Mise en œuvre d’une pratique avancée de pharmacien prescripteur : exemple de deux groupes de médecine de famille universitaire québécois
Bibliographic record
Abstract
Objectifs : Documenter les barrières et les facteurs facilitant la mise en œuvre et l’utilisation d’une entente de pratique avancée en partenariat permettant la prescription autonome par les pharmaciens dans deux groupes de médecine de famille universitaires de la région métropolitaine de Montréal. Décrire la manière dont l’entente a été mise en place et adoptée, puis dresser un portrait des nouveaux actes posés. Méthode : Entre mars et septembre 2022, un sondage, 21 entrevues et deux groupes de discussion ont été menés auprès de différents professionnels. Le sondage a décrit les perceptions des prescripteurs sur la pratique collaborative alors que les entretiens les ont approfondies et ont déterminé les thèmes dominants. Une compilation des interventions pharmaceutiques a été effectuée pour illustrer les champs d’application réels de l’entente. Résultats : Trois thèmes ont émergé : l’organisation du travail, les relations interpersonnelles et les effets de l’entente. Le milieu de type universitaire, la confiance et l’accessibilité du pharmacien étaient parmi les facteurs facilitants. La diversité des canaux de communication et la méconnaissance du rôle de chaque professionnel constituaient certaines des barrières identifiées. L’ajustement d’un médicament était le type d’acte pharmaceutique le plus fréquent. Les problèmes de santé pour lesquels une prescription était le plus souvent rédigée concernaient la santé mentale. Conclusion : Globalement, l’étude reflète une attitude favorable des professionnels à l’égard du rôle de prescripteur des pharmaciens, soutenue par une entente de pratique avancée en partenariat. La mise en œuvre de l’entente est facilitée lorsqu’il existe au préalable une confiance élevée entre les membres de l’équipe et que le pharmacien est présent quotidiennement. Summary Objectives: To document the barriers and facilitators to implementing a collaborative practice agreement (advanced practice partnership agreement or EPAP) allowing for autonomous prescribing by pharmacists in two university Family Medicine Groups (GMF-U) in the greater Montreal area. To describe how the agreement was established and adopted, and to outline the new activities performed by pharmacists. Method: Between March and September 2022, a survey was conducted along with 21 interviews and two focus groups with various professionals. The survey described prescribers’ perceptions of collaborative practice, while the interviews explored them in greater depth and identified dominant themes. Pharmacists’ interventions were compiled to illustrate the scope of the agreement. Results: Three themes emerged: work organization, interpersonal relations, and the impact of EPAP implementation. The university setting as well as pharmacist trust and accessibility were among facilitating factors. The variety in types of communication channels used and the lack of understanding of each professional’s role were among some of the barriers identified. Adjusting medication was the most frequent type of activity performed by pharmacists. Mental health was the health condition for which prescriptions were most frequently written. Conclusion: The study demonstrates the favourable attitude among professionals towards pharmacists’ prescribing authority, supported by a collaborative practice agreement. Implementation of the agreement is facilitated when there is a high level of trust between team members and when the pharmacist is present on a daily basis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".