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Background Due to the shortage of professionals, the ever-increasing needs and demands for appointments, consultation of physicians is getting harder, and delays are getting longer. To limit this issue, several countries have experimented different models of independent prescribing through pharmacies. Aim This study aimed to analyze the contribution of independent prescribing by community pharmacists, in primary care, using the micro, meso, macro level framework. Method Three different databases were used: Medline, Scopus and Embase. The search was executed on March 23rd, 2022, for each of them. Some relevant articles were added manually to the search. To be selected for the review, articles needed to be published after 2000, written in English or French, focus on independent prescribing by community pharmacists, and concern a minor condition. Original research was accepted. Articles were imported into the Covidence systematic review software to perform the review. Results The search resulted in 1768 articles and 846 after removing duplicates. After title and abstract screening, 792 articles were qualified as irrelevant, and 54 full text studies were reviewed for eligibility. Finally, eight studies were included in the scoping review. The various studies included are recent (from 2013 to 2021) and mostly of Canadian origin (6/8). For five of them, a quantitative study design is observed. As an independent prescriber, the community pharmacist can improve patient access to primary care, reducing consultation delays for minor conditions. In addition, patient safety is maintained, and the patient’s quality of life is increased. The pharmacist independent prescriber model seems to be cost-effective for society. Conclusion This review highlights the potential value and relevance of the pharmacist independent prescriber. The benefits to society are felt at all levels: micro, meso, and macro. Effectiveness and efficacy seem established, but further studies are needed in other fields, as efficiency.

Background The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults’ pharmacotherapy are opening. Objective This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers. Methods This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients’ care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. Results Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention’s impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. Conclusions The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. Trial Registration ClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794 International Registered Report Identifier (IRRID) DERR1-10.2196/42577

BACKGROUND The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these seniors are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person suffers from a MNCD, taking potentially inappropriate medications or polypharmacy (five different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing seniors' pharmacotherapy are opening. OBJECTIVE This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and education provided to these patients and their caregivers. METHODS This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semi-structured interviews (step 2). Seniors undergoing cognitive assessment, recently diagnosed with MNCD or receiving care for this at home, will be identified and recruited in FMGs in two Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients’ care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. RESULTS Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after six months of follow-up and compared between groups. At the end of the intervention study, we will conduct semi-structured interviews with FMG care team members (pharmacists, nurses, physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice, their satisfaction with and their perception of the intervention impacts for seniors and their families. We will assess the effect of improved pharmaceutical care for seniors with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. CONCLUSIONS The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more significant pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. CLINICALTRIAL NCT04889794