Patient care improves with pharmacists' expanded roles: study

(Edmonton) Researchers at the University of Alberta and the Université de Montréal reviewed recent changes to pharmacy practice across the country and around the world, and found strong evidence that patients receive better care when pharmacists have expanded roles and are more involved in patient care.

In many areas of Canada and abroad, changes to the scope of practice for pharmacists have allowed them to renew and write prescriptions, adjust doses, change a prescription to a similar drug, give vaccinations, and order and review lab work.

The research analysis was published Aug. 19 in the peer-reviewed Canadian Medical Association Journal. Ross Tsuyuki, a pharmacist and professor with the Faculty of Medicine & Dentistry at the U of A, co-led the analysis with Cara Tannenbaum, a physician who works at the Faculty of Medicine and Faculty of Pharmacy at the Université de Montréal.

Their analysis examined the results of numerous randomized, clinical trials around the world that provided strong evidence that patients' health improved when pharmacists were more involved with patient care thanks to an expanded scope of practice. The trial results showed that patients' blood pressure and cholesterol levels were better, and patients with heart failure had 31 per cent lower rates of hospital admission. Other research has shown improvements for patients who have asthma and diabetes, and increased vaccination rates.

Tsuyuki and Tannenbaum noted that more than 10 per cent of emergency room visits in Canada stem from drug-related problems, and elderly patients taking numerous medications who end up in emergency often have at least one drug interaction issue.

"Dealing with complex medication issues is their expertise-this is what pharmacists are trained to do-so expanding their role in this area makes sense and helps put patients first," said Tsuyuki. "People see their pharmacist more frequently than they see physicians. And some people don't have family doctors or can't get in to see a physician, so this expanded scope of practice for pharmacists benefits the public and could reduce the number of ER visits and hospitalizations.

"Alberta is a leader for expanding the breadth of scope of practice for pharmacists," said Tsuyuki, referring to changes that took effect in 2007, giving pharmacists in Alberta the broadest scope of practice in the country. "Here, pharmacists can do comprehensive medication assessments-asking questions about what each drug is for and whether it is still needed, and looking for interactions. A patient could be put on a medication for an upset stomach, and 20 years later she is still taking the drug, and no one really remembers why. Pharmacists can help out in this area."

The researchers noted that with this expanded role, pharmacists and physicians need to ensure they communicate well about any changes to patients' medications. The article also noted that pharmacists' expanded roles can alleviate the high demand on physicians and allows them to work together as a health-care team to help patients.

James Kehrer, dean of the U of A's Faculty of Pharmacy and Pharmaceutical Sciences, said the study reaffirms the value of the university's interdisciplinary approach to educating pharmacists. "This is excellent work that provides strong justification for the government's desire to encourage all health professionals, particularly pharmacists, to practise to their full scope, which increases patient access to care, improves outcomes and lowers costs. We have changed how pharmacists are educated to facilitate their abilities to practise in these areas of expanded scope, and to embrace team-based patient care.

"It's exciting to see this validated in real-world settings."