Abstract
Background: Pharmacists are increasingly recognized as a key player in primary care, evidenced by their vital role in COVID-19 pandemic responses in Canada and worldwide. In Canada, the role of pharmacists in the health system shifted, both prior to and during the pandemic, by expanded scopes of practice and new governance and funding models to support care provision and integration with other primary care providers (PCPs). Our research explores the integration of pharmacists in primary care and how the role can be optimized with the overarching goal of improving timely and equitable access to quality healthcare.
Approach: First, an environmental scan was conducted to review the policies and programs introduced since 2020 regarding interdisciplinary primary care and expanded scopes of practice for pharmacists in the provinces of Ontario and Quebec in Canada. We then conducted semi-structured interviews (n=11) and held a stakeholder dialogue with community pharmacists in Ontario and Quebec. We also conducted a secondary analysis that draws on findings from interviews conducted across interdisciplinary primary care teams, including administrators, family physicians and interdisciplinary health providers in Ontario and Quebec (n=44).
Thematic analysis identified several emerging themes concerning how pharmacists are working with other PCPs and providing direct patient care, both in the community (i.e., at pharmacies) and embedded within interdisciplinary primary care teams.
Results: Ontario and Quebec have legislated different aspects of pharmacist’s practice, but across the last decade both are in similar places. For example, both have authorized pharmacists to diagnose and prescribe for minor ailments.
Individual pharmacists working in the community reported significant differences in how they enact changes to their expanded scopes of practice. Organizational pressures and the control of health and human resources in the pharmacy impacted the types of services that could be offered and their capacity to provide such services. However, community pharmacists with more independence and self-efficacy could revise their workplans and prioritize resources to maximize their impact in the primary care system.
Within interdisciplinary teams, pharmacists on staff were well utilized as a resource to both patients and other providers in the team, and to conduct medication reviews and reconciliations. Some community pharmacists similarly described their role as supporting a physicians’ practice as a resource and by making recommendations. This resulted in some community pharmacists unsure about whether their integration was at the level of the system (i.e., where patients were centred and drove choices) or other PCPs (i.e., to support their practices) that was said to reinforce a medical hierarchy.
Overall, the distributed nature of pharmacists and community pharmacies leads to wide variation in enactment both within and across provinces.
Implications: There remain opportunities to improve integration, strengthen collaboration and optimize the pharmacists in primary care in Canada. Policymakers and researchers can consider whether integration with primary care is “the setting” or “the provider”, which may produce different health system impacts and patient experiences. Findings can inform best practices and future policies/reform plans intended to promote collaboration and enhance better access to quality primary healthcare in Canada and globally.