ENGAGE IN PHARMACY PRACTICE (ENACT): A REGISTRY OF PROFESSIONAL ABSTINENCE IN PHARMACY PRACTICE, AS SEEN BY PHARMACY STUDENTS
With scope of practice constantly evolving, pharmacists are seeing major changes in their practice (and, presumably their role as primary care providers). However, regulatory changes in scope of practice will not substantiate improved care if pharmacists themselves do not take steps to implement them. Concern over pharmacists not practicing to their full scope has been raised. Indeed, the choice to not provide patient care activities has been coined as “professional abstinence.”
Emerging out of this new scope are students with clinical training to provide clinical care within the redefined scope. However, students may observe professional abstinence firsthand when in practice or attending clinical placements – this can impact their training and socialization into the profession. This project aims to explore and enhance understanding of the role student pharmacists have in addressing professional abstinence; that is, to gain insight on the first-line barriers that promote professional abstinence, as well as the deeper root causes behind these issues from the unique inside perspective of pharmacy students.
- 1. Describe and share case studies/stories from pharmacy students across Canada regarding instances of professional abstinence in pharmacy practice
- 2. Explore the student's role in addressing professional abstinence
Methods & Data Collection:
- 1. Setting: Pharmacy students in any year of training who are attending clinical placements or are working in pharmacies are eligible to participate. For the purposes of this project, we will focus on community pharmacy only.
- 2. When instances of professional abstinence are encountered, students will be encouraged to document them anonymously in a registry. This registry will be designed and operated by the EPICORE Centre at the University of Alberta.
|What happened?||How did it make you feel?|
|Case 1||“The patient came in with complaints of not being controlled on their blood pressure medications, but the pharmacist chose to opt out of adapting the dose of an angiotensin-converting enzyme inhibitor (ACEi); they faxed the doctor instead!”||“I asked the pharmacist why they didn’t adapt, and they just said that most patients never know why they are even taking an ACEi, since it has so many indications, so the pharmacist wouldn’t know how to titrate the dose. I thought that might be fair, but the pharmacist didn’t even bother asking the patient—they just assumed, so I felt kind of disappointed and helpless.”|
|Case 2||"A patient called in asking if the pharmacist could prescribe antibiotics for pain—the pharmacist just did it without asking any questions. They told the student who answered the phone call to just say yes.”||“I felt as though the pharmacist should have assessed the patient more and asked more questions. This also adds to antibiotic resistance. It didn’t feel fair to the patient, because their life is basically in the pharmacist’s hands.”|
|Case 3||“The pharmacist would do the bare minimum during their shift. It reached a point where the district manager had to bring in a pharmacist from out-of-store once a week to do CACPs and SMMAs. There was just no incentive for the store pharmacist to do them even though these had been designed to give the pharmacy, not the pharmacist, compensation. There is no incentive for a pharmacist to do more or to be better on top of their already excessive workload.”||“It wasn’t actually all that discouraging. If anything, it makes me want to take part in creating policy. I don’t think it’s the pharmacist’s fault either. I think it may be up to the pharmacy owners to create their own incentives. I asked the pharmacists why they didn’t do any of the CACPs or SMMAs, and they told me it was because they don’t get paid more.”|
|Case 4||“Not checking indication when checking prescription: patient was receiving TMP/SMX for the first time, and the pharmacist dispensed the medication and counselled on side effects but never asked the patient what they were taking it for. When I asked why, the pharmacist said that even if the indication was incorrect, it would be difficult for him to oppose the doctor, so he prefers not to ask much anymore. On another occasion, a different patient came in asking if there were anything they could take for a skin infection or injury, but the pharmacist immediately referred the patient to a physician without asking too many questions or even performing SCHOLAR.”||“Very discouraged—this prevents pharmacies from becoming more than just dispensaries; we take all this clinical education for a reason.”|