Filling care gaps in Nova Scotia

This profile is reprinted from CFP’s Fall 2024 Changing Face of Pharmacy magazine. Click here to download the magazine and read more profiles of pharmacist-led primary care clinics.

Peter Muise is a 77-year-old Yarmouth, Nova Scotia resident who hasn’t had a family doctor in four years. He lives with type 2 diabetes and Parkinson’s disease, and suffered two aneurisms several years ago.

Since City Drug Store PharmaChoice opened a primary care clinic in his town as part of a provincial pilot program, Muise has sat down with the pharmacists every three months to go over his lab results and ensure he’s on track. “They helped me get my blood pressure and sugars under control and are so good at explaining stuff about my medication,” says Muise, who works full-time as a cold-storage operator. “I would bet my life on the fact that this clinic has helped me keep my job by getting me on the right side of the fence with my health.”

City Drug Store was among the first pharmacies to be part of the Nova Scotia pilot project for pharmacist-led primary care clinics in community pharmacies. In fact, when he heard about the pilot, pharmacy owner Mathieu Maltais jumped at the chance to participate.

“Mathieu had been anticipating a shift in pharmacy practice for many years and was already thinking about redesigning the store to add a counselling area when I joined the team,” says Pharmacy Manager Kaitlynn d’Entremont. “I was looking forward to being able to provide more care to patients in the community and utilize my full scope.”

City Drug Store opened its Community Pharmacy Primary Care Clinic in February 2023. Government funding enabled pharmacies to bill for assessments for more than 30 minor ailments as well as for strep-throat assessments (including point-of-care testing [POCT]), chronic disease management and POCT as needed for renewals and chronic disease management. Pharmacists could also order lab tests.

Participating pharmacies also received funding to help cover the added labour costs for a full-time administrative person and to ensure there was no overlap in staffing between the dispensary and the clinic, as stipulated by the pilot project. PANS provides guidance for administration and professional education. “I have a check-in with PANS every two weeks now and can also email questions anytime,” says d’Entrement.

Today City Drug Store’s clinic averages about 25 mostly in-person appointments a day and is open from 9:00 a.m. to 5:00 p.m. Monday to Friday, staffed by three rotating pharmacists and the dedicated administrator. “We spend a lot of time on chronic disease management around diabetes, high blood pressure, COPD and asthma, and minor ailments,” says d’Entremont, adding that prescribing for Lyme disease is also growing. Appointments usually require at least 15 minutes but can take up to an hour.

With pain from sciatic nerves in his hips, Muise says he can’t imagine sitting in an emergency room (ER) for hours for his quarterly check-ins. “Here there is no waiting, they are thorough and if I can’t make an appointment, it’s easy to reschedule,” he says.

The local hospital’s ER has listed the Community Pharmacy Primary Care Clinic on its whiteboard of services and sometimes even refers patients to them, says d’Entremont.

“These kinds of relationships we are building with our patients and other health- care providers, and feeling like we’re making a difference, are what’s most rewarding about all of this,” says d’Entremont. “We’ve always been able to build relationships with our patients, but providing these services has added another level of trust.”

The fact that the entire pharmacy team—which includes six pharmacists, the dedicated clinic administrator, three reg- istered techs, along with five full-time and several part-time assistants —has stepped up to adjust to their new workflow is key to its success, says d’Entremont. “Initially some were apprehensive about what this would look like and how patients and physicians would respond but it has been working. We communicate constantly and tell staff this is a first try at this and if it doesn’t work, we’ll try something different.”

Clinic staff work closely with other healthcare teams in the community too, including another primary care clinic staffed with physicians and nurses that works on a referral basis. “We wanted to make sure we’re working with these teams and along- side the family physicians to support their patients, when necessary,” says d’Entremont, adding that patients are advised they can fill their prescriptions at their usual pharmacy if they prefer. “We provide the same level of care regardless of their chosen pharmacy.”

Managing the length of appointments and fitting in emergency patients are ongoing but “manageable” challenges, says d’Entremont. “The last few months have been going quite smoothly but we’re always adjusting our services based on patient needs and changes in scope of practice.” On a personal note, she admits to struggling with work-life balance on occasion due to the added education needed to keep up to date with the expanded services. The biggest challenge is the clinic’s sustainability for the future. While certainly beneficial for patients and professionally rewarding for staff, d’Entremont says the clinic is not particularly profitable just yet. “The interim funding model has helped to ensure our clinic can cover wages and expenses, but it will be important that a longer-term funding model be put in place,” she says, noting that PANS is currently in talks with the Nova Scotia government. “The pilot project has been successful and lots of people rely on it so I really hope PANS and the government can come to an agreement that works.”