title: Patient, family physician and community pharmacist perspectives on expanded pharmacy scope of practice: a qualitative study.
abstract: BACKGROUND
  The RxEACH trial was a randomized trial to evaluate the efficacy of community pharmacy-based case finding and intervention in patients at high risk for cardiovascular (CV) events. Community-dwelling patients with poorly controlled risk factors were identified and their CV risk reduced through patient education, prescribing and follow-up by their pharmacist. Perspectives of patients, family physicians and community pharmacists were obtained regarding pharmacists' identification and management of patients at high risk for CV events, to identify strategies to facilitate implementation of the pharmacist's expanded role in routine patient care.
  
  
  METHODS
  We used a qualitative methodology (individual semistructured interviews) with conventional qualitative content analysis to describe perceptions about community pharmacists' care of patients at high risk for CV events. Perceptions were categorized into macro (structure), meso (institution) and micro (practice) health system levels, based on a conceptual framework of care for optimizing scopes of practice.
  
  
  RESULTS
  We interviewed 48 participants (14 patients, 13 family physicians and 21 community pharmacists). Patients were supportive of the expanded scope of practice of pharmacists. All participant groups emphasized the importance of communication, ability to share patient information, trust and better understanding of the roles, responsibilities, accountabilities and liabilities of the pharmacist within their expanded role.
  
  
  CONCLUSIONS
  Despite support from patients and changes to delivery of care in primary care settings, ongoing efforts are needed to understand how to best harmonize family physician and community pharmacist roles across the health system. This will require collaboration and input from professional associations, regulatory bodies, pharmacists, family physicians and patients.
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Maoliosa
authors.initials: M
authors.lastname: Donald
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Kathryn
authors.initials: K
authors.lastname: King-Shier
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Yazid N
authors.initials: YN
authors.lastname: Al Hamarneh
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Jones
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Wendy
authors.initials: W
authors.lastname: Tink
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Nairne
authors.initials: N
authors.lastname: Scott-Douglas
authors.affiliation: Department of Medicine (Donald, Manns, Tonelli, Scott-Douglass, Hemmelgarn); Interdisciplinary Chronic Disease Collaboration (Donald, Manns, Tonelli, Hemmelgarn); Department of Community Health Sciences (King-Shier, Manns, Tonelli, Hemmelgarn); Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta.; Department of Medicine (Tsuyuki, Al Hamarneh), EPICORE Centre, University of Alberta, Edmonton, Alta.; Southern Medical Program (Jones), University of British Columbia, Kelowna, BC; Department of Family Medicine (Tink), University of Calgary, Calgary, Alta.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn