It’s me, hi, I’m the solution, it’s me

Kudos to the team at the Canadian Pharmacists Association (CPhA) for executing a well-planned single day of discussion centred around the overdue argument that making full use of community pharmacists is an obvious and necessary response to Canada’s primary care crisis.And the arguments were convincing.I’m writing to an audience of healthcare professionals— I don’t have to tell you how bad things are (and how much worse they will get). But as CPhA’s chief pharmacist officer Danielle Paes noted yesterday, internationally, Canada ranks 3rd from last in terms of citizens’ being able to access primary care in a timely manner. And with our population aging and living longer with chronic ailments, and the physician workforce shrinking (according to Canadian Medical Association stats, 50% of Canadian doctors are now over the age of 60), a solution is needed, STAT!What would be an ideal solution? Well, you could quote Lionel Ritchie, as U of Alberta professor and researcher Yazid Al Hamarneh concluded, in a panel discussion on pharmacists’ value as chronic disease stewards: ‘Hello, is it me, you’re looking for?’ (As you can see by my blog title, I lean more towards Taylor Swift)It’s hard to find reasons not to integrate community pharmacists into the primary care health system immediately. The proof that it works is right there; in fact the entire day’s agenda unfolded almost like a meta-analysis of recent pilots, studies and initiatives demonstrating the value of pharmacists involvement in primary patient care. As panel moderator Ross Tsuyki noted, there have been so many studies and pilots demonstrating pharmacists value in chronic disease management that “if pharmacists were a drug, it would long ago been deemed unethical to keep studying their value and not begin using them to safe patient lives.”You only have to look to Nova Scotia for proof of how using pharmacists as a point of primary care is good for patients, the health budget and the healthcare system. Nova Scotia Health’s recent announcement that ER visits were down by more than 9% (despite a provincial population increase of 9%!) last year, the same year in which pharmacy primary care clinics were launched. Read: N.S. sees 9.2% drop in less urgent cases being dealt with in ERsHere are three key things about the successful pharmacy primary care movement in Nova Scotia: The government, the pharmacy regulatory body and the pharmacy professional association all bought into the idea and pulled out all stops to make it happen. Regulatory red tape was shredded, health budgets were re-allocated and pharmacy teams were supported. The change required a huge shift in public awareness—most Nova Scotians had no idea about what pharmacists could do for them or that they were a safe and capable alternative to a medical clinic or ER for common ailments and health queries. So the province funded an intensive public relations campaign that continues to this day.(And to me, the most important point): The pharmacists in Nova Scotia’s primary care clinics do not touch medications. They are the first point of contact for patients. They talk to patients and work with them closely but they do not work in the dispensary. If pharmacists are going to take on this key role as a primary point of care for Canadians, they are going to have to get out of the dispensary. It’s not sustainable (nor is it basic common sense) for pharmacists to take on a greater patient care role while also trying to stickhandle dispensary duties. Let pharmacy technicians and pharmacy assistants (and technology!) do what they are trained to do. It’s well beyond time. The thing is, many (although not enough) community pharmacists across Canada are already practising this way; placing themselves as the first point of contact —almost a triage station—for patients. Working this way, they are set up as primary care providers and able to spend precious time actually listening to patients so they can understand what care they really need, what problems they are facing and what is and isn’t working with their medications.It doesn’t take any government policy changes to do this, just a new way of working and thinking and a willingness to climb out of the dispensary rut. If you make this change, please let me know how it goes.Read: How I did it: Carlene Oleksyn explains how she implemented the ‘Pharmacist first’ workflow

From the Other Side of the Counter

It’s me, hi, I’m the solution, it’s me

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Vicki Wood

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