The British Columbia Pharmacy Association (BCPhA) believes that pharmacists have a key role to play in increasing access to primary care and reducing costs to the health care budget. As the association that represents more than 3,100 community pharmacists and more than 900 pharmacies, we believe it is important for pharmacy to be part of the health care debate associated with the upcoming election. To do that, we have developed seven specific clinical services proposals that we believe should be implemented in BC. The proposals are being successfully implemented in other health care jurisdictions and offer solutions that will generate savings to BC’s health care system and improve patient outcomes.
The BCPhA’s clinical services proposals include
Treatment of Minor Ailments
- Enabling pharmacists to consult and treat patients with minor ailments would most effectively utilize the skill set of both pharmacists and physicians, increase capacity in the health care system, and potentially increase efficiencies in health care spending. Minor ailments include common conditions such as headaches, back pain, insect bites, diaper rash, heartburn or indigestion, and nasal congestion.
- The BCPhA proposes a minor ailments program that includes providing appropriate training for pharmacists to deliver these services. This training would be based on a successful program in Saskatchewan.
- With BC physician billing for treatment of minor ailments estimated at $95 million in 2010/11, this service could result in annual savings to BC’s health care system of more than $32 million. These cost savings are in addition to the value of optimizing physicians’ time by enabling them to manage patients with more complex conditions.
- Click here to view the full proposal on the Treatment of Minor Ailments.
Trial Prescription Program
- Introduced in 1993, BC’s Trial Prescription Program (TPP) encourages pharmacies to dispense a small quantity of medications that have a high incidence of adverse effects. The program’s intent is to reduce drug wastage that results when individuals have an adverse reaction to a new drug and cannot use the remainder of the prescription.
- The BCPhA proposes extending the current TPP to include drugs prescribed for chronic conditions. The diseases would include those designated under the GPSC chronic and complex care programs.
- Savings to the health care system would be significant. As an example, using a moderate estimate of five per cent wastage for a single drug molecule, gabapentin, the avoidable drug cost opportunity would be approximately $1 million annually for that drug alone.
- Click here to view the full proposal on the Trial Prescription Program.
Medication Adherence Services
- Higher rates of medication adherence have been strongly linked to positive clinical outcomes, including decreased emergency department visits and hospitalizations.
- The BCPhA proposes increasing medication adherence among patients with chronic conditions through pharmacist intervention and repeated short-term follow-up when a medication is newly prescribed.
- This service aims to impact the significant annual costs in Canada due to medication nonadherence.
- Click here to view the full proposal on Medication Adherence Services.
Pharmacist-led Smoking Cessation Services
- The BCPhA proposes collaborating with the Ministry of Health to develop and implement a pharmacy-led smoking cessation program, to provide British Columbians with the improved access, medication expertise and ongoing counseling needed to successfully quit smoking. The program would be modeled after the Ontario Pharmacy Smoking Cessation Program.
- In BC, a pharmacist-led smoking cessation program could help an additional five to 11 per cent of smokers quit, potentially resulting in $52 to 134 million in net savings annually.
- Click here to view the full proposal on Pharmacist-led Smoking Cessation Services.
Community Pharmacist-led Anticoagulation Management Service
- Warfarin is the most widely used anticoagulant for the prevention and treatment of blood clotting diseases, but therapy requires ongoing measurement of a patient’s warfarin drug levels obtained through blood tests at medical laboratories.
- The BCPhA proposes that the Ministry of Health fund a British Columbia Community Pharmacist-Led Anticoagulation Management Service (BC CPAMS), allowing patients to access point-of-care testing (POCT) in their community pharmacy.
- Allowing patients greater access and immediate results for their blood testing needs has been shown to improve quality of life and patient outcomes. This warfarin management strategy has the potential to save BC $231 million dollars over 5 years.
- Click here to view the full proposal on the Community Pharmacist-led Anticoagulation Management Service.
Self-monitoring of Blood Glucose (SMBG) in Type 2 Diabetes
- Recent studies suggest patients with type 2 diabetes who are not insulin dependent can reduce their amount of blood glucose self-testing without negative health effects.
- The BCPhA proposes implementing a SMBG consultation service to reduce the burden of testing on these patients, while equipping them with tools to better manage their disease. Pharmacists are ideally positioned to educate patients about “testing with purpose.”
- This proposal anticipates a cost savings of approximately $17.1 million over the next three years, with a net savings to government of at least $9.6 million over three years.
- Click here to view the full proposal on Self-monitoring of Blood Glucose in Type 2 Diabetes.
Asthma Consultation Service
- The BCPhA proposes that the Ministry of Health fund a pharmacist-delivered program that provides education, assessment and management tools to patients, or their caregivers, to help improve control of their asthma.
- The Asthma Consultation Program would build on the already-implemented Medication Review Services program.
- Asthma-related physician and emergency department visits and hospitalizations cost BC's health care system an estimated $18 million annually. Having pharmacists collaborate with doctors to implement this program would have an impact on medication adherence and help patients achieve better quality of life and potentially generate cost savings for the health care system.
- Click here to view the full proposal on the Asthma Consultation Service.