NOVEMBER 2017 – Vision, culture, support—those three words summarize how Alex Dar Santos has worked with his pharmacy team to successfully incorporate a wide range of professional services into his busy Shoppers Drug Mart pharmacy on Cambie Road in Richmond, BC. “The key is not to add to pharmacists’ workload, but to change it. We understand that this is the right thing to do for patients, and that we have a lot to contribute to the healthcare system.”
Patience and persistence could be two more guideposts. Dar Santos began making significant changes 10 years ago, by hiring more support staff, but it took about five years for the frequency of services to pick up. He began with publicly funded flu shots, medication reviews and prescription adaptations, then expanded into privately funded vaccinations, travel consultations and strep throat testing. He also offers diabetes management support services with pharmacists who are certified diabetes educators, and compression stocking services. While patients do not pay fees for these latter two services, they can lead to referrals for other paid services (especially for diabetes patients).
When asked to name which services are most successful, Dar Santos replies it’s a tie between flu shots and medication reviews. He anticipates a record high of 2,000 flu vaccinations this season, and describes the post-immunization waiting period as an invaluable opportunity to get to know patients and possibly recommend other services. “The flu shots really help patients understand that pharmacists can speak with them about their health,” says Dar Santos.
Medication reviews similarly open the door to building deeper relationships over a longer perios of time. He and his pharmacists have become more efficient and more confident conducting the reviews, and patients have become more comfortable as well. “I am seeing more follow-ups and more complex consultations, in part because we’ve learned that it can take years to get all of the information out of patients. Over time they become more engaged and mention things they’ve never mentioned before,” notes Dar Santos.
Knowing that, pharmacists have come to see the review more as a starting point. “We now realize we are not going to fix everything at once and this leads to a really nice continuity of care. In B.C. we can do a full review every six months, and up to four follow-ups per year.”
Another key to success is pharmacists’ ability to share patients. “I may initiate a review but my team is very good about picking up the reins if I’m not there the next time. Our regular patients know all the pharmacists and are comfortable with this,” says Dar Santos.
Testing for the group A Streptococcus antigen is also proving to be successful on several fronts. “When we first started, physicians were understandably skeptical, but now we have physicians sending patients to us. We are making things easier for them and preventing emergency visits. And the education of patients is really important, helping them understand why they don’t need antibiotics,” he says. In fact, his team will try to dissuade patients from doing the $15 test if their answers during screening point strongly to a viral infection. Since he began offering the service three years ago, he estimates that one in 10 adults test positive, and one in five children.
Today, Dar Santos estimates that staff pharmacists spend about a quarter of their time with patients providing services above and beyond the usual prescription counselling, and he fully expects that to continue to climb. Here are his three essential steps for embracing change under an expanded scope of practice:
Vision You really need to know and believe in the “why” of expanded services. “Pessimists would say it’s for revenue, but that’s not so. We do it for our patients. We do it because it keeps us relevant in the healthcare system. We could not go back to doing we were doing before,” says Dar Santos.
Culture First, Dar Santos practices what he preaches. “I don’t want to be in any way hypocritical about anything I say. I do reviews [and other services] and I make a point of being public about it, including with local media.” Second, he encourages ideas and new approaches. “There is nothing wrong with trying something and realizing it doesn’t work. For instance, we tried testing for flu but for whatever reason it did not take off. At least we tried.”
Support Dar Santos describes his pharmacy assistants as “extraordinary,” and credits them with “keeping the engine running in the dispensary.” Training is extensive and ongoing, the primary goal being to ensure that pharmacists can focus on patient care. They also manage “a robust scheduling system that ensures the right staffing levels, with pharmacist overlap and solid pharmacy assistant support,” he says. During busy periods, there are typically three or four assistants on duty with the two pharmacists (one or whom tends to focus on services and counselling, while the other focuses on dispensing and workflow).