An initiative to help pharmacists better connect with patients with mental health and addictions issues has taken root in Nova Scotia.
By donalee Moulton
Launched as a pilot project in 2014, the Bloom Program – the first of its kind in the world – has now received ongoing support from the provincial government, and will continue to grow.
The success of the initiative is founded on partnership. In projects that came before Bloom, including More Than Meds, “we were connecting community pharmacists with people who had lived experience of mental illness. They trained together for one day, then went back to their community to train other pharmacists who then supported their community in a variety of ways,” says Dr. David Gardner, a pharmacist and co-lead of the Bloom Program.
The impact of More Than Meds was timely and aligned well with the province’s Mental Health & Addictions strategy report, which, ultimately, led to provincial funding of the patient-centred, innovative Bloom Program demonstration project. “Fast-forward three years, we have now completed the project, and it has received outspoken praise and ongoing support from the Minister of Health,” says Gardner.
To enroll in Bloom, patients have a self-disclosed diagnosis of a mental illness with or without a concurrent addictions problem along with one or more medication therapy issues. Once enrolled and following an in-depth assessment by the pharmacist, patients receive longitudinal medication therapy management. As for other persisting and chronic conditions, pharmacists in the Bloom program provide support and guidance to patients to encourage their access and use of other resources (e.g., primary care, specialized care, support organizations). An important part of getting ready to offer the Bloom Program is the requirement of pharmacists to identify and make connections with local mental health and addictions providers and support organizations.
Participating pharmacists said that this was initially challenging, very rewarding, and ultimately critical to their care of patients in the program. Familiar with local resources, programs, and organizations, pharmacists are able to offer referrals, support navigation, and on a few occasions when needed facilitate patient triage. Patient care meetings are a mix of regularly scheduled and on-demand depending on what suits the circumstances and are provided through face-to-face or telephone interactions on weekdays, evenings, and weekends. A core component of the program is collaboration – the program aims to improve communications among members of the patient’s circle of care.
“The intent is that people don’t live with unidentified, unresolved issues,” says Gardner, a professor of psychiatry and pharmacy at Dalhousie University.
Pharmacies involved in the Bloom Program, which are paid by the province to provide the service, support their communities by providing a mental health and addictions resource centre highlighting local supports and services. As well, pharmacies work with their local mental health and addictions communities to provide outreach support and education.
“The approach provides structure and support and encourages the setting of priorities in addressing medication and related health issues collaboratively among patients, pharmacists, and other members of the patient’s circle of care. In doing so, pharmacists and patients share expectations of one another and work together over weeks and months in a way that can be quite different from usual practice,” notes Gardner.
And it works. In the 27 months the demonstration project ran, 70 pharmacists and their pharmacy staff in 13 rural and 10 urban community pharmacies across Nova Scotia enrolled 221 Nova Scotians living with mental illness and addictions. According to an evaluation of the program released last year, four in five medication issues were fully resolved or improved. “Patients increased their medication and health knowledge and accessed and utilized pharmacists effectively,” says Dr. Andrea Murphy, program co-lead and an associate professor in the College of Pharmacy at Dalhousie.
They also got an important helping hand to access healthcare and other services. Almost three of every four patients surveyed reported being more aware of community resources, and 47 per cent were able to access them faster than previously.
Pharmacists also benefit significantly from the program. “A lot of community pharmacists can work in isolation,” notes Murphy. “Having the Bloom Program starts to build a community of practice. That has been really important to pharmacists.”
The success of the Bloom Program has not gone unnoticed. Federal Health Minister Jane Philpott recently travelled across Canada to learn more about innovations in mental health. The Bloom Program was on her list of must-see initiatives.
The project, which requires pharmacies to complete a nine-step application process, also points to the enhanced role pharmacists can play in the health system, says Nova Scotia Health Minister Leo Glavine. “The local pharmacy – what an ideal place to have engagement in support of those with mental health issues. It is another service well suited to re-visioning the purpose of the community pharmacy.”
By Talbot Boggs
Sometimes life presents opportunities you just can’t refuse. Cristina Privado wasn’t thinking of expanding Memorial Pharmasave in Orillia, Ont. until the store attached to the pharmacy closed. “When the landlord informed me that the space was available, it suddenly struck me that this was the opportunity of a lifetime,” Privado says. “I approached my two co-owners and said, ‘if we’re going to do this, it’s now or never.’”
With an immediate doubling of the store to 2,200 sq. ft., Privado and her team had some decisions to make about how best to use the space. The original store, which opened in 2012, was almost all dispensary with only about 300 sq. ft. of front shop. The new space gave her an ideal opportunity to turn Memorial into a health centre focused on offering health-related, educational and other services and products to her broad customer base – millennials at the local Lakehead University and Georgian College, seniors, young families, patients from Orillia Soldiers Memorial Hospital and two group homes, and customers from neighbouring communities.
Privado completely revamped the front shop by enlarging the OTC area, adding a home healthcare section, giftware, fashion accessories, and creating a section containing Melissa & Doug educational toys for the children of the growing number of young families in her trading area. “We do have a lot of young families and saw this as another opportunity,” Privado says. “So far the reviews have been great.”
She also took the availability of the additional space to significantly upgrade and expand her suite of services. She added a second private consultation room specifically to accommodate a new Ideal Protein weight loss and management program and also introduced a complementary line: Walden Farms specialty, calorie, fat, carbs, gluten and sugar free food products.
“We introduced Ideal Protein in my other store in Angus and got a lot of traction with it there, and felt it also would be very attractive to the large group of health-conscious consumers in the 30-65 age group,” Privado says.
The addition of the new counselling room has opened up space for Privado to expand her services to encompass injections, medication reviews, smoking cessation, compression therapy, methadone management and medication synchronization programs. “We’re currently implementing synchronization for patients with five or more chronic medications,” Privado says. “Coordinating refills of multiple medications at one time improves adherence and is a great convenience and comfort that patients really appreciate.”
She encourages compliance packaging for her large number of patients in two local group homes and from neighbouring communities, and provides delivery, home visits and MedChecks, order refills on smartphones through a Pharmasave app (a very popular option among her younger patients), and a Pharmasave rewards program.
Privado estimates the front shop business has risen by about 150 per cent since the addition was completed in February last year and she is gaining traffic and new customers each week. She has had to add staff to take care of the expanded front shop and the growing Ideal Protein program, and ensures that when the Pharmacist/manager is not working, at least one of the owners is on duty for consistency of staffing and a high level of service at all times.
“This means that our patients will see at least one of us each week, eight times a month, which is really important to give them that feeling of consistency and confidence and to develop loyalty both among existing and new customers,” Privado says. “This expansion truly was an opportunity of a lifetime that we’re really glad we took.”
Opening date: Feb. 2016
Store size: 2,200 sq. ft.
Investment: $225,000 total investment in the original store and the addition.
Services: Ideal Protein Weight Loss, injections, medication reviews, smoking cessation, compression therapy, methadone management, medication synchronization, delivery, in-home visits and MedChecks, compliance packaging, smartphone order refills, rewards program.
Employees: 1 FT pharmacist/manager, 3 PT pharmacists/owners, 1 FT pharmacy assistant, 1 FT front shop manager/Ideal Protein consultant, 1 PT pharmacy assistant.
Hours: 9 a.m.-7 p.m. Mon – Fri; 9 a.m.-5 p.m. Sat; closed Sundays and holidays
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