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      Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system

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          Abstract

          Canada’s universal public health care system provides physician, diagnostic, and hospital services at no cost to all Canadians, accounting for approximately 70% of the 264 billion CAD spent in health expenditure yearly. Pharmacy-related services, including prescription drugs, however, are not universally publicly insured. Although this system underpins the Canadian identity, primary health care reform has long been desired by Canadians wanting better access to high quality, effective, patient-centred, and safe primary care services. A nationally coordinated approach to remodel the primary health care system was incited at the turn of the 21 st century yet, twenty years later, evidence of widespread meaningful improvement remains underwhelming. As a provincial/territorial responsibility, the organization and provision of primary care remains discordant across the country. Canadian pharmacists are, now more than ever, poised and primed to provide care integrated with the rest of the primary health care system. However, the self-regulation of the profession of pharmacy is also a provincial/territorial mandate, making progress toward integration of pharmacists into the primary care system incongruent across jurisdictions. Among 11,000 pharmacies, Canada’s 28,000 community pharmacists possess varying authority to prescribe, administer, and monitor drug therapies as an extension to their traditional dispensing role. Expanded professional services offered at most community pharmacies include medication reviews, minor/common ailment management, pharmacist prescribing for existing prescriptions, smoking cessation counselling, and administration of injectable drugs and vaccinations. Barriers to widely offering these services include uncertainties around remuneration, perceived skepticism from other providers about pharmacists’ skills, and slow digital modernization including limited access by pharmacists to patient health records held by other professionals. Each province/territory enables pharmacists to offer these services under specific legislation, practice standards, and remuneration models unique to their jurisdiction. There is also a small, but growing, number of pharmacists across the country working within interdisciplinary primary care teams. To achieve meaningful, consistent, and seamless integration into the interdisciplinary model of Canadian primary health care reform, pharmacy advocacy groups across the country must coordinate and collaborate on a harmonized vision for innovation in primary care integration, and move toward implementing that vision with ongoing collaboration on primary health care initiatives, strategic plans, and policies. Canadians deserve to receive timely, equitable, and safe interdisciplinary care within a coordinated primary health care system, including from their pharmacy team.

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          During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Oct-Dec 2020
                18 October 2020
                : 18
                : 4
                : 2171
                Affiliations
                BSP. Medication Assessment Centre, University of Saskatchewan . Saskatoon, SK (Canada). taylor.raiche@ 123456usask.ca
                BSc, BSP, MSc. Northern Health, Prince George, Faculty of Pharmaceutical Sciences, University of British Columbia . Vancouver, BC (Canada). Robert.Pammett@ 123456northernhealth.ca
                BScPhm, PharmD. Canadian Pharmacists Association . Ottawa, ON (Canada). SDattani@ 123456pharmacists.ca
                BScPhm, PharmD, MSc. Leslie Dan Faculty of Pharmacy, University of Toronto . Toronto, ON (Canada). lisa.dolovich@ 123456utoronto.ca
                BSP, MSc. College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba . Winnipeg, MB (Canada). hamilt23@ 123456myumanitoba.ca
                BSc(Pharm), ACPR, PharmD. College of Pharmacy, Faculty of Health, Dalhousie University . Halifax, NS (Canada). nkennie@ 123456dal.ca
                BScPhm, PharmD, MSc. Leslie Dan Faculty of Pharmacy, University of Toronto . Toronto, ON (Canada). lisa.mccarthy@ 123456utoronto.ca
                BSP, PharmD. Medication Assessment Centre, College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, SK (Canada). derek.jorgenson@ 123456usask.ca
                Author information
                https://orcid.org/0000-0002-4469-4409
                https://orcid.org/0000-0003-1173-394X
                https://orcid.org/0000-0001-9940-1266
                https://orcid.org/0000-0002-0061-6783
                https://orcid.org/0000-0002-3355-3635
                https://orcid.org/0000-0002-4792-9365
                https://orcid.org/0000-0001-9087-1077
                https://orcid.org/0000-0001-5790-4711
                Article
                pharmpract-18-2171
                10.18549/PharmPract.2020.4.2171
                7603659
                33149795
                0cbb0d65-6d64-4d97-8b5e-754d60c9a615
                Copyright: © Pharmacy Practice and the Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                International Series: Integration of community pharmacy in primary health care

                pharmacies,primary health care,delivery of health care, integrated,ambulatory care,community health services,pharmacists,community pharmacy services,professional practice,canada

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