By Carlene Oleksyn, BSP Pharm, CTH
When I graduated from pharmacy over 20 years ago, the buzz and excitement at the time was “pharmaceutical care”. I remember carrying to my first job a copy of Hepler and Strand’s “Opportunities and Responsibilities in Pharmaceutical Care”(1990). Such was my enthusiasm to provide this type of care.
What ensued was 20 years of practice where the majority of my time was spent signing my name on the plethora of prescriptions presented to me. With counselling, ordering, compounding, etc. the majority of my time was spent on technical tasks which did not require my university degree.
Pharmacy practice has largely remained unchanged over the past 20 years. Pharmacists still perform technical tasks a large majority of their time. Often the only interaction pharmacists have with patients is to give verbal and written information about new drugs.
It is not surprising that real change hasn’t occurred in practice as profitability in pharmacy has historically depended on drug product going out the door as quickly as possible. Pharmacists, as the final check, were the rate limiting step for profits.
Today however, with the convergence of expanded scope practice and the changing landscape of pharmacy reimbursement, the time is ideal for pharmacists to step out front and fully embrace our role as pharmaceutical care providers. Medication reviews, care plans, adapting/prescribing, chronic disease management are all about optimizing drug therapy and solving drug related problems (DRPs).
However.…we simply cannot do this on the back end of work flow checking prescriptions.
Pharmaceutical care requires that we work WITH the patient, engaging them in their own care and decision making. To do this we need to be out front. We need to dialogue with patients when they present to allow for assessment of their medications, chief complaints and chronic disease therapy. The “pharmacist at intake” model has not been widely adopted, yet this is where we need to be. Here’s why:
- It is nearly impossible to identify DRPs with only a patient profile and a prescription hard copy in front of you (the most common “pharmacist checking” scenario). The vast majority of problems are not discovered due to lack of discussion with the patient. Assessment of the patient (not just the patient’s profile) is essential.
- Checking prescriptions can be done at a fraction of the cost by a registered technician. Therapeutic assessment of the prescription by the pharmacist can be done at intake along with the patient.
- If our only interaction with a patient is to provide information (ie: counselling), we will shortly be regarded as irrelevant. Approximately 92% of adults aged 18-39 now carry a computer in their pocket. Information is at our patients’ fingertips. We are no longer the only source of drug information.
- Profitability from product is shrinking (low fees/margin, loss of rebates, cuts on short fills). Profitability from services is increasing. Identifying opportunities and providing services requires pharmacist assessment and interaction with the patient.
- If a pharmacist discovers a DRP through back-end counselling, the prescription has already been entered, prepared, checked, and the patient has waited. Now the team must go through the entire process again to fix the problem. This model is highly inefficient.
Pharmacists have an incredible opportunity to step into their true role. No other profession has the expertise to solve DRPs and optimize drug therapy. Pharmacists have unique knowledge of therapeutic guidelines, patients’ current drug therapy, alternative drug therapy options, benefit lists, and administration solutions. We cannot afford to wait another 20 years. We need to step out from behind the counter and engage our patients where they’re at.
Carlene Oleksyn is owner of Meridian Pharmacy in Stony Plain, Alberta, and owner and director of the Stony Plain Travel Clinic.