Professor of Pharmacy at Dalhousie University
Improving Prescribing and Medicines Use: Approaches from Nova Scotia, Canada related to Antimicrobials
Nova Scotia is a Canadian province of about 1 million inhabitants. The provincial government is responsible for the delivery of health care. Hospitals and physicians are publically funded. Pharmacies are privately owned and prescriptions are paid for by a mix of public funding, private insurance and out of pocket charges.
The provincial gofvernment’s Department of Pharmaceutical Services uses a number of approaches to help provide safe, effective, and affordable drugs. Hospital and provincial drug program formularies have been developed. The Drug Evaluation Alliance of Nova Scotia (DEANS) was established to encourage appropriate drug use by analysing population drug use, identifying targets for improvement and developing and evaluating interventions to improve drug use for decision-makers, healthcare practitioners and patients. A key component of DEANS is a province wide academic detailing program which provides visits and educational materials to physicians in their office by health educators on various topics.
To improve antimicrobial use the Province of Nova Scotia, adopted the federal government’s framework for action on Antimicrobial Resistance which includes includes 4 key pillars: antimicrobial resistance surveillance, stewardship, infection prevention and control, and research. The Nova Scotia Pharmacare program funded an academic detailing program related to appropriate prescribing of antimicrobials. In addition, it developed pharmacare funding criteria for specific antimicrobials which necessitated adding a criteria code related to indication on the prescription. A 2015 antimicrobial use point prevalence survey in 12 hospitals found a prevalence of 31% and also identified the need for improved documentation of indication and areas where adherence to regional treatment guidelines could be improved. Future research needs to examine the impact of multifacted interventions and strategies targeting patients.
Ingrid Sketris is a Professor of Pharmacy at Dalhousie University. She was President of the Association of Faculties of Pharmacy of Canada and is a fellow of the Canadian Society of Hospital Pharmacists and the American College of Clinical Pharmacy. She is one of 12 chairs funded by CHSRF/CIHR as part of the Capacity for Applied Developmental Research and Evaluation in Health Services program. Her research involves examining approaches to increase the uptake of evidence-based drug therapies and the effectiveness of policy levers used by pharmacare programs to provide effective and affordable drugs. She has received the “best teacher” award three times. In 2017, Dal Health’ and the College of Pharmacy’s Dr. Ingrid Sketris was named a University Research Professor. The honourary title, which has a five year term, recognizes Dr. Sketris’ ability to conduct relevant and rigorous research to inform clinical practice and pharmaceutical policy.
• Pharmaceutical policy
• Drug safety
• Pharmacy practice
• BSc(Pharm) (U Toronto)
• PharmD (Minn)
• MPA(HSA) (Dalhousie)
• Clinical Toxicology Residency (UTennesse)
She founded a unit, Initiative for Medication Management, Policy Analysis, Research and Training, which conducts research on professional, regulatory, financial and organizational factors affecting the medication management system to improve its safety, effectiveness and affordability. Her research involves: identifying gaps in appropriate drug use and evaluating strategies to improve these.
Selected awards and honours
• Pfizer/AFPC Research Career Award, Association of Faculties of Pharmacy of Canada, 2010
• Distinguished Practitioner of the American National Academies of Practice in Pharmacy, 2009
• Hill-Taylor, B, Walsh, KA, Stewart, S, Hayden, J, Byrne, S, Sketris, IS. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ Potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: Systematic review and meta-analysis of randomized controlled studies. J.Clini Pharm Ther. 2016 Mar 17. doi: 10.1111/jcpt.12372.
• Black E, Sketris I, Skedgel C, MacLean E, Hanly JG. Adherence to guidelines and the Screening Tool of Older Persons’ Potentially inappropriate Prescriptions criteria for colchicine dosing for gout treatment in beneficiaries of the Nova Scotia Seniors’ Pharmacare Program. Clin Ther. 2015 Oct 1;37(10):2339-46. doi: 10.1016/j.clinthera.2015.08.016. Epub 2015 Sep 29.
• Mossialos, E, Courtin, E, Naci, H, Benrimoj, S, Bouvy, M, Farris, K, Noyce, P, Sketris, I. “From “Retailers” to health care providers: Transforming the role of community pharmacists in chronic disease management. Health Policy. 2015 May; 119(5):628-39, doi: 10.1016/j.healthpol.2015.02.007. Epub 2015 Feb 19.
• Conrad P, Sketris IS, Langille-Ingram E. Participants’ perceptions of a multidisciplinary training program for graduate and postgraduate students in drug use management and policy. Am J Pharm Educ. 2013 Jun 12;77(5):102. doi: 10.5688/ajpe775102.
• Hill-Taylor BJ, Hurley KF, Sketris IS, O'Connell C, Sinclair D, Wing A. Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department. CJEM. 2013 Mar 1;15(2):101-8.