pharmacists Age Gender Level of Education Additional Training Location of Completion of Entry-to-Practice Degree Primary Practice Setting Hours of Work Position or Employment Status Year in Practice Location of Practice Pharmacists Time Allocation and Job Satisfaction Pharmacists Perceptions on the Future Pharmacy (Myths vs Facts) Pharmacy Human Resources Challenges and Priorities

6 TABLE OF CONTENTS 3.5 Workplace Implications of Expanded and Innovative Pharmacy Roles HR Implications of Innovative and Expanded Roles (By Role) Broader Implications of Expanded and Innovative Pharmacy Roles (Comparative Analysis) Technology Requirements Challenges and Opportunities for Pharmacy Pre- and Post-Choicebook Attitudes Pharmacy Students Research Approach Key Findings Education and Career Choice Perceptions of the Pharmacy Job Market Future Plans and Practice Expectations Final Comments Deans and Faculties of Pharmacy Research Approach Key Findings Capacity Curriculum Final Comments Pharmacy Employers Research Approach Key Findings Hospital Employers Chain Drug Store Representatives Community-based Independent Pharmacy Owners Final Comments Concluding Remarks Canadian Pharmacists Association

7 GLOSSARY OF TERMS AND ABBREVIATIONS ACE ACW ADPC AFPC ASA CACDS CADTH CAPSI CAPT CCCEP CDE CEUs CHA CIHI CMA CNA CPhA CPTEA CSHP HR HRSDC INR IPG NAPRA OCP OPQ OSCE OTC PDA PDW PEBC UBC UT Angiotensin-converting enzyme Awareness, compliance, wellness Association of Deans of Pharmacy of Canada Association of Faculties of Pharmacy of Canada Acetylsalicylic acid Canadian Association of Chain Drug Stores Canadian Agency for Drugs and Technologies in Health Canadian Association of Pharmacy Students and Interns Canadian Association of Pharmacy Technicians Canadian Council on Continuing Education in Pharmacy Certified Diabetes Educator Continuing education units Canadian Healthcare Association Canadian Institute for Health Information Canadian Medical Association Canadian Nurses Association Canadian Pharmacists Association Canadian Pharmacy Technician Educators Association Canadian Society of Hospital Pharmacists Human resources Human Resources and Social Development Canada International Normalized Ratio International Pharmacy Graduate National Association of Pharmacy Regulatory Authorities Ontario College of Pharmacists L Ordre des pharmaciens du Quebec Objective Structured Clinical Examination Over-the-counter Personal digital assistant Professional Development Weekend (CAPSI s conference) The Pharmacy Examining Board of Canada University of British Columbia University of Toronto Pharmacy Human Resources Challenges and Priorities

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9 OVERVIEW OF MOVING FORWARD 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 Forward has 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. Pharmacy Human Resources Challenges and Priorities 1

10 SECTION I INTRODUCTION 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 pharmacists across Canada, in all types of practice settings; Pharmacy students, both undergraduates and graduates, currently enrolled in one of Canada s 10 Faculties of Pharmacy; Deans of Canada s 10 Faculties of Pharmacy; and Employers representing 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. 1 The 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 1 Canadian Pharmacists Association, Blueprint for Pharmacy DRAFT for pharmacy consultation, V4.2, May Canadian Pharmacists Association

11 SECTION I INTRODUCTION 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 Forward accepts 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 Priorities research stream. Pharmacy Human Resources Challenges and Priorities 3

12 SECTION 2 PHARMACY THOUGHT LEADERS 2. PHARMACY THOUGHT LEADERS As part of its research to support the Moving Forward initiative, 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 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 A purposive sample of thought leaders was developed in close coordination with the Moving Forward project 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 Canadian Pharmacists Association

13 SECTION 2 PHARMACY THOUGHT LEADERS Thought Leader Interviewees Name Jean-François Bussières Della Croteau Lisa Dolovich Greg Eberhart David Malian Ray Murphy Emily Musing Linda Poloway Adam Somers Ross Tsuyuki Perspective Director, Department of Pharmacy, CHU Sainte Justine Mother and Child University Hospital Centre Deputy Registrar, Ontario College of Pharmacists Associate Professor, Department of Family Medicine, McMaster University Registrar, Alberta College of Pharmacists Director, Government and Professional Affairs, Pfizer Canada Owner, Murphy s Pharmacies Director of Pharmacy, University Health Network Patient Safety Coordinator, Health Services Quality Improvement, David Thompson Health Region Associate, Shoppers Drug Mart Director and Professor, COMPRIS/EPICORE Centre, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta Once identified, participants were contacted by a letter or signed by the project co-chairs. Respondents were then contacted by telephone or 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/ . Those still having not responded within another two weeks were sent a final letter/ . 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. Pharmacy Human Resources Challenges and Priorities 5

14 SECTION 2 PHARMACY THOUGHT LEADERS 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 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 Canadian Pharmacists Association

15 SECTION 2 PHARMACY THOUGHT LEADERS 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 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. Pharmacy Human Resources Challenges and Priorities 7

16 SECTION 2 PHARMACY THOUGHT LEADERS 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 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 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 Canadian Pharmacists Association

17 SECTION 2 PHARMACY THOUGHT LEADERS 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. Pharmacy Human Resources Challenges and Priorities 9

18 SECTION 2 PHARMACY THOUGHT LEADERS 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 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 Canadian Pharmacists Association

19 SECTION 2 PHARMACY THOUGHT LEADERS 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. Pharmacy Human Resources Challenges and Priorities 11

20 SECTION 2 PHARMACY THOUGHT LEADERS 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 Canadian Pharmacists Association

21 SECTION 2 PHARMACY THOUGHT LEADERS 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. Pharmacy Human Resources Challenges and Priorities 13

22 SECTION 3 PRACTISING PHARMACISTS 3. PRACTISING PHARMACISTS A major component of the Pharmacy Human Resources Challenges and Priorities research 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 Methodology For the online pharmacist consultation, a dedicated website was built and was accessible via the main Moving Forward website at 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 ) The site was open during September and October 2007 and was 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 s, 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 Canadian Pharmacists Association

23 SECTION 3 PRACTISING PHARMACISTS 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 Online Consultation Tools The Online Choicebook : The Moving 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 closedended 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. Pharmacy Human Resources Challenges and Priorities 15

24 SECTION 3 PRACTISING PHARMACISTS 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 Canadian Pharmacists Association

25 SECTION 3 PRACTISING PHARMACISTS 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 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. Tell us about your experience with one area of responsibility of the new role for pharmacists. Tell us about an experience where you felt you lacked the necessary training to carry out your responsibilities Ideas 29 What do you think is required to get buy-in from pharmacists for an expanded role for pharmacists? What do you think is required to get buy-in from physicians for an expanded role for pharmacists? How should the reimbursement model change to ensure pharmacists are adequately compensated in a new role? What would need to change for you, in order to free up the time necessary to deliver services in the new role? 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 Pharmacy Human Resources Challenges and Priorities 17

26 SECTION 3 PRACTISING PHARMACISTS 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 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 Age Percentage < n= 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 Gender Percentage (%) Male 39.5 Female 60.5 n= 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 Census, Statistics Canada Canadian Pharmacists Association

27 SECTION 3 PRACTISING PHARMACISTS Table 3-4: Level of Education of Pharmacists Participating in the Online Consultation 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) Additional Training n=936 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 Additional training/certification Percentage (%) None 44.1 Fellowship 2.9 Specialty certification 10.0 Pharmacy board certification (USA) 5.2 Other 8.5 n= 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-topractice degree in the USA (2.0%) or in another country (3.6%). Pharmacy Human Resources Challenges and Priorities 19

28 SECTION 3 PRACTISING PHARMACISTS Table 3-6: Location of Completion of Entry-to-Practice Degree of Pharmacists Participating in the Online Consultation 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 n=884 Please note there are currently no known faculties of pharmacy in the provinces of New Brunswick or Prince Edward Island 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 Canadian Pharmacists Association

29 SECTION 3 PRACTISING PHARMACISTS Table 3-7: Primary Practice Setting 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 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%). 3 However, 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) 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 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 3 National Association of Pharmacy Regulatory Authorities. National Statistics. [Online] 2008 [cited March 2008]; Pharmacy Human Resources Challenges and Priorities 21

30 SECTION 3 PRACTISING PHARMACISTS 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 Employee type Percentage (%) Staff pharmacist 53.1 Manager/director 23.0 Owner 8.4 Self-employed 3.1 Not currently employed 2.4 Other 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 Years in practice Percentage (%) <5 years years 2.3 n=917 n=887 4 Canadian Institute for Health Information, Workforce Trends of Pharmacists for Selected Provinces and Territories in Canada, 2006 (Ottawa: CIHI, 2007) Canadian Pharmacists Association

31 SECTION 3 PRACTISING PHARMACISTS 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 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 A comparison of these findings to the national pharmacists licensure statistics maintained by NAPRA indicates that this research study sample was likely significantly underrepresented 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%) 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. 5 National Association of Pharmacy Regulatory Authorities. National Statistics. [Online] 2008 [cited March 2008]; Pharmacy Human Resources Challenges and Priorities 23

32 SECTION 3 PRACTISING PHARMACISTS Table 3-12: Size of City of Practice of Pharmacists Participating in the Online Consultation Size of city where practising Percentage (%) Small centre/rural area 15.6 Small city (10,000-99,999) 21.4 City (100, ,999) 36.3 Large city (>1,000,000) (suburban) 12.7 Large city (>1,000,000) (core neighbourhood) 14.0 n= 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 Canadian Pharmacists Association

33 SECTION 3 PRACTISING PHARMACISTS Table 3-13: Time Allocation of Pharmacists Participating in the Online Consultation % of Responding Pharmacists: How much of your time is spent performing the following work related activities? Technical (non-clinical) tasks related to dispensing/distribution Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies) Almost all About three quarters About half About one quarter Less than one quarter None Direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds) Third party payer/billing and related administrative matters Communicating with or advising other health professionals Supervising pharmacy staff/ managerial tasks Research/quality improvement projects Teaching/mentoring [Participating in] continuing education/professional development Other: please specify n=884 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%) Pharmacy Human Resources Challenges and Priorities 25

34 SECTION 3 PRACTISING PHARMACISTS 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 Canadian Pharmacists Association

35 SECTION 3 PRACTISING PHARMACISTS 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 Based on the amount of time you spend on each, how satisfied are you with performing the following activities? Technical (non-clinical) tasks related to dispensing/distribution Clinical tasks related to dispensing (e.g., patient counselling, screening for drug interactions, proper doses, contraindications, allergies) N/A (Do not perform) Percentage (%) of Responding Participants: Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Direct patient care not related to dispensing (e.g., clinical programs, patient self-care, medication reviews, attending rounds) Third party payer/billing and related administrative matters Communicating with or advising other health professionals Supervising pharmacy staff/ managerial tasks Research/quality improvement projects Teaching/mentoring [Participating in] continuing education/professional development Other: please specify n=884 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%) Pharmacy Human Resources Challenges and Priorities 27

36 SECTION 3 PRACTISING PHARMACISTS 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 satisfying, compared to more than 65% among those with 30 to 39 years experience Canadian Pharmacists Association

37 SECTION 3 PRACTISING PHARMACISTS I had been working with an elderly lady for almost 6 months, helping her to understand the affect of overuse of her inhalers, how she could change her lifestyle, and the fact that we could help her achieve a greater state of health. She always had an excuse for her inhaler usage, usually involving her extended family of asthmatics. I called her and offered to counsel her family on the facts of asthma (I prefer to call it irritable lungs ) on my day off as they only seemed available on the weekends. We had a long conversation about her lung health and at the end she said Oh all right and hung up. I wondered if I had lost a client. I next saw her a month later; I did not hear her wheezing up to my counter and when I looked up she had a smile on her face and her complexion was pink not grey! She told me she had given up smoking the moment she had gotten off the phone with me it was hard but she was now able to do activities she had thought beyond her for the past few years. It was only recently that she told me that she quit because she felt that if I cared so much about her health, maybe she should too! A story submission from an online participant A regular delivery customer of over 20 years is put on insulin for the first time, at the age of 80. She called one morning around 9am, quite upset because she had been up for a couple of hours but was afraid to eat breakfast because she couldn t figure out how to give herself her insulin. Fortunately I was working in a store that had pharmacist overlap at the time. I asked her to test her blood glucose for me right away. After discussing the result, I told her to eat her breakfast and that I would be over in 1 hour, after my second pharmacist arrived. At her house, I asked her to show me what she knew about her insulin pen, helped her understand what to do, and watched her inject her dose. We chatted over the next 45 minutes, both about personal issues and how to troubleshoot her insulin pen. She tested her blood glucose again, then I headed back to the store. I followed up with her before I left at suppertime to make sure she could inject her evening dose. Between myself and another pharmacist, we made 4 trips to her house in 2 weeks, but she finally grasped what she was doing. To date, that was the most rewarding experience in my practice. A story submission from an online participant 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 are noted. Pharmacy Human Resources Challenges and Priorities 29

38 SECTION 3 PRACTISING PHARMACISTS a) Pharmacists sense that there is an urgency to change what they are currently doing and to begin taking on new responsibilities The majority (62.5%) of participants agreed that there is an urgent need to take on new responsibilities. However this belief is not unanimous. Nearly 20% of respondents either disagreed or strongly disagreed with the statement, and a further portion was neutral. Table 3-15: Perceived Urgent Need to Take On New Responsibilities (%) Disagree Disagree Neutral Agree Agree Not Sure Pharmacists sense that there is an urgency to change what they are currently doing and to begin taking on new responsibilities (n = 833) 1.6% 17.6% 16.4% 43.8% 18.7% 1.8% b) Practising pharmacists are not prepared to take on [an] expanded role Almost 44% of participants disagreed with this statement, likely indicating that they are ready to take on an expanded role. However, about one-quarter (25.6%) believe they are not prepared for this and a similar percentage (24.2%) are neutral. This suggests a level of disagreement among participants on whether members of the profession are ready for the new role. Table 3-16: Practising Pharmacists Preparedness to Take On Expanded Role (%) Disagree Disagree Neutral Agree Agree Not Sure Practising pharmacists are not prepared to take on [an] expanded role (n = 833) 5.9% 37.6% 24.2% 25.6% 3.0% 3.7% c) New pharmacy graduates are not prepared to take on [an] expanded role A significant majority (69.2%) of participants disagreed with the statement, indicating that they believe new graduates to be prepared for [an] expanded role. Table 3-17: New Graduates Preparedness to Take On New Responsibilities (%) Disagree Disagree Neutral Agree Agree Not Sure New pharmacy graduates are not prepared to take on [an] expanded role (n = 833) 22.3% 46.9% 13.9% 8.9% 3.1% 4.9% d) Current continuing education programs are capable of preparing and supporting practising pharmacists for [an] expanded role Participants differed considerably in their responses to this statement. Similar numbers agreed and disagreed, presenting a fragmented set of opinions Canadian Pharmacists Association

39 SECTION 3 PRACTISING PHARMACISTS Table 3-18: Continuing Education Programs Capability to Prepare and Support Pharmacists Expanded Role (%) Current continuing education programs are capable of preparing and supporting practising pharmacists for [an] expanded role (n = 835) Disagree Disagree Neutral Agree Agree Not Sure 5.3% 31.6% 17.2% 31.3% 9.9% 4.7% Participants working in independent pharmacies agreed more strongly with the statement than those in other practice settings. Sixteen percent strongly agreed, compared with less than 10% in the three other practice settings. e) If pharmacists were not involved with the technical acts of dispensing, they would have the time to take on [an] expanded role A large majority of participants (88.1%) believe they would have the time to take on an expanded role if they were not involved with the technical acts of dispensing. Table 3-19: Time for Expanded Role Possible Without Dispensing Tasks (%) If pharmacists were not involved with the technical acts of dispensing, they would have the time to take on [an] expanded role (n = 836) Disagree Disagree Neutral Agree Agree Not Sure 0.8% 3.6% 6.3% 47.2% 40.9% 1.1% The majority of participants who disagreed work in independent pharmacy settings. Of those in independent pharmacies, almost 10% either strongly disagreed or disagreed. For other practice settings, this figure was less than 3%. f) [An] expanded role for pharmacists will not be offered extensively without new and flexible reimbursement models A large majority (85.6%) believed an expanded role for pharmacists will not be offered without new and flexible reimbursement models. Table 3-20: Expanded Role Not Offered Without Changed Reimbursement Models (%) [An] expanded role for pharmacists will not be offered extensively without new and flexible reimbursement models (n = 834) Disagree Disagree Neutral Agree Agree Not Sure 0.4% 3.0% 7.7% 37.4% 48.2% 3.4% g) Technology will make it easier for pharmacists to find the time to take on [an] expanded role Almost three-quarters (71.4%) of participants agreed that technology is a key enabler for pharmacists to be able to take on an expanded role. Pharmacy Human Resources Challenges and Priorities 31

40 SECTION 3 PRACTISING PHARMACISTS Table 3-21: Technology Will Make Expanded Role Easier (%) Technology will make it easier for pharmacists to find the time to take on [an] expanded role (n = 829) Disagree Disagree Neutral Agree Agree Not Sure 1.2% 10.3% 15.0% 51.7% 19.7% 2.2% Participants working in hospital pharmacies supported technology even more strongly than those in other practice settings. h) There will not be enough pharmacists to take on [an] expanded role if there has to be a pharmacist physically in every pharmacy for every minute that the pharmacy is open Participants disagreed about whether there will be enough pharmacists if one is always required to be present in a pharmacy during business hours. Almost half (47.2%) either strongly agreed or agreed with the statement, illustrating concerns about the future supply of pharmacists. In contrast, around one-third (33.7%) strongly disagreed or disagreed. Table 3-22: Shortage for Expanded Role if Pharmacist Presence Required to Cover all Pharmacy Hours (%) Disagree Disagree Neutral Agree Agree Not Sure There will not be enough pharmacists to take on [an] expanded role if there has to be a pharmacist physically in every pharmacy for every minute that the pharmacy is open (n = 826) 7.9% 25.8% 13.3% 32.2% 15.0% 5.8% i) Physicians are reluctant to work with pharmacists in an expanded role There is a perception among many participants that physicians will not be supportive of pharmacists playing an expanded role in the future. Almost half (48.0%) think physicians would be reluctant to work with pharmacists in an expanded role. Around one-quarter (25.6%) disagrees and almost another quarter (24.3%) is either neutral or not sure. Table 3-23: Physician Reluctance Towards Pharmacists Expanded Role (%) Physicians are reluctant to work with pharmacists in an expanded role (n = 831) Disagree Disagree Neutral Agree Agree Not Sure 2.0% 25.6% 18.8% 35.5% 12.5% 5.5% Hospital respondents agreed with the statement less strongly than participants from other practice settings: 38% of hospital pharmacists strongly disagreed or disagreed. In contrast, only 10% of those in chain pharmacies grocery and mass merchandisers and 19% in drug store formats felt the same way Canadian Pharmacists Association

41 SECTION 3 PRACTISING PHARMACISTS j) Canadians are not willing to use the services of pharmacists in an expanded role On the other hand, participants believed strongly that Canadians are ready for pharmacists to take on an expanded role over three-quarters (78.6%) felt Canadians would be willing to use their services in an expanded role. Table 3-24: Canadians Willingness to Use Pharmacists in Expanded Role (%) Canadians are not willing to use the services of pharmacists in an expanded role (n = 829) Disagree Disagree Neutral Agree Agree Not Sure 17.7% 60.9% 9.0% 6.8% 1.8% 3.7% Despite this strong consensus, participants in chain pharmacies grocery and mass merchandiser settings felt less strongly that the public would accept this expanded role. Twenty-one percent agreed or strongly agreed that Canadians are not willing to use the expanded services, compared to 5% of hospital pharmacists and 12% of those in independent pharmacies. k) Taking on [an] expanded role will lead to pharmacists who are more satisfied with their careers A large majority of participants (88.4%) responded that an expanded role will make them more satisfied with their careers. Over half (53.1%) strongly agreed with this statement. Table 3-25: Expanded Role Leading to More Career Satisfaction (%) Taking on [an] expanded role will lead to pharmacists who are more satisfied with their careers (n = 830) Disagree Disagree Neutral Agree Agree Not Sure.6% 2.3% 6.6% 35.3% 53.1% 2.0% l) In [an] expanded role there will be far fewer pharmacists needed to work directly within community pharmacies Half the participants (49.9%) did not believe that there will be far fewer pharmacists needed to work directly within community pharmacies in an expanded role. Table 3-26: Expanded Role Requiring Fewer Pharmacists (%) In [an] expanded role there will be far fewer pharmacists needed to work directly within community pharmacies (n = 828) Disagree Disagree Neutral Agree Agree Not Sure 10.9% 39.0% 16.8% 17.4% 5.9% 10.0% Pharmacy Human Resources Challenges and Priorities 33

42 SECTION 3 PRACTISING PHARMACISTS 3.5 Workplace Implications of Expanded and Innovative Pharmacy Roles The main section of the online Choicebook introduced participants to Moving Forward s expected vision for the future of pharmacy (adapted from the Blueprint) and its expanded and innovative roles. This section presented five expanded and innovative roles in the new vision as follows: Drug therapy management: In the future, pharmacists will spend more time managing drug therapy in collaboration with patients, physicians and other health providers. In doing so, they will closely follow patients medical/drug history, responses to treatment and make recommendations on changes to therapy to improve health outcomes. Public health outreach: In the coming years, pharmacists will play a prominent role in health promotion, disease prevention and chronic disease management. They will actively engage in their communities to improve population health. This may take the form of public immunization programs, group education sessions in the community, smoking cessation clinics, screening clinics for cardiac risk factors, promotion of healthy lifestyles, emergency preparedness and responding to public health emergencies. Prescribing and monitoring authority: In their new role, pharmacists will have greater responsibility and authority for making prescribing decisions and monitoring drug therapy outcomes in collaboration with other health care providers. This will involve initiating and modifying therapy, as well as ordering and performing diagnostic tests. This will also involve taking responsibility for any changes the pharmacist makes to a patient s medication regimen, following up to ensure the change was successful, and communicating the changes with other health care providers (e.g., the family doctor). Self-care patient support: Pharmacists will continue to support patient self-care. Pharmacists will continue to be accessible to the public in a timely manner for advice and consultation regarding the self-management of mild self-limiting conditions such as coughs and colds, fevers, constipation, emergency contraception, etc. However, in the future pharmacists will help patients to independently manage a much larger number of more complex medical conditions that do not require the immediate attention of a physician. Dispensing leadership: Pharmacists will retain responsibility for directing and supervising the safe distribution of pharmaceuticals. However, in the future, they will focus more on the clinical tasks related to dispensing prescriptions (e.g., checking doses, drug interactions, contraindications, allergies, appropriateness of drug selection and patient counselling) and entrust the technical aspects of dispensing to regulated pharmacy technicians. Participants were provided with basic context-setting information on each of these roles, as well as more advanced analysis through a variety of points-of-view on how each role would affect the pharmacy workforce. After this introductory material was presented, participants were asked to respond to a common set of statements about each of the roles. The first group of questions asked participants to assess the impact that each role would have on pharmacists workload, liability, stress and job satisfaction. The second group of Canadian Pharmacists Association

43 SECTION 3 PRACTISING PHARMACISTS questions asked participants to examine broader issues of each role, including the need for education and training, stakeholder acceptance and practice setting setup HR Implications of Innovative and Expanded Roles (By Role) Overall, participants indicated they are ready for the new vision for pharmacy and ready to take on expanded and innovative roles to make better use of their skills and to improve patient health outcomes. Participants felt each expanded role would lead to an increase in workload and liability, but more importantly, to an increase in job satisfaction. A significant majority felt they will be performing these roles in the next five years, and want to be doing so. Participants felt strongly that the public is ready to accept pharmacists performing these expanded and innovative roles. Fewer respondents felt that physicians are ready to work with pharmacists in expanded and innovative roles. Most participants felt their employers will support and encourage them to assume the expanded and innovative roles but that there is a need for changes to current payment models to make this viable. Detailed percentages for each issue relating to each innovative and expanded role are presented in the following sections. You only have to look at pharmacy in the UK to see what pharmacists are capable of achieving. Around 1998 I started working with physicians as a prescribing support pharmacist. Initially I mainly performed medication reviews. This progressed on to clinical audits, formulary development, prescribing cost analysis, new drug reviews, domicillary visits, chronic disease management discussions, training clinic staff etc. Pharmacists were then given supplementary prescribing rights as were nurses. Supplementary prescribing then changed to independent prescribing rights and now UK pharmacists are present in virtually ALL physicians clinics and are an accepted part of the healthcare team Since moving to Canada, I feel like a pharmacy technician rather than a pharmacist. It is very frustrating and in many respects is a professional step backwards by about 5 years. There is no reason why Canadian pharmacists cannot do all these fulfilling roles too. A story submission from an online participant I work in a town of 700 people with two doctors and one pharmacist. The opportunities to collaborate are far more numerous than any other location I have worked in. The doctors are very open to collaboration as they are on call 24/7 so anything I can do to help is very well received. Far more so than in a center with many doctors where some are open to ideas and other are not. Selling these small town opportunities is important to new grads of any health care profession. We have actually participated in a provincial collaborative now if we could just figure out how to get paid for the time contributed all would be well. A story submission from an online participant Pharmacy Human Resources Challenges and Priorities 35

44 SECTION 3 PRACTISING PHARMACISTS Participant responses indicated broad support for an expanded drug therapy management role. The large majority stated that this role would lead to an increase in workload (81.4%) and liability (82.4%), but also an increase in job satisfaction (88.1%). Comparatively fewer participants (51.1%) felt this role would lead to an increase in stress. Table 3-27: Participating Pharmacists Expectations Relating to an Expanded Role in Drug Therapy Management (%) Disagree Disagree Neutral Agree Agree An increase in workload (n = 807) An increase in liability (n = 807) An increase in your level of stress (n = 807) An increase in job satisfaction (n = 806) Not Sure We have been struggling to achieve a sustainable INR testing service in our small town pharmacy. We can only test at present, not advise in conjunction with a physician s plan; and yet we are finding physicians and clients who view this activity as a wonderful professional service. We have also been able to help physicians see it as a tool for patients to use for in home testing when their mobility is severely restricted. We now have regular clients that appreciate the convenience, speed of reporting to their physician, lack of exposure to Hospital Bugs and the fact that it is a finger prick and not a venous puncture. In fact we have one client who has such venous scarring that this is his preferred route of testing! The next step in Nova Scotia is to get the physicians on board for collaborative management with the pharmacist in direct dialogue with the client. We look forward to expanding our role in this area of health management. A story submission from an online participant b) Public Health Outreach The results for public health outreach were similar to those for drug therapy management. The large majority of participants stated that this role would lead to an increase in workload (80.7%) and liability (64.5%). They also felt this would create an increase in job satisfaction (80.8%), though support for this was slightly lower than for drug therapy management. Fewer participants felt this role would lead to an increase in stress (46.8%). Table 3-28: Participating Pharmacists Expectations Relating to an Expanded Role in Public Health Outreach (%) Disagree Disagree Neutral Agree Agree An increase in workload (n = 777) An increase in liability (n = 776) An increase in your level of stress (n = 773) An increase in job satisfaction (n = 775) Not Sure Participants from independent pharmacy settings indicated a public health outreach role would increase stress more than participants from other practice settings, especially hospital pharmacy. Fifty-seven percent of those in independent pharmacies agreed or strongly Canadian Pharmacists Association

45 SECTION 3 PRACTISING PHARMACISTS agreed that the role would lead to an increase in stress, compared to 40% of hospital pharmacists. Time is always a limiting factor, but I try to get out to a local senior s complex 2 to 3 times per year to discuss health issues with 20 to 30 seniors at a time. My current goal is to get back within the next month to spend about 1 hour with them talking about depression, how to prevent the winter blues etc. It is very rewarding. My boss covers my shift, then pays me as if I was dispensing during that time. I am always well-received and the project is coordinated by a nurse. A story submission from an online participant c) Prescribing and Monitoring Authority Participants responded positively to an expanded prescribing and monitoring authority role. A large majority responded that it would lead to an increase in job satisfaction (86.5%). Most (92.4%) felt this role would lead to an increase in liability, and many (65.7%) also felt it would increase the level of stress. The prescribing and monitoring authority role ranked highest in these three attributes (job satisfaction, liability and stress) of all the roles presented in this section of the Choicebook. Table 3-29: Participating Pharmacists Expectations Relating to an Expanded Role in Prescribing and Monitoring Authority (%) Disagree Disagree Neutral Agree Agree Not Sure An increase in workload (n = 762) An increase in liability (n = 763) An increase in your level of stress (n = 762) An increase in job satisfaction (n = 762) Participants with fewer years in practice felt more strongly that prescribing and monitoring authority would lead to greater stress. Seventy-one percent of respondents with less than five years in practice strongly agreed or agreed that the role would increase stress, compared to 59% of those with 20 to 29 years experience. Participants in chain pharmacies grocery and mass merchandisers felt more strongly than those in other practice settings that prescribing and monitoring will increase stress. Eighty-nine percent strongly agreed or agreed that stress would increase, in comparison to 63% of participants from hospital pharmacy. d) Self-Care Patient Support Compared to other elements of the new vision for pharmacy, fewer participants stated that self-care patient support will lead to an increase in workload (65.5%) and liability (61.9%). At the same time a relatively higher number of participants suggested it would increase their job satisfaction (79.0%). Furthermore, there was no clear indication about whether performing an extended self-care patient support role would increase stress for pharmacists. Pharmacy Human Resources Challenges and Priorities 37

46 SECTION 3 PRACTISING PHARMACISTS Table 3-30: Participating Pharmacists Expectations Relating to an Expanded Role in Self-Care Patient Support (%) Disagree Disagree Neutral Agree Agree An increase in workload (n = 750) An increase in liability (n = 750) An increase in your level of stress (n = 747) An increase in job satisfaction (n = 749) Not Sure Hospital pharmacy participants felt less strongly that self-care patient support would lead to an increase in their workload. Fifty-six percent of hospital pharmacists strongly agreed or agreed that the role would increase workload. This was lower than responses for other practice settings, such as chain pharmacies grocery and mass merchandisers, 84% of who strongly agreed or agreed. Hospital pharmacy participants also felt less strongly that self-care patient support would lead to an increase in stress. Thirty-three percent of participants in this setting strongly agreed or agreed the role would increase stress, in contrast with 62% of grocery and mass merchandisers. e) Dispensing Leadership Overall, participants differed in their responses to dispensing leadership. Significant numbers of respondents both agreed and disagreed with the statements that the role would lead to increases in workload, liability and stress. There was higher level of agreement that dispensing leadership would increase job satisfaction (71.3%). Table 3-31: Participating Pharmacists Expectations Relating to an Expanded Role in Dispensing Leadership (%) Disagree Disagree Neutral Agree Agree An increase in workload (n = 740) An increase in liability (n = 740) An increase in your level of stress (n = 740) An increase in job satisfaction (n = 740) Not Sure Hospital pharmacy participants agreed less strongly than those in other practice settings that dispensing leadership would lead to an increase in workload. Nineteen percent of hospital pharmacists strongly agreed or agreed, in contrast to 39% of those in chain pharmacies drug store format and 35% of grocery and mass merchandisers. Hospital pharmacy participants also felt less strongly that dispensing leadership would lead to an increase in liability. Thirty-two percent strongly agreed or agreed, compared to higher levels in other practice settings: 54% in chain pharmacies drug store format and 50% in independent pharmacies Canadian Pharmacists Association

47 SECTION 3 PRACTISING PHARMACISTS Participants from different practice settings also differed on responses to the role s impact on stress. Hospital pharmacy participants felt less strongly that it would increase stress, with 23% responding strongly agree or agree. In contrast, 53% of grocery and mass merchandiser participants provided the same responses Broader Implications of Expanded and Innovative Pharmacy Roles (Comparative Analysis) The second group of questions asked participants to examine a series of broader issues and HR implications of each role, by indicating their level of agreement or disagreement with a series of statements: I am currently performing this activity to some degree in my work. I expect to be performing this activity within the next five years. I want to be performing this activity within the next five years. I currently have the skills/competency required to take on this responsibility. [There is a] need for additional training/education. The training required to perform this activity is currently available. The public is ready to accept pharmacists performing this activity. Physicians are ready to work with pharmacists performing this activity. The setup of my practice site will make it difficult to perform this activity. My current payment model will need to change for me to perform this activity. I will need to spend much less time dispensing in order to perform this activity. My employer will support and encourage me to perform this activity. This section of the report examines participant responses to these statements across the five roles presented. a) I am currently performing this activity to some degree in my work Participants indicated that, overall, they are currently performing a number of the extended roles, in particular drug therapy management (73.6%) and dispensing leadership (68.4%). In contrast, more than 25% of participants indicated that they are not performing public health outreach or prescribing and monitoring. Table 3-32: Participating Pharmacists Responses on Extent of Current Performance of Expanded and Innovative Roles I am currently performing this activity to some degree in my work (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 803) Public health outreach (n = 774) Prescribing and monitoring authority (n = 762) Self-care patient support (n = 745) Dispensing leadership (n = 737) Pharmacy Human Resources Challenges and Priorities 39

48 SECTION 3 PRACTISING PHARMACISTS More participants in chain pharmacies drug store format indicated they are currently performing public health outreach than those in other practice settings, particularly grocery and mass merchandisers. Fifty-eight percent of respondents in drug store settings indicated they perform this task, compared to 37% of those in grocery and mass merchandiser settings. There are differences between types of practice setting in terms of the percentage of participants who currently perform prescribing and monitoring. More hospital pharmacy participants perform this task than their colleagues in other settings: 71% strongly agreed or agreed they perform this task, compared to 35% in grocery and mass merchandiser settings and 51% in independent pharmacies. Fewer hospital pharmacy participants indicated they currently perform self-care patient support in comparison to those in other practice settings. Forty-five percent of hospital pharmacists responded they currently do this, which is significantly less than participants in grocery and mass merchandiser (85%) and independent pharmacy (80%) settings. Fewer respondents in grocery and mass merchandiser settings indicated they are currently performing dispensing leadership than in other practice settings. Fifty-eight percent of participants from these settings carry this out, in contrast to 78% of hospital pharmacists and 72% of those in independent pharmacies. b) I expect to be performing this activity within the next five years Overall, participants expect to be performing all of the extended roles within the next five years. Large numbers expressed support (agreement levels for each role ranged from 66.0% to 79.7%), but of those, a large number did so by selecting agree rather then strongly agree. Slightly fewer participants stated that they expected to be performing public health outreach (66.0%) than performing the other four roles. Table 3-33: Participating Pharmacists Responses on Expectations of Future Performance of Expanded and Innovative Roles I expect to be performing this activity within the next five years (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 801) Public health outreach (n = 772) Prescribing and monitoring authority (n = 760) Self-care patient support (n = 741) Dispensing leadership (n = 734) A smaller number of grocery and mass merchandiser participants responded that they expect to be performing prescribing and monitoring in the next five years: 56% of pharmacists in this setting expect to be performing the role, compared to 76% of hospital pharmacists and 73% of those in drug store format settings Canadian Pharmacists Association

49 SECTION 3 PRACTISING PHARMACISTS Fewer hospital pharmacy participants felt they expected to provide self-care patient support in the next five years, compared to other practice settings. Only 53% said they expect to be doing so, versus 83% of respondents from independent pharmacies and 83% from grocery and mass merchandiser settings. c) I want to be performing this activity within the next five years A significantly high number of participants (ranging from 71.8% for dispensing leadership to 83.6% for drug therapy management) want be performing each extended role in the near future (during the next five years). Although small numbers said they do not want to do so, a moderate number of participants are still uncertain about whether they want to perform these roles. Table 3-34: Participating Pharmacists Responses on Desire to Perform Expanded and Innovative Roles I want to be performing this activity within the next five years (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 801) Public health outreach (n = 771) Prescribing and monitoring authority (n = 760) Self-care patient support (n = 744) Dispensing leadership (n = 734) Fewer hospital pharmacy participants want to be providing self-care patient support in the next five years than participants in other practice settings: 56% of hospital pharmacists want to be doing so, which is significantly less than the 85% of those in independent pharmacies and 87% in drug store settings who indicated they want to be doing it. d) I currently have the skills/competency required to take on this responsibility Participants felt more confident that they have the required skills/competencies for some of the extended roles than for others. A large number of participants responded that they have the skills for dispensing leadership (80.6%) and self-care patient support (71.0%). Fewer participants said they have the skills for public health outreach (56.7%) and prescribing and monitoring authority (51.7%). As a clinical pharmacist, I see that pharmacists can provide various services, such as contributing during clinical rounds, providing drug information, therapeutic drug monitoring and patient counseling and therapy monitoring. An idea submission from an online participant Pharmacy Human Resources Challenges and Priorities 41

50 SECTION 3 PRACTISING PHARMACISTS Table 3-35: Participating Pharmacists Responses on Possession of Required Skills for Expanded and Innovative Roles I currently have the skills/competency required to take on this responsibility (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 800) Public health outreach (n = 769) Prescribing and monitoring authority (n = 761) Self-care patient support (n = 745) Dispensing leadership (n = 735) Participants with more years in practice were less likely to indicate they have the required skills for drug therapy management than were pharmacists with less experience. Seventy-three percent of those in practice for less than 10 years, and 71% of those in practice for five to nine years, reported they have the skills for this extended role. However, only 49% of those with 30 to 39 years and 58% with 20 to 29 years in practice reported the same. More hospital pharmacy participants than those in other practice settings reported they had the required skills for drug therapy management. Seventy-five percent of hospital pharmacists believed they have the needed skills or competencies, whereas only 53% of respondents from independent pharmacy and 54% from drug store format settings have the same level of confidence. e) Need for additional training/education Despite the fact that many participants had previously indicated they had the required skills/competencies for the extended roles, participants suggested there was a need for additional training or education for a majority of the new roles. Participants felt most strongly that additional training or education was needed for prescribing and monitoring roles (89.2%), and for drug therapy management (88.4%). A smaller number of participants felt training or education was needed to provide self-care patient support (61.0%) and especially for dispensing leadership (36.2%). In fact, over 33% disagreed that they needed additional training or education for dispensing leadership. Table 3-36: Participating Pharmacists Responses on Need for Training to Perform Expanded and Innovative Roles There is a need for additional training/education Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 806) Public health outreach (n = 775) Prescribing and monitoring authority (n = 762) Self-care patient support (n = 747) Dispensing leadership (n = 739) Canadian Pharmacists Association

51 SECTION 3 PRACTISING PHARMACISTS Participants with fewer years in practice were less likely to report that providing self-care patient support required additional training or education than those with more years in practice. Forty-six percent of respondents with less than five years in practice said that training was necessary, compared to 68% of those with 20 to 29 years and 66% of those with 30 to 39 years experience. f) The training required to perform this activity is currently available Participants held varying views about whether training for each of the extended roles is currently available. A majority responded that training is available for dispensing leadership (66.0%) and for self-care patient support (65.5%). However, fewer participants considered it to be available for drug therapy management (45.9%), public health outreach (47.8%) and prescribing and monitoring (40.4%). Table 3-37: Participating Pharmacists Responses on Extent to Which Training for Expanded and Innovative Roles is Available The training required to perform this activity is currently available (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 804) Public health outreach (n = 772) Prescribing and monitoring authority (n = 763) Self-care patient support (n = 747) Dispensing leadership (n = 736) g) The public is ready to accept pharmacists performing this activity Participants suggested that the public is ready to accept pharmacists performing extended roles. More than 80% believed the public would accept them performing public health outreach and self-care patient support, and about three-quarters believed the public would be open to drug therapy management (76.8%) and dispensing leadership roles (76.9%). Finally, 68.7% indicated the public would accept them performing prescribing and monitoring authority. Table 3-38: Participating Pharmacists Responses on Perceived Public Acceptance of Pharmacists Performing Expanded and Innovative Roles The public is ready to accept pharmacists performing this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 803) Public health outreach (n = 772) Prescribing and monitoring authority (n = 764) Self-care patient support (n = 747) Dispensing leadership (n = 736) Pharmacy Human Resources Challenges and Priorities 43

52 SECTION 3 PRACTISING PHARMACISTS Participants from grocery and mass merchandiser settings were less certain that the public will accept them performing an extended drug therapy management role. Fifty-nine percent of these respondents thought the public would be ready compared to 80% of hospital pharmacy and 76% of drug store participants. Less-experienced participants were less confident that the public would be ready to accept them in an extended prescribing and monitoring role. Sixty percent of pharmacists with less than five years in practice feel the public is ready, compared to 79% of those with 20 to 29 years and 81% of those with 30 to 39 years in practice. h) Physicians are ready to work with pharmacists performing this activity In comparison to public acceptance, participants were less certain that physicians would accept them performing extended roles in pharmacy. In particular, participants felt that physicians were not ready to work with pharmacists in the areas of drug therapy management (33.4%) and prescribing or monitoring (22.0%). Perceived physician resistance was evident across all five roles, with the least resistance in the area of dispensing leadership (56.8% agreeing with the statement). Table 3-39: Participating Pharmacists Responses on Perceived Physician Acceptance of Pharmacists Performing Expanded and Innovative Roles Physicians are ready to work with pharmacists performing this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 805) Public health outreach (n = 772) Prescribing and monitoring authority (n = 763) Self-care patient support (n = 735) Dispensing leadership (n = 785) The pharmacist is best to prove themselves to physicians by being a reliable source of drug information and about patient care. An idea submission from an online participant Pharmacists also have to demonstrate a knowledge base beyond that of shopkeepers. An idea submission from an online participant Across all the extended roles, hospital pharmacy participants were more confident that physicians would accept working with pharmacists. For example, 49% of hospital pharmacists responded that physicians would work with pharmacists on drug therapy management, but only 23% of respondents in independent pharmacies and 13% in grocery and mass merchandisers felt the same way. However, even with this typically high level of support, not even hospital pharmacy participants were confident that physicians would accept working with pharmacists on prescribing and monitoring. For this role, hospital pharmacy participants demonstrated the same lower confidence as participants from other practice settings Canadian Pharmacists Association

53 SECTION 3 PRACTISING PHARMACISTS With a complete diagnosis and related information such as lab reports, the pharmacist will be prepared to collaborate with the physician to better help the individual patient with medicines. This will free up the physician s time to concentrate on the patient s needs without the need to also be a specialist in medications. An idea submission from an online participant i) The setup of my practice site will make it difficult to perform this activity The data shows a divergence of views on whether the setup of a pharmacy practice site will make it difficult to perform each of the extended roles. Responses were fairly evenly spread from strongly disagree to strongly agree. Table 3-40: Participating Pharmacists Responses on Suitability of Current Practice Site for Expanded and Innovative Roles The set-up of my practice site will make it difficult to perform this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 803) Public health outreach (n = 770) Prescribing and monitoring authority (n = 760) Self-care patient support (n = 744) Dispensing leadership (n = 731) Participants in the various practice settings held different views on whether the setup of their sites would make it difficult to perform drug therapy management. Only 19% of hospital pharmacy participants felt it would be difficult, compared to 87% of respondents from grocery and mass merchandiser and 64% of those from drug store settings. A similar spread in views appeared for public health outreach. Fewer hospital pharmacy participants (42%) and those in independent pharmacies (42%) stated that the setup of their practice site would make it difficult to perform public health outreach, than did respondents from other practice settings, such as grocery and mass merchandiser (77%). Similarly, only 22% of hospital pharmacy participants responded that their practice setup will make it difficult to perform prescribing and monitoring, compared to 72% of those in grocery and mass merchandiser and 46% in drug store and independent pharmacy settings. Finally, 20% of hospital pharmacy participants and 27% of respondents in independent pharmacies indicated that their practice setup would make it difficult to provide dispensing leadership, which was notably higher than for grocery and mass merchandiser (48%) and drug store (41%) settings. Pharmacy Human Resources Challenges and Priorities 45

54 SECTION 3 PRACTISING PHARMACISTS j) My current payment model will need to change for me to perform this activity A majority of participants indicated that their current payment models for four of the extended roles would need to change: drug therapy management (60.5%), public health outreach (64.9%), prescribing and monitoring (64.9%), and self-care patient support (54.1%). There was greater disagreement about whether the payment model would need to change to perform the dispensing leadership role (36.7% agreeing). Table 3-41: Participating Pharmacists Responses on Payment Models to Perform Expanded and Innovative Roles My current payment model will need to change for me to perform this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 802) Public health outreach (n = 770) Prescribing and monitoring authority (n = 758) Self-care patient support (n = 744) Dispensing leadership (n = 732) Compared to those in other practice settings, hospital pharmacy participants felt less strongly that their payment models would need to change to perform drug therapy management. Only 26% of hospital participants said these models would need to change, compared to 94% of those in independent pharmacies, 87% in drug stores and 89% in grocery and mass merchandiser settings. Similarly, hospital pharmacy participants felt less strongly that their models would need to change to perform public health outreach. Forty-one percent of participants in this setting saw a need for change compared to significantly higher numbers in other practice settings: 91% in grocery and mass merchandiser and 88% in independent pharmacy settings. Under prescribing and monitoring authority, 36% of hospital pharmacy participants saw a need for change in payment models compared to 98% of those in grocery and mass merchandiser and 91% in independent pharmacy settings. Similar differences between hospital pharmacy participants and respondents from other settings were apparent for self-care patient support and dispensing leadership. In order for the many owners of retail pharmacies to fully embrace a new or different delivery service model we will need to be comfortable with the new, adjusting revenue streams. An idea submission from an online participant Reimbursement must be done by paying pharmacists for consultations. A physician can get a fee just by checking blood pressure, but we can t ask for a fee for a half hour smoking cessation consultation. An idea submission from an online participant Canadian Pharmacists Association

55 SECTION 3 PRACTISING PHARMACISTS The reimbursement model must allow pharmacists to charge for the services provided. The pharmacy must be financially profitable at the end of the day. Thus the pharmacist cannot spend a lot of time each day doing things for which there is no reimbursement. An idea submission from an online participant k) I will need to spend much less time dispensing in order to perform this activity Overall, participants agreed that they would need to spend less time performing dispensing tasks in order to perform the expanded and innovative roles outlined in the new vision for pharmacy. Agreement was lowest for the role of dispending leadership (58.7%). Table 3-42: Participating Pharmacists Responses on Impact of Dispensing on Innovative and Expanded Roles The set-up of my practice site will make it difficult to perform this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 797) Public health outreach (n = 766) Prescribing and monitoring authority (n = 755) Self-care patient support (n = 741) Dispensing leadership (n = 735) Hospital pharmacy participants felt less strongly that they would need to spend less time dispensing to perform drug therapy management than those who responded from other practice settings. Seventy-two percent of hospital participants said they would have to spend less time dispensing compared to 98% of those in grocery and mass merchandiser and 90% of those in drug store settings. I have worked with some technicians who are super stars now. They care for the patients and recognize the benefit to the patient of having them spend quality time with the pharmacist. The super star technicians run the dispensary, problem solve in the areas of workflow, billing, automated dispensing technology etc., and also assist with recognition of patients in need and potential therapeutic issues. An idea submission from an online participant I see the potential to have well-trained technicians, prepared for expanded roles and more responsibilities. An idea submission from an online participant l) My employer will support and encourage me to perform this activity More than half of participants (ranging from 53.3% to 66.6%) responded that their employer would support and encourage them to perform each of the expanded and innovative pharmacy roles. Further, less than 15% suggested that their employer would not support them in any of the expanded and innovative roles. Pharmacy Human Resources Challenges and Priorities 47

56 SECTION 3 PRACTISING PHARMACISTS Table 3-43: Participating Pharmacists Responses on Perceived Employer Support for Expanded and Innovative Roles My employer will support and encourage me to perform this activity (%) Disagree Disagree Neutral Agree Agree Not Sure Drug therapy management (n = 801) Public health outreach (n = 769) Prescribing and monitoring authority (n = 756) Self-care patient support (n = 740) Dispensing leadership (n = 731) Hospital pharmacy participants and those in independent pharmacies felt more strongly that their employers would encourage them to assume extended roles in comparison to other practice settings. In particular more hospital participants indicated they felt their employers would be supportive of them performing drug therapy management and prescribing and monitoring. Participants from independent pharmacies felt stronger that their employers would encourage them to perform public health outreach, self-care patient support and dispensing leadership. Participants in the other practice settings chain pharmacies in drug store, grocery and mass merchandiser formats felt that their employers would be significantly less supportive of them playing any of the expanded roles. However, a majority of participants in these practice settings did feel that their employers would support them providing self-care patient support and dispensing leadership, though not to the degree of hospital and independent pharmacies. My employer currently encourages me to spend approximately half of my time at the local medical clinic where I do chart reviews and am accessible to the physicians for consults, drug information, etc. The physicians and nurse practitioner are very supportive of the expanded role that I am playing and they utilize me and my knowledge on a regular basis. A story submission from an online participant 3.6 Technology Requirements In addition to the focus on the five expanded and innovative roles of the new vision for pharmacy, the online Choicebook contained a section on technology. Questions in this section sought to determine the degree to which technology is being used in the profession and which tools pharmacists believe will be most important in the future. This section provides an overview of participant responses to questions on a series of topics: Tools currently used by pharmacists In focus: electronic health records In focus: automated dispensing machines Most important technologies for the future Canadian Pharmacists Association

57 SECTION 3 PRACTISING PHARMACISTS Information and Communication Tools Currently Used A high proportion of participants (more than 75%) indicated they currently have access to key tools for effective pharmacy practice, including access to the Internet and electronic medical/drug information databases at their practice sites. Nonetheless, there are still a significant number of participants (~20% to 25%) who indicated they lack access to these technologies in their workplaces. Table 3-44: Information and Communications Technologies Currently Used What technologies do you currently use in delivering pharmacy services? % (Yes) Do you have unrestricted access to the Internet in your practice site? (n = 742) 75.9 Do you have access to electronic medical/drug information databases in your practice site? (n = 740) 81.4 Do you have access to continuing education programs online? (n = 733) 87.2 Further analysis of the data shows significant differences in technology access across practice settings. Participants in both independent pharmacies (95%) and hospital pharmacies (88%) indicated they have unrestricted access to the Internet. In contrast, only 38% of those in grocery and mass merchandiser and 42% in drug store practice settings indicated they have the same access. There are also differences regarding access to medical/drug information databases, though not as significant as for Internet access. Nearly all hospital pharmacy participants have access to these databases (98%), whereas fewer respondents indicated they had database access in other practice settings: 64% in drug stores, 71% in independent pharmacies and 72% in grocery and mass merchandisers. Differences were also seen in overall access to dispensing software that allows pharmacists to document various characteristics about their patients. Almost all participants (93.7%) indicated they use dispensing software in which they can document drug allergies and previous medical intolerances (82.9%). Significantly fewer indicated that they have software that can capture height and weight (68.6%) and lists of diagnoses (61.6%), both of which are important if pharmacists are going to assume responsibility for extended roles such as drug therapy management or prescribing and monitoring. Barely half of the participants responded that they can store and access lab values (51.5%), over-the-counter (OTC) drug and herbal use (51.2%) and progress notes (50.8%), and less than half can store notes on kidney function (49.9%). Pharmacy Human Resources Challenges and Priorities 49

58 SECTION 3 PRACTISING PHARMACISTS Table 3-45: Documenting Functions of Dispensing Technologies Currently Used What technologies do you currently use in delivering pharmacy services? Does your dispensing software allow you to document for individual patients (select all that apply): (n = 748) % (Yes) Drug allergies 93.7 Previous medication intolerances 82.9 Height and weight 68.6 List of diagnoses 61.6 Lab values 51.5 OTC drug and herbal usage 51.2 Progress notes 50.8 Kidney function 49.9 Important differences in software capability exist across practice settings: 76% of respondents from hospital pharmacies indicated they can store and access lab values, compared to 28% in grocery and mass merchandisers, 30% in drug stores and 51% in independent pharmacy settings. Similarly, 82% of hospital pharmacy participants answered that they can store notes on kidney function, versus only 20% of those in grocery and mass merchandiser, 26% in drug store and 38% in independent pharmacy settings. Furthermore, hospital participants also indicated they have significantly greater access to notes on height and weight compared to participants in other practice settings. The opposite is true for notes on OTC drug and herbal use, where 68% of respondents in independent pharmacy and 67% in drug store settings indicated they have access, as opposed to only 35% of hospital participants. Table 3-46: Screening Functions of Dispensing Technologies Currently Used What technologies do you currently use in delivering pharmacy services? Does your dispensing software automatically screen and create alerts for (select all that apply): (n = 748) % (Yes) Drug allergies 89.6 Drug interactions 89.0 Duplication of therapy (e.g., patient on two ACE inhibitors) 68.6 High/low drug doses 40.0 Adherence to guidelines (e.g., diabetes patients not on ASA) 11.2 ACE: angiotensin-converting enzyme; ASA: acetylsalicylic acid Canadian Pharmacists Association

59 SECTION 3 PRACTISING PHARMACISTS Overall, a large proportion of participants (89%) indicated they have dispensing software that automatically creates alerts for individual patients based on drug allergies and drug interactions. Significantly fewer responded that they have software that will do the same based on duplication of therapy (68.6%) and high/low dose (40.0%). Very few have software that will issue an alert based on adherence to guidelines (11.2%). Fewer hospital pharmacy participants (29%) indicated they have software that issues alerts for high/low drug doses, compared to those in other practice settings (65% in grocery and mass merchandiser and 58% in drug store format settings). Table 3-47: Additional Technologies Currently Used What technologies do you currently use in delivering pharmacy services? When you are filling prescriptions or entering orders do you have electronic access to a provincial prescription database that has the dispensing record from all pharmacies for your patients? (n = 724) % (Yes) Do you have electronic access to patient laboratory data? (n = 723) 44.3 Do you have electronic access to the patients medical record? (n = 720) 28.6 Do you utilize an automated dispensing machine in your practice? (n = 713) Do you use a PDA such as the ipharmacist, to access drug information or document patient interventions? (n = 728) 45.5 PDA: personal digital assistant Less than half of all participants indicated they had access to the additional technologies in the table above. Just under half (44.5%) responded that they have access to a provincial prescription database when handling orders and electronic access to laboratory data. A similar number (45.5%) indicated they have a PDA to access drug information or document interventions. Of the 44.3% of participants with access to patient laboratory data, almost all are hospital pharmacists (92%) compared to 4% of respondents from the drug store format and 9% from the independent pharmacy setting. Access to electronic patient medical records is highly correlated with practice setting. Fifty-one percent of participants from hospital pharmacies indicated they have access to electronic records, versus 7% in drug stores, 8% in grocery and mass merchandiser and 11% in independent pharmacies. Similar differences between practice settings also existed for use of automated dispensing machines. Forty-seven percent of participants from hospital pharmacies have these machines, compared to 8% in grocery and mass merchandiser, 9% in independent pharmacies and 12% in drug store settings. Pharmacy Human Resources Challenges and Priorities 51

60 SECTION 3 PRACTISING PHARMACISTS In Focus: Electronic Health Records The technology section of the online Choicebook included parts on two important technologies to support the expanded pharmacy role: electronic health records and automated dispensing machines. Questions on these technologies sought to assess pharmacists perceptions on the impact each could make to their practice and workflow. A significant majority of participants (96.1%) agreed that access to electronic health records is required to fulfill the innovative and expanded pharmacy roles and that it is necessary for pharmacists to contribute data to update these records. Almost all participants (96.6%) also agreed that access to electronic health records will improve their patients health outcomes. Although a majority of respondents indicated they already have the skills to use electronic health records (74%), more than 20% disagreed or were neutral. Table 3-48: Participating Pharmacists Perceptions Regarding Electronic Health Records (%) Disagree Disagree Neutral Agree Agree Not Sure Access to electronic health records is required to fulfill the new role (n = 739) I have the skills necessary to use electronic health records (n = 739) Pharmacists will be given access to electronic health records when they are created (n = 738) It is necessary for pharmacists to contribute data to electronic health records (drugs dispensed & other information) (n = 740) Access to electronic health records will improve the health outcomes of my patients (n = 740) Concerns about ability to use electronic health records were strongest among respondents in drug store format practice settings. Twenty-one percent of these participants disagreed or strongly disagreed they had the necessary skills, compared to only 3% of hospital pharmacy participants and 8% of those in grocery and mass merchandiser settings In Focus: Automated Dispensing Machines The majority of overall participants (66.6%) agreed that automated dispensing machines will make it easier for pharmacists to allocate more of their time to clinical tasks. At the same time, they disagree that this will have an HR impact. The majority did not believe that automated dispensing machines would lead to a decrease in demand for pharmacists (71.3% disagreeing with statement) or pharmacy technicians (53.4% disagreeing with statement). Participants had mixed views about whether automated dispensing machines would make fewer errors than human beings and improve patient safety. While 48.1% did think that the Canadian Pharmacists Association

61 SECTION 3 PRACTISING PHARMACISTS machines would lead to fewer errors and higher safety, 41.8% did not believe so or were neutral. Table 3-49: Participating Pharmacists Perceptions of Automated Dispensing Technologies (%) Disagree Disagree Neutral Agree Agree Not Sure Automated dispensing machines will make it easier for pharmacists to get away from dispensing and have more time for the new clinical roles (n = 740) Automated dispensing machines will take jobs away from pharmacists (n = 739) We will need fewer technicians at my practice site if we were using automated dispensing machines (n = 738) Automated dispensing machines will make fewer errors and improve patient safety (n = 740) There were significant differences in responses about the impact of automated dispensing machines on errors and patient safety across practice settings. The majority of respondents from hospital pharmacies (62%) suggested that the machines would make fewer errors and improve patient safety, compared to approximately one-third of participants in each of the other practice settings Most Important Technologies in the Future Participants were asked which technologies would be the most important in supporting and encouraging the new and expanded role for pharmacy in the future. This provided insight on the technologies that respondents felt will be the most important enablers for the future vision. Participants were asked to individually rate a series of technologies using a scale from 1 to 5, where 1 indicated least important and 5 indicated most important. Table 3-50 shows a ranking of these technologies, based on the mean response using this scale. Overall, participants considered four of the technologies to be significantly important, with a mean rating of more than 4 out of 5. The top-ranked technology was electronic health records, followed by access to drug/medical information databases, dispensing software that can better support clinical practice, and unrestricted access to the Internet in all practice sites. Each of these technologies would likely be used by pharmacists on a day-to-day basis in supporting their clinical patient care activities. Participants gave lower ratings to online access to continuing education and to automated dispensing machines. Pharmacy Human Resources Challenges and Priorities 53

62 SECTION 3 PRACTISING PHARMACISTS Table 3-50: Participating Pharmacists Perceptions of Most Important Technologies for Pharmacy Rank Technology Mean 1 Access to patients electronic health record Access to electronic drug/medical information databases Dispensing software that can better support clinical practice Unrestricted access to the Internet in all practices sites Access to continuing education online Widespread utilization of automated dispensing machines Challenges and Opportunities for Pharmacy Challenges In the final section of the Choicebook, participants were asked to consider the factors that may pose the biggest challenges to making the innovative and expanded pharmacy roles a reality. Participants were asked to rate a series of challenges using a scale from 1 to 5, where 1 indicated small challenge and 5 indicated big challenge. The results provide insight on the factors that would be the most significant challenges to realizing the expanded and innovative roles. Table 3-51 shows a ranking of these challenges, based on the mean response using this scale. The top-ranked challenge was government unwillingness to fund expanded and innovative roles. Other significant challenges with a mean rating of more than 4 were physician skepticism about pharmacists skills and pharmacist reluctance to take on expanded/innovative roles based on reimbursement uncertainty. Table 3-51: Participating Pharmacists Ranking of Challenges Rank Challenges Mean 1 Governments unwilling to fund expanded/innovative roles Physicians skepticism about pharmacists skills Pharmacists reluctant to take on expanded/innovative roles based on reimbursement and compensation uncertainty Access to comprehensive patient information Changing the traditional image of the pharmacist Pharmacist employers unwilling to encourage and facilitate staff to take on expanded/innovative roles Pharmacists reluctant to take on expanded/innovative roles based on a perceived gap in required skills Pharmacists reluctant to take on expanded/innovative roles based on uncertainty around liability Not enough pharmacists available to practice in expanded/innovative roles (even if technicians are primarily dispensing) Patient/public skepticism about pharmacists skills Canadian Pharmacists Association

63 SECTION 3 PRACTISING PHARMACISTS The lowest-ranked challenge was patient/public skepticism about pharmacists skills, echoing a confidence throughout the Choicebook that participants felt the public is ready to accept pharmacists in expanded or innovative roles. Another, perhaps unexpected, finding was that participants did not regard concerns around liability as a significant challenge facing implementation of expanded and innovative roles. I agree that the liability is greater but the profession needs to move forward to contribute more directly in patient care. An idea submission from an online participant Opportunities In the final section of the online Choicebook, participants were asked to rate the opportunities that could be realized through the new roles. A series of opportunities were presented and respondents were asked to assess a score from 1 to 5, where 1 indicated small opportunity and 5 indicated big opportunity. Overall, participants indicated they are willing to take on expanded and innovative roles not because they want to be paid more, but rather because they want the health care system to actually use their skills to create better health outcomes for their patients. Opportunities that focused on patients and a healthy pharmacy profession were seen as key opportunities. In contrast, opportunities that were concerned with greater prestige and income for pharmacists were ranked as lower priorities. Table 3-52: Practising Pharmacists Ranking of Opportunities Rank Opportunities Mean 1 Governments unwilling to fund expanded/innovative roles Better health outcomes for patients Ensuring the pharmacy profession continues to be viable and has a role other than dispensing 4 Enhanced reputation among other health professionals Closer relationship with patients Greater respect from the general population Provincial governments paying individual pharmacists rather than the pharmacy for pharmacy services 8 Increase in incomes for pharmacists Pre- and Post-Choicebook Attitudes The Choicebook included a pre- and post-choicebook set of questions. At the very start and the very end of the Choicebook, participants were asked to respond to an identical set of statements about the pharmacy profession and the expanded and innovative roles for pharmacy. Pharmacy Human Resources Challenges and Priorities 55

64 SECTION 3 PRACTISING PHARMACISTS Attitudinal shifts were looked at by comparing participant responses to these sets of statements, specifically if learning about the new role changed participant views about the key issues. Overall, the responses held before and after the Choicebook were fairly consistent. Similar proportions of participants in each of the pre- and post-choicebook question sets felt that: Overall pharmacists are underutilized by the health care system (~93%); Expanded and innovative roles for pharmacists would improve health care delivery for Canadians (~97%); Pharmacists will have to take on expanded and innovative roles in order to adapt to changes in Canada s health care system (~93%); and Overall pharmacists are willing to take on the responsibilities associated with expanded and innovative roles (~56%). There were some shifts in responses that were identified. There was a slight decrease in the number of participants who said that pharmacists have the necessary skills to handle an expanded role. The results also demonstrated an increase in participants who believed physicians would not be willing to work with pharmacists in an expanded role. Conversely, slightly more participants felt members of the public and patients would welcome an expanded role for pharmacists after having completed the Choicebook Canadian Pharmacists Association

65 SECTION 4 PHARMACY STUDENTS 4. PHARMACY STUDENTS 4.1 Research Approach Canada s health care system strives to ensure that the right health care providers with the right skills are available in the right place at the right time and pharmacists have been identified as key players in achieving this goal. To do so, however, there is a need to better understand the factors contributing to current health HR pressures and to strategize ways of coping with those pressures. With that in mind, Moving Forward and the Canadian Association of Pharmacy Students and Interns (CAPSI) partnered to engage pharmacy students in an open discussion about their perspectives on the future for pharmacy. Students are key players in pharmacy HR planning and are the next generation of the pharmacy workforce. They have critical insights about the future of pharmacy and important perspectives on pharmacy education, skills and competencies for practice, and the labour market. This Moving Forward-CAPSI research partnership is a valuable component of Moving Forward s broader Pharmacy Human Resources Challenges and Priorities research stream, which also includes perspectives from the pharmacy workforce, educators, employers and other key stakeholders regarding the pharmacy workforce of the future Objectives One of the key stakeholder groups for Moving Forward is Canada s pharmacy students. In addition to the obvious that they are Canada s next generation of pharmacists pharmacy students affect current practice through interactions with preceptors in structured experiential training and with pharmacy staff in work during their studies. As well, advocacy efforts by their national association, CAPSI, have an important role in helping to shape the future of pharmacy. Thus, a core part of the strategy was to engage this important group and to explore several issues that are of direct relevance to Moving Forward. More specifically, the primary objectives of this component of the Moving Forward initiative included: Gain insight into the understanding and support for the future vision for the profession among Canada s pharmacy students, and Assess pharmacy students future expectations of the pharmacy profession in relation to the vision. Finally, this phase of the project set out to explore issues related to the future plans and expectations of students, including education, entry to practice, and exposure to the job market Methodology The primary strategy used to obtain the perspective of Canada s pharmacy students was a web-based survey. There were several steps to survey development and to increasing awareness of, and building interest in, the survey. Pharmacy Human Resources Challenges and Priorities 57

66 SECTION 4 PHARMACY STUDENTS First, a written survey was developed following a review of the literature of pharmacy student surveys about career expectations. Input on the survey was obtained from the CAPSI national executive and the Ascentum team. The survey and a brief introduction with instructions were translated into French, and the online version of the survey was developed and pilot-tested by the CAPSI national council (a larger group than the CAPSI national executive, consisting of the senior and junior CAPSI representatives from each pharmacy school). Slight wording changes were made to improve readability of the survey and website. The final survey was divided into two sections: seven questions addressing the demographics of the respondent, and 22 questions addressing future plans and expectations and exposure to the job market. At an early stage of development, the decision was made to partner with CAPSI on this initiative. CAPSI played an important role in encouraging pharmacy students to complete the survey. Local CAPSI representatives ed their classmates and made announcements about the survey in front of each pharmacy class. A standardized template for this announcement was developed and used. CAPSI representatives received weekly feedback on the completion rates of the pharmacy students at each school. Deans of Pharmacy were also contacted, briefed on the purposes of the survey, and encouraged to their student body about the importance of completing the survey. A draw for two cash prizes of $200 was created as an incentive to complete the survey. The online survey went live in early October 2007 and the students had approximately one month to complete the survey. To protect the confidentiality of the participants, no specific responses were attributed to specific individuals and, where appropriate, responses were edited to assist in masking the identity of the participant Participant Profile The response rate of undergraduate students was 29.8% (1281 out of 4305 students). The response rates by year of study were: first year 28.5%, second year 32.1%, third year 33.0%, and fourth year 25.0%. The response rates by university ranged from a high of 72.7% at Dalhousie University to a low of 5.6% at Université Laval. Table 4-1 contains the response rates for all nine pharmacy schools that were invited to complete the survey (students from the newest pharmacy school at the University of Waterloo were not invited to participate in the survey as their first class did not begin until January 2008) Canadian Pharmacists Association

67 SECTION 4 PHARMACY STUDENTS Table 4-1: Response Rates of Entry-Level Degree Pharmacy Students by Faculty of Pharmacy Faculty Number of completed surveys Number of entry-level degree pharmacy students Response rate University of British Columbia % University of Alberta % University of Saskatchewan % University of Manitoba % University of Toronto % Université de Montréal % Université Laval % Dalhousie University % Memorial University % An additional 30 students completed the survey for a total of 1311 returned completed surveys. This included those in post-bsc PharmD programs at the University of Toronto and University of British Columbia, clinical masters students in Quebec and those who did not specify their affiliation. So, while the response rate of approximately 30% would not be considered ideal, input from more than 1300 pharmacy students across the country was gathered. Among the 1289 students who specified their home province, the most common responses were Ontario (377, 29.2%), Alberta (199, 15.4%), Saskatchewan (186, 14.4%) and Nova Scotia (155, 12.0%). Among the 1283 students who specified their gender, 26.9% were male and 73.1% were female. The majority of students were in the 18 to 24 age range (80.3%), followed by 25 to 34 (17.2%). There was a large variation in the amount of university/ college education completed before beginning the entry-level degree program. The top responses were one year of university (377, 29.4%), two years of university (298, 23.3%), and an undergraduate degree (289, 22.6%). 4.2 Key Findings Education and Career Choice Education and preparation for career A majority of students felt that the education they are receiving from their current program will be sufficient to prepare them for their expected career. Seventy-eight percent of respondents either strongly agreed or agreed that they would be sufficiently prepared. Slightly more than half of students either strongly disagreed or disagreed with the statement, The education you are receiving from your current program will over-qualify you for your expected career ; 30.6% were undecided. The percentages answering strongly disagree and disagree increased over the duration of the program. Pharmacy Human Resources Challenges and Priorities 59

68 SECTION 4 PHARMACY STUDENTS Overall, pharmacy students feel confident that their education will sufficiently prepare them for their careers, while not over-qualifying them. Influences on future career choice Pharmacy students reported that a variety of factors from their pharmacy program (degree) have influenced their future career choice. The factors, in decreasing order of importance, were: structured practice experience, pharmacist preceptors, course content, family, professors, fellow students, friends and guidance counsellors. Work experience was the most common response given in the other category. Two differing perspectives provided by respondents highlight this factor: Working in a large retail pharmacy that is largely profit-driven and lacks pharmaceutical care has led me to look at hospital pharmacy, and Working in hospital for a summer made me seriously dislike it and the community pharmacy where I have worked for two years is wonderful and I would love to work there because of the great staff. Students were asked about the influence of a number of factors outside their pharmacy program. The external factors, in decreasing order of importance, were: talking generally to pharmacists, family considerations, debt from your time at university, and pharmacy conferences such as PDW (Professional Development Weekend CAPSI s annual conference for pharmacy students). The first factor, talking to pharmacists, was cited by 60.5% of respondents Perceptions of the Pharmacy Job Market Quantity and quality of career opportunities Pharmacy students feel quite positive about both the quantity and quality of career opportunities. More than 68% of students either strongly agreed or agreed with the statement, The quantity (number) of career opportunities in pharmacy will be greater in the future than they have been in the past, and more than 79% of students responded in a similar fashion when asked about the quality of opportunities. Finding a job/signing a contract: those who have found a job Students were asked a series of questions regarding finding a job/signing a contract for a pharmacist position. Overall, 14.0% of students stated they had already found a job/signed a contract. This percentage increased considerably as students progressed throughout their education (2.3% of first-year students, 13.6% of second-year students, 13.7% of third-year students and 30.4% of fourth-year students). The most common method of finding a job was recruitment by the employer (57.1% of those who have found a job). Those who have found a job cited a variety of factors that influenced their decision to accept that specific job: 30.5% cited financial security, 24.6% job security, 20.5% location and 20.3% said the reputation of the employer. Other responses included, The amount of clinical pharmacy services I am able to perform, The contract was not as rigorous as other companies, and Staff support and reasonable working hours Canadian Pharmacists Association

69 SECTION 4 PHARMACY STUDENTS Finding a job/signing a contract: those who have not found a job Of those students who have not found a job, the majority expect to find a job through recruitment by employers (60.9%), followed by visit/drop into pharmacy (16.9%). These students also tend to be unsure whether they will accept a job before graduation. Only 19% of these students indicated they do plan on accepting a job before graduation while 55.6% were not sure. Finally, these students remain optimistic that they eventually will find a position in their area of interest upon graduation. More than 77% of students indicated that they are confident or very confident that they will find such a position upon graduation Future Plans and Practice Expectations Staying in the profession/additional education Approximately 75% of pharmacy students expect to stay within the profession of pharmacy for their whole career. Still, about one-fifth (20.6%) were undecided. The percentage answering strongly agree to whether they expect to stay in the profession dropped from a high of 35.4% among first-year students to 23.9% among fourth-year students. Students were also asked about their intent to pursue additional education after graduation from their current pharmacy program. More than four in 10 students (42.9%) intend to do this, with the most common options being a pharmacy residency (218 students), a post-bsc PharmD (132 students) and the other category, with common responses in that category including MBA, medicine and law. The only discernable trend across the year of study was that over time fewer students plan on pursuing a Post-BSc PharmD. Finally, it is worth noting that only 12 students in total indicated that they planned on pursuing a PhD, which may not bode well for future HR requirements in pharmacy academia in Canada. Anticipated practice environment Community pharmacy is the anticipated practice environment for more than half of the respondents, although there was a significant difference between males (59.1%) and females (53.3%). Hospital pharmacy is the second-most anticipated, equally divided between those who plan on completing a residency (13.9%) and those who plan on practising right away as a pharmacist (12.2%). As the students progress in their education, more seem to decide upon community pharmacy practice (41.8% in first year, 65.8% in fourth year) while fewer choose hospital pharmacy practice (15.4% in first year, 8.0% in fourth year). The percentage of undecided decreases over time, from about one in five in their first year to about one in 15 in their fourth year. Basing compensation on cognitive services Pharmacy students are very open about basing their compensation on the level of pharmaceutical care they provide. In fact, only 7.2% of students either strongly disagreed or disagreed with the statement, The level of compensation I receive in my first job as a pharmacist should be influenced by the amount of cognitive services (pharmaceutical care) that I will provide. There were no significant differences according to the students year of study. Pharmacy Human Resources Challenges and Priorities 61

70 SECTION 4 PHARMACY STUDENTS Desired qualities in a pharmacy work environment In the next question, the pharmacy students were asked to rate the perceived importance of 20 characteristics of their future pharmacy work environment. These characteristics were based on a study published in the American Journal of Health System Pharmacy. 6 Table 4-2 contains the complete results. It should be noted that the perceived importance of the top-ranked quality (patient-focused decision making) increased slightly as students progressed in their pharmacy programs and was recognized equally by males and females. Table 4-2: Desired Qualities in a Pharmacy Work Environment (in decreasing order of importance) Rank Quality 1 Patient-focused decision-making 2 Health communication 3 Adherence to high standards 4 Employees love their job 5 Constructive problem solving 6 A daily effort by all to improve quality 7 An attitude that learning should continue for life 8 A team spirit 9 Cleanliness and orderliness 10 Leadership by example 11 An atmosphere of mentorship and praise 12 Basing decisions on facts 13 A service attitude 14 A rational approach to policies and procedures 15 Encouragement of independent action by employees 16 An orientation toward change 17 Creativity 18 Active involvement by employees in strategic planning 19 Not neglecting non-urgent work 20 A sense of urgency Expected tasks in a pharmacy work environment For this question, students were asked to assume that they will begin working as a pharmacist in a community or hospital pharmacy upon graduation. They were asked, On a typical day in your first job as a pharmacist upon graduation, how would you ideally like your time divided? What is your expected reality of the time allocated to each task? The categories they could choose were based on a previous survey of pharmacists. 7 As can be seen in Table 4-3, there were large differences between their ideal world and their expected reality. The percentages of time spent in dispensing/distribution and direct patient 6 Summerfield MR. Twenty qualities of a desirable pharmacy environment. American Journal of Health-System Pharmacy 1999; 56: Rogers Publishing Ltd., The Pharmacy Group. Trends & Insights Sponsored by McKesson Canada and Novopharm Limited p Canadian Pharmacists Association

71 SECTION 4 PHARMACY STUDENTS care are almost completely reversed in these two scenarios. These students expect that non-patient care activities such as dispensing, third party payer and administrative matters will consist of approximately two-thirds (65.8%) of their typical day whereas they would ideally spend less than one-third (30.1%) of their day in these activities. Table 4-3: Ideal Tasks vs Expected Tasks Task Your ideal world Your expected reality Dispensing/distribution 16.9% 38.2% Direct patient care (pharmaceutical care) 43.2% 19.2% Third party payer matters (formulary issues, etc.) 4.8% 15.5% Administrative matters (committees, management issues, etc.) 8.4% 12.1% Talking with other health professionals 18.0% 10.1% Research 8.7% 4.9% Influences on job satisfaction Pharmacy students were asked to rate the perceived importance of 10 different factors on their job satisfaction as a future pharmacist. More than 90% of respondents reported that the people with whom they work will have a large influence on their job satisfaction. The students were also asked to indicate, out of all the factors that they said would have a large influence, which factor would have the greatest influence on their job satisfaction. Table 4-4 contains the complete results. The top two factors accounted for more than half of all responses: 33.0% cited atmosphere of work environment while 25.0% said the people with whom you work. Salary and benefits was the first choice for a greater percentage of males (18.6%) than females (7.5%) whereas the atmosphere of work environment was the first choice for a greater percentage of females (36.1%) than males (24.7%). Table 4-4: The Most Important Factors to Influence Job Satisfaction (in decreasing order of importance) Rank Quality 1 Atmosphere of work environment 2 The people with whom you work 3 Amount of professional responsibilities 4 Salary & benefits 5 Hours 6 Opportunities for advancement 7 Time spent in non-pharmacy activities 8 Amount of staff 9 Location of pharmacy 10 Your boss 11 Access to technology at work Frustrating aspects of pharmacy practice For this question, the respondents were asked to assume that they will begin working as a pharmacist in a community or hospital pharmacy upon graduation. They were then asked, Please consider the following parts of a pharmacy job below and indicate what you expect Pharmacy Human Resources Challenges and Priorities 63

72 SECTION 4 PHARMACY STUDENTS to be the most frustrating (1), second-most frustrating (2) and third-most frustrating (3) parts of your position. The categories they could choose were based on a previous survey of pharmacists. 8 Table 4-5 highlights the findings. In this case, two issues related to lack of time (for pharmaceutical care and to complete all tasks properly) were tied as the expected most frustrating aspect of their first position as a pharmacist. Table 4-5: Most Frustrating Aspects of Future Position (in decreasing order of importance) Rank Part of your future position 1 (tie) Not enough time for pharmaceutical care 1 (tie) Lack of time to complete all tasks properly 3 Lack of communication from physicians & other health professionals 4 Lack of staff and support 5 Drug plan issues 6 Too much time spent on activities pharmacy technicians should be doing 7 Lack of autonomy/input into decision making 8 Too much time on administration/paperwork 9 Long hours, few (no) breaks 10 Demanding patients 11 Lack of private counselling area 12 Lack of proper orientation 13 Not enough time to learn the complex and dynamic health care system Other Comments For the final question of the survey, students were invited to provide further comments regarding future plans or expectations of their first job and/or the profession of pharmacy. A thematic analysis of the content revealed that responses regarding changes in the profession and a desire to practice according to a pharmaceutical care model were most common. Some comments related to this theme included: I do not wish to be a pill-counting machine and I really wish to work in an area where my cognitive skills are needed and go towards the betterment of the patient. I want to graduate into a profession where I really make an impact, not one where I am part of the fill-check-counsel assembly line. The second theme dealt with suggestions for improvement. Some comments related to this theme included: I would like to see more progress on the electronic health records and e-prescriptions. The more information I have on my patient the less likely errors will be made. I would love to see the enactment of the Blueprint for Pharmacy as this would allow pharmacists to use much more of the clinical knowledge that they acquire in school as well as reduce the burden on the health care system. 8 Rogers Publishing Ltd., The Pharmacy Group. Trends and Insights Sponsored by McKesson Canada and Novopharm Ltd p Canadian Pharmacists Association

73 SECTION 4 PHARMACY STUDENTS A third theme dealt with uncertainty about the profession and where it is headed. Some comments related to this theme included: I expect to be overworked and understaffed. I ve worked in the community for a long time and it s really disheartening to see how people practice... the retail version of pharmacy is a real goal-killer. 4.3 Final Comments The results from this national pharmacy student survey provided insight into pharmacy students future expectations of the pharmacy profession and their perspective on the types of activities they will be performing in the future. There are many reasons to feel encouraged about the next generation of pharmacists. Canada s pharmacy students are positive about the ability of their education to prepare them and both the quality and quantity of opportunities available to them. They are open to basing compensation on the level of pharmaceutical care they provide, and most plan on staying in the profession. It is clear that these future pharmacists desire a practice model that closely emulates the vision set out in the Blueprint for Pharmacy. Their most desired quality in the pharmacy work environment is patient-focused decision-making. They also expect the lack of time to provide pharmaceutical care to be a major frustration in their first position. One warning that can be taken from this survey is that current practice models may instill lower levels of job satisfaction amongst new pharmacists. Many students comments raised concerns about how the profession would really change to accommodate their desires and goals. The response rate of 30% also merits some discussion. Ideally, a response rate of at least 50% would have been obtained. A response rate of 30% does admittedly raise some concerns about response bias, as survey respondents are not necessarily representative of the target population. Often a lack of information about those non-respondents makes the response bias hard to rule out. 9 The approach that was followed in this initiative was targeted to maximize the response rate. This included partnering with CAPSI and following recommendations from seasoned survey researchers, 10,11 including the use of incentives, translating the survey, and pilot-testing and applying a user-friendly web-based survey. Still, the survey was quite long and pharmacy students may not have been convinced to complete the survey. While large differences in response rates among the different years of study were not observed (a range of 25% to 33%), large differences between the various pharmacy faculties were apparent. For example, the response rate of Dalhousie University pharmacy students was approximately 13 times that of pharmacy students at Université Laval. The response rate from the two pharmacy schools in Québec were the lowest despite the fact that the survey and the introduction to the survey were both translated into French, and the role of 9 Coons SJ. Responses to survey research: Transparency and representativeness are key. Clinical Therapeutics 2007; 29(3): Salant P, Dillman DA. How to conduct your own survey. New York: Wiley, Dillman DA. Mail and telephone surveys: the total design method. Toronto: Wiley, Pharmacy Human Resources Challenges and Priorities 65

74 SECTION 4 PHARMACY STUDENTS CAPSI was the same in these schools as in the others. The relatively low response rate from UBC also suggests that language may not have been a primary contributing factor to the response rate. This suggests that dissemination of information about the survey to pharmacy students might have been a major contributing factor to response rate. So, while the respondents to this survey are not a completely representative sample of all pharmacy students in Canada, the 1300 pharmacy students who did respond to this survey do provide important insights into issues concerning career expectations and perspectives on the future of the profession Canadian Pharmacists Association

75 SECTION 5 DEANS AND FACULTIES OF PHARMACY 5. DEANS AND FACULTIES OF PHARMACY The deans of Canada s 10 schools/colleges of pharmacy represent another key stakeholder group for Moving Forward. These individuals provide leadership related to the education of Canada s next generation of pharmacists and they also influence current pharmacists through preceptor training, continuing education programs and graduate programs. Thus, a core part of our strategy was to engage this important group and to explore several issues that are of direct relevance to Moving Forward. More specifically, the primary objectives of this component of the Moving Forward initiative were as follows: Determine the deans understanding and support for the future vision for the profession and key strategic actions; Framing educational system issues for pharmacy profession (demographics); and Obtain better understanding of future directions of pharmacy education. The two major components of this phase of the project were to explore issues related to capacity and to curriculum. 5.1 Research Approach Two primary strategies were used to obtain the perspective of Canada s pharmacy deans. First, a written survey was developed with input from the Moving Forward Management Committee, the Ascentum team and Dean Gorecki (Dean of the College of Pharmacy and Nutrition at the University of Saskatchewan and the Association of Deans of Pharmacy of Canada [ADPC] representative on the Moving Forward Management Committee). The survey was sent via by Dean Gorecki to his colleagues in September 2007 along with a cover letter explaining the purpose of the survey. The survey protocol was divided into three sections: (1) questions addressing the issue of capacity, that was further subdivided into questions on enrollment, faculty recruitment and retention, facilities, training beyond pharmacy practice degrees and new pharmacy schools/colleges, (2) questions addressing the issue of curriculum, that was further subdivided into questions on the details of the curriculum, evaluation of the curriculum, responding to changes in the practice environment in the curriculum, the introduction of the entry-level PharmD degree, and responding to the Blueprint for Pharmacy, and (3) a single open-ended question at the end of the survey that allowed for exploration of other issues not previously addressed in the survey. The deans were sent several reminders to complete the survey and were given until October 11, 2007 to return the completed survey. The responses from the completed surveys were entered into a MS Excel spreadsheet. Second, a focus group with the deans was held on October 14, 2007 in Kelowna, BC, in conjunction with the annual ADPC meeting. This audio-taped focus group meeting was approximately two hours in length and facilitated by one of the members of the Ascentum team (Dr. Neil MacKinnon). A semi-structured approach following the flow of questions in the written survey was used to guide the process. The timing of the focus group (held soon after the surveys were completed and analyzed) allowed for in-depth exploration and Pharmacy Human Resources Challenges and Priorities 67

76 SECTION 5 DEANS AND FACULTIES OF PHARMACY follow-up of the major themes and issues in the survey results. A transcription service transcribed the taped focus group and the facilitator s own personal notes supplemented the transcription. Finally, it should be noted that to protect confidentiality of the participants, while direct quotations from the focus group and replies from the survey are included, responses are not attributed to specific individuals and, where appropriate, responses have been edited to assist in masking the identity of the participant. The response rate from the written survey was 80% (eight out of 10 surveys returned). All 10 deans participated in the focus group. The Executive Director of ADPC (Dr. Frank Abbott) also sat in on the focus group as an observer. 5.2 Key Findings Results from the survey and focus group are presented together, according to the thematic areas previously outlined Capacity Enrollment A significant increase in the enrollment in the undergraduate pharmacy programs has occurred over the past few years in Canada. In fact, from the written survey results, six programs reported that they have already increased their enrollment; one other plans to do so upon completion of a new building, while the eighth respondent did not reply to this question. Table 5-1 contains the entry-level degree enrollment figures for the academic year In addition to these figures, the University of Toronto (UT) IPG program has 46 students while the University of British Columbia (UBC) IPG program has 14 students. UT also has 35 students in their post-bsc PharmD program while UBC has 17 students in this program (these numbers include all students currently enrolled in these programs). Many of the deans admitted that they felt pressure from the pharmacy community to increase the class size of their programs. There was not consensus when asked whether they personally believed that their school/college is producing enough pharmacy graduates to meet the demands of the sector. Some felt that the perceived shortage is artificial (i.e., more graduates are produced, then more stores open, then more graduates are needed ). As one dean said in the focus group, You increase enrollment and every second day a new box-store pharmacy opens up that needs four pharmacists. Others felt that their graduates were leaving their part of the country to seek employment elsewhere so increasing class size would not result in more pharmacists in their province/region Canadian Pharmacists Association

77 SECTION 5 DEANS AND FACULTIES OF PHARMACY Table 5-1: Pharmacy Entry-Level Degree Enrollment in Canadian Faculties of Pharmacy Enrollment by Year Totals Faculty All Years University of British Columbia University of Alberta University of Saskatchewan University of Manitoba University of Toronto University of Laval University of Montreal Dalhousie University Memorial University University of Waterloo Total A question that was asked in the focus group, but not in the written survey, was, It is five years from now. Pharmacists are practising in accordance with the vision for pharmacy as outlined in the Blueprint for Pharmacy. Do we need more, less or the same number of pharmacy graduates as now if everything else stayed the same? Not every dean responded to this question in the focus group but among those that did there seemed to be consensus that fewer pharmacists would be needed if they practiced at a higher level of care and pharmacy technicians took on more duties. Faculty Retention and Recruitment Regarding the issues concerning faculty recruitment and retention, a majority of deans felt that they had a sufficient number of qualified faculty members to effectively deliver the professional degree program(s). There was some concern expressed that as the programs continue to expand and/or switch to an entry-level PharmD degree that this would raise new challenges in recruiting the number of faculty needed to deliver these programs. One dean expressed a desire for more pharmacists among their faculty. Another dean spoke about the difficulty of encouraging pharmacy students to pursue graduate work: We don t have a lot of pharmacy students going into graduate studies. In the future I think we ll have problems. More specifically, If we select students for patient care or somehow view that patient-focused activity is the pinnacle of a graduate s life, then it should not shock us for one moment to find that our students don t go on [to graduate studies] because that s not what they re interested in. Overall, faculty recruitment and retention do not seem to be of major concern among Canada s pharmacy deans at the moment but the future may bring significant new challenges. Pharmacy Human Resources Challenges and Priorities 69

78 SECTION 5 DEANS AND FACULTIES OF PHARMACY Facilities Four pharmacy schools have either just recently moved into a new building or will do so in the near future. Among the other faculties, there was some need expressed for new offices, research space and larger classrooms. Training beyond pharmacy practice degrees A mix of responses was reported as to whether any changes in demand for their post-graduate pharmacy degrees and/or residency programs have been noted recently. Some reported no change in demand, while some reported an increase in the number of residency applications while others reported a decrease, attributing this to the pharmacist shortage. Others noted an increase in demand for advanced practice training for p harmacists. A majority of schools/colleges offer continuing education/professional development for practising pharmacists and many have a specific strategy for helping practising pharmacists expand their roles/scope of practice. For example, one program has recently placed significant resources into conducting a needs assessment to capture the learning needs and attitudes of practising pharmacists and then responded to these needs by developing new continuing education programs. Other potential forms of education were also mentioned including the development of specialty residencies that would lead to specialties in pharmacy and the certification that goes with it. New pharmacy schools/colleges Canada s 10th Faculty of Pharmacy recently opened at the University of Waterloo and we asked the deans whether they were aware of any other programs planned. At least three potential programs were mentioned by the deans but they were not aware of any new programs that have moved beyond the exploration phase Curriculum Details A majority of deans reported that their curriculum is taught via a mix of traditional didactic work and problem-based learning. All except one dean reported having placed emphasis in recent years on incorporating more teaching about interdisciplinary care. Most programs use interprofessional modules for this purpose. Several challenges were noted regarding the experiential training of pharmacy students. These include the training (or lack thereof) of preceptors, the quantity and quality of practice sites, and the number and adequacy of hospital sites. Approaches used to address these challenges include the development of a preceptor training program, working with pharmacy employers, targeted recruitment of new preceptors and obtaining funding specific to coordination of these activities. Nontraditional practice sites were also mentioned ( Why aren t we putting our students with family practitioners [for their clerkships]? ), although in some provinces there is legislation restricting pharmacy students to be under the direct supervision of a pharmacist for training Canadian Pharmacists Association

79 SECTION 5 DEANS AND FACULTIES OF PHARMACY Evaluation A majority of deans believe that their curriculum does a good job of preparing pharmacy students with the necessary skills and competencies for the current workforce. They attribute this to feedback from preceptors, employers and recent graduates, high pass rates of PEBC examinations, high demand for graduates and accomplishments and practice changes implemented by graduates. A variety of methods are used by the deans to evaluate the effectiveness of their curriculum to improve student learning and the achievement of the professional competencies. These include, among other things, objective structured clinical examinations (OSCEs), feedback sessions with students and formal written evaluations, and alignment with the AFPC competencies. Responding to Changes The deans did acknowledge the existence of some skills and competencies that will be needed in the future by pharmacists that are not currently included or emphasized in the curriculum. These include additional assessment skills, prescribing skills and interprofessional skills. One dean spoke about the influence of external change on the profession as a whole: What has changed dramatically is the legislative environment that gives the opportunity to actually practice at the levels we have ignored for far too long. Another added, The education required of future practitioners I see as being quite different from what it is currently. Most reported that they have a mechanism in place for continuously updating the curriculum but they also mentioned some barriers that might prevent them from implementing the skills and competencies required in the future. These include financial resources, time, personnel and the actual length of the program. Entry-level PharmD Two programs Montreal and Laval have either recently switched to this degree program or are planning for the change. No other deans reported on plans to switch over to this degree in the near future, although there is intent in at least two other faculties to begin phasing in some type of entry-level PharmD degree. One other faculty will consider this step once a new building is in place. Deans were asked whether they felt graduates from an entry-level PharmD program would be better prepared for practice than graduates from the current BSc programs. There was agreement that the actual skill set of entry-level PharmD graduates would be superior and several deans said that graduates from such a degree program may be more able to take on new roles quickly ( road ready ). Many felt this would be due to the increased amount of practice experience gained in entry-level PharmD programs. However, when asked whether entry-level PharmD graduates would better meet the health care needs of Canadians, responses contained many caveats. For example, one dean replied, No, our pharmacy graduates are already well trained but the current system does not allow them to use their skills to the fullest. Another replied, If we are changing the curriculum to do this [better meet the needs of Canadians], they should be [better able to meet these needs]. Pharmacy Human Resources Challenges and Priorities 71

80 SECTION 5 DEANS AND FACULTIES OF PHARMACY Responding to the Vision for the Future There was complete support among the deans for the vision for the profession as outlined in the Blueprint for Pharmacy. Overall, most deans felt that major changes to the curriculum would not be needed to produce pharmacy graduates who can practice in accordance with this vision. Identified changes included an increased emphasis on leadership and confidence and additional interdisciplinary education. The deans did note some additional resources may be required to make the changes they identified, including more practice sites and commitment by the pharmacy community at large to this vision. In the focus group, one dean spoke about the need to influence pharmacy student expectations about how they could practice at a high level as proposed in the Blueprint for Pharmacy: You turn them on [to pharmaceutical care] and say to them, think this way and demand it at a pharmacy and if they don t provide it to you, after some brief time you choose another employer. There was also recognition of the difference in expectations between academia and community pharmacy regarding the level of practice that students will be working in. One dean s experience was particularly telling in this area: Comments I ve received [from employers] is we re creating unrealistic expectations in our students and they re asking for things that are ridiculous, like actually being able to speak with patients. 5.3 Final Comments Overall, the results from both the written surveys and the focus group suggest that Canada s pharmacy deans feel positive about the state of pharmacy education in Canada. While they did raise some concerns about the quantity and quality of practice sites and the ability of their graduates to use the skills that they have learned, overall they argue there is much to be positive about: enrollment numbers have increased in response to the increased demand for pharmacists, many schools/colleges have new facilities, faculty recruitment and retention are not major concerns at the moment, there is confidence in both the abilities of their graduates and in the responsiveness of their curricula to external factors in the pharmacy environment, and they concurred with the vision for the profession as presented in the Blueprint for Pharmacy. Admittedly, this is a period of transition as some programs move to the entry-level PharmD degree and the strategies to meet shifting demand/addressing gaps in knowledge and practice have not been completely delineated. It is clear from both the survey and focus group that the deans perceive the structure of the community pharmacy business environment to be one of the major barriers to change. As one dean noted, The bigger challenge is convincing the business owners that they need to change the culture in which the services that pharmacists do provide are valued, They are employers and their only issue is how to maximize profit, and They are comfortable with the business model and they don t want to change it. However, overall, Canada s pharmacy deans expressed confidence that they are well-positioned to meet the broader human resource requirements and challenges for the pharmacy profession into the future Canadian Pharmacists Association

81 SECTION 6 PHARMACY EMPLOYERS 6. PHARMACY EMPLOYERS 6.1 Research Approach The final piece of research conducted under the Human Resources Challenges and Priorities banner was a series of discussions with pharmacy employers to share and explore the results already generated through this research. Objectives were to: Further explore the input received from pharmacists who participated in the online consultation as well as other input gathered from thought leaders, deans and students; and Identify the barriers and enablers that the profession faces in making the innovative and expanded roles for pharmacy a reality within the context of the hospital and community pharmacy settings. Focus groups (called Discussion Forums) were used to investigate the perspectives of pharmacy employers on the barriers, enablers and HR implications of making the expanded and innovative pharmacy roles a reality. Three focus groups took place. These included one in Toronto, ON, for hospital pharmacy employers (n=22), a second in Toronto, ON, for chain pharmacy employers (n=13), and a third in Halifax, NS, for independent pharmacy owners (n=8). Each was led by an experienced group facilitator who asked the groups to consider: (1) the evolving role of the pharmacist and their support for the predicted changes to the profession; (2) the top HR challenges to the achievement of the future vision, and (3) unique/individual challenges to the achievement of the future vision. The facilitator led participants through discussions of each question. Each session lasted about two hours. The data consisted of some quotations as well as key issues raised and discussed. The use of focus groups for this aspect of the research was useful for probing and further clarifying issues and comments raised in surveys, interviews and the online consultation. It allowed the researchers to garner deeper meaning behind participants comments. The flexible nature of focus groups also encouraged participants to speak freely and provide examples of their ideas and experiences. Limitations to this aspect of the research include the threat of bias introduced by the investigator in the collection and analysis of the data and the difficulty of generalizing findings. 6.2 Key Findings Three sessions were conducted with three diverse target groups. This included a discussion with hospital employers, chain pharmacy representatives and individual community-based pharmacy owners. The key information points raised through discussions have been organized by session. Pharmacy Human Resources Challenges and Priorities 73

82 SECTION 6 PHARMACY EMPLOYERS Hospital Employers The first part of the session explored the evolving role of pharmacists and whether hospital employers supported the predicted changes to the profession. What follows are highlights of the key issues raised and discussed by the group: It was suggested that the hospital setting is more conducive to advances on these fronts (i.e., role evolution) and that there were lessons to be learned from this advanced practice setting experience: That being the case, there are hospitals at very different levels in terms of supporting role evolution Physicians appear to have a greater acceptance of prescribing in hospital than community setting Increased automation is key to facilitating the change process. The importance of medication therapy management and the importance of the profession taking ownership and accountability for this role were both stressed: Ownership of medication management (need to take responsibility end-to-end) Ownership of drug therapy management with a focus on outcomes for patients There is a need for a common vision and national standards of care for the profession (of pharmacy). The profession needs to establish minimum standards of care and basic standards of practice that include responsibility and accountability for all aspects of medication management standards sanctioned by the profession. A common standard across hospital and community-based pharmacy settings needs to be developed. Separating distribution from clinical or standard of care for profession is required. There is an insufficient resource base to support role evolution. There is a shortage of secure, confident graduates emerging from the pharmacy programs who can easily assume these new roles particularly in relation to ownership and accountability of drug therapy management: Curriculum must be in place (medical school has a good model) to teach pharmacy students how to make decisions Experience key to education Style of teaching and training should increase responsibility Young pharmacists have the knowledge, lack the confidence Clash of what is being taught and what is required in the workforce There are resident students who are unable to get spots Vast majority of pharmacy students go to community practice A need to reconstruct the professional culture (i.e., break it down and rebuild it). Experience in retail is not lost or wasted. It is valuable experience in the hospital setting Canadian Pharmacists Association

83 SECTION 6 PHARMACY EMPLOYERS Infrastructure needs to be ramped up. Funding model to support direct patient care and drug therapy management. Need to demonstrate the value proposition of a pharmacist performing additional roles with other health care professionals to support role evolution. The second part of the session asked participants to list the top HR challenges to the achievement of the future vision for the pharmacy profession. Participants were also asked to rate the challenges they identified (low to high) in terms of feasibility and impact. Specifically, what is the feasibility (or the likelihood) of addressing the challenge, and if addressed, what impact will that have. Table 6-1: Feasibility and Impact of HR Challenges Identified by Hospital Pharmacy Employers (Breakout Groups) Group Challenges Feasibility vs Impact Increase in workload 2. Lack of a standard of care 3. Sub-standard level of training for entry to hospital practice 4. Demographics of the workforce 1. Need for common vision to mobilize HR adequately 2. Funding model that supports direct patient care 3. Expectation of new generation 4. Limited number of hospital-ready graduates 5. Succession planning for leadership 6. Need to define scope and requirement for care 1. Sufficient qualified practitioners 2. Communication/agreement on vision for patient care 3. Sufficient human and financial resources 4. Generational differences toward the job (expectations and reward) 5. Recruitment and compensation in equities between hospital and community practice 1. Low feasibility; low impact 2. High feasibility; high impact 3. Medium feasibility; medium impact 4. Low feasibility; high impact 1. Low feasibility; high impact 2. Low feasibility; high impact 3. Low feasibility; high impact 4. High feasibility; high impact 5. High feasibility; high impact 6. High feasibility; high impact 1. Low feasibility; high impact 2. High feasibility; high impact 3. Low feasibility; high impact 4. Low feasibility; low impact 5. Low feasibility; medium impact Chain Drug Store Representatives The first part of the session explored the evolving role of pharmacists and whether chain drug store representatives supported the predicted changes to the profession. What follows are highlights of the key issues raised and discussed by the group: Overall agreement that pharmacy will/should evolve. If not, it will result in a decrease in pharmacy stores (contraction) in the next 10 years. The need is for the current business model to adapt to the changing role within the next five years. A viable business model is a key to supporting role evolution. Pharmacy Human Resources Challenges and Priorities 75

84 SECTION 6 PHARMACY EMPLOYERS Economic/financial pressures are significant: Each area of the evolving role of the pharmacist must be individually viable Proper funding and reimbursement models must be in place A possible scenario is fewer stores, more volume and lower wages. The prospect of higher costs without a payer could lead to a need for fewer pharmacists and more technicians. Need to establish and demonstrate the value proposition of the pharmacist. Short-term nature of political decision-makers will be a challenge in getting the funding necessary. Capacity exists to perform these roles within the community-based pharmacies. May require additional training/education or location retrofits which are costly. The question may be better positioned in terms of Do they want to vs Can they. Pharmacy entry requirements are getting so high that we are getting fewer people people. Overall graduates are socially less capable. There is a need for students to learn more about the business model when entering the community-based pharmacy setting. Change management is a key to supporting role evolution: Communicate intent and rationale We need to evolve the pharmacist role Communicate support We support this initiative... Educate pharmacists about the impact this new role will have on the business model. The second part of the session asked participants to list the top HR challenges to the achievement of the future vision for the pharmacy profession. Participants were also asked to rate the challenges they identified (low to high) in terms of feasibility and impact. Specifically, what is the feasibility (or the likelihood) of addressing the challenge, and if addressed, what impact will that have Canadian Pharmacists Association

85 SECTION 6 PHARMACY EMPLOYERS Table 6-2: Feasibility and Impact of HR Challenges Identified by Chain Drug Store Employers (Breakout Groups) Group Challenges Feasibility vs Impact Facilities/workspace and workflow 2. Role definition (day-to-day) 3. Availability/labour supply (need for funding for more trained pharmacists) 4. Viability of business model (cost to train/monitor skills) 5. Change management (selling the role) 1. Supply demand ratio of 1:1 2. Increase the competencies of pharmacy graduates 3. Integration of pharmacy economics and advocacy skills in pharmacy education 4. Orientation and support to enable current practitioners to understand and feel confident about new roles 5. Performance management/reward structures 1. High feasibility; low impact 2. High feasibility; low impact 3. Low feasibility; high impact 4. Low feasibility; high impact 5. High feasibility; high impact 1. High feasibility; high impact 2. High feasibility; high impact 3. High feasibility; high impact 4. Low feasibility; high impact 5. High feasibility; high impact Community-based Independent Pharmacy Owners The first part of the session explored the evolving role of pharmacists and whether community-based independent pharmacy owners supported the predicted changes to the profession. What follows are highlights of the key issues raised and discussed by the group: Financial recognition for evolving roles is required. A new business model is needed that includes respectable margins. Need for remuneration/recognition, otherwise it is unfair to take on new roles. The issue of value what is the value proposition of pharmacists performing these new roles? The need for technicians to assume greater role in dispensing with pharmacists responsible for more clinical tasks (dispensing leadership as in the hospital setting). Need to demonstrate the value of the role the pharmacist can play to other health care professionals (in many cases this is especially true for physicians). Liability needs to be better defined it should not inhibit role evolution without being properly defined. The challenges around prescribing are partly around the inaccurate information and lack of effective communications that exist on the topic. Roles are changing across all health care professions there will be overlap and a need to resolve the boundaries and working relationships. Need to spend more time with patients to deliver better health care demonstrate the positive impact pharmacists can have on health outcomes (ACW: awareness, compliance, wellness). Costs will be prohibitive to role evolution if the customer is going to have to pay. Need to demonstrate savings in terms of rising drug costs. Overall owners are open to change but they need to keep business afloat while the role evolves this will be challenging. Pharmacy Human Resources Challenges and Priorities 77

86 SECTION 6 PHARMACY EMPLOYERS Based on inclement weather, attendance at this session was lower than anticipated. Instead of structured breakout groups, the participants discussed their unique challenges. These discussions are summarized in Table 6-3. Table 6-3: Top HR Challenges Identified by Independent Community Pharmacy Employers Challenges Feasibility vs Impact Systems Improved staffing process/workflow Reimbursement Dispensing Patient understanding/ education Education and training Credibility Enhancements are required to make the job of pharmacists easier Third party insurance Maintain integrity within the system Build on best practices Processes can be improved New roles have to be funded Models for payment must also be developed Needs to be an expanded role for technicians for a reasonable price Technician accreditation/certification is required Liability (technicians must be liable for what they are able to do) Automated dispensing opportunities need to be further developed Public education campaign Educating the public on the important role of the pharmacist in a community s health care ( Getting the most out of your pharmacists ) The need for bridging programs to support role evolution Specialization will likely be an issue post university Importance of continuing education Need to build credibility both within and outside the profession Need physician buy-in Too many barriers and layers have been added to the delivery of health care services 6.3 Final Comments Overall, the qualitative findings obtained from the employer discussion groups illustrate the range of HR challenges that must be addressed to develop the necessary pharmacy workforce for the future. While challenges across practice settings vary, familiar themes emerged in the dialogue. The related issues of staff workload and workflow reflect a common concern to both understand and implement the new roles that pharmacists and pharmacy technicians will play in the future delivery of health care. The implementation of these new roles is tightly linked to a need for new and flexible models for the reimbursement of expanded or innovative pharmacy services. Finally, employers in all practice settings recognize that effective change management is critical to developing the new pharmacy workforce of the future. The findings from these discussion forums represent the views of a limited number of pharmacy employers. While illuminating, the views of these participants cannot be seen as necessarily representative of all pharmacy employers. However, the key points and observations provided by these participants serve to reinforce the critical pharmacy human resources challenges that Canada is currently facing Canadian Pharmacists Association

87 SECTION 7 CONCLUDING REMARKS 7. CONCLUDING REMARKS The development of the pharmacy workforce of the future, as illustrated by the vision for pharmacy endorsed by pharmacists and pharmacies, requires that important changes be made to optimize the management of available pharmacy human resources. In the future, pharmacists will spend more time managing drug therapy in collaboration with patients, physicians and other health care providers. Pharmacists will play a more prominent role in health promotion, disease prevention, and chronic disease management and will continue to focus on clinical tasks related to dispensing prescriptions. Their work will be supported by specially trained and regulated and/or certified pharmacy technicians who also play a critical role in ensuring that the right individuals with the right skills are in the right place at the right time to help deliver necessary health services to Canadians. The HR implications of the new and innovative roles for the pharmacy workforce are great. The education and workload of pharmacists and pharmacy technicians, the recruitment and retention strategies utilized by their employers, and training and career development programs provided by educators must continue to change to prepare a strong pharmacy workforce ready to meet the future health care needs of Canadians. Pharmacy Human Resources Challenges and Priorities 79

88 SECTION I INTRODUCTION Canadian Pharmacists Association

89 SECTION I INTRODUCTION Pharmacy Human Resources Challenges and Priorities 81

90 ASSOCIATION OF DEANS OF PHARMACY OF CANADA (ADPC) ASSOCIATION OF FACULTIES OF PHARMACY OF CANADA (AFPC) CANADIAN ASSOCIATION OF CHAIN DRUG STORES (CACDS) CANADIAN ASSOCIATION OF PHARMACY TECHNICIANS (CAPT) CANADIAN PHARMACISTS ASSOCIATION (CPhA) CANADIAN SOCIETY OF HOSPITAL PHARMACISTS (CSHP) NATIONAL ASSOCIATION OF PHARMACY REGULATORY AUTHORITIES (NAPRA) THE PHARMACY EXAMINING BOARD OF CANADA (PEBC) OFFICE OF THE SECRETARIAT 1785 ALTA VISTA DRIVE, OTTAWA ON K1G 3Y6 TEL.: FAX: Funded by the Government of Canada s Foreign Credential Recognition Program