Foong Esther Ai-Leng, Edwards David J, Houle Sherilyn, Grindrod Kelly A
University of Waterloo School of Pharmacy, Waterloo, ON.
Can Pharm J (Ott). 2017 Oct 4;150(6):387-396. doi: 10.1177/1715163517732089. eCollection 2017 Nov-Dec.
Since 2012, Ontario pharmacists have been authorized to administer the influenza vaccine. In April 2016, the Ontario College of Pharmacists (OCP) proposed to expand the Pharmacy Act to allow pharmacists to vaccinate against 13 additional conditions. The OCP held an online public consultation and invited pharmacists, members of the public and organizations to weigh in on the proposed changes. Our objective was to explore the factors influencing how Ontario pharmacists may adopt or reject an expanding scope of practice, using data from the public consultation.
We coded the responses to the public consultation in 2 ways: 1) sentiment analysis and 2) an integrative approach to coding using Rogers's diffusion of innovations theory across 5 domains: relative advantage, compatibility, complexity, trialability and observability.
Responses from pharmacists, the public and organizations were moderately positive on average. Pharmacists most commonly mentioned relative advantages, including benefits for patients, pharmacists, physicians and the health system. Positive responses focused on accessibility for patients, improved vaccine coverage, lower health care spending and freed physician time but cited lack of prescribing privileges as a barrier to the proposed changes. Negative responses focused on increased workload, patient safety concerns and the complexity of travel medicine.
The expanded immunization services are likely to be well received by most pharmacists. Convenience and accessibility for patients were commonly cited benefits, but the changes will be only a slight improvement over the current system unless pharmacists can prescribe these vaccines. Although employers responded positively, the question remains whether they will support pharmacists in a way that aligns with pharmacists' values and expectations. Decision makers must pay close attention to the pharmacy infrastructure and how this will affect uptake of these services. Recognition of this, combined with pharmacists' positive perceptions of the expanded scope, will facilitate smooth integration of this legislation into Ontario pharmacy practice.
自2012年以来，安大略省的药剂师被授权接种流感疫苗。2016年4月，安大略省药剂师学院（OCP）提议扩大《药房法案》，允许药剂师针对另外13种情况进行疫苗接种。OCP举行了一次在线公众咨询，邀请药剂师、公众和组织就提议的变更发表意见。我们的目标是利用公众咨询的数据，探讨影响安大略省药剂师采用或拒绝扩大执业范围的因素。
我们以两种方式对公众咨询的回复进行编码：1）情感分析；2）采用罗杰斯创新扩散理论，在5个领域进行综合编码，这5个领域包括：相对优势、兼容性、复杂性、可试行性和可观察性。
药剂师、公众和组织的回复平均呈中度积极。药剂师最常提到相对优势，包括对患者、药剂师、医生和医疗系统的益处。积极回复集中在患者可及性、提高疫苗接种覆盖率、降低医疗保健支出以及节省医生时间，但指出缺乏处方权是提议变更的障碍。消极回复集中在工作量增加、患者安全担忧以及旅行医学的复杂性。
扩大免疫服务可能会受到大多数药剂师的欢迎。患者的便利性和可及性是普遍提到的益处，但除非药剂师能够开具这些疫苗的处方，否则这些变更相对于当前系统只会有轻微改善。尽管雇主回复积极，但问题仍然是他们是否会以符合药剂师价值观和期望的方式支持药剂师。决策者必须密切关注药房基础设施以及这将如何影响这些服务的采用。认识到这一点，再加上药剂师对扩大范围的积极看法，将有助于这项立法顺利融入安大略省的药房实践。
