OPEN Summit Program • • • • • • • • • • • • • • • • • • page 1

OPEN Summit Schedule • Mandarin ballroom

DAY 1: TUESDAY, OCTOBER 7 TIME PRESENTATIONS PRESENTERS

Mor

ning

sess

ions

8:30 – 9:00 Registration and breakfast

9:00 – 9:15 9:15 – 9:30

Welcome Opening remarks from Ministry of Health and Long-Term Care representatives Michael Hillmer, Planning, Research & Analysis and Brent Fraser, Drug Program Services

Nancy Waite, Lisa Dolovich

9:30 – 10:00 OPEN overview and progress Lisa Dolovich, Nancy Waite

10:00 – 10:15 Break

10:15 – 11:45 Session 1 — ICES administrative data Moderators: Linda MacKeigan, Nancy Waite

10:15 10:30 10:45 11:00

11:15 – 11:45

1. A descriptive analysis of MedsCheck Annuals 2. Impact of pharmacists on influenza vaccination uptake in Ontario: A descriptive

analysis using administrative claims data 3. A descriptive analysis of Ontario’s Pharmaceutical Opinion Program 4. Initial uptake of the Ontario Pharmacy Smoking Cessation Program: Descriptive

analysis over two years

Knowledge user panel remarks and group discussion Panelists: Brent Fraser, Dennis Darby, Donnie Edwards

Lisa Dolovich Jeff Kwong Giulia Consiglio Suzanne Cadarette

11:45 – 1:00 Lunch and poster presentations

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ns

1:00 – 2:30 Session 2 — Stakeholder perspectives Moderators: Barb Farrell, Martin Cooke

1:00 1:15 1:30 1:45

2:00 – 2:30

1. Capturing the perspectives of academics, policy makers, physicians and pharmacists about the evaluation of pharmacy — preliminary results

2. Implementation of MedsCheck and Pharmaceutical Opinions: Preliminary findings from corporate pharmacy interviews

3. Pharmacists’ perspectives on pharmacists as immunizers 4. Identification of challenges and opportunities for community pharmacists to manage

chronic pain — dialogue exchange by chronic pain stakeholders

Knowledge user panel remarks and group discussion Panelists: Shannon Fenton, Sandra Winkelbauer, Wade Thompson

Lisa Dolovich Linda MacKeigan Nancy Waite Ayesha Khan

2:30 – 3:00 Break

3:00 – 3:15 Guest speaker: Jeff Poston

3:15 – 4:45 Session 3 — Pharmacy practice data Moderators: Martin Cooke, Lisa Dolovich

3:15 3:30 3:45 4:00

4:15 – 4:45

1. Audit of community pharmacist–delivered MedsCheck and Pharmaceutical Opinions services in Ontario

2. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified Delphi process

3. Deprescribing guideline development: Methods and results of a proton-pump inhibitor deprescribing guideline

4. Bias in pharmacist interactions with patients

Knowledge user panel remarks and group discussion Panelists: Maureen Charlebois, Perry Eisenschmid, Dawn Jennings

Nedzad Pojskic Barb Farrell Wade Thompson Lisa Wenger

4:45 – 5:00 Closing remarks Nancy Waite, Lisa Dolovich

5:00 – 7:00 Networking reception (with cash bar), Ottawa room

6:15 – 8:30 OPEN Advisory Committee meeting, Denver boardroom

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Oral Presentations • Day 1 Session 1: Institute for Clinical Evaluative Sciences (ICES) administrative data

1. A descriptive analysis of MedsCheck Annuals Dolovich L, Consiglio G, Abrahamyan L, Bojarski E, MacKeigan L, Pechlivanoglou P, Pojskic N, Rac V, Su J, Krahn M, Cadarette S

A MedsCheck Annual consultation is a medication review service funded by the Ontario government for people taking three or more prescription medications for chronic conditions. Leveraging administrative data housed at Institute for Clinical Evaluative Sciences, we sought to describe the demographic and clinical characteristics of MedsCheck Annual service recipients in Ontario from April 1, 2007 to March 31, 2013. This project is the first of three investigating MedsCheck Annual medication reviews.

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2. Impact of pharmacists on influenza vaccination uptake in Ontario: A descriptive analysis using

administrative claims data Kwong J, Cadarette S, Schneider E, Campitelli M, Church D, Consiglio G, Pojskic N, Houle S, Waite N

Since the 2012–13 flu season, pharmacists in Ontario have been authorized to provide influenza vaccination as part of Ontario’s Universal Influenza Immunization Program. Health administrative databases are being leveraged to examine the impact that pharmacists have had on influenza vaccine uptake in Ontario. Preliminary results provide a comparison of the numbers and rates of physician-administered influenza vaccinations compared with pharmacist-administered vaccinations over time, and descriptive characteristics of patients who received influenza vaccination from a physician versus those who received influenza vaccination from a pharmacist.

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3. A descriptive analysis of Ontario’s Pharmaceutical Opinion Program

Dolovich L, Consiglio G, Bojarski E, MacKeigan L, MacCallum L, Pojskic N, Cadarette S

A Pharmaceutical Opinion occurs when the pharmacist makes a documented recommendation to the prescriber regarding the drug therapy. Based on consultation with the prescriber, the prescription may be dispensed as prescribed, may not be dispensed, or the prescription therapy may be adjusted. Leveraging administrative data housed at ICES, we sought to describe the demographic and clinical characteristics of Pharmaceutical Opinion recipients in Ontario from April 1, 2011 to March 31, 2013.

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4. Initial uptake of the Ontario Pharmacy Smoking Cessation Program: Descriptive analysis over two years Wong L, Burden A, Liu Y, Tadrous M, Pojskic N, Dolovich L, Calzavara A, Cadarette S

The Ontario Pharmacy Smoking Cessation Program was launched in September 2011. We used medical and pharmacy claims data in Ontario to describe public drug plan beneficiaries receiving and pharmacies providing smoking-cessation services between September 2011 and September 2013. These data were supplemented with publicly available data and grey literature to describe regional differences in program uptake. Patient characteristics were summarized, stratified by drug plan group: seniors (ages ≥65 years) or on social assistance. Trends over time were examined by plotting the number of services, unique patients and unique pharmacies by month. We also examined use of follow-up services, prescription smoking-cessation medications and quit status.

Session 2: Stakeholder perspectives

1. Capturing the perspectives of academics, policy makers, physicians and pharmacists about the evaluation of pharmacy — Preliminary results Dolovich L, Akram S, Rietkoetter S, Slonim K, Nainifard A, MacKeigan L, Patel T, Waite N, Chang F, Farrell B

To inform the development of the pharmacy services evaluation framework, a series of key informant interviews were undertaken to capture expert perspectives on the critical structure, indicators and processes to be included in such a framework and to gain a better understanding of the potential barriers and facilitators to its development and uptake. Results of the thematic analysis of 19 interviews will be presented, highlighting emergent common themes, as well as areas of divergence among participants. This project has highlighted the importance of gathering input from diverse stakeholders in advance of creating an evaluation framework.

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2. Implementation of MedsCheck and Pharmaceutical Opinions: Preliminary findings from corporate

pharmacy interviews MacKeigan L, Bensimon C, Winterbottom M, Dolovich L, Pojskic N, Bojarski E, MacCallum L

To identify strategies used by Ontario pharmacies to enhance the uptake of MedsCheck (Annuals and Diabetes) and pharmaceutical opinions (POs), to ensure service quality, and/or to reach high-risk patients, semi-structured interviews were conducted with key informants from community pharmacy corporations, independent community pharmacies, Ontario professional pharmacy organizations, and the Ontario Ministry of Health and Long-Term Care. Descriptive content analysis

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was used to identify themes. According to the 13 corporate executive interviews, documentation and patient identification software plus pharmacist training were common implementation strategies for MedsCheck. Regarding POs, underbilling was a consensus theme; restricted patient eligibility and unclear service criteria were attributed causes.

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3. Pharmacists’ perspectives on pharmacists as immunizers

Schneider E, Wenger L, Pojskic N, Raman-Wilms L, Waite N

Although an important public health strategy, the provision of flu shots by pharmacists in Canada is still in its infancy. To understand the perceptions and experiences of pharmacists with this new service, the OPEN immunization team surveyed Ontario-based community pharmacists from August – September of 2014 (n=780, RR: 18%), including both those certified to administer and those who are not. Preliminary survey findings will be presented that provide valuable insight into past and future practices related to advertising and administration, perceived challenges and enablers to the provision and receipt of flu shots in a pharmacy setting, and ideas from pharmacists for engaging more patients in this service.

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4. Identification of challenges and opportunities for community pharmacists to manage chronic pain

— dialogue exchange by chronic pain stakeholders Chang F, Khan A, Patel T, Grindrod K, Aoki K, Chen K, Milic A, Mercer K, Sproule B

Chronic pain is a significant public health issue and affects many domains of life: physical and psychological. Community pharmacists have the opportunity to impact pain management, as they are highly visible and easily accessible to patients. The purpose was to identify and better understand the challenges and opportunities for community pharmacists to optimally manage chronic pain as perceived by patients, caregivers, advocacy groups and healthcare providers, in order to plan for patient-centred pharmacist interventions. The nominal group technique was used to gather and rank data collected. Participants identified numerous opportunities for pharmacists to meet needs of patients with chronic pain.

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Session 3: Pharmacy practice data

1. Audit of community pharmacist–delivered MedsCheck and Pharmaceutical Opinions services in Ontario Pojskic N, MacKeigan L, Dolovich L, MacCallum L

The goal of this project is to use community pharmacy records of MedsCheck Annual (MCA), MedsCheck Diabetes (MCD) and Pharmaceutical Opinion (PO) patient encounters to determine quality of services provided. Thirty-five community pharmacies from four regions in Ontario will be recruited for participation. Each pharmacy visit includes collection of a random sample of 16 of each of MCA, MCD and PO forms, which two expert reviewers will assess for comprehensiveness, pharmacist recommendations, and inappropriate medications using a structured form. Service documentation will be compared across regions, pharmacy ownership types and prescription volume levels. The audit is currently underway, with nine pharmacy visits completed to date. Full results are expected by the end of 2014.

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2. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners:

A modified Delphi process Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K

A modified Delphi approach was used to identify and gain consensus on prioritized medication classes that would benefit from development of an evidence-based deprescribing guideline. An expert panel meeting was followed by three rounds of surveys among a 65-member Canadian panel of geriatrics experts. Top five priorities were identified as well as nine other classes that participants identified as being in need of a deprescribing guideline. This session will demonstrate that overtreatment and the need for deprescribing guidelines occur throughout the spectrum of primary care and that practitioners identify multiple needs for deprescribing guidance.

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3. Deprescribing guideline development: Methods and results of a proton-pump inhibitor

deprescribing guideline Thompson W, Farrell B, Pottie K, Rojas-Fernandez C, Walsh K, Welch V, Boghossian T, Rashid J, Pizzola P, Moayyedi P

Deprescribing guidelines are being developed with the aim of providing clinicians with practical, evidence-based tools they can use to reduce inappropriate medication use in older persons. The first of these guidelines is focused on proton-pump inhibitors. Development of an evidence-based deprescribing guideline is a complex and comprehensive process. Important steps include guideline

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team formation, development of research questions and scope, gathering and synthesis of evidence, assessment of strength and quality of evidence using GRADE, formulation of recommendations, consideration of patient preferences and costs, and dissemination of findings. This presentation will review the process of developing a deprescribing guideline for proton-pump inhibitors, and will provide a summary of key results and recommendations. A clinical algorithm being trialled in pilot sites will also be presented.

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4. Bias in pharmacist interactions with patients

Wenger L, Pearson-Sharpe J, Waite N

Among pharmacy’s strengths is the profession’s accessibility to patients. As part of the effort to ensure that this accessibility is as cognitively developed as it is spatially distributed, we conducted a scoping review of literature on bias within pharmacist practice. Although findings indicate that many pharmacists are engaging with a range of populations with respect and participating in broader conversations about the value of culturally competent healthcare, there are clear opportunities for improvement. This review highlights patterns in the literature related to deficits in pharmacists’ knowledge about marginalized groups, biased, stereotypical and stigmatizing perceptions of certain patient groups and related care, and constrained service provision, as well as gaps in the extant literature and related research opportunities.