Abstract
A: By identifying a need and making the commitment to act on it. Having a collaborative relationship with a physician or group of physicians is very helpful. We are certainly in a growth phase in the profession, with new positions being developed, such as with the primary care networks in Alberta and the family health teams in Ontario.
Outside of cardiology and infectious disease, there isn't a lot of breadth or depth in specialization within the profession that is consistent across the country. This is a problem. I would encourage pharmacists to “dare to be different.”
A: There are few wards dedicated to gastroenterology. Most cases are now dispersed on general medicine and surgery wards, which creates barriers to specialization (unlike coronary care units for those with an interest in cardiology). Most decentralized pharmacy services are structured around a physical location in the hospital. You really have to make an effort to work with the specialists in the area when you're dealing with this situation. You also need support from clinical services managers to facilitate this. In many cases just showing an interest in the area is enough to develop relationships. I find gastroenterologists very open to having input from pharmacists.
A: Technology will likely play an important role in facilitating communication. In gastroenterology, an excellent starting point would be for hospital pharmacists to identify patients being discharged after hospitalization for a peptic ulcer—related bleed, so the community pharmacist can then follow up on H. pylori status.