Innovation update: Culturally safe pharmacy care

Pictured in the photo above, from left are: Glenda Phillips, PharmD students Hannah Dalagan and Hailie White, and Larry Leung.

At Nuxalk Nation Health and Wellness in Bella Coola, B.C., a medication review may also include a discussion about traditional medicines, a follow-up through a monthly virtual clinic or a referral to a unique diabetes education program inspired by community feedback.

It’s the latest chapter in a project first supported by the Canadian Foundation for Pharmacy’s Innovation Fund in 2023. Over the past three years, the partnership between the UPROOT Team, led by Larry Leung and Jason Min, each of them an Associate Professor of Teaching in the University of British Columbia’s Faculty of Pharmaceutical Sciences, and Nuxalk Nation Health and Wellness, has continued to grow, with new clinical services, expanded student learning opportunities and an evolving vision for community-based pharmacy care.

Originally developed to improve access to culturally safe medication management, the program now combines in-person clinics with monthly virtual appointments and traditional medicines programming, integrated as part of Nuxalk Nation’s Home and Community Care. This ensures community members receive ongoing follow-up rather than one-time consultations, and healthcare providers, students, and youth have access to training on traditional medicines. Pharmacy students remain at the heart of the initiative, working alongside Leung during community visits while also helping coordinate virtual care throughout the year. In fact, each community visit typically includes three or four students and dozens of students have participated since the start of the program.

“The services have been really good so far and we’ve been delivering them both in-person and online,” says Leung. The team now visits the community twice a year, while monthly Zoom clinics provide medication reviews, education and follow-up care between visits.

Shaped by the community

Perhaps most importantly, the program continues to evolve in response to priorities identified by members of the community.

“We’ve been able to meet with community members and identify the gaps,” says Glenda Phillips, Home and Community Care Manager at Nuxalk Nation Health and Wellness. “With that information, it’s truly a Nuxalk-led initiative.” She says community feedback helped shape programming to better support people returning home from treatment while ensuring services are culturally safe and reflect what community members want and need.

That community-driven approach inspired the team’s latest initiative: a comprehensive diabetes education program that welcomed approximately 50 community members during its first clinic day on July 14. The clinic features five stations for health assessments, point-of-care A1C testing, medication reviews, diabetic foot examinations and diabetes education. After rotating through each station, participants and the healthcare providers set up a plan for ongoing follow-up care. The diabetes program will continue through the fall as part of a larger eight-week education initiative by the First Nations Health Authority, using curricula shaped by local knowledge keepers.

Leung and Phillips have worked together for 16 years, building a relationship that has allowed pharmacy services to evolve alongside the community’s priorities. Rather than creating programs independently, Leung says his team works closely with Nuxalk Nation Health and Wellness to ensure services reflect local priorities. “We really wanted a diabetes clinic because that’s what the community asked us to do,” he says.

Transforming pharmacy education

Each in-person visit includes pharmacy students who help conduct patient interviews, complete documentation and participate in medication reviews under the supervision of Leung and Phillips. Students have also taken on leadership roles, coordinating monthly virtual clinics, developing documentation templates that incorporate questions about traditional medicines and healing practices, and helping organize new community programming.

For PharmD student Hailie White, the experience has considerably broadened her understanding of pharmacy practice. “Being able to not only learn about the traditional medicines but actually get to go into community and see the impact they have…has just been such an experience that not every student gets to have,” she says. “It really opens your mind.”

Building on the original Innovation Fund pilot project, Leung and Min have developed a land-based learning elective that brings Indigenous and non-Indigenous pharmacy students together with First Nation knowledge keepers and elders, including those from Nuxalk Nation. A pilot involving 12 students happened this spring, creating what Leung describes as a reciprocal model where students contribute to community programming while the community, in turn, teaches future pharmacists about Indigenous knowledge, traditional medicines and culturally safe care.

“There’s an opportunity for the students to give back to the community, but the community is also providing teaching to our students,” he says. “It’s a really sustainable way of looking at both practice and education.”

Looking ahead, the partners envision pharmacy services becoming fully integrated into Nuxalk Nation Health and Wellness’ expanding primary care model, with pharmacists working alongside physicians, nurses, social workers and other healthcare professionals. Longer term, Leung also hopes to create more opportunities for pharmacists interested in rural and remote practice by exploring how to support First Nation communities interested in operating their own pharmacies.

For Leung, the project’s greatest success isn’t a single clinic or program—it’s the relationships that have developed over time.

“I’m just very happy about this hopefully being an example of what reconciliation can look like in pharmacy,” he says. “Building things the right way takes time…I hope other pharmacies and pharmacists are encouraged to do this type of work.”