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As part of Pharmacist Awareness Month (PAM) the BCPhA is running a campaign called "More Than Pills”. This campaign highlights the services that pharmacists deliver beyond dispensing. Scroll down for pharmacist and patient profiles and videos on the many ways we're #MoreThanPills!
Instead of driving several hours to reach a pharmacy in a nearby town – on what can be extremely dangerous roads during winter – residents in remote towns in British Columbia can fill prescriptions in their own communities, thanks to the advent of telepharmacy.
This technology, since launching in community pharmacies in 2005, has provided a critical link to patients living in rural and isolated areas. There are now a total of 11 remote telepharmacy sites around BC, operated by four different centralized community pharmacies. The remote areas being served generally have populations of less than 1,000 and find it extremely difficult to recruit and retain pharmacists.
Munro’s Sorrento Prescriptions, based in Sorrento, began offering telepharmacy services in 2007. “We see the benefit for patients every day in the sites where we use telepharmacy full-time,” says Regan Ready, pharmacist and operations manager of Munro’s. One of the clearest indicators of this success, Ready says, is that Munro’s now employs the equivalent of one full-time pharmacist whose sole responsibilities are to handle the needs of its remote telepharmacy sites.
Watching Ready oversee operations from Sorrento doesn’t appear to be much different than if he were right there beside his remote assistants. Ready and his pharmacy assistants can both see and hear each other in real time on the video conference screen. Like colleagues who work next to each other daily, they joke briefly with each other, then Ready checks the prescriptions the assistants have prepared on a high-resolution camera. He then authorizes the prescriptions to be dispensed to patients. He also has access to necessary remote site computer screens such as those containing full patient records.
Recently, a patient walked into Peoples Drug Mart in Port McNeill looking for some ointment for what they believed was a minor cut. Pharmacist Brittany Swanson realized the cut was much more serious than the patient had thought. She quickly phoned the Port McNeill Collaborative Clinic, a local medical clinic, to ask if the patient could be squeezed in to see a doctor.
The clinic gladly obliged and as a result the patient avoided a likely trip to the hospital the following day for intravenous antibiotics. This kind of collaboration between pharmacists and physicians is commonplace in Port McNeill.
Port McNeill has a population of 2,700 and is serviced by five physicians, three pharmacists and various other health professionals, some of whom also work in the nearby town of Port Hardy and serve remote communities. The health professionals in Port McNeill are proud of their strong collaborative relationships and couldn’t imagine working any other way.
“I think it’s a lot easier to develop a relationship with physicians out here,” says Downey, pharmacy manager and owner. “As long as you have a great relationship and mutual trust, our voices are heard and weighted more.”
Dr. Dave Whittaker, who originally hails from South Africa, is one of five family physicians that work out of Port McNeill Collaborative Clinic. Whittaker says it’s not unusual for him to send and receive up to eight text messages back and forth with pharmacists each day to discuss his patients’ medication needs.
And this is just one of the many modes of communications he uses, together with phone calls, letters and face-to-face meetings. There can be up to 30 phone calls per day that take place between physicians and pharmacists. “When we are making decisions on medications we speak to our community pharmacist,” Whittaker explains.
Read the rest of the story in the upcoming Mar/Apr issue of The Tablet.
Peoples Drug Mart in the small town of Chase is one of a number of pharmacies in BC that is demonstrating a commitment to improving patient care by offering anticoagulation therapy services to patients.
This service enables the pharmacy to take the lead in monitoring a patient’s INR drug levels, a task that would normally fall under the scope of a family doctor.
In Chase the service is run by pharmacists Ellen Bovair and Robert Caravan, who are both anticoagulant specialists. “It was a program born out of need," says Bovair. The pharmacy decided to start offering anticoagulation services in November 2006 because of the aging population in the town, combined with a shortage of physicians to take care of them.
Bovair says the success of the program in Chase can be attributed to a number of factors including a strong pharmacy team, patients’ willing participation and the support of local doctors.
“The service has been positive for all parties involved: the patients, the physicians and ourselves,” Bovair says. "Our patients find it very convenient. I know for a fact that it has aided us in having new patients come to our pharmacy strictly for that purpose.” The pharmacy currently manages anticoagulation therapy for 23 patients. Over the past nine years this number has ranged from 60 to 10.
Bovair says it has helped build strong relationships with the local health-care community. “I know it’s a matter of trust,” she says. “Because physicians have a working relationship with us they feel more comfortable asking us questions or referring other patients to us. They value what we’re doing, have confidence in us and rely on us.”
Patients coming in to fill prescriptions before their travels would often ask Jennifer Chan what medications they should take before heading off to Mexico, South America or Africa.
As the pharmacy manager for Save-On-Foods in South Surrey’s South Point shopping centre and part of the first group of pharmacists trained to administer injections, Jennifer had been giving influenza and other vaccines to adults for a number of years along with travel medicine advice. So, she decided to take it one step further and begin offering travel health consultations to patients.
Jennifer and her team book private consultations with patients and go through what vaccines are heavily recommended for their travel destination and what medications are recommended. The travel pharmacist goes through an in-depth assessment with the patient on where they’re travelling and if that location has had any disease outbreaks, if they’ve to the location multiple times, and what their vaccination history is and if all their shots are up-to-date.
“Every consult is different. We need a lot of data intake to see what kind of trip they’re taking,” Jennifer says. “It doesn’t just depend on where they’re going but even what time of year they’re going and what the current resistant strains (of diseases) and outbreaks are, so we really have to individualize each consult.”
At the first consultation, the travel pharmacist lets the patient know what their options are, including whether they need a prescription from their doctor for a specific medication, such as anti-malaria pills or antibiotics.
The patient then brings in any prescriptions, and Jennifer and her team order in specific vaccinations before the second consultation, where the pharmacist administers the vaccinations.
An active Vancouver resident always busy with tennis and exercise, Barbara Elworthy ended up in the ER in 2011 after a lingering cough that progressed to breathing difficulty.
Tests revealed both of her lungs were full of blood clots, and she was soon placed on the anticoagulation medication warfarin.
Measuring a patient’s blood clotting time is a required component of warfarin therapy. The average patient has their blood tested every four weeks at a laboratory. The lab reports the results back to the physician, who contacts the patient to provide instruction on any necessary dosage adjustments. Then, these adjustments are often made at a community pharmacy.
“It was all very complicated and very confusing,” said Elworthy.
However, having this testing available right in community pharmacies allows patients on warfarin to be better managed, and also saves money for the health-care system. Elworthy now goes to her local pharmacy for a monthly appointment to check her blood as part of their anticoagulation program.
“I’m very lucky to have found the wonderful pharmacy team at London Drugs,” she says. “I book appointments ahead of time, and they work around my busy travel schedule. They are always polite, on time and treat me so well. Every time the pharmacist asks about my health, my breathing, my lungs, or any changes I might have noticed.
“I sincerely don't think I could have stayed on warfarin without them,” she said. “My pharmacist does a lot more than pills.”
Surrey pharmacist Allan Wong knows that personalized medicine is the way of the future for patient care. And he’s excited to be part of a ground-breaking research project in which community pharmacists can bring the latest research out of the lab and to their patients.
Wong is one of 22 BC pharmacists who are participating in an 18-month research project called “Genomics for Precision Drug Therapy in the Community Pharmacy.” It’s funded by the BC Pharmacy Association and Genome BC, with research being done by a team at the University of British Columbia’s Faculty of Pharmaceutical Sciences.
The aim of this project is to help health-care providers use a patient’s DNA to make decisions about which medications are right for them.
Pharmacists will collect saliva samples from 200 patients who are on warfarin, a widely-prescribed anticoagulation medication, and then send the samples to UBC researchers. Researchers will analyze how DNA information would have altered the drug dosage patients were prescribed.
“This will be good for patients because it will allow us to get closer to tailoring medications – the right dose, the right time and the right types of medication,” Wong said.
Pharmacogenomics, or the study of how a person's genetic make-up influences how they respond to a drug, is the foundation of personalized medicine.
This project makes the science of pharmacogenomics accessible to patients in their communities and brings the promise of personalized medicine one step closer to being a reality. It’s one more way that pharmacists are a lot more than pills.
In British Columbia, more than 176,000 people are on the hunt for a family doctor. Pharmacists often provide the first point of care for patients in smaller, rural communities.
Since 2010, pharmacists Larry Leung and Jason Min have been collaborating with community members and local health-care professionals to develop clinical pharmacy services in First Nations communities.
These services include medication management, speciality clinics for blood pressure, foot care, and preventing falls, as well as home visits and patient education.
“It’s very important for pharmacists as the medications experts to be involved in care and be a point of contact for patients,” said Leung.
In addition, they deliver all their services with a culturally-sensitive, integrated approach that respects the First Nations community, culture and values.
“Our work is very rewarding,” said Min. “Every community we go into has a different culture, different traditions, and we’ve been fortunate to have been welcomed with open arms.”
Leung and Min’s work is continued through the Pharmacists Clinic at the University of British Columbia's Faculty of Pharmaceutical Sciences. It has also formed the basis of an Aboriginal Health elective now offered to undergraduate pharmacy students at UBC.
Community pharmacy is integral part of BC’s health-care system. Pharmacies play a key role in increasing access to primary care, improving patient outcomes and reducing health-care costs.
Reaching patients in rural communities is just one more example of the services pharmacists provide that are a lot more than pills.
But during recent outbreaks of whooping cough and measles in B.C.’s Fraser Valley, Abbotsford pharmacist Sundeep Dhillon showed how pharmacists do a lot more than pills.
In 2009, pharmacists were given authority to administer vaccines to British Columbians older than age 5. While many patients already visit their community pharmacist for their annual flu shot, the outbreaks presented an opportunity for pharmacists to prove their role as key health-care providers.
In 2013, about 60 women and newborns in the post-natal unit of the Abbotsford Regional Hospital and Cancer Centre were exposed to the measles virus. The Fraser Health Authority quickly mandated that staff had to prove they were already immunized or get the vaccine. Wait times at public health clinics were reaching upwards of two hours. If staff members weren’t immunized, there was potential for the hospital to grind to a halt.
As the pharmacy manager of the Pharmasave Health Centre, Dhillon set up a drop-in vaccine clinic open seven days a week. Some days he vaccinated up to 50 people a day.
“My goal was to make sure nobody was forced out of work if they were not immunized, even if it meant vaccinating the entire ambulatory department,” Dhillon said. Since the outbreaks, Dhillon has seen an increase in demand for pharmacists to provide immunizations for all patients.
“Patients find that community pharmacists are easily accessible and a convenient option for receiving immunizations,” Dhillion says. “Patients recognize pharmacists as being health-care professionals, and they recognize that we have a lot to provide in terms of health-care.”
Providing immunizations is just one more example of how the work pharmacists do is a lot more than pills.