Intake: Where it’s at

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Typical day in our pharmacy.  Pharmacists are at intake engaging with patients.  Yes, we did not tidy up before I snapped this candid of my staff!

When I graduated from pharmacy over 20 years ago, the buzz and excitement at the time was “pharmaceutical care”.  I can remember carrying to my first job a copy of Hepler and Strand’s “Opportunities and Responsibilities in Pharmaceutical Care”(1990).  Such was my enthusiasm to provide this type of care to patients.

What ensued was 20 years of practice where the majority of my time was spent signing my name on the plethora of prescriptions presented to me.  Mixed in with some counselling on new prescriptions or a smattering of other tasks such as dealing with drug plans, inventory, orders and narcotics, what’s striking is that about 80% of my time was spent on technical tasks which did not require the university degree I had worked so hard to attain.

Pharmacy practice has largely remained unchanged over the past 20 years.  Pharmacists still perform technical tasks a large majority of their time, tasks more suited to registered technicians and assistants.  Often the only interaction pharmacists have with patients is to give verbal and written information about new drugs.

It is not surprising that real change has not occurred in pharmacy practice as the profitability in pharmacy has historically depended on the drug product going out the pharmacy door as quickly as possible. Pharmacists, as the final check, were the rate limiting step for profitability, thus honing our skills for fast, efficient dispensing was paramount.

Today however, with the convergence of expanded scope practice and the changing landscape of pharmacy reimbursement, billable and cash paying services, the time is ideal for pharmacists to step out front and fully embrace our role as pharmaceutical care providers.  Medication reviews, care plans, adapting therapy, chronic disease management are all about optimizing drug therapy and solving drug related problems (DRPs).

However.…we simply cannot do this on the back end of work flow when we’re checking prescriptions.

Pharmaceutical care requires that we work WITH the patient, engaging them in their own care and decision making, becoming involved in their therapy, taking responsibility for drug therapy decisions and collaborating with other care providers.  To do this we need to be out front.  We need to dialogue with patients when they present to allow for assessment of their medications, chief complaints and chronic disease therapy.   The “pharmacist at intake” model has yet to be widely adopted, but initial pharmacist assessment is absolutely critical to providing patient centered care.  Here’s my top 5 reasons why:

  1. It is nearly impossible to find and resolve DRPs with only a patient profile and a prescription hard copy in front of you (ie: the most common “pharmacist checking” scenario). The vast majority of problems are not discovered due to a lack of discussion with the patient. Assessment of the patient (not just the patient’s file) and shared decision making along with the patient are essential.
  2. Checking prescriptions can be done at a fraction of the cost by a registered technician. Pharmacists are no longer needed for back end checking. Therapeutic assessment of the prescription can be done on the front end of work flow along with the patient.
  3. If our only interaction with a patient is to provide information (ie: counselling), we will shortly be regarded as irrelevant. This is the information age and approximately 92% of adults aged 18-39 now carry a computer in their pocket.  Information is at our patients’ fingertips and pharmacists are no longer the only source of drug information.
  4. Profitability from drug product is shrinking (low fees/margin, PPNs, loss of rebates/pan-Canadian, cuts on short fills/blister packaging). Profitability from expanded services is increasing.  Identifying opportunities and providing expanded scope service requires assessment and engagement of the patient by the pharmacist.
  5. Pharmacist on the back end is highly in-efficient.  If a pharmacist does discover a DRP through back-end counselling, the prescription has already been entered, prepared, checked, and the patient has waited.  Now the team must go through the entire process again to fix the problem and the patient waits yet again.  This is a highly inefficient use of staff resources.

 

Pharmacists have an incredible opportunity to step into their true role. No other profession has the expertise to guide patients and engage in shared decision making to optimize drug therapy.  Pharmacists have unique knowledge of therapeutic guidelines, patients’ current drug therapy, alternative drug therapy options, drug benefit lists, drug administration solutions, and previous response to medications. We cannot afford to wait another 20 years.  We need to step out from behind the counter and engage our patients where they’re at.

My Practice

PharmacyU recently came in and produced a short video on my practice at Meridian.  It is really well done and highlights how we use expanded scope in patient care.  Kudos to PharmacyU for their superb editing skills and to my staff for their efforts in this production.

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Video Link Here under “Innovators”

Magazine Feature Here

 

 

 

 

Pocket Wisdom

I was rifling through a box of papers from the days of my first few years of practice in the small town of Chemainus (1994-1998).    The beginning of learning how to care for patients and fit into the medical system.   I came across a folded up piece of paper that I recognized as one I had carried in my lab coat pocket for many of those early years…

Ode to Patient Care

If we speak with the tongues of specialists and consultants,

and have not love, we will have nothing more than the noise

of our own voices and the clanging of pet ideas.

If we develop new methods, write new curriculum,

and learn new techniques,

and if we understand all about the five stages of dying

so that we are not surprised when a patient is angry or depressed:

and yet we have not love, we are useless.

If we give up our old anxieties about talking with patients

concerning their true feeling,

but we have not love, we gain nothing.

Love never ends.

As for tumour conferences,

they will pass away;

As for workshops,

they will cease;

As for inservice training,

it will change.

For our methods are always imperfect

and our plans often don’t work out.

When I first became a helper, I thought like an idealist

and talked like an expert.

As I began to mature, I realized that I too was afraid

and the patient often taught me.

For now we see only reflections of sickness and death,

but someday we will see them face to face.

And the time will come when we will know for sure what it is like,

and we will be sorry we ever judged.

So methods, techniques, case conferences, care plans,

seminars, small group experiences, counselling-

There is all this and much more we would suggest for

gaining insight and increasing effectiveness:

But greater than all of these is love.

Dan McEver

Now posted once again where I practice daily so I can be reminded of what really matters….