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Expanded scope sees pharmacists spreading their wings

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Canadian consumers are gaining awareness of the services pharmacists can offer beyond filling prescriptions, but there is still a huge opportunity for them to offer even more, particularly in the treatment and management of some chronic diseases.

by Talbot Boggs

“Consumers are becoming empowered to take more control of their health and the way they access healthcare services, driven by the belief they don’t want to wait till they’re sick to get involved in managing their health, by the proliferation of information on the internet and through greater collaboration with other healthcare providers,” Anne Marie Wright, president of Elements Strategy, told a Canadian Foundation for Pharmacy forum.

A recent Ipsos Reid poll has found that more than half of consumers are aware that pharmacists provide expanded services and two thirds believe they can play an even greater role by providing more services. Thirty per cent say they are willing to pay for these services. “There is enormous potential for pharmacy to turn this trend into action to improve patient outcomes and business value,” Wright said.

Besides dispensing medication, pharmacists can play a key role in diabetes care teams by participating actively in the five Rs of organized diabetes care: Recognizing patients with, or at risk of developing the disease, maintaining a Registry of those patients and their treatments, providing Resources by collaborating with other inter-professional team members, Relaying information to other team members, and Recall or reminder calls, reviewing patients’ medications and performing reassessments.

Pharmacists also can provide medication therapy management services in the ongoing treatment of arthritis and osteoporosis by identifying at-risk patients and through patient counselling and improving treatment and medication adherence.

“Pharmacists may help identify high-risk patients who can then be targeted for bone mineral density (BMD) testing, provide counselling and education on medication use, fall prevention, and the importance of calcium, vitamin D and exercise,” said Dr. Famida Jiwa, president and CEO of Osteoporosis Canada.

The implementation of clinical programs and services in the pharmacy can pay huge dividends for patients, pharmacists and the business.

A high-volume, large format Shoppers Drug Mart in downtown Toronto recently implemented CANRISK screening and A1C programs for early detection and management of diabetes, as well as cardiovascular risk screening, assessment and management and home outreach programs.

The pharmacy handled as many as 300 CANRISK patients in one hour, and the A1C program resulted in more than 1,700 pharmacist interventions. The pilot cardiovascular program provided lipid screening and Framingham Risk Score (FRS) assessments on 56 patients. Pharmacist interventions led to drug therapy changes and lifestyle modifications.

Of the 56 patients screened, 25 had clinically significant drug therapy problems requiring a modification to their medication regimen. Recommended medication adjustments were communicated to the prescribing physicians and in nine cases responses were received, indicating the physicians had implemented the pharmacist’s recommendations.

The pharmacy’s homebound outreach program provided A1C, blood pressure and diabetes monitoring, cholesterol screening and flu vaccinations to patients who couldn’t access pharmacy services. The home visits proved to be an effective way to address drug therapy issues in the homebound individuals, minimize inappropriate medication usage, maximize healthcare cost savings, and expand the scope of pharmacy practice.

“For patients these clinical programs provided convenience, improved care, and a better relationship with the pharmacy,” said pharmacist and co-owner John Papastergiou. “While pharmacists benefited from increased job satisfaction, expanded scope of practice, the opportunity to participate in research and get out of the dispensary, the pharmacy gained from increased customer loyalty, physician and patient referrals, increased professional revenue and growth in the business.”