Expanded role for pharmacists in Canada is an opportunity to offer better patient care

Main Category: Pharmacy / Pharmacist
Article Date: 19 Aug 2013 - 9:00 PDT Current ratings for:
Expanded role for pharmacists in Canada is an opportunity to offer better patient care

The newly expanded role of pharmacists in Canada to help manage the health of patients can benefit both patients and physicians, according to an article in CMAJ (Canadian Medical Association Journal).

The article, written by a physician and a pharmacist, summarizes the opportunities for collaborative care and how physicians can work with pharmacists.

Pharmacists in Canada have recently been given broader responsibilities, including in some provinces, prescribing privileges, ability to order and interpret laboratory tests, and ability to vaccinate and inject medications. Pharmacists in other countries such as the United Kingdom, United States and New Zealand are also increasingly involved in collaborative care arrangements.

There is strong evidence that pharmacists' care can benefit patients, especially in providing vaccines and managing high blood pressure, diabetes, heart failure, asthma and other conditions.

"As pharmacists more actively participate in medication management, physicians should be aware that in interprofessional models of care, every member of the team is accountable for the care he or she provides and is not to be held directly liable for the acts of others," write Dr. Cara Tannenbaum, Faculties of Medicine and Pharmacy, Université de Montréal and Dr. Ross Tsuyuki, Faculty of Medicine and Dentistry, University of Alberta.

Because more than 10% of visits to emergency departments are for drug-related problems, collaboration can help reduce the number of drug?"drug interactions and avoid visits to the emergency department. Pharmacists, who have specialized expertise in drug dosing, drug interactions, pharmacology and related areas, can help physicians manage safe prescribing in complex (often elderly) patients taking 5 or more drugs. They can also help in tapering patients off medications.

"Once established, collaborative care with pharmacists will likely yield tremendous benefits to both patients and physicians. The expanding scope of pharmacists' practice offers many opportunities to improve patient care. However, it is also an ongoing process that must be evaluated as regulated activities change, new pharmacists enter practice and scopes of activities continue to expand," the authors conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Expanded role of paramedics shows promise for closing California's health-care gaps

Main Category: Public Health
Article Date: 16 Aug 2013 - 2:00 PDT Current ratings for:
Expanded role of paramedics shows promise for closing California's health-care gaps

In a new report, the UC Davis Institute for Population Health Improvement (IPHI) recommends that the state launch pilot programs to test a new model of community-based health care that would expand the role of paramedics under certain circumstances.

In "Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care," Kenneth W. Kizer, director of the IPHI and professor of emergency medicine in the UC Davis School of Medicine and Betty Irene Moore School of Nursing, and his colleagues explore a new model of community-based care in which paramedics, after undergoing additional training, would function outside of their usual emergency response and transport roles to facilitate more appropriate use of emergency departments and to increase access to primary care for medically underserved populations.

This feasibility study is the first of its kind in California and reflects the perspectives of stakeholders from nearly 40 different organizations, including emergency medical services (EMS) associations, health-care providers, health plans and payers.

"Expanding the role of paramedics is a very promising model of community-based care that uses existing health-care workers in new and innovative ways," said Kizer. "It is a model of care that several other states and countries have implemented to better leverage the skills of paramedics to meet specific community needs and to help ensure that emergency departments are more appropriately utilized."

Community paramedicine programs begin with a community health-needs assessment, during which local health-care service delivery gaps are identified. These programs then typically look at how locally developed collaborations among EMS and other health-care and social-service providers could fill the identified gaps in services.

The expanded roles of paramedics might include transporting patients with conditions not needing emergency care to care settings more appropriate than hospital emergency departments; releasing individuals at the scene of an emergency response rather than transporting them to hospital emergency departments if it is determined that emergency care is not needed; or helping frequent 9-1-1 callers access primary care or social services instead of emergency department care. The new roles of paramedics might also include making home visits to check on patients recently discharged from the hospital or emergency department, to check on individuals with certain types of chronic conditions, or even to provide immunizations or other disease prevention services.

Kizer notes that EMS data show that about a third of 9-1-1 medical emergency calls are not for true medical emergencies, but EMS providers are required by law to take all 9-1-1 patients to a hospital emergency department. In such cases, instead of transporting the person to a hospital emergency department, it might be more appropriate to take these persons to a primary care or mental health clinic or their doctor's office.

"Community paramedicine could be an important part of the solution to California's growing health-care access problem," Kizer said. "There already are not enough health-care workers in California, especially in rural and other medically underserved areas, and the situation is likely to get considerably worse in the next few years as a result of the Affordable Care Act expanding health-insurance coverage to many previously uninsured persons, as well as continuing population growth and increasing numbers of people having chronic diseases like diabetes."

The report recommends that 10 to 12 community paramedicine pilot or demonstration projects be launched to refine and evaluate details about the need for additional education and training, possible changes in the paramedic scope of practice, and how best to provide medical supervision of paramedics, among other things.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The report was commissioned by the California Healthcare Foundation and state Emergency Medical Services Authority, and was funded by the California HealthCare Foundation. It includes a history of EMS systems and paramedicine in California; an overview of the development of community paramedicine in other states and countries, as well as early efforts to establish community paramedicine programs in San Francisco and San Diego; a summary of current perspectives on community paramedicine based on interviews with stakeholders; and a discussion of legal and other barriers to implementing community paramedicine programs in California.

The complete report is available on the UC Davis Institute for Population Health Improvement website

UC Davis Health System

Please use one of the following formats to cite this article in your essay, paper or report:

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UC Davis Health System. "Expanded role of paramedics shows promise for closing California's health-care gaps." Medical News Today. MediLexicon, Intl., 16 Aug. 2013. Web.
16 Aug. 2013. APA

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'Expanded role of paramedics shows promise for closing California's health-care gaps'

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