1. All Records x/555 (%)
Renewals 550 (99.1)
Adaptations 5 (0.9)
Records of renewals x/550 (%)
Of a single medication in one encounter 379 (68.5)
Of multiple medications in one encounter 171 (31.5)
Reasons for
Renewal
Emergency supply 459 (83.5)
Upcoming appointment 65 (11.8)
Prescriber unavailable 21 (3.8)
Records of adaptations x/5 (%)
Type of
adaptation
Dose 3 (60)
Dosage Form 2 (40)
Regimen 0
Route of administration 0
• Changes needed to allow for future study
1) Data fields being collected
• Incorporate into modules the following fields: Days’ supply
authorized by RPh, prescriber characteristics (unique ID,
credentials, postal code), patient does not have primary care
prescriber for adaptations
• Make available the following fields for multiple renewals
performed in one encounter: DIN, medication name, strength,
route of administration, quantities authorized and dispensed
by RPh
2) Number of RPh routinely documenting
• More RPh in greater variety of jurisdictions over longer time
frame
• Unclear if more renewals than adaptations documented
because:
i. renewals happen more frequently,
ii. differences in requirement for notifying prescribers
between renewals and adaptations, or
iii. differences in ease of documentation with e-modules
Results Discussion
Uptake of Authority to Renew and Adapt Prescriptions by Ontario
Community Pharmacists: A Preliminary Investigation
Rebecca Babaei-Rad1-3, Thomas Huang2-3, Elizabeth Bojarski2,3, Lisa McCarthy1-4
1Women’s College Hospital, 2University of Toronto, 3Ontario Pharmacy Research Collaboration (OPEN), 4Women’s College Research Institute
Table 1. Desirable data fields found to be currently available or unavailable within the renewals and adaptations
documentation e-modules
• Design: Feasibility evaluation
• Process:
• Research team brainstormed and compiled desired variables
• Desired variables presented to partners who advised which
ones are currently captured in e-modules
• Data sharing agreement developed, ethics approval obtained
• Data file covering all renewals and adaptations recorded in e-
modules since inception of the system (Feb 2014) to Mar 2015
supplied to OPEN
• OPEN team conducted descriptive analysis, determined
feasibility of retrospective cohort study and developed
recommendations for next steps
Table 2. Descriptions of renewals and adaptations
documented
Acknowledgements
• Thank-you to Nikki Roy and Linda Perfetto (PASI), Michael Nashat and
Sandra Hanna (OnPharm Inc.) for their partnership on this project and
to Abhijeet Minhas for his critical review of this poster.
• This research project was supported by a grant from the Government
of Ontario. The views expressed in this poster are those of the
presenters and do not necessarily reflect those of the funder.
Introduction
Methods
• In October 2012 Ontario pharmacists (RPh) gained authority to
independently renew and adapt prescriptions, however to date
there has been no evaluation of the uptake of these services
• RPh documentations serve as data sources but earlier work
examining hard-copy prescription records proved too resource
intensive for a wider-scale audit
• We partnered with:
• OnPharm Inc. (OP) - supports 230 independent pharmacies in
Ontario
• Pharmacy Access Solutions Inc. (PASI) - a pharmacy
documentation database vendor
• Together they had developed e-modules for renewals and
adaptations to be used by OP-member RPh
• Overall Aim: To explore whether data from e-modules is useful for
estimating uptake of renewal and adaptation authority
• Research Questions:
• What variables (data fields) are desired for a study describing
whether and to what extent RPh are renewing and adapting
prescriptions?
• How useful is the currently available data?
• Are the desired data fields currently being documented in
the existing system?
• Are a reasonable number of Ontario RPh adequately
entering data into the documentation system?
Category Currently Available Currently Unavailable
Patient unique ID, gender, birth year, postal code
Pharmacist (RPh) unique ID
Pharmacy unique ID, postal code mean daily prescription volume
Prescription (Rx)
unique ID (Rx number), date of Rx, DIN, AHFS classification,
medication name, strength, route of administration, number of
refills for last filled Rx, quantity authorized for last filled Rx
Renewal
reason for renewal, quantity authorized by RPh, quantity dispensed
by RPh, patient does not have primary care prescriber (Y/N), method
of notification of primary care prescriber (phone, fax, other)
days’ supply authorized by RPh
Adaptation
type of adaptation, quantity authorized by RPh, quantity dispensed
by RPh, notification to prescriber (Y/N), method of notification of
prescriber (phone, fax, other)
days’ supply authorized by RPh,
patient does not have primary
care prescriber (Y/N)
Prescriber unique ID, credentials, postal code
• A retrospective cohort study estimating the uptake of renewals and
adaptations through review of RPh clinical e-documentation is not
feasible at this time
• Analysis of data collected through e-modules feasible though
changes to modules desirable to increase usefulness of data
• Enhanced usage of the documentation modules by RPh in a
greater number of jurisdictions is required for evaluating
uptake of prescriptive authority
Conclusions
Fig 1. Percentage of adaptations and renewals
completed by each RPh in the two
pharmacies from which data were collected
ID, identifier; DIN, drug identification number; AHFS, American Hospital Formulary System
Pharmacy 1 Pharmacy 2
100%
0% 0% 0% 0% 0% 0% 0%
55%
15% 15%
7%
4% 1% 1% 1%
RPh 1 RPh 2 RPh 3 RPh 4 RPh 5 RPh 6 RPh 7 RPh 8
PercentageofAdaptations/Renewals
Adaptations Renewals