January 2018 — Pharmacy has done a commendable job in using clinical practice research to demonstrate the value of what pharmacists do in the healthcare system. But the data can only go so far in showing pharmacists’ worth day to day in contributing to better patient outcomes. That was the message relayed by speaker Dr. Lisa Dolovich, at the Canadian Foundation for Pharmacy’s annual Pharmacy Forum this past November.
Dolovich, who is Ontario College of Pharmacists Professor in Pharmacy Practice at the University of Toronto’s Leslie Dan Faculty of Pharmacy, and an executive member ofthe Ontario Pharmacy Evidence Network, told the audience of pharmacy stakeholders that “health is a constellation and expecting that one medication change by pharmacists will affect everything else down the road is unrealistic.” Instead it’s about how pharmacists integrate into the overall system to bring those best outcomes to patients that will have the greatest impact.
While pharmacy should be proud of initiatives like the Ontario Cardiovascular Health Awareness program—which demonstrated how pharmacists can help increase the use of hypertensives and reduce hospitalizations—Dolovich said there is need for many more such initiatives. “On one hand we have improvements on specific things but when you take it further to how [pharmacy] impacts patients, we’re a little less certain,” she said. “The evidence is mixed and we need to recognize this.”
Rather than stay on the path of micro-measurement of whether a particular pharmacy service is delivered, Dolovich noted that pharmacy needs to get onside of the rest of the healthcare system, which means truly understanding the contribution pharmacists can make as part of a system of healthcare professionals. “We have to also consider that while we want to be part of the team, we’re not the centre of the system—only the patient is," she said. “We need a lot of components for learning the healthcare system, including the participation of patients and their families.”
Dolovich also suggested that documentation evolve so it can be easily shared with patients and helathcare professionals. “Imagine a world where all the recommendations pharmacists make are explicitly documented and available to patients, so they can really see what you do,” she said. “What a powerful voice that would be for patients to have.”
Dolovich told the audience that it’s also high time pharmacy—and the entire healthcare system—shifts from volume to value. “We have to measure health outcomes and costs and use that to improve care delivery and reward high-value care,” she said.