Which of the following specialty areas are available to pharmacists who wish to become certified

Specialization in pharmacy has been a topic of interest for Canadian thought-leaders within the profession since the mid-1980s. Over the years, a number of initiatives have taken place to explore and advance this concept, such as the formation of the now-defunct Canadian Board of Specialties in Pharmacy, the Pharmacy Examining Board of Canada’s Committee on Specialty Certification, the Task Group on Specialization in Canada and the Quebec initiative for the formal recognition of pharmacy specialties. With the expansion of pharmacists’ scopes of practice in Canada and the increased momentum of pharmacist specialization south of the border, the subject has gained renewed interest among hospital and community pharmacy practitioners and employers.

The Board of Pharmacy Specialties (BPS) was established in the United States in 1973 and provides certification to pharmacists in areas such as pharmacotherapy, ambulatory care, nuclear, nutrition and psychiatric pharmacy. Until recently, the number of pharmacists obtaining certification through BPS was quite limited: by 2014, BPS had certified only 8% (21,906/290,780) of the country’s pharmacists (BPS Executive Director William Ellis, personal communication, Dec. 9, 2014). This number is increasing rapidly, however, and the organization expects to provide 25% (81,950/est. 327,800) of US pharmacists with specialty certification by 2020.1-3 Many international pharmacists are also now obtaining specialty certification through BPS as well as the Commission for Certification in Geriatric Pharmacy (CCGP), whether or not they receive official recognition for this certification in their home countries.

The Blueprint for Pharmacy initiative, led by the Canadian Pharmacists Association (CPhA), has incorporated pharmacist specialization with its priority of education and continuing professional development since the Blueprint’s Vision for Pharmacy document was published in 2008. The most recent Blueprint undertaking around specialization involved contracting Intergage Consulting Group Inc. through a Request for Proposals process in 2014 to conduct a needs assessment of pharmacist specialization in Canada. The research included a literature and high-level jurisdictional review, interview consultations with key stakeholders, a national survey of pharmacists and pharmacist employers, and 2 roundtable consultations with thought-leaders and stakeholders. The purpose of the research was to obtain a current profile of the level of need, demand and feasibility of introducing a formal specialty certification and/or recognition process to Canada. The final report can be accessed at www.blueprintforpharmacy.ca.4

A number of interesting findings are contained within Intergage’s report of specialization in Canada. First and foremost, it is clear from the survey of Canadian pharmacists and pharmacist employers that there is little agreement about what constitutes pharmacist specialization. Even though a working definition of pharmacist specialization, developed by the Task Group on Specialization in Canada, was provided to respondents at the beginning of the survey, distinct understandings of the term were found throughout the survey results between hospital and community pharmacists.

Results indicate that whereas community pharmacists are more likely to identify specialization as a higher level of certification in areas of disease state management (e.g., diabetes, asthma, smoking cessation), hospital pharmacists in general see specialization in terms of specific conditions or groups of patients (e.g., oncology, geriatrics). For example, pharmacist respondents were asked to identify the areas of specialization in which they practice, whether or not they are formally certified as specialists through a certification body. The majority of community pharmacists (n = 211) chose diabetes (56%), smoking cessation (33%) and other (19%), which included compounding and injections. In contrast, hospital pharmacists (n = 426) chose other (32%), which included infectious disease and nephrology, oncology (23%) and pharmacotherapy (18%).

These conflicting definitions of specialization from within community and hospital pharmacy were found throughout the survey results and formed the number one recommendation that agreement must be reached among leaders and stakeholders as to what constitutes specialization before any further work to advance pharmacist specialization in Canada can occur.

Recommendation #1: Obtain Agreement on Definitions of Pharmacist Specialization in Canada

It is recommended that the Blueprint for Pharmacy, the Task Group on Specialization in Canada and other key stakeholders seek agreement within the profession on definitions regarding what constitutes pharmacist specialization as opposed to advanced practice and how to define different areas of specialization within the profession.

Another finding from the survey identified broad support for formal processes for recognition and certification of pharmacist specialization in Canada from among hospital and community pharmacists and employers. Survey respondents were asked the extent to which they agree that a process to support the certification and formal recognition of key pharmacist specialty areas should be available in Canada. In total, 89% of practising pharmacists (1574/1769) and 85% of employer respondents (105/123) strongly agree/agree that formal certification and recognition should be available in Canada. No significant difference was found in the level of support from pharmacist respondents working in hospital vs community pharmacy settings. It is worth noting that respondents aged 25 to 34 were twice as likely to support formal certification and recognition of pharmacist specialists in Canada compared to other age groups.

Survey respondents indicated less support for mandatory certification for pharmacists who wish to practise in specialty areas where formal certification might be available (presently or in the future). Only 69% of community pharmacists (409/593), 54% of hospital pharmacists (294/545) and 65% of employer respondents (66/102) agreed that formal certification should be mandatory in these instances.

Pharmacy regulators interviewed for this assessment (n = 8) are generally supportive of a formal certification process for pharmacist specialties in Canada. However, they caution it should be driven by patient needs and the needs of the health care system. Those consulted also see a value in developing a Canadian process for the formal recognition of pharmacist specialization but believe that it must be structured and communicated properly so that patients can make informed decisions as to the level and quality of care they need and the type of pharmacists from whom they should seek care. Regulators also expressed uncertainty regarding the feasibility of introducing a formal process of recognition for pharmacist specialization given the lack of understanding regarding the associated costs and benefits that might result from its introduction.

Recommendation #2: Research and Identify a Formal Process for the Recognition of Canadian Pharmacist Specializations

It is recommended that possible regulatory models and processes for the formal recognition of pharmacist specialization in Canada be examined. This would require a comparative review of other jurisdictions and other health professions’ specialization recognition processes as well as consultations with respective regulatory authorities. It is clear from this assessment that a process for recognition of pharmacist specialization is needed, but it is beyond the scope of this report to make recommendations about the optimal process.

During the interview consultations for this assessment, community pharmacy employers (n = 4) indicated that demand for pharmacist specialization in Canada is low and that such specialization will likely come from a small minority within the profession who are leaders and innovators. These employers affirmed that they provide support for their pharmacists to become certified in areas of injections/vaccinations, diabetes education and geriatrics. Outside of these areas, specialization is not considered a priority. Interviews with community pharmacist employers in Alberta (n = 2) revealed that with Alberta’s Advanced Prescribing Authority for pharmacists, the priority for employers in that province is to support pharmacists in obtaining this designation.

On the side of hospital pharmacy, it is evident that a large portion of pharmacists are employed and are considered specialists even though they are not formally certified in their specialty areas. Sixty-eight percent of pharmacist respondents (357/525) who indicated they practise in a specialized area without formal certification were employed in hospital pharmacy or another health care facility vs only 19% of community pharmacists (100/525). Moreover, only 61% of hospital employer respondents (11/18) indicated they will require formal certification for pharmacists who wish to practise in specialized areas.

In 2015, it was estimated that approximately 262 Canadian pharmacists held BPS certifications in 2014. A further 394 Canadian pharmacists are believed to have held a certificate in Geriatric Pharmacy Practice through the CCGP in 2014. Based on National Association of Pharmacy Regulatory Authorities’ statistics published on January 1, 2015, this represents only about 1.7% (656/38,737) of licensed Canadian pharmacists (or less, as some pharmacists may have both certifications).5,6 In light of these numbers, it is possible that implementing a formal process for the certification of pharmacist specialization in Canada may be unsustainable at the present time.

Recommendation #3: Research Potential Processes for the Formal Certification of Pharmacist Specialization in Canada

It is recommended that further research be undertaken, including a cost-benefit analysis, to determine the best model for the certification of pharmacist specialists in Canada. Key options include these:

  • Adapting existing certification processes to the Canadian context (e.g., BPS)

  • Formally recognizing pharmacy specialization with certification obtained through international certification processes

  • Introducing a Canadian model for the formal certification of pharmacist specialists

From the literature review, Intergage Consulting Inc. concluded that the most direct and significant benefit of pharmacist specialist certification lies in the ability of the pharmacist to provide better care to patients or selected groups of patients.7 In interview consultations, pharmacist specialists (n = 5) also expressed the opinion that specialization allows pharmacists to better promote their services to the public.

Within the national survey of specialization, the top 3 reasons indicated by formally certified pharmacist specialists (n = 246) as to why they obtained specialty certification are 1) for personal and professional growth (98%), 2) to increase professional confidence (91%) and 3) for professional recognition of advanced competencies in specialized areas (84%). In terms of the potential benefits that could be derived from formal certification in a specialty area, 86% of pharmacist respondents (1425/1658) indicated that formal certification would likely lead to enhanced quality of patient care, safety and outcomes. Ninety percent (1492/1658) agreed that formal certification would lead to greater confidence in the knowledge and skills of pharmacist specialists.

Recommendation #4: Conduct Public Outreach to Increase Stakeholder Understanding and Awareness of the Potential for Pharmacist Specialization

It is expected that demand for pharmacist specialization will be driven by the public, other health care providers, policy-makers and regulators. Increasingly, public and other key stakeholder understanding of the potential for expanded roles for pharmacists (including specialization) is viewed as a key step in influencing demand for the formal recognition and certification of pharmacist specialization.

CPhA and Blueprint for Pharmacy stakeholders look forward to pursuing the recommendations from this report. Further research into formal certification and credentialing of pharmacist specialists is contained within CPhA’s 3-year strategic plan, and the topic remains an interest of the Association of Faculties of Pharmacy of Canada, the Pharmacy Examining Board of Canada, the Canadian Society of Hospital Pharmacists and the Canadian Council on Continuing Education in Pharmacy. ■

Author Contributions:K. Skromeda drafted the manuscript. Both authors revised, edited and approved the final version of the manuscript.

Declaration of Conflicting Interests:The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding:This study was funded by the Blueprint for Pharmacy with a grant from Walmart Canada Inc., the Pharmacy Examining Board of Canada and the Canadian Council on Continuing Education in Pharmacy. Project management support was provided by CPhA through the Blueprint for Pharmacy National Coordinating Office, and project guidance and oversight were contributed by the Specialization Project Advisory Group as well as the Blueprint for Pharmacy Steering Committee.

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