Yazid Al Hamarneh¹, Scot Simpson², Ross Tsuyuki¹, Darius Ramrattan², Bo Pan¹, Karen Sullivan^1
1Other, ²Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta

Purpose:Community pharmacy primary care clinics were established to improve access to pharmacy services for assessment and management of common ailments and chronic diseases, point-of-care testing, and administration of medications by injection. As part of an ongoing assessment program, we report the characteristics of people who accessed the first clinic to open in Alberta and services they sought during the first seven months of operation.

Methods:This cross-sectional study examined information collected from self-reported intake forms submitted when individuals visited the clinic in Lethbridge, AB. Individuals seeking services between June 24, 2022 and January 31, 2023 were eligible for inclusion.

Results:There were 3305 people who visited the clinic 4962 times. They submitted 3831 intake forms with 4611 reasons for seeking care. Mean age was 32 years (range 0 to 96) and 62% were female. Almost one in three (32%) reported not having a family physician and 5% reported usually seeking medical care in an emergency room (ER) or urgent care clinic. Reasons for seeking care were: 79% Common Ailments  (e.g., upper respiratory symptoms, urinary tract infections, ophthalmic symptoms, musculoskeletal pain); 16% Chronic Disease Management (CDM, e.g., diabetes, hypertension, hypothyroidism); 4% Point-of-Care Testing or Immunization; or

Conclusion:The community pharmacy primary care clinic has improved access for people who do not have a family physician and supported those with a family physician. It is also likely that these clinics reduced some ER visits for primary care issues.  

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James Morrison¹, Molly Yang¹, Anna Taddio², Charlotte Logeman^1
1Other, ²Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:The CARDTM system (Comfort-Ask-Relax-Distract) is a knowledge translation tool that incorporates research evidence about how to reduce pain, fear and other immunization stress-related responses. CARD was previously demonstrated to improve the experiences of individuals undergoing pharmacy-led vaccinations across settings, including community pharmacies and university campuses. To date, no studies have evaluated the impact on vaccinations performed in senior residences. This study evaluated the experiences of individuals vaccinated with CARD in a senior resident home in Mississauga, Ontario.

Methods:One independent community pharmacy affiliated with Wholehealth Pharmacy Partners led a vaccination clinic in a community senior residence on Nov25, 2024. Organizational leaders supported CARD integration, including educating pharmacy staff, and setting-up clinic spaces and processes. Vaccine clients included residents (without dementia), caregivers and staff. Clients were educated about CARD using posters and invited to select coping strategies using a checklist. Post-vaccination, clients reported their experience compared to the last vaccination (primary outcome) and injection-related symptoms (pain, fear, dizziness). A target of >30% reporting a more positive experience was considered significant based on prior research. 

Results:Altogether, 50 clients (38 residents, 12 staff and caregivers) were vaccinated. Mean age was 71.9 years (SD=22.7) and 72% were female. Most clients received influenza (90%) and COVID-19 (78%) vaccines. Twenty-nine percent reported a baseline fear of needles. The most common coping strategies selected were having a support person present (12%), using a topical anesthetic cream (12%), not looking at the needle (10%), and taking deep breaths (10%). Forty-eight percent of clients (21/44; 95% CI: 33%-62%) endorsed a better vaccination experience compared to the last vaccination. Clients commented on the speed, convenience, and friendly atmosphere of the clinic. Mean pain, fear and dizziness scores (range, 0-10) were 1.3 (1.8), 1.1 (1.7), and 0.5 (1.4), respectively.

Conclusion:This study demonstrated positive attitudes in clients vaccinated by pharmacy professionals with CARD in a senior residence. Additional pain interventions are recommended to further improve experiences and prevent injection-related symptoms.

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Yazid Al Hamarneh¹, Ross Tsuyuki^1
1Other

Purpose:Point of care testing (PoCT) is a technology that can make the patient’s diabetes care journey easier. Regular monitoring can help patients with diabetes feel empowered, make healthier lifestyle choices, and assist in avoiding serious complications. PoCT might also provide that “teachable moment” to engage patients in their care. We evaluated the impact of adding PoCT to government-funded medication reviews, compared to medication review only or no medication review, on the treatment regimen of patients with diabetes.

Methods:This retrospective matched cohort study was conducted in community pharmacies from a single Canadian pharmacy group. We included individuals with diabetes who received at least one medication review and a PoCT. This cohort was then matched, based on age, gender, pharmacy location, and hypertension and dyslipidemia presence, with patients with diabetes who received at least one medication review but did not receive a PoCT, and those who are eligible to receive a diabetes medication review but did not receive either a medication review or a PoCT.

Results:The matched cohort included 9,409 patients from each group. The mean age was 64.6 (SD 13.1) years and almost half (44.6%) of the participants were female. Mean baseline A1C was 7.07% (SD 1.25). Of those patients who received medication review plus PoCT, 28.1% had a diabetes treatment regimen change, vs 22.6% in those who received medication review only and 25.6% who did not receive any interventions, p

Conclusion:While we observed statistically significant changes in diabetes medication regimen when PoCT was added to a medication review, the absolute level of changes absolute differences was small and likely not clinically relevant. It is important to note that more than half of patients had good glycemic control at baseline, suggesting that pharmacist selection of patients and the criteria for eligibility for diabetes medication review is suboptimal.

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Mira Maximos¹, Ryan Pelletier¹, Sameer Elsayed¹, Colleen Maxwell ¹, Sherilyn Houle¹, Brie McConnell¹, John-Michael Gamble^1
1School of Pharmacy, University of Waterloo

Purpose:Oral challenges using agents such as amoxicillin or other penicillins are safe and effective for delabeling patients with low-risk penicillin allergy histories. However, although 90% of individuals reporting a penicillin allergy can be safely delabeled following evaluation, detailed data on the frequency, types, and timing of reactions during and after oral challenge interventions remain limited. This knowledge is essential for optimizing oral challenge protocols and integrating them into routine clinical practice. This study aims to characterize the interventions commonly used for oral challenges, classify reported reactions, and identify predictors of hypersensitivity reactions in randomized controlled trials and quasi-experimental studies involving patients with low-risk penicillin allergies.

Methods:This study builds on a systematic review and meta-analysis assessing the effectiveness of oral challenges in low-risk penicillin allergy patients. This analysis summarizes adverse reactions among participants undergoing oral challenges. Specifically, participant demographics, intervention protocols, and the frequency, type, and timing of post-challenge reactions are reported. Reactions were categorized as immediate, delayed, or other, with frequencies summarized using descriptive statistics. A random-effects meta-analysis quantified the pooled adverse reaction percentage from studies reporting reaction incidence. Predictors of hypersensitivity reactions were synthesized narratively.

Results:Across 26 studies (2 randomized trials, 24 quasi-experimental studies), the average participant age was 56 years, with 61% female and 88% identifying as White. Amoxicillin was the most used oral challenge agent, typically administered as a single 250 mg oral dose. The reaction or non-delabeling rate was 4% (95% CI: 3%, 6%), I²=43%, P=0.0001. Cutaneous reactions, such as rashes, were the most frequent. Delayed reactions, primarily mild maculopapular rashes, were uncommon and managed with antihistamines or topical steroids. Risk factors included higher baseline allergy burden and shorter intervals since the index reaction.

Conclusion:Most oral challenges used a single 250 mg dose of amoxicillin. Reactions were infrequent, mild, and predominantly cutaneous, with few delayed occurrences. Standardized protocols and follow-up are crucial for effective delabeling. Future research should prioritize diverse populations and equity-driven frameworks to improve generalizability.

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Dominic Chaput¹, Alexandre Chadi¹, Daniel Thirion^1
1Faculté de pharmacie, Université de Montréal

Purpose:Assess the association between chronic diseases or medications and vaccination uptake for respiratory infections in Quebec community pharmacies.

Methods:This retrospective observational study analyzed the medication and vaccination records of Quebec community pharmacy patients from January 2020 to October 2024. The odds of complete vaccination coverage for COVID-19 (≥3 doses), influenza (≥3 doses), and pneumococcus (≥1 dose) in pharmacy were compared between patients who received ≥3 medications from a therapeutic class and patients who did not. Age-stratified subgroups were analyzed using multivariable logistic regression, and odds ratios (ORs) were pooled. Comparisons were also made for polypharmacy (≥10 therapeutic classes) and urban versus rural settings.

Results:A total of 2,774,082 patients were included. Complete vaccination coverage was achieved in 401,437 patients (14.5%) for COVID-19, 379,923 (13.7%) for influenza, and 161,668 (5.8%) for pneumococcus.   Odds of COVID-19 coverage were lowest among patients receiving HIV treatments (OR:0.84; 95% CI:0.79-0.88), and antituberculosis agents (OR:0.61; 95% confidence interval (CI):0.57-0.65) and highest among patients receiving calcium-channel blockers (OR:1.11; 95% CI:1.03-1.20) and macrolides (OR:1.11; 95% CI:1.09-1.13).   Odds of influenza coverage were lowest among patients receiving HIV treatments (OR:0.69; 95% CI:0.64-0.73) and antituberculosis agents (OR:0.77; 95% CI:0.72-0.83) and highest among patients receiving calcium-channel blockers (OR:1.17; 95% CI:1.10-1.25), antilipemics (OR:1.18; 95% CI:1.17-1.19), and macrolides (OR:1.21; 95% CI:1.19-1.23).   Odds of pneumococcus coverage were lowest among patients receiving respiratory tract anti-inflammatory agents (OR:0.728; 95% CI:0.56-0.95) and highest among patients receiving HIV treatments (OR:1.25; 95% CI:1.15-1.37), macrolides (OR:1.25; 95% CI:1.22-1.28), antineoplastic agents (OR:1.31; 95% CI:1.27-1.35), immunosuppressive agents (OR:1.41; 95% CI:1.36-1.47), and disease-modifying antirheumatic drugs (OR:1.50; 95% CI:1.45-1.56).   OR of coverage for COVID-19, influenza, and pneumococcus were 1.48 (95% CI:1.45-1.50), 1.72 (95% CI:1.69-1.75), and 1.53 (95% CI:1.50-1.56) respectively among patients receiving ≥10 therapeutic classes.

Conclusion:Community pharmacy vaccination practices for respiratory viruses vary according to the medications and diseases of patients. Patients at higher risk of complications from respiratory infections, particularly patients receiving immunosuppressive medications and patients with immunosuppressive diseases, had higher odds of pneumococcal vaccination but not influenza or COVID-19. Macrolides, an antibiotic class commonly used to treat respiratory infections, correlated with increased coverage for all three vaccines.

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Araniy Santhireswaran¹, Etienne Gaudette², Mina Tadrous¹, Martin Ho¹, Katherine Callaway Kim², Shanzeh Chaudhry¹, Katie Suda², Lisa Burry^1
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other

Purpose:The rise of drug shortages poses a dilemma for pharmacy professionals who are forced to manage shortages to provide timely patient care. However, approaches to quantifying shortage risk of drugs are lacking, and pharmacists lack of resources aimed at helping them manage and proactively prepare for shortages. It is essential to determine the impact of shortages on drug use trends and identify predictors associated with decreases in use to ascertain shortage risk and inform future policy prioritization and pharmacy practice. To develop a predictive model to anticipate shortage risk using characteristics associated with meaningful supply decreases following shortage events.

Methods:We conducted a matched cross-sectional study analyzing monthly trends in drug purchasing using IQVIA MIDAS data from 2017-2021. Incidence density sampling was used to match each drug with a supply chain event (cases) to 10 drugs without an event (controls). Shortage reports were obtained from Drug Shortages Canada. A logistic regression model with random effects was used to compare odds of a meaningful supply decrease (33%) within 2 quarters following reports for cases and controls.

Results:Of 1591 drugs, 972 (61%) unique drugs were exposed to 1919 supply chain events. Meaningful supply decreases (≥33%) were observed in 11% of cases, compared to 7% of controls. Drugs with sales less than 100 had higher odds of experiencing meaningful supply decreases.

Conclusion:Our findings highlight factors strongly associated with supply issue-related decreases in drug supply and indicate only 1 in 10 supply chain events led to meaningful decreases. These can be used to build a predictive model to score shortage risk of Canadian drugs and develop a national at-risk medicines list accounting for supply chain and clinical risk. Equipping pharmacists with this resource will allow them to understand which drugs are at higher risk of shortage, and consequently prioritize these drugs and pre-emptively plan for shortages in their daily practice. Our work is guiding policies for managing drug shortages, ultimately improving healthcare delivery and patient outcomes.

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Paula Newman¹, Sammu Dhaliwall¹, Feng Chang², Dora Chan¹, Kevin McDonald^1
1Other, ²School of Pharmacy, University of Waterloo

Purpose:Opioid-related harm is a public health crisis.  The death rate continues to climb in Canada with 32,000 opioid-related deaths January between 2016 to June 2022.  Pharmacists are ideally positioned to lead opioid stewardship programs (OSP) to coordinate interventions designed to guide, monitor, and evaluate the use of opioids to support and protect human health.  Rural Family Health Teams (FHT) often lack specialized clinicians in chronic non-cancer pain (CNCP) management, including the care of a pharmacist.  Despite rapid growth of videoconferencing technology to improve healthcare access in these communities, the effectiveness of a pharmacist-led OSP in remote and rural Canadian settings has yet to be studied.

Methods:The objective was to evalusate the feasibility and effect of a pharmacist-led OSP for CNCP using videoconference in a rural FHT.  This mixed-methods pilot study included web-based surveys and/or semi-structured interviews by telephone, with patient, clinicians, and pharmacists involved in the OSP to understand their experiences and/or satisfaction with the program.  Retrospective chart review was undertaken to collect data on patients opioid dosing and pharmacist recommendatons.  Adults with CNCP taking at least 50 morphine equivalent dose (MED) for at least 30 days, or, less than 50 MED, with persistent problematic pain and/or adverse effects were schedule to attend 5 videoconference sessions over 10 weeks.  Descriptive statistics were generated from numeric variables, and change in patients MED were analyzed with paired t-test or non-parametric testing.

Results:Nineteen participants were enrolled, most with upper body (53%) or back pain (29%).  The OSP pharmacist made 35 recommendations, 65% accepted and implemented.  Clinician and patient interviews and surveys showed the OSP had a positive impact and an interest in continuing to implement elements of the program into existing patient care practices.  Engaged clinicians felt more confident in managing patients on opioids, that continuity of care was improved, and recommended having an OSP pharmacist.  Program participants reported sessions were valuable, recommend the program, and satisfied with the care they received.

Conclusion:Results generated from this study may add new evidence on the feasibility and effectiveness of a clinical model in this kind and managing high dose opioid prescription in remote communities.

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Paula Newman¹, Sammu Dhaliwall¹, Kevin McDonald¹, Olena Polyakova¹, Glenys Vanstone^1
1Other

Purpose:Individual community pharmacies in remote locations in Canada often serve an extensive geographic region.  A large proportion of these communities are Indigenous Peoples that carry a high burden of chronic disease, with an incidence of diabetes four times greater in Indigenous communities.  Pharmacists have demonstrated a positive impact on health and economic outcomes in the care of patients with chronic disease.  Complex medication regimens present challenges for pharmacists to proved much needed medication management (MM) in the community setting.  Remote pharmacist MM, in a collaborative, patient-centreed care model to support patients, prescribers and community pharmacists may be a strategy to overcome barriers in communities where health care disparities exist.

Methods:The objective of this prospective cohort study was to determine patient satisfaction with a remote pharmacist-led MM program for patients with diabetes in a Northern Canadian Indigenous community.  Secondary objectives included describing pharmacist identified drug-related problems (DTP), pharmacist interventions and their acceptance rate.  DTPs were classified according to The Pharmaceutical Network of Europe DTP Classification System V9. Participants were adult patients prescribed at least one medication for diabetes who had an upcoming appointment with their Family Health Team.   Patients were asked to self-report their level of satisfaction with the MM program via annonymous questionnaire following their interaction with the pharmacist. Descripive statistics were applied.

Results:Thirty of 47 the patients contacted agreed to, and completed the MM program with the following medians: 60 years, HbA1c 9.5, 11 non-diabetes medications and two medications for diabetes.  The pharmacist identified 78 DTPs in 29 patients, the majority preventable events that could interfere with desired outcomes (71%) due to an impact on treatment effectiveness (63%) or safety (22%). Pharmacist interventions were primarily at the prescriber level, 31% accepted and fully implemented, with a 31% DTP resolution rate.  Overall, patient satisfaction with the program was positive.

Conclusion:Findings from this study found patients with diabetes in a rural community were satisfied with a remote phamacist MM program.  This collaborative model may add new evidence to ascertain the feasibility and effectiveness of a clinical program to meet the needs of Indigenous communities with a high burden of chronic disease.

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Sherilyn Houle¹, Saleema Bhaidani², Taher Rehmanji², Wasem Alsabbagh^1
1School of Pharmacy, University of Waterloo , ²Other

Purpose:Community pharmacies are a leading setting where Canadians receive vaccinations, and many provinces and territories also allow pharmacy professionals to administer other injectable medications. Considering pharmacies’ accessibility and convenience, the objective of this work was to examine the proportion of these services scheduled at times when other primary care providers are typically unavailable, and predictors impacting when patients schedule these services.

Methods:A retrospective analysis was performed of all injections scheduled using MedMe Health and MedEssist programs from January 1 to December 31, 2023. Vaccines were grouped by the disease being prevented and medications were grouped by drug class. ‘Off-clinic’ hours were defined as those when other primary care settings are generally unavailable to provide injections and included times before 9:00 AM or after 5:00 PM, weekends, and holidays. Analyses explored the proportion of services scheduled within off-clinic hours and if this differed by the specific vaccine or drug being scheduled and pharmacy-level factors including type (chain vs. banner/independent), province, and rurality. Ethics approval was received from the Office of Research Ethics at the University of Waterloo.

Results:Of 1,226,903 injections scheduled over the study period, 99.1% were for vaccines and 0.7% for non-vaccine products, with the remaining 0.1% unknown. Across all pharmacies, 27.0% of injections were scheduled during off-clinic hours, ranging from 9.1% among banner/independent pharmacies to 34.0% among chain pharmacies. Weekends were the most frequent among the ‘off-clinic’ hours appointments followed by weekdays outside of 9:00 AM to 5:00 PM, and holidays falling on weekdays. The leading products administered during off-clinic hours were COVID-19, influenza, herpes zoster, hepatitis, and HPV vaccines.

Conclusion:Public interest in scheduling injection services on evenings, weekends, and holidays appears to be high when this is available. Pharmacy staffing during respiratory virus season when demand for vaccines is highest may be well allocated to supporting appointments during these times when possible.

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Noah Zlotnik¹, Marisa Battistella¹, Angelina Abbaticchio², Madeline Theodorlis², Michelle Cross², Jo-Anne Wilson^3
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other, ³College of Pharmacy, Dalhousie University

Purpose:Patients on hemodialysis (HD) have a high pill burden and are at increased risk for polypharmacy-related adverse events. Deprescribing is a potential solution to mitigate the harmful effects of polypharmacy among patients on HD. However, deprescribing in this population remains understudied. The overall aim of this study is to implement and evaluate the effectiveness and safety of a deprescribing intervention, utilizing a deprescribing toolkit in multiple HD units across Canada, ultimately leading to a validated and standardized deprescribing program that can be adopted nationwide. This preliminary study aims to demonstrate the efficacy and safety of a deprescribing intervention within one HD unit in Toronto, Canada.

Methods:This single-center study included patients on HD for a minimum of 3 months who were on at least one of the 9 study medication classes. Clinicians applied deprescribing algorithms to determine if deprescribing was recommended. Clinicians and patients could decline the algorithm’s recommendation if desired. The primary outcomes include the number of patients successfully deprescribed by discontinuing or reducing the dose of their medication over 6 months, and clinically significant adverse events. Secondary outcomes include clinician and patient acceptance of algorithm recommendations and clinical safety monitoring.

Results:Ninety-eight patients were included and were taking an average of 12.88+4.33 medications, with an average of 2.15+1.59 being study medications. The algorithms recommended 40 patients to deprescribe 49 study medications. Clinicians agreed to 39 (80%) recommendations, and patients agreed to 28 of those 39 (72%). Twenty patients successfully deprescribed 23 medications (82%), while 5 patients failed and restarted 5 medications (18%) at their baseline dose. Clinical monitoring and spontaneous reporting revealed no adverse events considered related to the intervention.

Conclusion:Using our validated deprescribing pharmacy led program, approximately 1 in 5 eligible patients successfully deprescribed a medication with minimal clinical detriment. Currently this deprescribing program is being implemented and evaluated in 4 additional HD units in Canada.

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Marisa Battistella¹, Madeline Theodorlis², Angelina Abbaticchio², Noah Zlotnik¹, Michelle Cross², Anna Gagliardi², Setayesh Yazdani¹, Jo-Anne Wilson^3
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other, ³College of Pharmacy, Dalhousie University

Purpose:Polypharmacy is common among patients undergoing hemodialysis (HD), increasing the risk of adverse health outcomes. Deprescribing, the intentional reduction of unnecessary medications, can mitigate polypharmacy-related risks, but is often challenged by patient-, clinician-, and system-level barriers. This study explores the perspectives and experiences of patients and clinicians involved in a deprescribing intervention to identify barriers, facilitators, and strategies for improving deprescribing practices in the HD population.

Methods:_This single-centre study involved one-on-one, semi-structured qualitative interviews with patients and clinicians enrolled in a 6-month deprescribing intervention in the outpatient HD unit at Toronto General Hospital, University Health Network._ English-speaking adults on HD who were taking at least one study-specific medication, and clinicians (nephrologists, nurse practitioners, pharmacists), were recruited through convenience sampling. Data collection and analysis were informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, using a qualitative descriptive approach, with themes identified inductively and mapped to RE-AIM.

Results:Nineteen patients (10 who attempted deprescribing, nine who did not) and six clinicians (four physicians, one pharmacist, one nurse practitioner) completed an interview. Facilitators identified by both groups included reducing pill burden, guidance from trusted providers, information about the rationale, risks, and benefits to deprescribing, and integrating deprescribing into routine medication reviews. While follow-up was valued, patients with minimal side effects found it less necessary. Clinicians emphasized the role of multidisciplinary collaboration and deprescribing tools (e.g., algorithms), though time and resource constraints were noted as challenges. Other key barriers included fear of symptom recurrence and medication dependence.

Conclusion:Barriers and facilitators to deprescribing were identified, offering insight to enhance the process of deprescribing. Future interviews with patients and clinicians who completed the deprescribing intervention at additional HD sites across Canada could provide further understanding of how to promote effective and ongoing deprescribing in the HD population.

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James Morrison¹, Molly Yang^1
1Other

Purpose:Mifepristone/misoprostol (Mifegymiso), a drug regimen indicated for medical termination of a pregnancy, first became available in Canadian community pharmacies in 2017. This study sought to understand the experience of Ontario pharmacists providing medical abortion prescriptions, including the challenges of maintaining inventory and dispensing, and the level of pharmacist willingness to dispense mifepristone/misoprostol. 

Methods:A voluntary, anonymous 14-item Web-based survey on pharmacists experiences dispensing mifepristone/misoprostol was developed based on previous surveys that examined pharmacist dispensing of mifepristone/misoprostol. The survey included both open-ended and closed-ended items and was disseminated via social media, and by email to 1583 pharmacists. Letters inviting survey participation were mailed to 254 Ottawa region pharmacies. Demographics questions included gender, years of experience, rural vs urban practice setting, role in the pharmacy, and type of pharmacy (banner, chain, etc.) Survey topics focused on dispensing practices, barriers to maintaining stock, challenges to dispensing, and personal support for dispensing the product.   Responses were collected during a one-month period from June to July 2024. 

Results:Forty Ontario pharmacists surveyed responded electronically and represented both urban (n=29) and rural (n=11) pharmacies. The majority of respondents (93%) were very supportive or somewhat supportive of dispensing mifepristone/misoprostol prescriptions.  The perceived number of mifepristone/misoprostol prescriptions reported dispensed in the past year ranged from 0 to 100 (average 8.45) units. Eleven pharmacists reported patients having difficulty accessing mifepristone/misoprostol in their communities. The primary barriers to maintaining adequate stock levels were low demand (n=23), high cost (n=6), and expired stock (n=5). Twelve respondents reported no barriers to maintaining inventory and nine pharmacists reported their pharmacy does not stock mifepristone/misoprostol. The main challenges to dispensing were the need for additional education (n=9) and the time required for counseling (n=10). Five pharmacists that do not dispense mifepristone/misoprostol had not identified another pharmacy to refer patients to.

Conclusion:Addressing the identified barriers could improve access to mifepristone/misoprostol, ensuring more comprehensive and inclusive care for patients accessing medical abortion prescriptions. Further studies should involve collecting patient and prescriber perspective to have a broader understanding of these issues.

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Shania Liu¹, Ross Tsuyuki¹, Michelle Graham¹, Dorothy Nelson², Gary Semeniuk², Yazid Al Hamarneh^1
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Other

Purpose:Cardiovascular disease (CVD) is the leading cause of death worldwide. CVD risk factors are well-known, but treatment gaps persist. Community pharmacist prescribing to lower CVD risk is supported by trials evidence. We developed an electronic tool (“Care Pathway”) for guideline-directed assessment, prescribing and follow-up for CVD risk reduction. The aim of this randomized controlled trial is to determine the impact of a pharmacist-led Care Pathway intervention on participants’ estimated risk for major cardiovascular events.

Methods:This trial will include 982 patients (18 years and older) who are at an elevated risk for CVD. We will recruit at least 50% females to ensure a representative sample. Patients will be randomized in a 1:1 ratio to a pharmacist-led intervention which features shared decision-making and is driven by a guideline-based electronic Care Pathway tool or control (usual care). Pharmacist-led intervention will include assessment, education, prescribing medications and follow-up on CVD risk factors. The primary outcome is the difference in change in estimated CV risk from baseline to the 6-month follow-up between the groups. Secondary outcomes include patient satisfaction and quality of life. Analyses will be conducted using intention-to-treat principles and will be stratified by sex.

Results:Not applicable as this is a trial protocol.

Conclusion:The PRxOACT Trial will evaluate a unique “Care Pathway” to help pharmacists assess, prescribe, follow-up and document CVD risk reduction. Recruitment is underway and we anticipate results in early 2026. The development of Care Pathways for the management of other conditions including osteoarthritis, diabetes, chronic obstructive pulmonary disease, and influenza-like illness are in progress.

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Kathleen Bergin¹, Kyle Wilby^1
1College of Pharmacy, Dalhousie University

Purpose:Pre-exposure prophylaxis (PrEP) is a highly effective way to prevent newly acquired HIV (human immunodeficiency virus) infection and pharmacists can increase access to PrEP through pharmacist prescribing. The PrEP-Rx study, conducted in Nova Scotia, Canada, was a pilot project involving pharmacists who prescribed and monitored PrEP for HIV prevention. To be able to add this prescribing practice to the routine scope for pharmacists in Nova Scotia, the acceptability of pharmacists to prescribe PrEP must be evaluated. This study aims to identify how pharmacist led PrEP prescribing is accepted by community pharmacists and to determine the facilitators and barriers of implementing this practice in Nova Scotia from the perspective of community pharmacists.

Methods:This was a qualitative case study using interviews with pharmacists who participated in the PrEP-Rx study. The interview questions aligned with the 8 constructs of Theoretical Framework of Acceptability (TFA) (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness, self-efficacy, and perceived safety) to assess how PrEP Prescribing aligns with their perceived scope of practice, their own beliefs, and the costs and benefits they observed by participating in this study. Interviews were audio-recorded and transcribed verbatim. Transcripts were deductively coded according to the TFA then inductively coded to identify boarder themes according to a reflexive thematic analysis.  

Results:A total of 8 pharmacists participated in this study (80% of eligible participants). Main findings related to self-efficacy and perceived effectiveness of the intervention, which were both positively received by pharmacists. This study found that pharmacists are overall very accepting of having PrEP prescribing implemented into their practice and determined that it aligns with their perceived scope of practice. Adequate planning, using appointment bookings, and proper training on PrEP prescribing were identified as strategies to reduce burden of this service within practice settings.

Conclusion:Pharmacists were accepting of PrEP prescribing according to all TFA constructs. Pharmacists were willing to be held accountable for the increase in responsibility, however, strategies such as appointment bookings should be implemented to reduce burden on workflow and adequate reimbursements models need to be in place to increase buy form pharmacists.

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Sara Guilcher¹, Lauren Cadel¹, Rasha El-Kotob¹, Jacob Crawshaw¹, Diana Zidarov², Lisa McCarthy¹, Lisa Dolovich¹, Crystal MacKay², Sander Hitzig², James Milligan², Stephanie Cimino², Aisha Lofters^2
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other

Purpose:Prescription medications are widely used in Canada, but patient-reported experience measures (PREMs) for medications are not commonly implemented or used in clinical practice. Understanding, measuring, and acting on patient-reported experiences is paramount to delivering safe, effective, and quality patient-centered care. The objective of this study was to examine the barriers and facilitators to the use of a PREM for medications in routine practice in Ontario, Canada.

Methods:This cross-sectional survey study is part of a larger, mixed methods study informed by the Theoretical Domains Framework. The survey was developed based on literature search, qualitative interviews, and meetings with an advisory committee consisting of persons with lived experience of taking medication (PWLE). Most questions on the survey were answered on a 5-point Likert-type scale from strongly disagree to strongly agree. Participants included PWLE, medication prescribers (physicians, pharmacists, nurses), and decision-makers from Ontario, Canada. The survey was online and self-administered. It collected information on participant demographics, barriers and facilitators to the use and implementation of a PREM for medications, and the ideal delivery of a future PREM. The data were analyzed descriptively in R.

Results:The survey was completed by 400 participants, including 195 PWLE, 190 medication prescribers (97% pharmacists), and 10 decision-makers. Participants identified the following TDF domains as barriers to implementing and/or using a PREM for medications: _Knowledge, Reinforcement, and Environmental Context and Resources_. Participants identified the following TDF domains as facilitators to implementing and/or using a PREM for medications: _Skills, Beliefs about Capabilities, Optimism, Goals, and Social Influences_. Specific to the delivery of a future PREM for medications, participants thought it should take individuals 10 minutes or less to complete and it should consist of closed and open-ended questions. Prescribers preferred for the PREM to be implemented in community pharmacy, PWLE preferred for it to be implemented in primary care, and decision-makers preferred acute care.

Conclusion:We identified key barriers and facilitators, aligning with the TDF, to the implementation and use of a PREM for medications. These insights will support the development and implementation of a PREM for medications that is effective and sustainable in improving patient-centered care.

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Teri Charrois¹, Arwa Nemir¹, Nicole Domanski¹, Anita Kapanen¹, Yuki Meng¹, Jillian Reardon¹, Nasheena Poonja¹, Tiana Tilli¹, Adrian Ziemczonek¹, Jamie Yuen^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:As of June 1, 2023, pharmacists across British Columbia (BC) were granted prescribing authority for contraception. Despite provincial coverage of contraceptive products, the uptake of pharmacist contraceptive prescribing in BC has been suboptimal. However, the low uptake of the service cannot be explained by a lack of demand since up to 40% of pregnancies in Canada are unplanned (Black et al., 2015). Therefore, our study sought to gain a deeper understanding of the barriers and facilitators to pharmacists prescribing contraceptives, from the perspectives and experiences of patients.  

Methods:Using a case study methodology, we adopted a qualitative approach focusing on the context of pharmacy practice in BC. We conducted semi-structured virtual interviews via Zoom with patients recruited through the REACH BC platform. Patients were eligible if between 18-55 years old and sought out contraceptive care from a BC pharmacist, regardless of if they received a contraception prescription or not. Our analysis utilized a multi-coder thematic approach.   

Results:We interviewed 15 patient participants, 14 of which received a contraception prescription post-assessment with 93% of prescriptions being issued for oral contraception. 80% of patients self-identified as a woman, and the mean age of participants was 33 years old. Patients learnt about the contraception prescribing services offered by BC pharmacists through the pharmacy, social media, family members, friends, and the workplace. In addition, 67% of patients had a walk-in appointment with the pharmacist, and 53% shared they were comfortable receiving a prescription for any form of contraception from the pharmacist. Facilitators to patients’ experiences receiving contraceptive care from a pharmacist include; a private and quiet pharmacy atmosphere, an efficient prescribing process, a pharmacist conducting a comprehensive assessment, and pre-existing relationship with the pharmacist. On the other hand, barriers include; the pharmacist’s negative attitude and demeanour, patient-pharmacist interaction in a public space, and logistical challenges with contraceptive device insertion post-prescription.

Conclusion:While contraception prescribing by BC pharmacists aims to optimize patient care provision in the province, the novelty of the service warrants increasing public awareness about its existence in addition to addressing the barriers to patients’ experiences with receiving contraceptive pharmacist care.

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Loretta Lee¹, Swasti Bhajan^1
1Other

Purpose:Unnecessary use of intravenous (IV) rather than enteral (PO) medications increases hospital length-of-stay, risk of hospital-acquired infections, nursing administration time, drug cost, and environmental footprint.  Choosing Wisely Canada (CWC) suggests using oral formulations rather than IV when clinically appropriate. SHN initiated an IV to PO stewardship program for levetiracetam and pantoprazole. A 10% decrease in IV usage was targeted.

Methods:The hospital-wide project included all clinical areas at three SHN sites during pre-intervention June 2022 to February 2023 and post-intervention March 2024 to November 2024. Step-wise interventions to enhance appropriate IV to enteral formulations included 1) initial education and awareness of evidence-based practices through e-mail and medicine rounds, 2) development of prescribing criteria for IV use by Drugs and Therapeutics Committee, 3) electronic health record decision support tools that recommend enteral or PO stepdown options, and 4) pharmacist interventions to recommend IV to PO stepdown. The primary outcome measure was intravenous medication doses per 1000 patient days, as gathered from pharmacy dispensing and electronic admission records. Statistical process control charts were used to establish statistical significance. Secondary measures included enteral formulation dispenses per 1000 patient days.  Balancing measures include a survey of provider awareness/satisfaction.

Results:A total of 832,915 patient-days were included; 334,404 pre- and 498,511 post-intervention. Levetiracetam IV dispenses decreased from 26.5 to 22 per 1000 patient days (17% reduction, special cause variation June 2024). Pantoprazole IV dispenses decreased from 107.8 to 76.6 per 1000 patient days (29% reduction, special cause variation December 2023). There was a decrease in the IV/PO ratio by 23% for levetiracetam and 29% for proton pump inhibitors, indicating an increase usage of enteral options.

Conclusion:Inter-disciplinary collaboration with prescribers and utilization of electronic decision support tools are both necessary to facilitate IV to PO stewardship.  Regular education and positive feedback will be required to sustain ongoing efforts.  Future analysis of cost savings and carbon footprint reduction are also underway to evaluate economic and ecological impact.  It is believed that the findings from this project can be applied to other IV drugs with similar PO efficacy and safety.

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Samantha Cunningham¹, Roy Dobson¹, Jason Perepelkin^1
1College of Pharmacy and Nutrition, University of Saskatchewan

Purpose:To evaluate whether a patient-reported experience measure questionnaire could be administered feasibly in a community pharmacy environment, and whether the findings would be acceptable and useful to the pharmacy team. 

Methods:A mixed method, two-phase study was carried out in the summer and fall of 2024.  The first phase involved eight pharmacies inviting their patients to complete a patient experience questionnaire developed by the Saskatchewan College of Pharmacy Professionals. Responses were compiled by the research team and a feedback report provided to the pharmacy manager at each site. In the second phase, focus groups were held with the pharmacy teams from seven of the pharmacies. Pharmacy teams were asked to comment about their experience with patient recruitment for the study, and team member perspectives on the patient feedback in terms of acceptability, and perceived usefulness in supporting quality improvement. Descriptive statistics from the questionnaires were aggregated and focus group transcripts were analyzed using thematic analysis.

Results:A total of 133 patients responded to the survey across the eight participating pharmacies. All pharmacies scored highest in the domain of Communication and Collaboration, and lowest in the domain of Providing Care. Statements ranked highest most frequently included “they listen to me”, “they explain things in a way that is easy to understand”, and “they respect my privacy”. Statements ranked among the lowest included, “they check with me to see if my medication is working when I refill it”, “they know about my medication history”, and “they tell me about the benefits of all my medications” . Pharmacy professionals and staff found the survey process minimally disruptive to workflow, but that patients were not motivated to respond. The feedback was found to be generally acceptable to pharmacy staff, who commonly identified strengths and areas for improvement that reinforced what they previously assumed.  Perspectives of the usefulness of patient feedback varied among the pharmacies.

Conclusion:Administration of a patient-reported experience measures survey is feasible, and feedback provided is often acceptable to pharmacy professionals and staff. Further research should investigate how to effectively support pharmacies to use the feedback provided in quality improvement initiatives.

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Sherilyn Houle^1
1School of Pharmacy, University of Waterloo

Purpose:Travel consultations have increasingly become part of pharmacists’ professional service offerings over the past decade, supported by changes in scope of practice and heightened public awareness of both health risks while travelling and pharmacists’ roles in patient care. To support pharmacists with providing evidence-based care now and in the future, perspectives of pharmacists experienced in travel health were sought to provide insight on education and resource needs and a vision for pharmacist practice in travel health.

Methods:A panel of Canadian pharmacists from varied backgrounds with experience in travel health were purposively recruited to participate in an asynchronous virtual checkpoint in June 2024. Questions were posed for feedback and discussion on needs and preferences related to continuing professional development, use of clinical decision support software and other resources, and areas of concern and opportunities related to pharmacy practice in this field.

Results:Nine pharmacists completed the checkpoint. Key themes arising from discussions were: (1) The value of holding a Certificate in Travel Health; (2) Education needs related to changes in disease epidemiology and therapeutic options; (3) The use of specialized travel software to inform consultations but the need to use clinical judgment when applying recommendations to patient care; (4) A need to balance maximizing pharmacists’ accessibility with the maintenance of high standards related to quality of care in this specialty, and (5) An appetite for creating a community of Canadian travel health practitioners for networking and peer support.

Conclusion:Canadian pharmacists experienced in travel health see value in maximizing pharmacists’ accessibility to provide pre-travel care to patients; however, they also recognize travel health as a specialty field, especially for more complex cases, where additional training/credentialing should be leveraged to ensure quality care.

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Jason Min¹, Adam Shahin¹, Charles Au¹, Rince Wong^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:Emerging evidence from clinical practice highlights that while the Interim Federal Health Program (IFHP) covers medications for resettled refugees and refugee claimants in Canada, this population continues to experience significant barriers to accessing medications. Comprehensive strategies to address these barriers have yet to be developed. This study aims to identify the enablers and barriers to medication access under the IFHP and propose strategies to improve medication access through pharmacy-led interventions and healthcare provider education.

Methods:A scoping review was conducted following the JBI Manual for Evidence Synthesis. The search strategy included two databases: PubMed and Ovid MEDLINE. Covidence was used for screening, removal of duplications, and data extraction. Studies were included if they addressed barriers or enablers to medication access under the IFHP involving refugee claimants and resettled refugees or healthcare providers in Canada, and were published in English between 1946 and July 31, 2024. Exclusion criteria included studies that did not focus on medication access and the IFHP, studies on general healthcare access without specific reference to medication access, and studies that focused only on immigrant populations (i.e., individuals who have settled permanently).

Results:The search yielded 298 studies after removal of duplications. 9 articles met inclusion criteria: 5 qualitative studies (56%), 2 surveys (22%), 1 systematic review (11%), and 1 case report (11%). Key barriers identified were administrative challenges (5 studies, 56%), provider knowledge gaps (5 studies, 56%), and language or cultural barriers (3 studies, 33%). Enablers included community navigational aids for patients (3 studies, 33%) and handout resources for healthcare providers (2 studies, 22%), such as information for physicians on how to register with the IFHP and obtain reimbursement.

Conclusion:Significant barriers exist when providing care to resettled refugees and refugee claimants under the IFHP, including administrative challenges and knowledge gaps. Development of healthcare-specific resource guides tailored for physicians and pharmacists can address these medication access barriers. An environmental scan in Spring 2025 will be conducted to further inform pharmacy-led interventions to improve medication access for IFHP claimants.

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Jennifer Lake¹, Monika Roerig², Laura Brady¹, Izzah Khairi², Caroline Sirois³, Agnes Grudniewicz², Elisabeth Martin², David Rudoler², Sara Allin^2
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other, ³Faculté de pharmacie, Université Laval

Purpose:The overall study explored how recent legislation has supported the integration of Ontario and Quebec’s community pharmacists into primary care. A comparison of the different ways that community pharmacists have enacted new legislated tasks, drawing lessons about the strengths and challenges within each province, and to propose educational, research, and policy based on this work.

Methods:An interpretive qualitative study with multiple data sources including documents, community pharmacists’ interviews, and a dialogue with interested parties. Interviews were completed May – August 2024 with the dialogue in January 2025. Data was analysed both deductively and inductively. The research team created themes using iterative review and re-analyzed across the different steps to provide recommendations.

Results:Legislative changes were monumental for the profession, and all participants noted an immense need for more patients being able to access care. Recent legislation focused on integration of services into the primary care setting and not collaborations between pharmacists and other healthcare professionals. This distinction was essential when discussing implementation, as many participants focused on how new tasks and their delivery impacted their own relationships with physicians; not their own expertise and autonomy to deliver patient care. Individual pharmacists faced challenges with implementation which was both aided and hindered by different corporate infrastructures and access to clinical information. Differently than reported by other primary care providers, community pharmacists had a clear understanding of peoples’ choice in using their services, which focused them on maintaining their longitudinal relationship with patients.

Conclusion:Pharmacists are legislated to deliver some services autonomously in Ontario and Quebec; they should deliver because it supported patients receiving much needed care. However, individual pharmacists require implementation plans and educational support to adapt new tasks to their local circumstances. Recommendations included increased access and bilateral documentation into electronic charts for improved coordination and communication. Research evaluating the longitudinal nature of pharmacist-patient relationships to see if this is a marker of a healthy primary care system similar to that seen with other primary care providers.

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Rishabh Sharma¹, Tejal Patel¹, Tanaya Sharma¹, Brent McCready-Branch¹, Arshia Chauhan¹, Caitlin Carter¹, SooMin Park¹, Imra Hudani¹, Prapti Choudhuri^1
1School of Pharmacy, University of Waterloo

Purpose:This scoping review aimed to explore medication use in older adults with frailty living in the community, including the prevalence of potentially inappropriate medications (PIMs), polypharmacy, medication adherence, medication errors, and their role in adverse drug events. 

Methods:This scoping review followed the five-stage framework outlined by Arksey and O’Malley, with additional guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR). A comprehensive literature search was conducted across Ovid EMBASE, PubMed (MEDLINE), Scopus, EBSCOhost CINAHL, and Ovid International Pharmaceutical Abstracts, from inception to November 2023. Eligible studies focused on older adults (aged 65 years or older) with frailty living in community settings, employed defined frailty criteria, and examined medication use. Exclusion criteria included studies published in languages other than English, those lacking medication-related health outcomes, and research conducted in hospital or institutional environments. Two independent reviewers screened the publications, with a third reviewer resolving any disagreements. Data on study design, participant demographics, frailty assessments, and outcomes were extracted for analysis. 

Results:Out of 4,726 studies initially screened, 223 were included in the analysis, spanning 39 countries, with the majority conducted in Europe (108 studies). Frailty prevalence ranged from 0.9% to 89.2%, influenced by geography, study design, and measurement tools. Polypharmacy (5–9 medications) and hyper-polypharmacy (≥10 medications) were notably more common among individuals with frailty, with polypharmacy rates ranging from 1.3% to 96.4%. Twelve studies examined the prevalence of PIMs across frailty groups, reporting rates between 2.4% and 95.9%, using tools such as the Beers Criteria® and the Screening Tool of Older People’s Prescriptions (STOPP). Drug-related problems (DRPs), including adverse drug interactions and anticholinergic burden, were also associated with an increased risk of frailty, with prevalence ranging from 0.2% to 77.6%.  

Conclusion:This scoping review highlights the considerable challenges and complexities in understanding the relationship between medication use and frailty in older adults. The findings highlight that the prevalence of PIMs and medication-related problems differs among individuals with frailty, with this variation influenced by the criteria/tool used for assessment. This result emphasizing the importance of adopting tailored approaches to address medication-related risks in this vulnerable population. 

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Jamie Yuen¹, Elizabeth Sugiarto¹, Adam Bleik¹, Minh Tri Van¹, Jillian Reardon¹, Arwa Nemir^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:Many patients with hypertension do not have their blood pressure optimally managed and pharmacists can incorporate digital health technology into monitoring and management efforts. The University of British Columbia Pharmacists Clinic (the Clinic) is a pharmacist-led, academic clinic that offers in-person or virtual consultations. The objective of this study was to evaluate pharmacist and patient experiences and perspectives of a remote hypertension management program.

Methods:This study was a 6 month, pre- and post-intervention study of a pharmacist-led, remote monitoring hypertension program enabled by a mobile health application to monitor patient blood pressure (BP). This was coupled with routine pharmacist consultation and intervention. Using a mixed-model design, surveys were deployed during the 6-month study with the addition of interviews with patients and pharmacists to gain insight into their experiences. Inclusion criteria for patients included age 18 and above, hypertension, under active care at the Clinic, smartphone capability, ability to participate in phone/video interviews and to self-monitor BP. Interviews were conducted via Zoom and transcribed verbatim. Data analysis of interview transcripts was informed by qualitative description methodology to inductively develop final themes.

Results:17 and 10 patient participants were interviewed at one week and 6 months, respectively, and 6 pharmacists at both time points. Both groups acknowledged the simplicity of using the application owing to its “user friendly” and “easy to navigate” features. At six months, all patients shared they would recommend the program to their friends and family because of how it provided them autonomy in managing their health via facilitating conversations with their primary care provider and keeping an electronic record of their BP readings to adjust their medications accordingly. Most pharmacists highly rated the program as being helpful and efficient in informing their decision making and increasing their confidence in providing patient-specific recommendations. Pharmacists also commended the program for supporting interprofessional collaboration and information sharing with primary care providers via attaching patients’ BP readings to the pharmacists’ consult notes.

Conclusion:This study reported first hand experiences of patients and pharmacists collaborating to manage hypertension remotely. Findings can be applied to other chronic disease management efforts through leveraging health technology.

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Bincy Baby¹, Ghada Elba¹, SooMin Park¹, Imra Hudani¹, Rishabh Sharma¹, Kirk Patterson², Annette McKinnon², Sara JT Guilcher³, Feng Chang¹, Linda Lee², Catherine Burns², Dagmar Hajducek¹, Ryan H. Griffin², Tejal Patel^1
1School of Pharmacy, University of Waterloo , ²Other, ³Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:To evaluate the usability and user experience of medication adherence technologies (MATech) among older adults with diverse physical, cognitive, sensory, motivational, and environmental capabilities. 

Methods:We conducted a mixed-methods study with older adults aged 60 years and over. We used cognitive walkthrough to assess usability by measuring unassisted task success rates, total error rates, total task completion time, and efficiency for unassisted tasks. Participant capabilities were assessed using validated questionnaires including Self Medication Assessment Tool (SMAT), Self-Efficacy for Appropriate Medication Use Scale (SEAMS) and 3 other measures. Participants tested between one and seven MATech from a selection of 10 electronic and 3 smart MATech, relying solely on the instructional materials provided with the devices. Descriptive statistics summarized key variables, while Spearman correlation analysis explored relationships between usability outcomes and participant characteristics. Poisson generalized estimating equations (GEE) were used to identify significant predictors of usability outcomes.

Results:The study included 96 participants, with a mean age of 75.1 years (SD: ±7.7 ). The overall mean unassisted task success rate was 74.85% (SD: ±21.27) while the total error rate averaged 16.87% (SD: ±15.89); efficiency for unassisted tasks had a mean of 9.27 (SD: ±7.87), and the average total task completion time was 11.42 minutes (SD: ±5.48). These usability measures were evaluated across each device and in relation to different user capabilities, including cognitive, physical, vision, hearing, motivational, and environmental factors. Significant predictors of unassisted task success included the type of device tested, gender, cognitive scores, physical scores, vision scores, and motivational and environmental factors. The total error rate was significantly associated with type of device tested, age, gender, physical scores, vision scores, and environmental routine factors. 

Conclusion:Various individual-specific barriers were found to be significant predictors of successful device use and error occurrence. The findings highlight the importance of designing MATech that addresses the unique needs of older adults with diverse capabilities. Further research is needed to explore the long-term impacts of these technologies. 

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Katie Halliday¹, Jo-Anne Wilson¹, Natalie Ratajczak¹, Karthik Tennankore², Steven Soroka², Cynthia Kendell², Marisa Battistella³, Penelope Poyah², Keigan More², Natalie Kennie-Kaulbach¹, Nolan Barkhouse¹, Daniel Rainkie¹, Hannah Ramsay^1
1College of Pharmacy, Dalhousie University , ²Other, ³Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:Chronic kidney disease (CKD) affects 1 in 10 Canadians. Medications removed by the kidneys can accumulate to cause harm if not dosed correctly. Pharmacists are well positioned to mitigate harm. This study aimed to develop evidence and expert-informed medication algorithms for community pharmacists for individuals with an estimated glomerular filtration rate below 60 ml/min/1.73m² and validate them for content and face validity.

Methods:Fifty medication algorithms were developed by team experts and revised using Lynn’s 3-step method (domain identification, item generation per domain, and instrument formation). For each algorithm, a 2-part questionnaire was administered to two participant groups: first to team experts, followed by community pharmacists. Each group, consisting of 5-6 participants, rated the content and face validity of each algorithm using Likert scales over at least two rounds. The item-level content validity index (I-CVI) and scale-level content validity index (S-CVI/Average) were computed for each medication algorithm per round. To measure face validity, percentages of those that “agreed” or “strongly agreed” to five statements were calculated for both groups. Virtual interviews were conducted and analyzed. Revisions were made to the algorithms between rounds.

Results:Thirty-eight of the 50 medication algorithms achieved content and face validation by 22 team experts in 2 rounds between August-September 2024. I-CVI and S-CVI/Average ranged from 0.5-1 and 0.83-1 and the overall percentage of participants who agreed or strongly agreed to 5 face validity statements ranged from 50-100%. Thirteen medications were excluded from the pharmacist’s validation. In 2 additional rounds, 23 pharmacists, with a mean ± standard deviation of 13.74 ± 9.14 years of experience, validated 38 algorithms between October-December 2024. I-CVI and S-CVI/Average per algorithm ranged from 0.83-1.0 and 0.90-1.0 which met the content validity threshold of 0.83-1.0 (p< 0.05) for at least 5-6 participants per round. Participants overall agreement to face validity statements ranged from 75-100% which was above the prespecified threshold of 70% for consensus.

Conclusion:Thirty-eight medication algorithms achieved high content and face validity. Future research will integrate these algorithms into an electronic drug dosing and decision support kidney (eDoseCKD) tool and assess their effectiveness and safety in community pharmacy practice in people with CKD.

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Cheryl Sadowski¹, Andrea Gruneir², Xueyi Chen², Scott Garrison², Erik Youngson², Christian Ono², Roni Kraut^2
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Other

Purpose:Evidence suggests that the use of scheduled acetaminophen (paracetamol) in long-term care (LTC) is a low-value intervention, that it does not improve pain or quality of life, and that it has the potential for adverse effects. However, pharmacists continue to recommend this therapy for older adults with the perception that it is relatively safe.  Our objective was to assess the usage of regular acetaminophen in Canadian LTC facilities as well as the costs associated with its use.

Methods:This cross-sectional study analyzed acetaminophen 2022 dispensations for four Canadian provinces provided by a national LTC pharmacy provider. Descriptive statistics were used to characterize prevalence, dosing, dispensation frequency, and direct costs of regular acetaminophen dispensations (cost of tablets, nursing dispensation time, and carbon emissions).

Results:The 49,419 residents (median age: 86, female: 65%) were from BC (5.5%), Alberta (7.1%), Manitoba (23.0%), and Ontario (64.4%). The mean prevalence of regular acetaminophen dispensations was 45.7%, ranging from 39.1% in BC to 46.6% in Manitoba. Across all provinces, 85.0% of regular acetaminophen users were prescribed >1000 mg of acetaminophen/day and 59.3% were dispensed acetaminophen ≥3 times per day. In 2022, 27.8 million tablets of acetaminophen were dispensed for residents in these 4 provinces. This treatment cost 870 thousand dollars; had a carbon footprint of 430.1 tonnes of carbon dioxide equivalents (CO2e); and required 70.5 thousand nursing hours, the equivalent of 34 nurses working full time for one year.

Conclusion:Regular acetaminophen use is highly prevalent in LTC with substantial costs. It would be advantageous to re-examine acetaminophen use in LTC facilities.

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Tony Ning¹, Mina Tadrous¹, Jamie Kellar¹, Natalie Crown¹, Lisa Dolovich¹, Samir Gupta¹, Terry Li^1
1Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:Pharmacists are accessible community healthcare providers with a high frequency of patient contact. Canadian pharmacists’ scope of practice has grown to include diagnostic and prescribing roles, with further opportunities to improve chronic disease management.   Electronic clinical decision support systems (CDSS) have been developed for multiple medical conditions to provide optimal evidence-based care to all patients, but have had limited uptake in real-world medical or pharmacy practice.   This study is a qualitative analysis of community pharmacy team member preferences and values related to electronic CDSS.

Methods:Serial focus groups consisting of 4-6 participants were conducted virtually, until saturation of new themes was reached (anticipated 4-6 rounds). Participants included licensed pharmacists, registered pharmacy technicians, and pharmacy assistants who worked in a community pharmacy setting in Ontario. Participants were recruited via snowball sampling and through the University of Toronto Pharmacy Faculty’s preceptor database.   Each 1.5-hour semi-structured focus group was moderated by 2-3 trained interviewers and used an existing evidence-based CDSS (the Electronic Asthma Management System - eAMS) to solicit feedback and preferences through specific and open-ended questions. Focus groups were recorded, transcribed, and analyzed using sequential inductive qualitative analysis.

Results:Qualitative themes were generated from 5 focus groups (24 participants) conducted between July 2024 – Jan 2025. The following overarching  themes were identified: general overall willingness to use electronic CDSS; concerns and perceived barriers with regard to the use of electronic CDSS in a community pharmacy setting, particularly when patient input of data is required; need for consideration of impact on existing pharmacy workflows and technologies; concerns about prescriber perception of pharmacy/pharmacist-initiated clinical decision making; desire to improve patient outcomes without need for financial incentives; perceived business benefits of offering CDSS; trend of pharmacists seeing their practice as more focused towards being clinical decision makers rather than technicians or dispensers.

Conclusion:Evidence-based clinical care is a process that can be facilitated with electronic decision aids in the community pharmacy setting. A number of themes were identified during our study that will be valuable to take into consideration when designing pharmacy-specific CDSS.

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Sandra Gerges¹, Lisa Bishop², Leeya Wilson³, Jennifer Donnan², Kelsey Westall¹, Ashley Hosker-Field¹, Marilyn Cresswell¹, Kati Whelan², Daniel Bear^1
1Other, ²School of Pharmacy, Memorial University , ³Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:With the increased prevalence of cannabis use for medical and recreational purposes, pharmacists need information and guidance to provide support to patients on safe cannabis use. Pharmacists need reliable resources to consult when providing cannabis-related patient care.  

Methods:An environmental scan was conducted in November 2024 to identify and summarize cannabis-related drug information resources that were available to Canadian pharmacists for providing patient care. Educational programs or events were excluded.  

Results:The environmental scan revealed 15 different sources, with the majority (80%) of resources focusing on medical cannabis or cannabis use disorders. Many of the resources focused on the efficacy of medical cannabis, primarily related to pain management or chemotherapy-Induced nausea/vomiting (CINV), as well as pharmacokinetics of different dosage forms (inhaled, edible, pharmaceutical cannabinoids), contraindications for use, and side effects. Most of the information was for pharmaceutical cannabinoids, such as nabilone and nabiximols. There was limited information on drug interactions or specific dosing. Dosing recommendations were general and included using lower THC concentrations and starting low and increasing gradually. Some cytochrome P450 enzyme drug interactions and their management were identified.  Only a few resources (20%) provided information on recreational cannabis. These resources primarily emphasized recommendations to limit or avoid use, choose products with low THC content, and avoid synthetic or inhaled cannabis products. Information on harm reduction approaches was limited.

Conclusion:Some drug information resources exist for pharmacists, but more resources are needed that provide information on conditions other than pain or CINV, product information on medical cannabis products, and dosing. Additionally, pharmacists need information about recreational cannabis products, usage, and harm reduction. The information from this scan will be used to inform the Pharmacists as Cannabis Educators (PACE) research project which is building education and resources for pharmacists.  

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Cheryl Sadowski¹, Arden Mills¹, Randy So¹, Bo Pan², Adrian Wagg², Yazid Al Hamarneh^2
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Other

Purpose:Lower urinary tract symptoms (LUTS) are common, particularly in older adults, yet patients are rarely asked about incontinence.  Pharmacists in the community are ideally placed to provide care for LUTS.  The purpose of this study was to determine if older adults experience improvement in LUTS when assessed and managed by community pharmacists.  This report focuses on a description of the patients recruited through community pharmacies.

Methods:This randomized controlled trial involved pharmacists screening older adults presenting to the pharmacy then enrolling those screening positive for LUTS.  Patients completed a questionnaire at baseline and the intervention arm underwent a pharmacist assessment and implementation of a care plan, with 4 and 8 week follow-up.  The control arm experienced no intervention and completed the study at 8 weeks.

Results:A total of 66 patients were recruited, 44% female.  The majority were white (57%), 13% were South Asian, and 3% were Indigenous.  Of the n=32 in the intervention arm 78% had spoken with their physician about bladder health but only 50% had spoken to another healthcare professional.  For self-treatment 62% had already tried changes in fluid intake, 44% had tried medications or made a medication change for LUTS, 41% used absorbable products, 32% tried dietary changes, 18% tried pelvic floor muscle training, and  9% had recorded a bladder diary. 

Conclusion:_Older adults with LUTS presenting at community pharmacies have attempted to discuss their bladder condition and have tried a variety of interventions prior to their assessment by pharmacists.  This study highlights the diversity of interventions for a geriatric syndrome and the importance of pharmacists_

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Yu Xie (Jenna) Zhang¹, Vincent Huynh¹, Anna Nguyen¹, Justin Lee¹, Fatima Hashemi-Sabet¹, Certina Ho^1
1Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:Recognizing the concerns raised about standards for quality control, assurance, and formulation consistency of compounded products, the National Association of Pharmacy Regulatory Authorities (NAPRA) published the NAPRA Model Standards for Pharmacy Compounding. These standards were adopted and implemented by the Ontario College of Pharmacists. This project intends to assess pharmacy professionals perception of best practices and challenges in fulfilling the NAPRA Model Standards for Pharmacy Compounding in Ontario.

Methods:We surveyed pharmacy professionals in Ontario through an online questionnaire, including both quantitative and qualitative open-ended items, from August to October 2024. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.

Results:We received 50 responses, of which 60% reported participation in in-house pharmaceutical compounding practices. Most (77%) respondents were familiar with and aware of the NAPRA Model Standards for Pharmacy Compounding for Non-Sterile Compounding, even if they did not participate in compounding (70%). Many (81%) believed that standardizing compounding practices would improve patient safety. However, 52% respondents found it challenging for pharmacies to implement the NAPRA standards, and 44% commented that maintaining compliance with the standards was also challenging. Limitations in implementing the NAPRA Model Standards for Pharmacy Compounding were reported to be associated with financial implications (64%), lack of space (56%), and human resources (52%).

Conclusion:While most respondents believe standardizing compounding practices would improve patient safety, challenges in implementing and maintaining compounding standards exist. Future investigations should explore avenues to improve compliance to compounding standards/guidelines, which may also encourage uptake of compounding practices.

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Julie Méthot¹, Julie Boisvert¹, Cassendra Denis¹, Catherine Denis¹, Joelle Flamand-Villeneuve^1
1Faculté de pharmacie, Université Laval

Purpose:To describe the number and types of geriatric pharmacological problems detected by a clinical tool among patients aged 75 years and older admitted to targeted clinical units.

Methods:This prospective longitudinal descriptive study evaluated an electronic tool designed to identify elderly patients vulnerable to medications and manage the pharmacological problems detected.

Results:A total of 67 patients were included in the data analyses. Ninety-nine potential pharmacological problems were detected, with an average of 1.5 ± 0.8 problems per patient. The two most frequently identified potential problems were "Osteoporosis and 15 medications" (47.7%) and "1 or more potentially inappropriate medications (PIMs)" (31.3%). On average, patients were taking 0.6 PIMs. A total of 139 interventions were carried out, including 107 directly related to the identified potential pharmacological problems. An average of 40 minutes was required to perform 2.1 interventions per patient. Complex cases included patients with more geriatric syndromes and investment of time. These tended to result in a greater number of pharmacological interventions.

Conclusion:The utilization of the tool led to at least one intervention in the majority of cases with a reasonable time invested. The vast majority of interventions did not require the expertise of a pharmacist specialized in geriatrics.

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Derek Jorgenson^1
1College of Pharmacy and Nutrition, University of Saskatchewan

Purpose:To describe characteristics of acute otitis media (AOM) management academic detailing visits and clinicians subsequent evaluation.

Methods:Academic detailing (or educational outreach) visits were provided to Saskatchewan clinicians by pharmacists who received additional training on AOM management. The visit was accredited through the College of Family Physicians of Canada, and no industry funding was provided to support the visit. Clinicians who participated in a visit were invited to complete an online survey to evaluate the visit. Survey responses were analyzed using descriptive statistics.

Results:Service Delivery: From May to November 2024, 10 pharmacists provided academic detailing visits to 755 primary care clinicians (338 physicians, 154 nurse practitioners/nurses, 150 pharmacists, 77 medical residents, 36 other providers). Cliniancs were located in 55 communities across Saskatchewan. 75% of respondents participated in a large group visit (5 people or more). Survey Results: Survey response rate was 23%. Most respondents (99%) agreed that the visit enhanced their knowledge and 97% agreed that they felt more confident managing drug therapy in this area. Of key messages, over 50% of respondents indicated, “infection-related complications are rare with common respiratory tract infections with or without an antibiotic” will change or confirmed their practice. “If required, amoxicillin is first-line for AOM or sinusitis; reserve amoxicillin-clavulanate" confirmed the practice of 69% of respondents. “Identify low allergy risk patients using Firstline or PENFAST for possible penicillin/amoxicillin allergy delabeling” changed the practice of 82% of respondents. No bias was percieved by 99% of respondents.

Conclusion:Academic detailing provided by independent pharmacists enhanced clinican knowledge and confidence related to AOM management.  

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Emily Black¹, Kaelyn Budden¹, Kathryn Slayter², Tasha Ramsey¹, Rebecca Lawrence², Jennifer Isenor¹, Fawziah Lalji³, Janusz Kaczorowski², Nancy Waite⁴, Donna Halperin², Scott Halperin^2
1College of Pharmacy, Dalhousie University , ²Other, ³Faculty of Pharmaceutical Sciences, University of British Columbia , ⁴School of Pharmacy, University of Waterloo

Purpose:National Advisory Committee on Immunization (NACI) provides recommendations on vaccinations for children and adults, while provinces/territories decide which vaccines to publicly fund and include in program implementation. Lack of public funding can result in low vaccine uptake due to potential out-of-pocket costs. In most Canadian jurisdictions, pharmacists and pharmacy technicians have the authority to administer vaccines. An environmental scan on the immunization landscape across Canada was conducted to gain a comprehensive overview of NACI recommended immunizations that are publicly funded and available for administration in pharmacies in each Canadian province/territory and if the cost (product, prescribing, and/or administration fee) is publicly funded for delivery in community pharmacies.

Methods:This environmental scan used openly accessible information to determine which NACI recommended vaccine schedules for children and adults are publicly funded in each province/territory. To determine NACI recommendations, the Canadian Immunization Guide and NACI statements were reviewed. Public Health and Pharmacy Association websites in each province/territory were cross referenced with the Canadian Immunization Guide to determine which publicly funded vaccines are available in pharmacies. Additionally, Standards of Practice and Pharmacy Acts were analyzed to determine pharmacy professionals’ authority to prescribe/administer vaccines in each province/territory.

Results:Pharmacists are authorized to prescribe vaccines in 8 provinces/territories and administer vaccines in 11 provinces/territories. Pharmacy technicians are also authorized to administer vaccines in 7 provinces/territories. To date, pharmacy professionals in the Northwest Territories and Nunavut do not have authority to immunize. Some public funding for pharmacy professionals to prescribe and/or administer immunizations for specific vaccines is provided in 11 provinces/territories. Of the 30 NACI recommended vaccines analyzed, British Columbia and Yukon provide the most funding for administration of immunizations in pharmacies with 21 of 30 vaccines being publicly funded. Whereas Newfoundland, Nova Scotia, Ontario, and Saskatchewan provide funding for only influenza and COVID vaccines in pharmacies.

Conclusion:Discrepancies across provinces/territories in public funding that may improve access to NACI recommended vaccines through pharmacy professionals in Canada has been identified through this environmental scan. Additional public funding in pharmacies across Canada may decrease cost-related barriers to immunization and increase vaccine accessibility and uptake.

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Emily Black¹, Sara Mizen², Kathryn Slayter², Tasha Ramsey¹, Rebecca Lawrence², Jennifer Isenor¹, Fawziah Lalji³, Janusz Kaczorowski², Nancy Waite⁴, Donna Halperin², Scott Halperin^2
1College of Pharmacy, Dalhousie University , ²Other, ³Faculty of Pharmaceutical Sciences, University of British Columbia , ⁴School of Pharmacy, University of Waterloo

Purpose:Many vaccines recommended by the National Advisory Committee on Immunization are not publicly funded in Canada requiring individuals to pay out-of-pocket or use private insurance, which may contribute to low uptake. Research indicates that the public and many healthcare professionals perceive unfunded vaccines as having less value. Cost-related barriers are also important concerns among prescribers who may be hesitant to recommend unfunded vaccines due to concerns about affordability. This study explored key informant perspectives on a novel funding approach for recommended but unfunded vaccines (RUVs) implemented in community pharmacies. The proposed funding model introduces a phased cost-reduction strategy, where government coverage gradually increases over time, progressively reducing the financial burden on the public.

Methods:Seventeen semi-structured interviews were conducted between April and October 2024 with government representatives, pharmacists, pharmacy associations, pharmacy regulatory authorities, private insurers, and advocacy organizations across Canada. Thematic analysis informed by the Theoretical Framework of Acceptability, was used to identify patterns within the interview transcripts.  

Results:The analysis identified five key insights into perspectives on the proposed funding model for RUVs: 1) _Skepticism,_ regarding the effectiveness and benefits of the proposed funding model; 2) _Burden on workload_, which could be addressed by offering compensation to pharmacies; 3) _Equal funding does not mean equitable access_, leading to concerns about financial inequities within this funding model; 4) _Untangling logistical challenges_, which included concerns and confusion on implementing this funding model and explaining the model to the public; and 5) _Improved access: When something is better than nothing_, with many respondents feeling that any reduction in cost is better than paying full price. While key informants agreed on the importance of addressing cost-related barriers, many emphasized that any funding changes should be accompanied by pharmacist education and a public awareness campaign to maximize effectiveness.

Conclusion:Findings highlight the widespread understanding that cost-related barriers have a negative impact on the uptake of RUVs and that the proposed funding model could be an effective solution to address low uptake for RUVs. A combination of reducing the vaccine cost and promoting vaccine awareness and education were seen as important solutions to addressing cost-related barriers for RUVs. 

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Deborah Kelly¹, Sarah O'Reilly¹, Nicole Pittman, Breanna Lynch¹, Ross Tsuyuki², Bo Pan², Timothy Chen², Mohammed Mohammed^2
1School of Pharmacy, Memorial University , ²Other

Purpose:The Medication Therapy Services (MTS) Clinic, operated by Memorial University’s School of Pharmacy, offers pharmacist-led comprehensive medication assessments (CMA) to patients. We assessed the impact of CMA using the medication-related burden quality of life (MRB-QoL) survey, then conducted patient interviews to determine the extent to which the MRB-QoL adequately reflected patient experiences with CMA.

Methods:Patients who received CMAs between Feb 2021 and May 2023 provided repeat MRB-QoL measurements as part of an observational study. CMA involved an initial 1-hour assessment where goals were set, medication and medical history were collected, and drug therapy issues were identified, with pharmacist follow up as appropriate. The MRB-QoL questionnaire was completed prior to initial visit and at 6-and 12-weeks; changes in scores were analyzed using paired t-tests. Patients who received CMA between Feb and April 2024 were invited to participate in a 20-minute semi-structured interview to discuss their experience. Deductive content analysis was used to identify codes related to the domains of the MRB-QoL. Like codes were combined into themes; themes that did not fit within domains of the MRB-QoL were noted separately.

Results:Significant improvements in MRB-QoL were seen at 6 and 12 weeks in overall score (both p

Conclusion:The MRB-QoL questionnaire provided a good representation of most concerns expressed by participants, however it did not completely capture all concerns addressed through the CMA.  The MRB-QoL could be supplemented by additional questions relating to financial burden and medication efficacy to be more comprehensive.

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Jocelyn Morrison¹, Kyle Wilby¹, Madison Slack¹, Daniel Rainkie¹, Emily Black¹, Natalie Kennie-Kaulbach¹, Jeremy Macdonald¹, Jo-Anne Wilson¹, Andrea Bishop², Lisa Woodill^2
1College of Pharmacy, Dalhousie University , ²Other

Purpose:Pharmacists in Nova Scotia use physical assessment (PA) to initiate therapy for multiple indications, such as Lyme disease, shingles, otitis media and pharyngitis. Services including prescription renewals, advanced medication reviews, and chronic disease management may also benefit from PA, although it is not routinely used. This study aims to explore how pharmacists in community and primary care settings perceive the acceptability of incorporating PA into their daily practice.  

Methods:We conducted a survey with pharmacists practicing in community and primary care clinics in Nova Scotia from Nov 2024 to Jan 2025. The survey was informed by a literature review and grounded in the seven domains of the Theoretical Framework of Acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, self-efficacy, burden, ethicality, and opportunity costs. Survey items were developed, piloted, and revised based on desk validation and cognitive interviews. The final survey consisted of 39 items based on the TFA (4-5 Likert items and a free text response) and 16 demographic questions.  

Results:162 pharmacists completed the survey with 51% identifying as a staff pharmacist. 40% of respondents worked in banner pharmacies, 21% in pharmacy chains and 13% were in pharmacies located in grocery stores. 66.7% had more than 11 years of experience. Pharmacists used inspection at least once in the past week to initiate and monitor drug therapy (72% and 59% respectively), while palpation (19%, 12%), auscultation (2%, 3%) and percussion (3%, 2%) were used far less often. Pharmacists report high overall rates of perceived effectiveness (average 72% agree or strongly agree), intervention coherence (70%), self-efficacy (70%), and affective attitude (63%). 80% of pharmacists felt PA would support their therapeutic decision-making. Opportunity costs, particularly time and reimbursement, were important barriers for 38% of pharmacists. 49% of pharmacists believe their team could not overcome additional workload to conduct PA on select patients. 

Conclusion:Pharmacists are accepting of physical assessment in their practice. Important barriers include the burden and opportunity cost of both training and incorporation into pre-existing workflow. Training programs that target a hypothesis driven approach may address the burden and opportunity cost concerns and optimize affective attitude, perceived effectiveness, and self-efficacy.  

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Javiera Navarrete¹, Christine Hughes¹, Mackenzie d'Entremont-Harris², Zara Matthews³, Connor Booker², Amanda Butt³, Tasha Ramsey⁴, Shea McInnis², Kyle Wilby⁴, Ye Zin Zin³, Deborah Kelly^3
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Other, ³School of Pharmacy, Memorial University , ⁴College of Pharmacy, Dalhousie University

Purpose:The APPROACH 2.0 study evaluated the implementation of point-of-care (POC) and dried bloodspot (DBS) testing for HIV, hepatitis C, and/or syphilis by pharmacists in Newfoundland and Labrador (NL), Nova Scotia (NS), and Alberta (AB). A post-implementation focus group evaluation explored pharmacists’ experiences with the testing model for this study.

Methods:Six focus group sessions were conducted via Zoom in September 2024. Pharmacists who had at least one testing encounter were recruited via email and offered an honorarium to participate. Sessions were audio-recorded and transcribed verbatim. Three research members independently performed coding, employing thematic analysis to interpret the data.

Results:Of the 50 eligible pharmacists, 18 participated (AB=4, NS=4, NL=10). Preliminary themes include: 1) preparedness for sexually transmitted and blood-borne infections (STBBI) testing; 2) challenges and facilitators of implementation of the testing model; 3) fulfillment of expectations; and 4) patient-centred care and personal commitment as motivations. Participants reflected on their confidence in performing testing, from understanding the procedure to explaining it to patients. Overall, they felt prepared to offer these services after completing the training program provided by the research team. Participants discussed how time management, staffing, and integration into workflow influenced their ability to conduct testing. They noted that compensation and colleagues adoption of new practices presented challenges. However, adaptations to the protocol, collaborative networks, regulatory structures, and support from decision-makers aided the implementation process. Most pharmacists found that their expectations of participating in the study were met, though demand for testing was lower than anticipated for some. Lastly, most participants articulated two interconnected motivations for participating. They mentioned that DBS and POC testing are essential services that were well-received by the patient population. Additionally, participants expressed a desire to expand their scope of practice and skill set.

Conclusion:In general, pharmacists reported positive experiences with the testing model. Participants felt well-prepared and found it relevant to provide STBBI testing services to their communities. However, it is essential to consider various facilitators and challenges. The insights from participants underscore critical points to consider when supporting a larger scale-up of a pharmacist-led STBBI testing model.

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Holly Mansell¹, David Blackburn¹, Chidimma Umeaghadi ^1
1College of Pharmacy and Nutrition, University of Saskatchewan

Purpose:In 2023, a community pharmacy launched a primary care clinic in Saskatchewan in collaboration with community physicians.  Pharmacist services were guided by collaborative practice agreements (CPAs) focused on specific health conditions.  The purpose of this study was to describe service claims over the first 9 months.  

Methods:Prior to launching the primary care pilot project, the provincial drug insurance provider created pseudo billing codes to be submitted by the pharmacy following each patient encounter.  These billing codes captured setting (e.g., phone vs in person), activity (e.g., prescribing, injection, or point of care testing), and CPA (i.e., COPD, mental health, thyroid, hypertension, anticoagulation, or diabetes).  We obtained de-identified claims and reported them descriptively by date and CPA.        

Results:Between December 2023 and August 2024, the pharmacy submitted 598 pilot project claims for 181 unique patients.  The most common claim was “injection”, submitted 343 times (62.5%) for 118 patients.  Anecdotally, the injection claims were primarily related to the administration of antipsychotic depot medications for patients under that care of a collaborating psychiatrist.  Care plan claims were submitted 117 times (21.3%) for 55 patients, and prescribing activities were claimed 85 times (15.5%) for 48 patients.  Few claims were submitted for point of care testing (32 claims, 19 patients).  Care plans were most frequently performed on patients with mental health conditions (n=20) through the psychiatrist collaboration.  The next most common care plan was for patients with thyroid conditions under a collaboration with a local general practitioner (n=14).  

Conclusion:Clinical activities governed by CPAs in a community pharmacy clinic varied by the types of patients and the partnering physician.               

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Andy Luu¹, Erin Yakiwchuk¹, Megan Surkan^2
1College of Pharmacy and Nutrition, University of Saskatchewan , ²Other

Purpose:The Geriatric Evaluation and Management Program at Saskatoon City Hospital is a multidisciplinary outpatient program that provides assessment and management of complex medical, functional, and psychosocial issues in older adults. Older adults are more likely to live with multiple medical comorbidities and take many chronic medications. Combined with the physiological changes associated with aging, older adults are more susceptible to Drug Therapy Problems (DTPs). The purpose of this project was to identify which DTPs are most commonly seen in older adults referred for geriatric assessment, which medications and medical conditions are commonly implicated in DTPs, and whether these problems are able to be addressed within the length of stay in the program (an average of 8 weeks). 

Methods:Retrospective chart review of individuals enrolled in the Geriatric Evaluation and Management Day Hospital Program from January 1, 2023 - June 30, 2024. Identified DTPs were categorized per Hepler and Strand. Frequency of each DTP category, as well as implicated medical conditions and medications, were determined for each patient. Rates of resolution of DTPs within the timeframe of Day Hospital Admission were also determined. 

Results:A total of 183 patients met the inclusion criteria for this study. Participants had an average age of 79.9 years, and 58.8% were female. Participants used a median of 6 prescription and 3 non-prescription medications, and had a median of 5 drug therapy problems each. The most commonly-identified drug therapy problem category was Additional Drug Required (41%), and the most commonly implicated medical conditions for this DTP were chronic nociceptive pain (13.5%) and osteoporosis (11%). The next most common DTP category was Adverse Drug Reaction (19%), with orthostatic hypotension/antihypertensive medications most commonly implicated here. The majority of DTPs (87.9%) were able to be resolved during GEM Day Hospital admission, with the most common outstanding issue being osteoporosis assessment due to wait times for bone-mineral density testing.

Conclusion:Untreated osteoporosis, undertreated chronic pain and orthostatic hypotension were commonly identified among patients referred for geriatric assessment, indicating a need for enhanced screening and management for these issues in older adults in the community. 

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Jessica Riad¹, Yasmin Abdul Aziz¹, Kevin Schwartz², Noah Ivers², Angeline Ng², Lisa Dolovich¹, Nardine Nakhla³, Lauren Lapointe-Shaw², Mina Tadrous^1
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other, ³School of Pharmacy, University of Waterloo

Purpose:The Canadian healthcare system is under strain due to a growing population and limited access to resources, a challenge worsened by the COVID-19 pandemic. To help alleviate this strain, the minor ailments (MA) prescribing service was introduced. This service enables pharmacists across Ontario to provide care to residents across the province. The objective of this study is to assess whether the MA service meets the healthcare needs of Ontario residents and reduces the burden on the healthcare system by examining the experiences of pharmacists and patients.

Methods:A qualitative approach was used to address the aims of the study. This was achieved by conducting one-on-one semi-structured interviews with patients who had received the MA service in an Ontario community pharmacy within the past two months prior to the interview, and by conducting focus groups with community pharmacists who had provided the service.  Interviews and focus groups were conducted from February to April 2024. Interviews and focus groups were transcribed verbatim. Transcribed videos were thematically analysed using NVivo 11.7.

Results:Forty pharmacists and thirty-five patients participated in the focus groups and one-on-one interviews, respectively. All participants positively perceived the expanded scope as beneficial to patients and the healthcare system. Pharmacists’ confidence in providing the service was variable and pharmacists stated the need for systems to better manage workflow. Patients highly rated the service in the areas of access, ease of use and willingness to use the service for future minor ailments, stating a need for a more expanded list of ailments. Both pharmacists and patients highlighted the need for better communication and increasing public awareness of service availability.

Conclusion:This initial assessment of the MA service suggests that it benefits Ontario residents; however, enhancing pharmacist support and broader communication could improve its effectiveness. Further research should aim to identify ways to better support pharmacists and inform policy changes.

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Woo Jung Kang¹, Arsh Jassal^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:Salbutamol sulfate and ipratropium bromide are bronchodilators for symptomatic relief of asthma and chronic obstructive pulmonary disease (COPD). They are available as nebules (NEB) or metered-dose inhalers (MDI), the latter containing potent greenhouse gases. Our study aims to determine the proportion of suboptimal salbutamol and ipratropium orders in hospitals that use the computerized physician order entry (CPOE) system and identify contributing factors to discuss potential optimization strategies.

Methods:We conducted a retrospective, cross-sectional chart review of 150 salbutamol and 150 ipratropium orders, representative of 25137 orders across 8 Vancouver hospitals. We used systematic random sampling and assessed the orders based on pre-defined criteria considering clinical and environmental impact. The criteria include no documented indication, suboptimal daily dose, suboptimal frequency, no MDI/NEB selection guidance, MDI for PRN/ONCE NOW, and duplicate orders.

Results:89% of ipratropium and 99% of salbutamol orders (±8%, 95% confidence interval) met at least one primary outcome criterion, deeming them suboptimal. The most prevalent factors were ordering MDI for PRN/ONCE NOW schedules, suboptimal daily dose, and suboptimal frequency.

Conclusion:For each factor contributing to suboptimal prescribing, we propose implementing specific decision support tools in the CPOE system and providing prescriber education. A lack of documented indication can be interpreted as a lack of comprehensive medication reconciliation, which can be mitigated by adding an indication checkbox in the CPOE system. Prescribing should be based on evidence-based clinical judgment, and therefore, PowerPlans need to be reviewed and revised to ensure they follow Health Canada-approved doses and frequencies. A low carbon footprint label for NEB can be added to the CPOE system to encourage prescribers to consider the less wasteful option for less frequent schedules. We also recommend adding a field in the CPOE system to specify the preferred formulation, as ordering MDI and NEB simultaneously without such guidance can result in inadvertent medication waste. When orders are flagged as duplicates, prescribers and pharmacists should be aware of alert fatigue and are encouraged to investigate order details to resolve or justify the duplication. These simple yet effective optimization strategies can improve clinical outcomes and minimize the environmental impact of medication waste.

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Alexa Muir¹, Wade Thompson², Christine Rodriguez¹, Lisa McCarthy^1
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other

Purpose:Statins are often beneficial and well-tolerated, yet reassessing their use for older adults living with frailty is good practice. deprescribing.org has developed an evidence-based clinical practice guideline and decision-support algorithm (i.e., tools) to support statin deprescribing decision-making for older adults. This study explored long-term care (LTC) clinicians recommendations for statin continuation or deprescribing for residents using prototypes of the newly developed tools in practice.

Methods:This multi-method study involved clinicians responsible for medication decision making in LTC homes. Participants engaged in an education session to introduce the draft statin deprescribing guideline and prototype algorithm and then applied these tools in practice over the next 3 months. Participants completed an online form when they applied the tools in practice to collect data about LTC residents to whom the tools were applied and their tools-informed recommendation re: continued statin use. Data collection also included pre- and post- focus groups to gather feedback about the tools and surveys to explore self-efficacy for statin deprescribing throughout the study.

Results:Sixteen healthcare providers (3 nurse practitioners, 4 pharmacists, 9 physicians) serving Ontario LTC homes attended the education session, participated in focus groups, tested the tools in their practice, and provided feedback on the tools. Clinicians applied the tools to 111 different residents; 63% of residents were ≥80 years of age (n=70), 35.1% were 65-79 years (n=41), 1.8% were

Conclusion:The statin deprescribing guideline and algorithm were successfully piloted in LTC homes across Ontario. Clinicians recommendations about statin use were well aligned with the recommendations in the newly developed deprescribing.org tools.

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Adrian Ziemczonek¹, Yuki Meng¹, Nasheena Poonja^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:Minor Ailments and Contraception Services (MACS) enable pharmacists to provide timely access to medications and essential services, thereby expanding the capacity to address healthcare gaps. Currently in British Columbia, the Ministry of Health (MOH) reimburses pharmacies for in-person services only. Absence of a virtual reimbursement model presents a significant barrier in accessing care, particularly for individuals in underserved or remote communities. The UBC Pharmacists Clinic (the Clinic) offers both in-person and virtual medication management services, and in the past year 93% of appointments were conducted virtually (n=1562/1684). Despite the known benefits of virtual healthcare services, there is a paucity of literature describing virtual pharmacist prescribing services. This quality improvement project aimed to assess clients experience accessing MACS virtually at the Clinic, identifying strengths, challenges, and opportunities for improvement. 

Methods:A 13-question voluntary feedback survey aimed at evaluating client experiences regarding quality of care, accessibility, convenience, and privacy was developed. Survey questions consisted of Likert-scale, multiple choice, and open-ended prompts which were informed by an environmental scan of virtual primary care service provision. The survey was emailed or mailed to patients with consent after receiving a virtual MACS. Survey responses were collected anonymously and will be analyzed using descriptive statistics and content analysis.

Results:The Clinic has provided 47 MACS assessments, 28 (60%) of which were conducted virtually either by phone or zoom. Two clients completed the survey in the first 4 weeks of launch. Data collection and analysis are currently ongoing to ensure increased client input to inform future service development and improvement. Interim analysis of survey data and informal client feedback indicate that the service improved accessibility, was convenient, and communication was clear. In one instance, a client accessed virtual MACS from the Clinic during an active COVID-19 infection, citing that this mode of service delivery minimized social contact and the potential for transmission.

Conclusion:Virtual delivery of MACS has been well received at the Clinic thus far, primarily enhancing accessibility for individuals unable to attend in person. This model also presents a valuable opportunity to bridge care gaps in rural and remote communities while promoting the judicious use of healthcare resources.

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Natalie Crown¹, Andrea Bishop², Theresa Charrois³, Shanna Trenaman⁴, Christine Rodriguez¹, Olivia Steinberg¹, Zubin Austin^1
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other, ³Faculty of Pharmaceutical Sciences, University of British Columbia , ⁴College of Pharmacy, Dalhousie University

Purpose:The purpose of this study was to explore community pharmacist perspectives on expansions to scope of practice, including their readiness, willingness, and capacity to assume new roles enabled by legislative changes.

Methods:This was a qualitative study with community pharmacists in Nova Scotia (NS), Ontario (ON) and British Columbia (BC). Data were collected through semi-structured virtual interviews. Interviews were transcribed and notes from the observations were recorded. Data were coded and analyzed thematically using inductive and deductive methods. Deductive coding was informed using the 9Ps of practice change. Data from each province were analyzed separately, and comparative analysis planned.

Results:Thirty-six community pharmacists participated (NS n=12, ON n=13, and BC n=11). In Nova Scotia, themes related to: (1) public expectations for service delivery, (2) shifting professional roles, (3) education and training, and (4) system and practice supports for change. Participants described public misconceptions about pharmacist scope, the challenge of hyper-accessibility, and public expectations for service delivery. Participants largely embraced new scope and described the COVID-19 pandemic as a window that accelerated the pace of change. Many described their role in the context of alleviating burden for the healthcare system, other providers and addressing societal need. Participants described system supports required to unify enabled scope with care and remuneration models to support them. Current workplace realities were described as a contributor to burnout. In Ontario, themes were identified relating to: (1) pharmacist professional identity, (2) patient and societal expectations of pharmacists, and (3) organizational and structural changes. Participants identified prescribing as part of their role and also described a mismatch in patient expectations for immediate, accessible care and the care process. Many also described challenges with traditional community pharmacy workflow models (e.g., staffing, workflow, and physical spaces) that impact the full scope implementation. BC and cross province comparative analysis are in progress.  

Conclusion:Preliminary results suggest that pharmacist experiences with legislative changes to scope of practice are largely similar across Nova Scotia and Ontario. While health system context and pace of change may differ between the two provinces, overall, expansions to pharmacists’ scope of practice represents a professional and regulatory change management process. 

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Shawn Bugden¹, Kevin Friesen^2
1School of Pharmacy, Memorial University , ²College of Pharmacy, University of Manitoba

Purpose:There is ongoing concern about the level of opioid use in North America.  Low-dose codeine (≤8mg/tablet) products are available over-the-counter in Canada.  One Canadian province requires a prescription for low-dose codeine and has enabled pharmacists to do this prescribing.  This study evaluates the impact of this policy change and the role of pharmacists’ prescribing. 

Methods:The use of low-dose codeine was assessed from the time of policy implementation (April, 2016) to March, 2023 using population-wide administrative data.  The level of pharmacist prescribing of low-dose codeine was assessed.  The volume of low-dose codeine presciptions was also assessed at the level of the the pharmacy.

Results:In the seven years since the implementation of this policy the use of low-dose codeine has continued to decline.  After an initial 93% drop in usage in the first year, the use dropped a further 65.2% by 2023.  Prescribing was initially evenly split between pharmacists and physicians but pharmacists’ prescribing declined from 48.8% to 34.1% of total low-dose codeine use by the end of the study period. Most pharmacies dispensed only a small number of low-dose codeine prescriptions (median 13, IQR 5 to 30).  However, a small number of outlier pharmacies dispensed a large number  (>5000 prescriptions/year)of low-dose codeine prescriptions.

Conclusion:The policy change to require a prescription for low-dose codeine has produced a dramatic and sustained reduction in usage of these products. Pharmacist prescribing of low-dose codeine declined over the study period.  A small number of pharmacies dispense much larger volumes of low-dose codeine and may benefit from additional regulatory oversight.

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Shawn Bugden¹, Kevin Friesen^2
1School of Pharmacy, Memorial University , ²College of Pharmacy, University of Manitoba

Purpose:Tramadol is a prodrug that is converted to a metabolite that acts on opioid receptors.  Although not initially classified as a control drug, due to concerns about safety and misuse tramadol was reclassified as a control drug in Canada in March 2022.  This study assesses the impact of this reclassification and inclusion in a prescription monitoring program on the use of tramadol in Manitoba, Canada. 

Methods:Population administrative data on all prescriptions for tramadol were evaluated from its introduction in Canada to a year after the regulatory change.  Descriptive statistics and an interrupted time series analysis were used to assess the change in tramadol usage and its impact on codeine usage. 

Results:When comparing the year before to the year after the regulatory change there was a 19% reduction in the use of tramadol (in morphine equivalents), a 45% reduction in the number of people using tramadol and a 25% reduction in the number of prescriptions for tramadol.  There was no indication of an increase in codeine use over the same period. 

Conclusion:Reclassification of tramadol as a control drug and inclusion in a prescription monitoring program substantially reduced the use of tramadol.  This change does not seem to be associated with an increase in other opioids (codeine) with fewer regulatory restrictions. 

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Ziyi Xiao¹, Certina Ho^1
1Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:A culture of safety is important for improving patient safety and patient care. Indeed, positively perceived safety culture is associated with positive safety outcomes. Safety climate questionnaires, which provide a snapshot of safety culture, have not been reported in the literature for hospital pharmacy settings in Ontario. The objective of this study is to perform a descriptive, cross-sectional exploration of Ontario hospital pharmacy patient safety climate.

Methods:This study was conducted using the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) 2.0, consisting of 10 composite measures (from Teamwork to Communication Openness) adapted to the Ontario context with 4 additional demographic questions and 1 optional free-text question. The online Google Form questionnaire was posted on LinkedIn, Facebook, and X, from March 4 to April 7, 2024, and engaged with by the Ontario College of Pharmacists and the Canadian Society of Healthcare-Systems Pharmacists Ontario Branch, on the same social media platforms, for hospital pharmacists and pharmacy technicians’ anonymous and voluntary participation. Descriptive statistics were used to analyze quantitative data, and thematic analysis was applied to free-text responses accordingly. 

Results:Sixty-three responses (75% pharmacists, 25% pharmacy technicians) were received with the majority (54%) from the Toronto Region. An overall positive patient safety culture was perceived by more than 70% of respondents. Of the 10 composite measures, “Teamwork” and “Supervisor, Manager, or Clinical Leader Support for Patient Safety” were the top two, while “Handoffs and Information Exchange” was the lowest. Subgroup analysis showed higher patient safety ratings in those with over 20 years of pharmacy experience and those working in non-direct patient care. Staffing, compensation, and ease of error reporting were identified as important facilitators for advancing patient safety climate in the free-text responses. 

Conclusion:Ontario hospital pharmacy patient safety culture was generally positively perceived by pharmacy professionals. Teamwork, including peer and leader collaboration could be leveraged to address patient safety gaps at transition points in care, such as handoffs. Patient safety climate could be explored in future studies using qualitative research methods for further insight, followed by development of potential interventions.   

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Lisa Bishop¹, Sandra Gerges², Jennifer Donnan¹, Daniel Bear², Ashley Hosker-Field², Kati Whelan¹, Marilyn Cresswell², Isobel McMahon¹, Caitlyn Coles^1
1School of Pharmacy, Memorial University , ²Other

Purpose: The legalization of recreational cannabis in Canada has increased accessibility and acceptability leading to increased consumption. Pharmacists are trained as medication experts and can play a key role in supporting customers through harm reduction and safe medical cannabis use decisions. However, there are limited roles for pharmacists outlined in the pharmacist's professional standards of practice for helping their patients navigate cannabis-related decisions, outside of assessment for use. The purpose of this study was to identify pharmacists perceived roles in providing cannabis-related care.   

Methods: This mixed methods study combines a survey (n=345) with qualitative semi-structured interviews (n=18) conducted with Canadian pharmacists. Participants were recruited through the Canadian Pharmacists Association, email listservs, and online pharmacy forums. Descriptive statistics were used for survey data, while thematic analysis was conducted on interview transcripts. Data was integrated to understand pharmacist's roles and how they could be implemented in practice. 

Results: Pharmacists surveyed believed that they should have a role in dispensing (78%) and counselling (80%) medical cannabis. Almost half (47%) believed they had a role counselling for recreational use. Qualitative findings helped to contextualize these roles and how to operationalize them further. The following themes were identified: regulations, education and clinical guidance, operational challenges, and harm reduction.  

Conclusion:Pharmacists are accessible healthcare providers with medication expertise and can support patients about their cannabis-related care. However, there are barriers to providing care that need to be overcome before pharmacists can fully embrace this role.

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Mathew DeMarco¹, Elizabeth Vernon-Wilson¹, Zahava Rosenberg-Yunger², Lisa Dolovich³, Nancy Waite^1
1School of Pharmacy, University of Waterloo , ²Other, ³Leslie Dan Faculty of Pharmacy, University of Toronto

Purpose:The Ontario Pharmacy Evidence Network (OPEN) introduced the OPEN Citizens’ Council (OCC) in 2019 as a forum for citizen engagement. The OCC plays a pivotal role in offering OPEN researchers’ opportunities to integrate citizens’ perspectives into pharmacy practice research in Ontario.The purpose of this paper is to summarize how continuous evaluation and monitoring shaped development of the OCC and citizen engagement process.

Methods:Mixed methods were used for ongoing evaluation of the OCC. The Public and Patient Engagement Evaluation Tool (PPEET) and participant feedback interviews were offered to both OCC participants and researcher presenters following meetings. Descriptive statistical analysis of quantitative data (PPEET) was conducted. Inductive thematic analysis was used to conceptualize themes from qualitative data (open text feedback from PPEET responses and interviews of both OCC members and researcher presenters).

Results:Ongoing collection of survey data guided changes to OCC delivery, including meeting scheduling, time and materials available for preparation, and discussion time. Qualitative analyses revealed researchers were seeking patient engagement at different project stages: design, delivery and evaluation. Three major themes were developed: 1) rationales for participation in OCC, 2) OCC meeting experience, 3) outcomes and impact of citizen engagement meetings. Researchers approached the OCC to improve their research by including citizen stakeholders’ perspectives as the health care end-users while OCC members shared their involvement was motivated by improving the health care system for patients. Both researchers and OCC members recalled positive interactions during OCC meetings that invited diverse perspectives. Researchers found citizen engagement impactful in shaping their research objectives, aligning projects with patient priorities, and identifying gaps to address. OCC member felt their input was always valued and considered, which reinforced their role as partners in system improvement.

Conclusion:Regular evaluation enabled development of a panel that provided researchers with a valuable way of exploring broad societal views on strategic and implementation stages of research studies. By tapping into broad civic knowledge, citizen engagement panels can complement engagement activities with patients who have specific, experiential knowledge. Greater recognition of engagement types, activities and associated value along with resources to support collaborative initiatives will lead to a more responsive research landscape.

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Heba Aref¹, Cheryl Sadowski¹, Yazid Al Hamarneh², Tony Kiang³, Elaine Yacyshyn⁴, Cheryl A Sadowski^1
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Faculty of Medicine and Dentistry, University of Alberta, ³Faculty of Pharmacy & Pharmaceutical Sciences-University of Alberta, ⁴Other

Purpose:

Given the limited evidence on cannabis safety and efficacy, particularly in older adults, individuals may have knowledge gaps that can adversely affect the quality of their decisions. This study aimed to explore the determinants of decision-making to use cannabis and decisional deficits among individuals with arthritis.

Methods:

Between December 2023 and July 2024, individuals with arthritis were invited to participate in semi-structured interviews. The Ottawa decision support framework and reflexive thematic analysis were used as the basis for the deductive and inductive analysis of interview transcripts using Quirkos software.

Results:

Twelve participants took part in the interviews. Of those, 84% were white, 75% were female. The age ranged between 59 and 70 years. Key determinants of cannabis decision-making were knowledge about cannabis use, expectations about cannabis harms and benefits, clinical needs for cannabis, personal values regarding cannabis use and the degree of physician support. These factors contributed to the status of decisional conflict (i.e., uncertainty in choosing among options involving potential risk, loss, regret or challenges to personal values). Participants highlighted the need for informational support from clinicians and stronger societal support to address social stigma.

Conclusion:

Older adults with arthritis often face decisional conflict when considering the use of medical cannabis. Factors contributing to this conflict include insufficient knowledge, unrealistic expectations, and unclear decisional roles in the decision-making process. Implementing shared decision-making (SDM) practices may help address these challenges. A cannabis decision-support tool could facilitate the SDM process by providing both patients and clinicians with evidence-based information and structured questions to help patients clarify their preferences and values. This approach is expected to enhance patient satisfaction with their decision, optimize health outcomes, and significantly improve overall quality of life. Such an approach is expected to enable informed cannabis use decisions among older adults with arthritis and ultimately aid in strengthening patient health.

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Mathew DeMarco¹, Nancy Waite¹, Sherilyn Houle^1
1School of Pharmacy, University of Waterloo

Purpose:To meet increasing patient vaccine needs in community pharmacies, regulated pharmacy technicians (RPhTs) trained in injection administration have become an important team member involved with screening patients and/or administering vaccines following pharmacist assessment. It is important to identify vaccine service delivery models that incorporate RPhTs in an efficient and effective manner.This research describes injection-certified RPhT and pharmacist self-identified best practices for optimal vaccination workflow in Ontario, Canada.

Methods:Ten RPhT-pharmacist pairs from the same community pharmacy workplace completed individual semi-structured interviews. Participants were recruited using a purposeful sampling approach that targeted 6-12 pairs in seeking coding saturation or no further changes to the codebook. Qualitative data was categorized using inductive thematic analysis to identify themes related to the injection-certified RPhT role in the vaccination workflow, important workflow influences and associated workflow impacts in community pharmacy practice in Ontario.

Results:Two vaccination workflow models were identified: (1) The “High Efficiency” (HE) model, characterized by pharmacy assistants completing patient intake and monitoring while the RPhT administered vaccines during high volume times; and (2) The “Flex and Protect”(FP) model, where RPhTs conducted intake, administered vaccines, and supported the dispensary between vaccinations, which was used during periods of lower vaccine volume, a busy dispensary, or staff shortages to protect dispensary resources. Both models involved pharmacists in clinical assessment for vaccine eligibility and appropriateness, providing timely patient engagement, and vaccine administration when RPhT resources were limited. RPhTs administering injections significantly reduced patient wait times, improved vaccination availability, access, and uptake, and enhanced patient satisfaction. Their involvement also improved workflow distribution across the pharmacy team, alleviated some of the pharmacists workload, allowed pharmacists to focus on clinical tasks, reduced dispensary interruptions, and maintained patient safety by minimizing multitasking-related errors. 

Conclusion:Two workflow models were identified that optimized use of pharmacy staff skills and managed patient volume while considering dispensary needs and staffing. Future research is needed that compares the workflow models incorporating injection-certified RPhTs to pharmacist-only vaccination models and quantitatively describes impacts on vaccination workflow efficiency, volume-related capacity, injector availability, patient waiting time, and pharmacist availability to perform clinical assessment.

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Daniel-Jiajun Yu¹, Bruno Riverin², Geneviève Létourneau², Violaine Masson^1
1Faculté de pharmacie, Université de Montréal , ²Other

Purpose:Catatonia is a neuropsychiatric syndrome characterized by diverse etiologies including psychiatric disorders, medical conditions, and neuroinflammatory processes. It is particularly prevalent in elderly patients, reported at 11% in hospitals. Post-stroke affective disorders occur in up to 50% of cases, yet post-stroke catatonia remains rare and poorly characterized. Severe complications of catatonia include deep-vein thrombosis and pulmonary embolism, and the risk may be further increased in the context of a COVID-19 infection. While electroconvulsive therapy (ECT) is generally considered safe and effective, its use is in patients with deep vein thrombosis (DVT) treated with anticoagulation is controversial. This report highlights the diagnostic and management challenges of post-stroke catatonia in an elderly patient with COVID-19 and DVT.

Methods:A 73-year-old woman developed recurrent catatonia two months after a stroke. Initially responsive to benzodiazepines, her condition became refractory upon withdrawal. Diagnosic evalution included neuroimagery, electroencephalogram and a lorazepam challenge test, and severity was assessed with the Bausch-Francis Catatonia Rating Scale. Treatment augmentation included venlafaxine, then memantine, mirtazapine and ECT within a geriatric psychiatry unit. Her acute COVID-19 infection was discovered fortuitously and generally asymptomatic, but subsequent DVT required apixaban for one week, posing challenges for ECT due to bleeding risks.

Results:Following the initiation of advanced therapeutic interventions, the patient demonstrated partial clinical improvement, as indicated by a reduction in Bausch-Francis scale scores. The combination of lorazepam with antidepressants, memantine, and ECT proved beneficial in stabilizing symptoms. Anticoagulation was effective and ECT was paused until further approval by anesthesiologist.

Conclusion:To our knowledge, this is the first case report to describe the augmentation of memantine and antidepressants with ECT for post-stroke catatonia with concomitant coronavirus and DVT. It shows a possibly effective strategy for treatment-resistant cases. The use of the Bausch-Francis scale provided an objective measure of clinical improvement, reinforcing its utility in assessing catatonia severity. These findings contribute to the growing literature on catatonia management in the context of thrombo-embolic events.

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Carissa Chan^1
1Faculty of Pharmaceutical Sciences, University of British Columbia

Purpose:Access to abortion in Canada has historically been inadequate and inequitable, with geographic disparities. The mifepristone-misoprostol abortion medication became available in Canada in January 2017, offering the potential to reduce geographic disparities. Despite rapid uptake, patients and providers report difficulty finding pharmacies that dispense mifepristone. This study quantified the proportion and geographic distribution of community pharmacies that dispense mifepristone within three calendar days in British Columbia (BC). 

Methods:In this cross-sectional mystery caller telephone survey, we called all community pharmacies in BC (July-August, 2024), posing as patients looking to fill a mifepristone prescription within three days. We calculated the proportion of pharmacies that could dispense mifepristone within three days and the proportion of non-dispensing pharmacies that provided a valid referral to a dispensing pharmacy. Using road network analysis, we estimated the proportion of reproductive-aged (15-49 years) females residing in census dissemination areas within 15- and 60-minute driving times of a mifepristone-dispensing pharmacy and proportions of pharmacies in each drive time that dispensed mifepristone. 

Results:Of the 1,511 community pharmacies in BC, we excluded 29 pharmacies that were either closed or served only specialty populations. We collected data from 1,460 community pharmacies (98.5% response rate). Two thirds (66%) of pharmacies could dispense mifepristone within three days. Among non-dispensing pharmacies (n=498), two thirds (66%) did not provide a valid referral to another pharmacy. Nearly all reproductive-aged females (99.7%) lived within a 60-minute drive of a community pharmacy and 98.4% were within a 15-minute drive of a mifepristone-dispensing pharmacy. While the absolute number of dispensing pharmacies in urban areas was higher, the proportion of pharmacies that dispensed mifepristone per dissemination area was higher in rural (vs. urban) communities (74% vs 64%).

Conclusion:Nearly all reproductive-aged females in BC live within a 15-minute drive of a mifepristone-dispensing pharmacy. However, 1 in 3 pharmacies in urban areas were not able to dispense mifepristone within three days, and most of these pharmacies did not provide a valid referral, putting the onus on the patient to identify a dispensing pharmacy. Despite widespread availability of mifepristone through community pharmacies, improving pharmacy referral networks could further improve mifepristone access. 

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Certina Ho¹, Justin Lee¹, Anna Nguyen¹, Enna Aujla^2
1Leslie Dan Faculty of Pharmacy, University of Toronto , ²Other

Purpose:There has been limited research that quantitatively analyzes quality related events (QREs) in pharmacies. Several Canadian provinces have moved towards mandatory reporting of QREs in pharmacies to the National Incident Data Repository for Community Pharmacies (NIDR [1]). The objective of this project is to quantify and characterize medication-related QREs that were anonymously reported to the NIDR by pharmacies in a Canadian province over 7 years.Links:------[1] https://ismpcanada.ca/national-incident-data-repository-for-community-pharmacies-nidr/

Methods:A retrospective descriptive analysis was conducted on medication-related QREs reported by community pharmacies in Saskatchewan between December 1, 2017 and June 30, 2024. Descriptive analysis was performed on all medication-related QREs with respect to type of incident, discoverer, medication system stages, medications, and outcome.

Results:A total of 38,812 QREs were anonymously reported by 452 pharmacies in Saskatchewan to the NIDR. Overall, 48.6% (18,440) reported medication-related QREs did not reach the patient (i.e. near misses) and 3.89% (1,510) resulted in harm. Reports of incorrect dose/frequency (22.5%; 8,734), incorrect drug (18.07%; 7,012), and incorrect quantity (15.12%; 5,870) were most common. Pharmacists discovered the majority of medication-related QREs (56.47%; 21,918). Administration was the most frequently reported medication system stage for error occurrence, followed by prescription order entry. Medications with the highest proportion of QREs associated with harm were metformin + empagliflozin, brexipiprazole, and fluvoxamine.

Conclusion:Pharmacists play a significant role in patient safety and preventing medication incidents. Our findings might have identified new high-alert medications. Medication system stage-specific and medication-focused interventions are necessary to mitigate harm and improve patient safety.

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Catherine Richer¹, Abby Emdin¹, Samuel Stewart¹, Kenneth Rockwood¹, Melissa Andrew¹, Jasmine Mah¹, Shanna Trenaman^2
1Other, ²College of Pharmacy, Dalhousie University

Purpose:We expect that changing healthcare needs at end-of-life may be reflected in medications prescribed. This study describes polypharmacy (5 or more medications) and hyperpolypharmacy (10 or more medications) in community-dwelling people living with dementia (CDPLWD), people living with dementia in long-term care (PLWDLTC), and community dwelling older adults without dementia (controls) in the last year of life.

Methods:We employed a case-control study design to compare polypharmacy, hyperpolypharmacy, and classes of medications among three groups (CDPLWD, PLWDLTC, and controls). Cases were identified as those CDPLWD or PLWDLTC who had a date of death between January 1, 2019, and January 1, 2021. Cases and controls were matched with replacement on age, administrative sex, and date of death +/- 30 days. Reported findings included rates of polypharmacy, hyperpolypharmacy and descriptions of medications used in three time periods (first four months, middle four months, and final four months of the last year of life).

Results:We analyzed 1274 CDPLWD, matched to 1274 controls, and 1274 PLWDLTC (with replacement). Polypharmacy was highest in CDPLWD in the middle of the last year of life at 43% and lowest for controls early in the last year of life at 31%. Hyperpolypharmacy was highest in CDPLWD in the middle of the last year of life at 6.5% and lowest for controls early in the last year of life at 3.5%. The most frequently dispensed medications were levothyroxine, furosemide, and metoprolol in the early and middle period of the last year of life. In the final period of assessment furosemide, levothyroxine, and cyanocobalamin were the most frequently dispensed.

Conclusion:Polypharmacy affected nearly half of the assessed Nova Scotians in the last year of life. Hyperpolypharmacy was less common in the last year of life. Medications most frequently used in the last year of life did not change in ways that reflected deprescribing recommendations. Prescribing and deprescribing at end of life is a potential area for pharmacist support and involvement.

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Scot Simpson¹, Danielle Nagy², Darius Ramrattan¹, Dean Eurich², Christine Hughes¹, Darren Lau^2
1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta , ²Other

Purpose:To determine if an internet-based toolkit for community pharmacists would improve pneumococcal vaccine uptake in people 65 years and older.

Methods:This stepped wedge-cluster randomized trial (SW-CRT) ran in 20 Alberta community pharmacies from March 1 to August 31, 2023. Administrative health data was used as the primary data resource. Eligible study subjects were people ≥65 years of age on March 1, 2023 with ≥1 visit to a study pharmacy during the trial period and ≥1 visit to the same pharmacy in the previous year. Individuals were excluded if they did not have an indication for pneumococcal vaccination on March 1, 2023. The provincial immunization database was used to identify pneumococcal vaccinations before (to determine indications) and during (to determine outcome events) the study. Mixed effects logistic regression was used to determine if the intervention was associated with a difference in pneumococcal vaccinations.

Results:Although 6,411 (58%) of 11,125 people ≥65 years of age had a previous pneumococcal vaccination, 5,360 had a single 23-valent polysaccharide vaccine >1 year before the study and were eligible for a follow-up vaccination with either the 13- or 20-valent conjugate vaccine. Our study sample included 10,335 people (mean age 75 years, 55% women) who had an indication for pneumococcal vaccination on March 1, 2023. There were 111 people vaccinated (41 per 10,000) during the usual care stage and 169 (48 per 10,000) during the intervention stage (OR 1.23; 95% CI 0.80-1.88). Pharmacies were the most common vaccination site (73% of vaccinations), followed by community health clinics (18%) and physician offices (9%).  The most common pneumococcal vaccine administered was the 20-valent conjugate vaccine (55% of vaccinations), followed by the 23-valent polysaccharide vaccine (41%) and 13-valent conjugate vaccine (4%).

Conclusion:This pilot study demonstrates feasibility of running a pragmatic SW-CRT in community pharmacies and using administrative health data to determine eligibility and identify pneumococcal vaccinations. While this study observed a similar prevalence of pneumococcal vaccination history as previous population surveys (58%), 88% of these individuals were eligible for a follow-up vaccination. Knowledge gained from this study provides strong rationale to test the intervention in a large-scale trial.

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Nhu Nguyen¹, Samantha Yau², Jessica Cuppage^2
1School of Pharmacy, University of Waterloo , ²Other

Purpose:In Canada, the health sector contributes 4.6% of total greenhouse gas (GHG) emissions, with 25% of those linked to pharmaceuticals. Effective waste management is a key enabler of low-carbon, sustainable and climate-resilient health systems. By recognizing the environmental cost of medication production, distribution, usage and waste, pharmacies are uniquely positioned to lead sustainable practice initiatives. Our goal is to conduct a review of expired medications with the aim to reduce environmental impacts of medication use in a geriatric post-acute hospital.

Methods:Expired medications from April 2023 to March 2025 were analyzed. The data analysis included drug name, strength, quantity expired, formulary status and cost. Total GHG emissions were estimated from the UK-based Medicine Carbon Formulary (MCF), which estimates the carbon footprint based on the process mass intensity of producing the drug’s active pharmaceutical ingredient, excipients and packaging, and categorizes them under low (< 10 gCO2/dose), medium (10-100 gCO2/dose), high (100-1000 gCO2/dose) or very high (> 1000 gCO2/dose).

Results:A total of 32,591 units of drugs were wasted. Drugs with a low carbon footprint rating accounted for 23% of expired drugs, medium (26%), high (13%), and very high (0%). No MCF rating was available for 38% of the expired drugs. Formulary drugs accounted for 87% and 13% were non-formulary. The total cost of expired drugs annually was approximately $11,500. The majority of expired medications had low utility or therapeutic alternatives. 

Conclusion:This review identified opportunities to incorporate sustainability strategies and the addition of an environmental impact scale to an annual formulary review. As one of the only standardized carbon footprint tools available, MCF ratings added environmental context for decision-making. However, the tool’s limitations – such as a focus on single active pharmaceutical ingredient tablets or capsules commonly prescribed in the UK, and assumptions of domestic production – likely underestimated the true carbon impact. As carbon footprint tools become more robust, a green prescribing program that encourages the use of low-carbon alternatives and implements alerts for high-waste, high-carbon drugs emerged as key areas for future consideration. Climate change can feel overwhelming but pharmacists are well-positioned to reduce healthcare’s carbon footprint while improving patient care.

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