Embracing Change in Lindsay, Ontario

AUGUST 2021 – Mike Cavanagh is so happy with the appointment-based model of pharmacy practice so far that he’s volunteered to be part of a study that he expects will prove its worth.

“This is a much more holistic approach to providing service,” says the owner of Kawartha Lakes Pharmacy in Lindsay, Ontario. “It more actively involves the pharmacist in patient care. It is more effective and efficient.”

The model synchronizes chronic medications in order to facilitate more focused follow-up appointments with patients, in person or by phone, every three months. A medication review is conducted once a year in person.

“This really allows us to see adherence,” says Cavanagh. “Patients don’t realize they are not being adherent.”

He notes that any recommendations flowing from the check-ins and med review are passed along to the patient’s family doctor. “These are mostly accepted.”

More than one-third of residents in the community of roughly 21,000 people are seniors, and Cavanagh has tailored many services to them and their families. This has included compliance packaging, travel medicine and fittings for compression stockings.

Cavanagh and his team of four pharmacists, two registered technicians and four pharmacy assistants have added their own unique stamp to the appointment-based model, which is gaining momentum in the U.S. This included creating their own therapeutic check documents. “There was no good Canadian version,” says Cavanagh, who opened Kawartha Lakes Pharmacy in 2009.

At present, these documents are filled in by hand, but Cavanagh is creating a platform that will be cloud based and provide a digital patient record.

To integrate the model into the ongoing workflow of the pharmacy, Cavanagh realigned the roles of his team. The pharmacists provide a therapeutic check, the assistants do the packaging, and the technicians complete a technical check. “Pharmacists don’t have to look at the package to make sure the right pill is in the right spot,” says Cavanagh. “We have almost doubled our blister pack program over the last three years with no increase in workload.”

The University of Toronto grad started his appointment-based service three years ago. It really ramped up during the COVID-19 pandemic, he notes. “It was easier to connect with patients at home.”

Gathering proof

Now Cavanagh and his team are working with Green Shield Canada, a health benefits provider, to evaluate the program. Employees of Green Shield will be enrolled in an observational study and measured on a number of health factors at the outset, then again at six and 12 months. Eventually any patient with a chronic condition will be invited to take part.

“We’re doing our best to see if the appointment-based model works,” says Cavanagh. “Anecdotally we know patients enjoy the program. They like this level of care. They feel the pharmacist is giving them more.”

Cavanagh owns four pharmacies in Ontario. So far, the appointment-based model is up and running in the Kawartha Lakes pharmacy only. The study results will dictate its expansion. “If we document a benefit, we will roll it out to all our pharmacies.”

Cavanagh also believes the study results may be of interest to governments and pharmacy regulators. As a past chair of the Ontario Pharmacists Association, Cavanagh heard concerns about pharmacists’ ability to perform their core functions, particularly as new services become possible under an expanded scope of practice. “There is a need to ensure core services are done at an exceptional level. The appointment-based model helps alleviate those concerns.”