JULY 2021 – The Medication Therapy Services (MTS) Clinic at Memorial University’s School of Pharmacy in St. John’s is a place where ideas thrive—and failure is embraced. “We built this clinic to be an incubation centre, to try different models of practice and approaches to meeting patients’ needs. We recognize some of those approaches would not be successful,” says Dr. Debbie Kelly, Associate Professor and Clinic Director.
Established in 2015, the province’s only “pharmacist clinic” operates as a licensed non-dispensing pharmacy. At the time, the School of Pharmacy was moving from bachelor’s degrees to professional doctorate degrees. “We recognized that students needed more experiential opportunities, and innovation is a focus,” says Kelly. “We expose students to different ways of delivering care and hopefully inspire them.”
The MTS Clinic grew out of the reality that many patients have complex medication needs that are not being fully addressed. These patients take multiple medications, have comorbidities or are frail older adults. “It is difficult for these patients to navigate the system,” notes Kelly.
It can be equally difficult for pharmacists to provide the depth of service required to assist them, she adds. “Community pharmacists often do medication reviews but may not have the time to work with family doctors or lack access to all of the patient’s medical information to inform decision-making on more complex issues.”
Desprescribing among services
The MTS Clinic provides comprehensive medication therapy assessments; chronic disease management supports; medication adherence supports and education; services to address complex medication regimens, adverse effects and drug interaction management; and deprescribing assessments. As well, smoking cessation and vaccination services are available.
The initial appointment, conducted by phone or video conferencing during the pandemic, runs 60 to 90 minutes. A pharmacy student may join the clinic pharmacist as part of their training. The assessment includes learning about the patient’s medications, medical conditions and any challenges related to their medications and health, including quality-of-life issues.
“We look at everything from social supports to a frailty assessment. This helps us understand how medications are affecting a person’s life,” says Kelly. “It’s very much a goal-based assessment.”
The clinic has access to patients’ comprehensive medical records through the provincial pharmacy network and electronic medical record, as well as laboratory and other diagnostic test results.
After the assessment, a plan is put together, discussed and finalized with the patient. The pharmcist sends the plan and recommendations to the patient’s practitioners. About 80% of all recommendations are accepted, Kelly notes, adding that patients are followed up by the clinic pharmacist and/or student to ensure outcomes are achieved and to provide support for medication changes.
Backed by research
Research is a cornerstone of the clinic’s work, and a full-time research assistant is on staff. One study published last year in the International Journal of Clinical Pharmacy found that a pharmacist-led deprescribing program successfully reduces the number of unnecessary and potentially harmful medications taken by long-term care residents.
Currently the team is investigating the impact of comprehensive medication assessments that consider patients holistically. The intent is to better understand how such assessments can help improve outcomes by, for example, reducing potentially inappropriate medication and reducing medication complexity to improve medication-related quality of life. Evidence is lacking in this area, says Kelly.
The study, funded by the Canadian Foundation for Pharmacy’s Innovation Fund, involves patients with comorbidities and multiple medications who receive a comprehensive medication assessment at the MTS Clinic. It is expected to conclude late in 2022.
As for the MTS clinic itself, the future is unclear. Initial funding from the School of Pharmacy was a one-time offering and the clinic does not generate revenue. “There is no billing code for our services,” says Kelly. “It definitely is a threat to sustainability if we cannot secure ongoing funding, but plans are being worked on.”