title: Policy versus practice: a community-based qualitative study of the realities of pharmacy services in Nunavut, Canada.
abstract: OBJECTIVE
  Nunavut is an Arctic territory in Canada subject to many social, economic and health disparities in comparison to the rest of the nation. The territory is affected by health care provision challenges caused by small, geographically isolated communities where staffing shortages and weather related access barriers are common concerns. In addition to national universal healthcare, the majority of the inhabitants of Nunavut (~85 %) are Inuit beneficiaries of no-charge pharmaceuticals provided through federal and/or territorial budgetary allocations. This research examines how existing pharmaceutical administration and distribution policies and practices in Nunavut impact patient care.
  
  
  METHODS
  This grounded theory research includes document analysis and semi-structured interviews conducted in 2013/14 with patients, health care providers, administrators and policy makers in several communities in Nunavut. Thirty five informants in total participated in the study. Interviews were audiotaped, transcribed and analyzed with qualitative data analysis software for internal consistency and emerging themes.
  
  
  RESULTS
  Four distinct themes emerge from the research that have the potential to impact patient care and which may provide direction for future policy development: 1) tensions between national versus territorial financial responsibilities influence health provider decisions that may affect patient care, 2) significant human resources are utilized in Community Health Centres to perform distribution duties associated with retail pharmacy medications, 3) large quantities of unclaimed prescription medications are suggestive of significant financial losses, suboptimal patient care and low adherence rates, and 4) the absence of a clear policy and oversight for some controlled substances, such as narcotics, leaves communities at risk for potential illegal procurement or abuse.
  
  
  CONCLUSIONS
  Addressing these issues in future policy development may result in system-wide economic benefits, improved patient care and adherence, and reduced risk to communities. The interview informants who participated in this research are best positioned to identify issues in need of attention and will benefit the most from policy development to address their concerns.
authors.affiliation: Department of Anthropology, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, Ontario Canada ; Department of Anthropology, University of Toronto, 19 Russell Street, M5S 2S2, Toronto, Ontario Canada.
authors.forename: Sandra J
authors.identifier: 0000-0002-5043-4355
authors.initials: SJ
authors.lastname: Romain
authors.affiliation: Associate Professor and Director, Global Affairs, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario Canada.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Kohler
authors.affiliation: School of Public Health, University of Alberta, 11405-87 Avenue, T6G 1C9, Edmonton, Alberta Canada.
authors.forename: Kue
authors.initials: K
authors.lastname: Young
keywords: Arctic; Medication; Nunavut; Pharmacy; Policy; Prescription; Remote