Part 1: Barriers to the advancement of the pharmacy profession

This is the first of 5 short papers reporting the results of a survey of pharmacy leaders and professionals from a broad range of practice settings and geographic locations across Canada. Ninety-six individuals who were invited to attend the Pharmacy Thought Leadership Summit on June 23-24, 2016, in Calgary, Alberta, were also invited to complete a survey prior to the summit. The goal of the summit was to reach agreement on priorities and actions that the Canadian Pharmacists Association (CPhA) can take forward with partner organizations to achieve an optimal future for pharmacy practice—a future that reflects the aspirations of pharmacy professionals and the health care needs of Canadians. Additional details on the survey methodology have been published previously. ¹

Of the summit participants invited to complete the survey, 65 responded, for a response rate of 68%. Participants were asked to rate their level of agreement regarding barriers that affect the advancement of the pharmacy profession. The barriers were broken down into system, workplace, educational and individual barriers. The top 3 responses for each barrier group are presented in Table 1.

Table 1.

Respondents’ level of agreement regarding barriers that affect the advancement of the pharmacy profession

	Participants who strongly agreed/agreed, %*
System level (n = 65)
Poor understanding of the potential scopes of practice/services of pharmacy professionals in the health care system among patients/Canadians	92.3
Poor understanding of the potential scopes of practice/services of pharmacy professionals in the health care system among other health care professionals	84.6
Inability to bill for certain pharmacy services	84.6
Workplace level (n = 65)
Too many competing priorities in the pharmacy workplace	92.3
Insufficient time for pharmacy staff to provide advanced services	86.2
Lack of business models to implement advanced pharmacy services in the community pharmacy setting	84.6
Education level (n = 65)
Lack of clinical rotations for pharmacy students in collaborative team settings	61.5
Lack of community pharmacy residency programs	56.9
Limited opportunity to develop skills in pharmacy students to use more advanced pharmacy-related technologies such as electronic health records	52.3
Individual level (n = 64) †
Lack of confidence among pharmacists	85.9
Lack of interest/motivation among pharmacists	79.7
Lack of expertise and skills among pharmacists	56.3

^*The percentage of respondents who ranked their level of agreement with the item as “strongly agree” or “agree” on a 1- to 5-point Likert scale.

^†One respondent did not answer this question.

Participants had an opportunity to provide additional comments in this section of the questionnaire, which helped to provide context to the quantitative results in Table 1.

The reimbursement model for community pharmacy remains focused on dispensing fees, which puts pharmacists in a conflicted position when it comes to medication management. —Pharmacist respondent

Convincing corporate executives, pharmacy owners and patients of the value of pharmacists’ expertise is the key to success. —Pharmacist respondent

Participants appeared to feel more strongly about the impact that system- and workplace-level barriers had on the advancement of the pharmacy profession, as compared to individual- and education-level barriers. In particular, nearly all participants believed that the major barriers affecting the pharmacy profession included 1) poor understanding of the scopes of practice/services of pharmacy professionals in the health care system among patients/Canadians and 2) too many competing priorities in the pharmacy workplace.

These survey results were further echoed at the Pharmacy Thought Leadership Summit meeting, when the participants met in person to discuss and debate these issues. All participants at the summit voted on 11 priority areas that would have the greatest impact on advancing the profession over the next 10 years.² The priorities that received the most votes were 1) technology and workplace environments and 2) payer/policy issues.² The final article in this series goes into more depth on these priority areas.³

Editorial note.

Why do we need to pay attention to what participants in a Thought Leadership Summit have to say about barriers to the advancement of the pharmacy profession? It is reasonable enough to note that those pharmacists who work day-to-day in the “real world” may have had enough of thought leaders’ pronouncements; the disconnect between pharmacy’s official and self-appointed leaders sometimes reflects the gap between rhetoric and reality. Recognizing that this is one source of data, the findings of this study do highlight important tensions between corporations and employee-pharmacists, as well as between idealized visions of what pharmacists could do and what they actually have the time, expertise and capacity to do. Completely disregarding the opinions of these thought leaders is as problematic as overreliance upon them. What is needed now, more than ever, is a vehicle to mobilize all pharmacists in a profession–wide project to consider how our profession needs to evolve to best serve Canadians.

—Zubin Austin

University of Toronto

The findings of both the survey and discussions at the Pharmacy Thought Leadership Summit meeting suggest that pharmacists’ individual skills, training, confidence and motivation are not considered the major barriers to practice change.^1,2 Rather, summit participants believe that the focus should be on eliminating system- and workplace-level barriers to achieve practice change and to improve patient health outcomes. ■