Twenty years ago, the thought of a community pharmacy that did not dispense any medication would have been unthinkable.
By Mike Boivin BSc.Phm.
Photography by John Packman
Even today, many patients and other healthcare professionals associate pharmacists with the products they dispense versus the knowledge and services they provide. This is truly unfortunate, as many patients don’t require more medication, but need education, counselling and support to better manage their health.
Home Care Rx is focusing on changing the delivery of pharmacist care, moving away from dispensing products to dispensing knowledge. Based in Aurora, Ont., this small pharmacy has no storefront and does not stock any medication. It is providing care to patients commonly missed by the healthcare system. These are the chronically ill who have difficulty leaving their homes. Home Care Rx pharmacists provide these patients with a comprehensive medication assessment in their home.
“We see a substantial care gap in our patients. They tend to be some of the sickest people, who for many reasons are not able to readily access the care they require,” explains Lisa Sever, one of the pharmacy owners.
Home Care Rx was launched when a regionally funded home visiting pharmacist pilot program ended. “All three of us were part of this initiative,” Lisa says. “We could see the difference we were making for our patients. We were able to identify so many issues that had not been identified through the standard patient interaction in a community pharmacy. Healthcare professionals only see a small fraction of what is happening with patients when they see them in an office or pharmacy setting.”
The partners, Lisa, Danielle and Cynthia, decided to look for opportunities to continue the same type of care for the patients in their community. That’s why, in 2014, they started Home Care Rx, a fully accredited pharmacy with no medications to dispense, owned and operated by certified geriatric pharmacists, ready to put knowledge into action.
A holistic approach
“We provide a holistic approach to seniors’ care,” says Cynthia. “We assess the patients, their medications, support and living arrangements to develop a comprehensive care plan to reduce unnecessary pill burden, improve adherence and educate them on their health. The goal is to remove or lessen the risk of medication harm that might compromise their ability to remain living in the community.”
Through the thousands of pharmacist home visits, they have developed a structure to their assessments which maximizes the time in the patient’s home. Danielle states, “Our service focuses on the medications and how they integrate with the patient and/or caregiver. Although we are reimbursed by the government for providing a medication review and collecting expired medications, we take it to the next level to make recommendations to optimize therapy and reduce medication risks that align with the patient’s goals.” Comprehensive medication can decrease hospital readmissions, delay long-term care admissions and reduce the burden on their caregivers.
There were some barriers when the partners launched Home Care Rx. The pharmacists didn’t immediately see a flood of referrals. And they had to convince prescribers, homecare agencies, caregivers and patients that what they were providing a service that was unique and would help patients.
Other pharmacies were also initially very resistant to referring their patients for consultations, even though they are challenged to provide pharmacist care in the home. “We are not competing with a standard community pharmacy as we don’t fill prescriptions,” Danielle explains. “If anything, we can help other pharmacies as we promote medication adherence and work hard to keep people in the community filling prescriptions at their pharmacy versus moving to long-term care.”
Home Care Rx is now developing a network of pharmacist consultants across the province who have the same passion. “We support our consultants by providing the infrastructure, methods and marketing which enable them to develop and offer the program in their community,” says Lisa.”
Looking ahead, the owners are searching for ways to improve the care they provide to their patients. They hope that government and payers will see the value of this type of service and find new ways to support what they do. With more funding, they know they can further enhance patient care and reduce the long-term costs of these types of patients.
“We can tell you from experience that what we do is one of the most professionally rich and emotionally rewarding jobs in pharmacy,” Lisa adds. “We know we make a difference and plan to continue to improve the care of patients in our community, and with the help of the right consultants, across the entire province.”
It’s a sentiment echoed by all three owners.