Science and Practice
Advances in Pharmacy Practice
Evaluation of a medication safety and adherence program within a First Nations community in Saskatchewan, Canada

https://doi.org/10.1016/j.japh.2020.08.001Get rights and content

Abstract

Objective

The objective of this mixed methods report was to describe a pharmacist intervention to support medication adherence of patients living with chronic health conditions in a First Nations community.

Setting

The intervention took place in a First Nations community health center.

Practice description

Multidisciplinary primary care clinic.

Practice innovation

A pharmacist was integrated into the weekly primary care clinics to regularly monitor patients and address any medication-related issues.

Evaluation

The pharmacist intervention was evaluated qualitatively by using focus groups and interviews, and quantitatively by analyzing medication refill claims.

Results

The entire health care team believed that the support provided by the pharmacist encouraged the patients to take control of their health conditions and was beneficial to increasing patient self-management behaviors, including improved medication adherence. All staff appreciated the team-based model because it optimized appointment times and promoted better patient care. The patients valued having a pharmacist they trusted and with whom they had a relationship to address their concerns. In the 6 months after the date of the initial visit with the pharmacist, the median number of refill claims increased in comparison with the 6 months before.

Conclusion

A clinical pharmacist contributes to improved satisfaction and medication adherence when integrated into a primary care team providing care in a First Nations community.

Section snippets

Objective

The objective of this mixed methods report was to describe the implementation and evaluation of a pharmacist intervention to support medication adherence among people living with chronic conditions in a First Nations community.

Setting and practice description

This pharmacist intervention took place in a First Nations community with a total population of 3015; of these, 1827 residents lived on the reserve. The community is located approximately 50 km north of a small city with a population of 35,926 in rural Saskatchewan, Canada.22,23 Less than 5% of the community residents are aged 65 years or older, whereas 35% are aged younger than 15 years.23,24 The Plains Cree language is preferentially spoken at home by 15% of the community.22,25

The community

Practice innovation

The pharmacist intervention described here was not originally developed for the First Nations community. It was initially launched in an urban pharmacy, and was based on a formal partnership between a community pharmacist and family physicians to support patients taking medications for chronic conditions. After a physician visit, the pharmacist contacted patients as necessary to identify any concerns or adverse effects relating to medication use; the physicians were promptly alerted to issues

Evaluation methods

In September 2019, the pharmacist intervention was evaluated qualitatively using focus groups and interviews, and quantitatively through analysis of medication refill claims. Our initial interview questions were influenced by previous related research,20 but evolved and changed through discussion with community leaders and other key stakeholders to the project. The patient focus group questions surrounded coping with illness and strategies for wellness, beliefs about medications, and

Providers’ experiences and perspectives of community pharmacy services

The addition of the pharmacist as a health care team member was highly valued at the health center; supporting quotes can be found in Table 2. All staff appreciated the team-based model because it optimized appointment times, minimized repetition of information, and promoted better patient care. All care providers were very open to work with each other and admitted that this was part of what helped the program to succeed. In addition, the pharmacist had a pre-existing relationship with the

Discussion

Although the intent of this project was to support medication adherence, it seems to have had a broader impact. The program fostered improved patient self-management, bolstered the team-based care environment, and supported best prescribing practices. The addition of a pharmacist to a primary care team in a First Nations community was highly appreciated by health care providers and patients alike. Colleagues recognized the role played by the pharmacist in making important contributions to the

Conclusion

A clinical pharmacist contributed to improved satisfaction and possibly improved medication adherence when integrated into a primary care team providing care within a First Nations community in Saskatchewan. The evidence provided in this project justifies additional research funding to precisely quantify the costs versus benefits of this strategy for improving the quality of health care with indigenous peoples living in rural and remote communities.

Acknowledgments

We would like to acknowledge Norma Rabbitskin and Shirley Bighead for graciously welcoming us into their community, supporting the implementation of the pharmacist intervention, assisting with formal evaluation of the program, and providing insight into the creation of this manuscript. We would also like to acknowledge gratitude for all health care providers and patients who participated in the program evaluation focus groups and interviews.

Rebecca Erker, RN, MN, Doctoral Student, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

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  • Cited by (0)

    Rebecca Erker, RN, MN, Doctoral Student, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Qais Alefan, PhD, Associate Professor, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan

    Donna Goodridge, RN, PhD, Professor and Director, Respiratory Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Alex Crawley, BSP, ACPR, Associate Director, RxFiles Academic Detailing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Norma Rabbitskin, RN, BN, Senior Health Nurse, Sturgeon Lake First Nation Health Centre, Sturgeon Lake, Saskatchewan, Canada

    Shirley Bighead, Director, Sturgeon Lake First Nation Health Centre, Sturgeon Lake, Saskatchewan, Canada

    David Blackburn, PharmD, Professor, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Disclosure: David Blackburn is the Chair in Patient Adherence to Drug Therapy within the College of Pharmacy and Nutrition, University of Saskatchewan. This position was created through unrestricted financial support from AstraZeneca Canada, Merck Canada, Pfizer Canada, and Saskatchewan’s Ministry of Health. The authors declare no other relevant conflicts of interest or financial relationships.

    Funding: This project was funded by Innovative Medicines Canada (formerly Rx&D).

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