APRIL 2021 – After working for seven years as a consultant helping pharmacies implement new practice models, Judith Choquette decided it was time to walk the talk. In 2009 she purchased what would become Pharmacie Judith Choquette in Longueuil, Quebec, a 20-minute drive from downtown Montreal.
“As a consultant, I felt like a Monday morning football coach,” says Choquette. “I was worried about a lack of credibility because I wasn’t working in a pharmacy, but I also had a vision of what we could do as pharmacists.”
At the time, expanded scope was in its infancy. Additional services had to be paid for by the patient or offered free of charge. Yet Choquette believed that the provision of new and enhanced services was the only way forward. “I wanted to transform the traditional pharmacy model into something more modern and meaningful, says Choquette.
Back to square one
She anticipated barriers and delays. What she didn’t anticipate was having to go back to basics before being able to forge ahead. “I had to build a strong foundation before I could build a new house,” says Choquette.
The rebuild started with a review of the pharmacy’s practices and approaches to patient care. For example, pharmacists could not easily look at the patient’s file when filling a script. There was also no private consultation room. “It was pill counting and chatting with people,” says Choquette, a graduate of Université de Montréal. “It was not proactive.”
As well, under the old system prescriptions were placed in a stack as they came in. This often meant the earliest prescriptions ended up at the bottom of the stack, and patients waited unnecessarily for their medication.
A complete workflow engineering, new software and a small renovation to enable confidential conversations resolved these issues and significantly improved consistency, efficiency and patient care. They also set the stage for tailored services. “Everything is now documented in the patient’s profile. This attention to detail also shows government and private payers what pharmacists can do for the patient. It will help us to generate data.”
Ready for billable services
During this time, the regulatory landscape changed significantly in Quebec. The government legislated a number of new billable services, including case management to adjust prescriptions to achieve therapeutic targets (get details in CFP’s provincial services chart). Choquette and her team are pleased to offer the full range of authorized services. She points out that having two pharmacists on duty at the same time enables these efforts.
“What has increased a lot in the last few years is our ability and capacity to bill government and third-party payers for cognitive services,” she says, adding that revenue from these services has more than tripled.
Recently, for instance, a prescription came in from a 79-year-old patient with diabetes who was undergoing chemotherapy. Choquette realized this patient would not be able to tolerate the higher dose of the diabetes medicine. “I adjusted the script so we could get to where the patient and her doctor wanted to go,” says Choquette, who consulted with both the patient and the physician. “This takes time, but we make a difference.”
Four pharmacists and seven technicians are currently on her team. Two pharmacists are on duty every afternoon. One works the frontline, the other does follow-ups with patients and compliance packaging. In particular, the second pharmacist reaches out to seniors in their own homes to help them with appointments and medication management, a service that has become more important during the pandemic. “Some patients we haven’t seen for a year. This outreach has changed our relationship with patients. You need to invest in people,” says Choquette.
New look and workflow
Renovations are next in Choquette’s quest to create a “dream pharmacy.” The large front store will become less prominent and the small pharmacy lab will be enlarged. The compliance packaging area, currently in the basement, will move upstairs to allow the team to work more efficiently. As well, the work area will be less linear in design, enabling staff to move more freely. A new welcome centre at the entry and two consultation areas will visibly communicat the commitment to patient-centred care.
Also coming soon: a flip in the workflow for filling prescriptions. Instead of speaking with patients after a prescription is filled, pharmacists will speak with patients first. “We will have more information as a result,” says Choquette. “We will be able to do a better job.”