December 2014 – Several community pharmacists with thriving service offerings shared their strategies at the Canadian Foundation for Pharmacy’s recent Pharmacy Forum event in Toronto. “Our licenced pharmacy techs quarterback everything,” stressed John Shaske, owner of Howe Sound Pharmacy in Gibson, B.C. “They take care of documentation and work flow, make sure the pharmacists have their schedules, that the paperwork is signed by patients and more.”
As a result, pharmacists can focus solely on medication management and supporting patients’ goals for health. “Our pharmacists do no data input whatsoever. Not a key stroke.” While he concedes it was initially a challenge for some to let go of old tasks particularly checking prescriptions it wasn’t long before the drug-related issues uncovered during the in-depth counseling sessions demanded most of their time.
Thanks to past and ongoing participation in pilot projects as well as government-funded programs, pharmacists at Howe Sound Pharmacy have been able to immerse themselves in medication therapy management services. During the wait periods after flu shots, for example, pharmacists sit down with patients to conduct medication reviews. And while hypertension, pain and gastrointestinal conditions are most often involved in drug-related issues, the pharmacy has found that 78% of the interventions involve “other” conditions, which means that pharmacists are constantly doing additional research and seeking out continuing education. “This can be a major challenge, for pharmacists to keep up with everything,” said Shaske.
John Papastergiou, associate-owner of two large Shoppers Drug Mart pharmacies in Toronto, has implemented health-risk screenings, diabetes support and home visits as services that strike a chord with customers while also generating a steady flow of billings for other government-funded services. Investing in staff upfront is a necessary first step, he emphasized. “These services are driving more prescriptions into the business, and you have to staff appropriately.”
The pharmacy’s complementary diabetes screening clinics use the CANRISK questionnaire. “It is a really easy way to start. In three hours we can screen 300 patients. You don’t get paid for it, but it starts the relationship,” said Papastergiou. For those patients identified to be at moderate or high risk, pharmacists offer to conduct an A1C test. If the result is high, the pharmacist then offers to contact the physician and, if the patient is on the provincial drug plan, can submit a claim for a professional opinion.
Patients already diagnosed with diabetes participate in MedsCheck for Diabetes reviews and follow-ups, which are funded by government. During each appointment, pharmacists conduct an A1C test.
The home visits for homebound patients, or those just out of hospital, have probably generated “the most attention,” noted Papastergiou, adding that “we make sure to reach out to the physician.” During visits, pharmacists routinely test blood sugar, blood pressure and cholesterol, and administer flu shots. “These are very complicated patients, on 12 medications on average.”
Westport Village Pharmacy is building its business in professional services by tailoring offerings to the unique needs of its location. In a town with a local population of just 680, the pharmacy caters to the thousands of tourists and summer residents who frequent the picturesque area, part of Ontario’s Rideau Canal system. Four out of five customers are covered by the province’s public drug plan, which sets the stage for billings to the MedsCheck review program and the pharmaceutical opinions program.
The absence of an urgent care clinic also inspired the pharmacy’s owner, Tracey Phillips, to obtain independent prescribing authority for a wide range of common ailments through medical directives with local physicians. “Our area is endemic for ticks. We can provide immediate relief, which is very gratifying,” says Phillips. Prescriptions to treat poison ivy, skin infections and conjunctivitis are also common.
Phillips can also administer injections for conditions currently not authorized in Ontario for example, for shingles and HPV after obtaining direct orders from physicians. “Our physicians are very collaborative and excited [with what we’re doing,]” said Phillips in her presentation, though she advised other pharmacists to see expanded relationships with physicians as an “evolution” that takes time. “First we asked, then we notified, and now doctors are starting to recommend our services.”
Westport does not bill for the injections; however, pharmacists are usually able to conduct a MedsCheck review during the waiting period after the injection. For prescriptions for common ailments, the pharmacy charges an assessment fee of $18. “One hundred percent of the time they pay, and are happy to pay,” says Phillips.
Phillips’ last bit of advice was to pharmaceutical manufacturers: “We need tools and resources from pharma; for example, the same prescribing information you give to doctors.”