Resource Spotlight: Pharmacy Practice in Rural and Remote Areas of Canada
February 28, 2023
Written by Layne Liberty
This article was written and researched by a CSHP student member for Interactions
, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca
Background
Practicing in rural areas of Canada provides pharmacists with opportunities to work closely with other health care providers and unique patient populations. Rural pharmacists often practice as generalists which, on one hand, allows them to expand their skills and utilize their full scope of practice, but on the other, can lead to occupational burnout due to lack of relief coverage and higher workload. Additionally, rural communities experience high turnover of health care professionals (HCP) which contributes to occupational burnout and the decreased access to care these patient populations experience.1 Currently, there are no mandatory requirements for students in Canadian pharmacy programs to complete practicums in rural areas. Although implementing a required rural practicum component would help increase exposure and promote students to return to these areas after graduation, this is often not feasible due to lack of available accommodations and high travel costs. This Resource Spotlight highlights a few financial aids for students interested in completing rural practicums, as well as background information on rural health to help them prepare. This spotlight also aims to connect rural hospital pharmacists with support for coping with feelings of professional isolation, as well as providing access to rural health toolkits, best practice guides and training on delivering culturally competent care. To learn more about the issues surrounding Rural Hospital Pharmacy Practice, check out the Canadian Society of Hospital Pharmacists (CSHP) recent Clinical Pearl article here.
External Resources
Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use. Resources are free unless otherwise indicated.
Mental Health Resources for Pharmacists
Practicing in rural and remote areas where healthcare providers may not have their family and friends around them may lead to feelings of isolation. Additionally, lack of relief coverage and staffing resources can contribute to provider burn out and can potentially lead to errors which may affect patient safety. Access to mental health services may be difficult to obtain in these underserved communities so utilizing virtual mental health networks can help pharmacists connect to supportive resources.
CSHP has a member wellness kit that was originally created to support pharmacists during the COVID-19 pandemic, but still offers a collection of valuable mental health and wellness resources.
The University of Toronto Leslie Dan Faculty of Pharmacy has developed an initiative to support the resilience of the pharmacy workforce and has compiled a repository of resources to help pharmacists navigate professional burnout and connect them with supportive services.
The Canadian Psychological Association has created a program that provides access to registered psychology practitioners, free of charge, for all healthcare workers who have been on the front lines of the current COVID-19 pandemic and national healthcare crisis.
The Ontario Pharmacists Association sponsors a podcast called A Prescription for Professional Wellness that facilitates conversations around the current mental health challenges that pharmacists experience during professional practice.
Resources for Rural Canadian Pharmacy Experiential Education
There are currently no requirements for students in any of the Canadian Doctor of Pharmacy programs to complete experiential learning in rural and remote areas. Rural practicum placements can be difficult for students due to travel costs and lack of affordable accommodations. Funding and grants specifically for pharmacy students to cover the costs of accommodation and travel are limited but available in select provinces.
The University of Manitoba Rady Faculty of Health Sciences program recently created a fund to help students who complete practicums outside of Winnipeg by covering their accommodation and travel expenses. This travel policy reduces student financial stress and increases opportunities for more students to experience rural healthcare with the hope that they will return post-graduation. In the first year of the fund, it sent 200 students to complete practicums in rural hospitals, community centers and private clinics.
The majority of the Canadian population lives in or around urban centers, so many students and practicing pharmacists may be unfamiliar with the rural community experience. To help with exposure to underserved western communities, the University of British Columbia created a Rural Opportunities for Practice Education (ROPE) website that is a tool and resource designed to help students in healthcare programs prepare for clinical practicums in rural BC. This website can also be useful for healthcare providers looking to practice in rural areas. To help prepare students for rural practice placements this site provides resources to optimize rural placements through community integration guides and supplies learning objectives and activities directed at supporting interprofessional collaboration and professional development. It also provides an opportunity for individuals interested in rural areas to virtually explore different areas of BC and supplies information about the First Nations Health Authority teams and programs, which is important for understanding patient medication coverage.
Canadian Rural Hospital Pharmacy Practice Resources
Finding ways to understand the current state of hospital pharmacy in rural Canada is essential for determining a course of action to plan and enhance access to care and pharmacy services in these areas. There are large gaps between urban and rural hospitals in respect to what services and resources are available and there is a lack of published information regarding rural pharmacy practice.2
To help identify and understand these gaps, CSHP introduced a section specifically for small hospitals (less than 50 acute care beds) into the 2020/2021 Hospital Pharmacy in Canada Survey Report. This new survey section allows data to be gathered regarding demographics, pharmacy service models, drug distribution systems and use of technologies, among others.
Additionally, a quantitative study based on the same domains reported in the Hospital Pharmacy in Canada Survey was conducted to analyze data about current pharmacy distribution, clinical, and management services for small hospitals using telepharmacy services. The study provides valuable information that can be used by pharmacist interested in rural practice to see a snapshot of rural practice, and also for hospital and pharmacy leaders to understand resource need, differences in practice and to evaluate clinical pharmacist key performance indicators.
Telepharmacy allows for an expansion in pharmacy services and assists in closing service gaps. CSHP has created guidelines and a recorded webinar for implementing telepharmacy services in hospitals, ambulatory care clinics and long-term care facilities. The guide shares best practices and provides support in deciding whether to provide telepharmacy services, in preparing for implementation, and in providing service support.
Indigenous Health Resources
Indigenous populations are more likely to live in remote and northern areas of Canada3, and due to their geography in combination with discrimination and long-term repercussions of colonization, experience health inequalities and barriers to treatment.4 Pharmacists in rural areas may be more likely to provide healthcare services to these populations, making it essential for them to offer culturally competent care. A previous Canadian Society of Hospital Pharmacists Resource Spotlight for Indigenous History Month compiled resources about cultural competency and clinical guidelines that will aid pharmacists in developing and applying these skills in rural practice.
American Rural Hospital Pharmacy Practice Resources
Smaller hospitals with more basic facilities can make clinical practice look different compared to urban areas. Pharmacists in this environment most often practice as a ‘jack of all trades’ or generalist due to reduced staffing resources and fewer specialized departments. These hospitals with one or two pharmacists may not be servicing a large enough population to support additional specialized positions or there may be a lack of funding to expand resources. Learning from other rural health best practices can help pharmacists make the best use of limited funding and resources.
American Society of Health-Systems Pharmacists (ASHP)
ASHP has a Small and Rural Hospital Resource Center that contains a collection of resources including practice tools, articles, materials, and best practices relevant to health care practitioners in rural communities. Part of this resource contains an assortment of podcast episodes, linked below, that are specific to hospital pharmacists:
1. Strategies that pharmacists can use to navigate medication safety issues and address barriers to safety initiatives in a rural hospital
2. A primer on effective precepting in rural hospitals and discussion of best practices to ensure students experience a well-rounded rotation and help inspire a future career in rural practice
3. Pharmacists in small and rural hospitals share best practices regarding the implementation, training and use of telepharmacy services and how it can improve access to care
4. Discussion regarding implementation of progressive pharmacy care models that identify and address barriers to underserved patients in rural health settings
The Rural Health Information Hub (RHIhub)
The RHIhub is a repository of information dedicated to rural health that is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services. This site focuses on providing information, resources and best practices to support healthcare and population health in rural areas of the United States. Although it is not pharmacy specific, the website houses many useful evidence-based tool kits and guidelines that can be adopted to better serve rural patients. It also provides valuable background information about the importance and benefits of healthcare access and the barriers that rural residents experience.
A few examples of useful rural resources:
1. Antibiotic Stewardship in Rural Hospitals outlines core elements to ensure prevention of multi-drug resistance.
2. A topic guide discussing the social determinants of health of rural populations focusing on the barriers these patients experience and ways to address them to improve health.
3. A webinar discussing the rural-urban differences in all-cause mortality, suicide, alcohol-related deaths, motor vehicle traffic deaths, and drug overdose deaths.
4. A topic guide dedicated to providing information about the disparities in healthcare in rural communities and strategies to improve access.
References
1. Brown A. UNBC [Internet]. Issues affecting access to health services in northern, rural and remote regions of Canada; [cited 2023 Jan 10]. Available from: https://www2.unbc.ca/sites/default/files/sections/northern-studies/issuesaffectingaccesstohealthservicesinnorthern.pdf
2. Canadian Society of Hospital Pharmacists. Hospital pharmacy in Canada survey report 2020/2021 [Internet]. Ottawa: [publisher unknown]; 2021 [cited 2023 Jan 10]. 136 p. Available from: https://www.cshp.ca/docs/pdfs/HPCS-2020-21-Qs-ENG.pdf
3. Statistics Canada. Indigenous population continues to grow and is much younger than the non-Indigenous population, although the pace of growth has slowed [Internet]; 2022 Sep 21 [cited 2023 Feb 7]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm#shr-pg0
4. National Collaborating Centre for Indigenous Health. Access to health services as a social determinant of First Nations, Inuit and Métis health [Internet]. Prince George: [publisher unknown]; 2019 [cited 2023 Feb 7]. 16 p. Available from: https://www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf