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Pharmacy forum reveals seismic shift in community practice

Pharmacy forum reveals seismic shift in community practice

Written by Staff on November 24, 2010 for

While each speaker used different language, to anyone listening it was obvious that, yes, the earth really has been moving and nothing is where it used to be anymore.

Appointed in June, 2010, Diane McArthur took on the role of assistant deputy minister and executive officer of Ontario’s Public Drug Programs in a firestorm of activity as that province’s dramatic drug system reforms began to come into full effect. Those reforms, which saw an end to professional allowances and drastically cut generic prices (and as a result, pharmacist reimbursement) were a harsh but necessary step towards a system that separates pharmacists from the delivery of product, said McArthur.

An impressive roster of government, pharma and pharmacy leaders met in Toronto this week, charged by the Canadian Foundation for Pharmacy to answer a question about the changes being experienced in community pharmacy: Is the current paradigm shift in pharmacy seismic or just a tremor?

Picture of MC for the gala

Preceding CFP’s Pharmacy Forum was a gala dinner celebrating the Foundation’s 65th anniversary and its 2010 Innovation Fund Grant recipient Neil MacKinnon. He received $48,000 for his research around SafteyNetRx, a one-of-kind program designed to help pharmacists reduce medication errors and improve patient safety.

Insisting that the province aims to move towards a healthcare outcomes-based, patient-centred policy model, she noted that initiatives in the works in the province will only build upon the foundation of Ontario’s fee-for-pharmacy services initiatives, such as MedsCheck and Medscheck Followup.

A working group, tasked this summer with coming up with recommendations for moving to a pharmacy services model in the provincial drug plan, has submitted its final report to the Ministry for review. Meanwhile, McArthur added, the province is moving as quickly as possible to roll out a provincial Drug Information System which will finally give health professionals greater access to prescription records and activity as well as the clinical tools to enable better prescribing and counselling decisions.

Speaking from the perspective of industry, Sean Kelly, director, patient access and health policy (Ontario) for Pfizer Canada, stressed the need to challenge the status quo. “The cost of health care is not sustainable and patient-centred care is our common opportunity,” he said. “We need to innovate how we work together to get those outcomes.” Kelly noted that industry can play a key role in the continuing education component necessary to get pharmacists equipped for patient-centred services going forward.

In her dual role as Sr VP of Pharmacy Innovation in Patient Care at Shoppers Drug Mart and leader of the Canadian Pharmacy Services Initiative (CPSI) of the Blueprint for Pharmacy, Susanne Priest is helping to drive the shift towards bringing a pharmaceutical care-based model of pharmacy into reality, both inside the pharmacy and in the healthcare and drug plan policy environments.

The recently-approved  CPSI model of pharmacy services sets out three levels of pharmacy services: Dispensing services, based on drug distribution; Enhanced dispensing, a medication-based practice that involves more patient care services, and a Pharmacy Practice model, built on a more complex menu of medication and healthcare service offered on an appointment-based system.

Pharmacists will be hearing more about the new framework over the next few weeks and months as changes are expected to come into play starting April, 2011.

Meanwhile, in her position at the country’s largest drug chain, Priest is planning two educational conferences  for Shoppers pharmacists designed, she said, to start them on a change management process towards the new services-based pharmacy practice model.

B.C. is recognized as a leader for its track record of working amicably with both government and other healthcare providers to change policies affecting pharmacy services and the way they are valued. B.C. Pharmacy Association Executive Director Marnie Mitchell gave a progress report on the provincial Medication Management demonstration project.

What is required now is real innovation in our thoughts and practices and in our culture

In this project, which kicked off September 2010, 292 pharmacists in the province are providing medication management services to patients under strict research-focused protocol designed to provide a true outcomes-based value to the provision of pharmacy medication management services.

As of November 23, more than 1,110 patient encounters with 894 patients had taken place under the pilot, which runs until January 2011 and will then be evaluated.

In other developments, Mitchell noted that the provincial Pharmacy Services Agreement includes a commitment of  $10 million for pharmacy clinical services in 2010/2011, $25 million in 2012/13 and $35 million thereafter.

Although she’s also based in B.C., Pharmasave CEO Sue Paish has seen the changes across the country impact her company in ways that vary according to provincial policy. Paish, who came to the world of community pharmacy from the legal profession, has been able to bring fresh eyes – and an innovative perspective – to the issue of pharmacy competitiveness and survival.

Rather than “navel gazing,” warned Paish, community pharmacy needs to look up, recognize what the health policy needs are, and then ensure that the profession and business of pharmacy is structured to meet those needs. Rather than discussing pharmacists’ expanded scope of practice, she suggested, pharmacy would do better to find out what the key healthcare needs are and what role pharmacy can play in meeting those needs effectively.

She also suggested “stealing” innovative and effective practices from other disciplines such as law or accounting. The platform on which the community pharmacy used to be built is not just changing, it’s on fire, she warned. “What is required now is real innovation in our thoughts and practices and in our culture.”

Wrapping up the forum, Donnie Edwards, former chair of the Ontario Pharmacists Association and owner of Boggio & Edwards I.D.A. described the last couple of years as a trip “To Hell and Back,” for an independent pharmacy owner. However, unlike a number of other pharmacies in his fairly rural region, Edwards said he has managed to survive the trip by focusing his practice on service, service and more service.

Working closely with other healthcare providers, he has a growing patient base built on disease management services. Other steps he’s taken to survive include  bringing related healthcare professionals into his own pharmacy, innovating with new patient monitoring and compounding technologies and using social media, an expanded website and public appearances to educate patients and healthcare workers, market his services, and raise his profile.

Edwards reinforced the message of all the forum’s speakers when he concluded his presentation by saying that pharmacists need to “identify patients’ healthcare needs and focus on those as your GPS.” The road ahead leads to patient-centred healthcare, he added. Those who adapt to that reality can determine their own future path.

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