Carlene Oleksyn, pharmacist-owner, Meridian Pharmacy, Stony Plain, Alta.
Mr. L. presents with a prescription for pregabalin 25 mg for diabetic neuropathic pain in his legs. The prescription is the same dose he’s been receiving for the past several months. When asked, he mentions that he is not having any problem with his prescription. At the majority of Canadian pharmacies, this prescription would be filled and Mr. L. would leave with his pregabalin prescription.
By Mike Boivin, BSc.Phm.
Pharmacists in almost every province have seen their scope of practice expand over the last several years. Although they can perform a variety of new services, many pharmacists are not using their expanded scope to improve patient care and the revenue for their pharmacy.
Not so at Meridian Pharmacy in Stony Plain, Alta.
“Every patient visit and prescription is an opportunity for using my expanded scope and improving patient-centred care,” explains Carlene Oleksyn, pharmacist and owner. At Meridian, the flow of a prescription is very different from at most pharmacies. “Our goal is for the patient to interact with the pharmacist as soon as they approach the counter,” she says. “When they present with a prescription, I scan their file and determine if the patient is a candidate for an expanded service and if the current prescription is the best option for the patient.”
Carlene received her Additional Prescribing Authorization (APA), which allows her to prescribe, adapt and substitute medications. “If the prescribed medication is not the best option, I will adapt it to something different or prescribe something I feel is better for that patient. My primary objective is to work with the patient to determine the best therapies to help him reach his goals.”
The role of dispensing has been transferred from the pharmacist to the registered pharmacy technician. “My pharmacy technician, Aysha, is a dispensing expert, and I have happily allowed her to practise to her full scope,” explains Carlene. With Aysha managing dispensing, Carlene and Meridian’s other pharmacist, Graham, can focus on the delivery of patient centred care.
“We assess every patient who presents in the pharmacy. I know from experience that almost every patient with chronic disease states is a candidate for expanded services. We capture every opportunity as it is good for the patient and the pharmacy. Everything I do is in the best interest of the patient, and I feel confident that I am making choices to help my patients reach their best possible health.”
The service has not only benefited patients, but has had a tremendous impact on Meridian’s bottom line. “I disagree with pharmacists who feel we cannot survive in the changing pharmacy environment. Close to half of our income is generated from expanded services, and the profitability of this portion of our business is rising rapidly.” From a business standpoint, expanded services require little inventory and pharmacists are paid for the knowledge they deliver versus simply dispensing a product.
Best of all, the patients love the care provided at Meridian. “We are building a strong allegiance with patients in our community and are being recognized as advocates for their care.”
When asked about physician resistance, Carlene says, “Initially some physicians were not supportive of pharmacist prescribing, but when we confidently make clinical decision to improve the patient’s care, many become huge supporters.”
Some physicians are now referring complex patients to Meridian, as they feel pharmacists’ insights help to manage these challenging cases. “When we change or prescribe a new therapy, we follow up regularly with the patient. When we start a patient on a medication and it turns out not to be the best option, we simply change it to another option. This is what physicians and nurse practitioners regularly do.”
Carlene is demonstrating the influence pharmacists are now having on patients’ prescription therapy. “Pharmacists can now partner with the patient, other healthcare professionals and payers to ensure every patient is receiving the therapy that helps reach his/her goals.”
With the changing pharmacy environment and scope of practice, innovators like Carlene will continue to thrive and grow and have more of an overall impact on prescription therapy and patient care.
When Mr. L. presented his pregabalin prescription at Meridian, Carlene performed an assessment of the patient and the therapy. His pain was 8 on a visual pain scale of 0-10. Carlene felt the dose was too low, prescribed a week of 50 mg twice daily and checked back in a week. Through regular follow-up, Carlene increased Mr. L. to his current dose of 75 mg BID. His pain level is currently 2. The patient benefited tremendously through the intervention and Carlene was reimbursed for the changes and her follow-up. This one intervention was life-changing for the patient and life-affirming for pharmacists dedicated to improving overall patient care.