FEBRUARY 2021 - For Fady Faltas, the term expanded scope is a misnomer. “At some point,” he says, “expanded scope is simply your scope.”
The pharmacy manager of Lawtons Drugs Mill Cove (Sobeys Pharmacy Group) in Bedford, N.S., believes that offering more and new services is inherent in optimizing patient-centered care. “I don’t think of expanded scope as above and beyond. To our team, it’s about solutions.”
Many of those solutions come from innovation, a constant core practice since the drugstore opened 12 years ago. From medication reviews to injection services and prescribing for minor ailments, the pharmacy team, which includes pharmacists Mary-Jane Driscoll, Rebekah Schmid and Noha Naguib, was already at the starting gate when new provincial programs or authorities were put in place. Pharmacogenomic testing is one of the latest innovative services the team has been involved with trialing.
“The team has been very receptive to these initiatives,” says Faltas. “They are open to expansion, and we try to do the best for the patient.”
Faltas cites the support of head office as key to their success. It provides guidance and resources to all of its pharmacies to embrace new authorities. In Nova Scotia, that includes prescribing for renewals (for which provincial funding became available at the start of the pandemic) as well as prescribing for urinary tract infections, oral contraception and shingles. Where public funding is not available, for example to prescribe for cold sores and vaccinations other than flu shots, head office provide tools to bill patients directly. Sobeys also encourages pharmacists to set up and maintain personalized care plans, including blood work results obtained from the province's SHARE network.
The Mill Cove store serves as a model of how pharmacy is evolving for parent company Sobeys, a national chain. The pharmacy, staffed by two full-time and two part-time pharmacists and three full-time and three part-time pharmacy assistants, features a large dispensary and consultation space, and more offerings in such areas as home health care. “This is what patients want,” says Faltas. “We felt an obligation to meet their changing needs.”
Sobeys has also given Faltas flexibility within his budget to embrace expanded scope. Using available relief pharmacist resources, for example, he has been able to allocate additional time for clinical services on weekdays that did not have pharmacist overlap. The focus is on virtual consults for medication reviews and to assist patients with chronic disease management.
The Pharmacy Association of Nova Scotia has also been central in helping Faltas and his team undertake new and timely programs through its pilot projects, for example in minor ailment prescribing. The pharmacy is quick to volunteer, and Faltas notes that funding for pilot project participants makes participation more feasible.
Regardless of the funding support (which may not continue after a pilot is done), the promise of enhanced health outcomes is the single biggest driver behind the new programs and services, says Faltas. “Patients are the biggest winners when the pharmacy has an understanding of their health goals – where they currently are and where they want to go.”
The Cairo University pharmacy graduate points out that the implementation of a new service requires the team to pull together and collectively incorporate new efforts into existing models of service.
“We assimilate these new services into our workflow,” explains Faltas, noting that it is about more than simply taking on more work. “We delegate what we can, especially on the technical side, and we are shedding historical duties, including paperwork and billing, where possible.”
Faltas notes that the pharmacist schedule follows a rotation template that includes time set aside for each pharmacist for clinical services. Pharmacists and pharmacy assistants have their designated stations, which also rotate. “This improves efficiencies and enables the pharmacist to dedicate more time for clinical services,” says Faltas.
In addition, pharmacy management tasks are done using pharmacy management software, if possible, rather than manual logs. The time saved is re-allocated to clinical services.
The Mill Cove team also has an extended relationship with a medical clinic located above the drugstore. Patients shared between the clinic and pharmacy often have comprehensive care plans in place and medication management solutions, such as the use of blister packs, are identified and implemented. “We have a very meaningful, robust relationship,” says Faltas. “It exceeds the tenant-landlord relationship.”
Enhanced relationships – and improved patient outcomes – were also the results of a unique collaborative care project in 2018 that brought co-located physicians and pharmacists together in a model that resembled hospital rounds. “It was very fruitful. It gave us a better understanding of the patients’ full health picture,” says Faltas.
The goal of the Collaborative Care Demonstration Project (CCDP) was to assess the outcomes of pharmacists playing a role in the management of patients with hypertension, congestive heart failure, COPD and diabetes. Positive outcomes and lessons learned from CCDP will be applied to an upcoming round of demonstration projects, which may be announced in the coming months.
The Bedford pharmacy has also created partnerships with public and private sector organizations, hosting onsite immunization clinics. Next up for Faltas and his team: a spotlight on medication optimization. This will involve focusing on improved compliance, enhanced communication with patients, better electronic documentation and the offering of more medication management programs.
“That is the future,” says Faltas. “It’s about keeping the patient in mind."