Pharmacists are seeing the gaps in care. So how can they close them?

Pharmacists across Canada are taking on a growing role in primary care. But how can they best leverage their skills (some of which they've only just been allowed to start using in some cases) to deliver measurable improvements in patient outcomes?“We always talk about the work we do on a day-to-day basis that helps patients and ultimately leads to better patient outcomes,” said Ajit Johal, founder and clinical director of Immunize.io, during his presentation at the B.C. Pharmacy Association’s annual conference.“The challenge is, how do we quantify that?”Beginning with a real-world example, he referenced a recent study which found older adults in B.C. living with mental illness had more primary care visits and specialist interactions than the general population, yet received worse chronic disease management outcomes. Despite having more frequent contact with the healthcare system, they were less likely to receive recommended lab testing and chronic disease medications for diabetes, heart failure and COPD, researchers found.“We often see the struggle in this province as the lack of attachment to a primary care provider, and the need to train more physicians,” said Johal. “But attachment does not mean outcomes, as was shown in this study.”Johal argued that pharmacists are actually best-positioned to identify those unmet needs and gaps in care in cases like these—particularly in preventative care and chronic disease management—by more proactively using tools such as medication reviews, lab testing and immunization. To illustrate that point, Johal, also a clinical assistant professor at the University of British Columbia, highlighted a pharmacist-led project a team he was part of carried out in B.C. supportive housing facilities. During medication reviews, students used B.C.’s CareConnect system to check residents’ vaccination histories, identify who qualified for the province’s expanded Prevnar 20 program and offer vaccination immediately onsite during the same visit. After reviewing 178 residents, Johal said pharmacists administered 172 pneumococcal vaccines, increasing vaccine coverage in the group from roughly 5% to 80%—bringing the population up to the Public Health Agency of Canada’s 80% coverage target for high-risk adults.That direct connection between screening patients, recommending vaccination and administering the shot immediately, Johal argued, is what drove the results.“We said, ‘We recommend this vaccine. We can provide it here today, for you, right now,’ and that’s why we had such high uptake.”That same idea carried into a second project, focused on diabetic kidney disease. Also using CareConnect, pharmacy teams identified diabetic patients who had gone long periods without urine albumin-creatinine ratio testing, a key screening tool used to detect early kidney damage.Among diabetic patients reviewed, more than 30% had not received recommended kidney monitoring within the previous 18 months, despite it needing to be done annually. For those who needed it, pharmacists issued lab requisitions and worked with physicians on medication changes aimed at slowing kidney disease progression. “What was really interesting is that 100% of our recommendations were accepted by prescribers.”However, Johal said several practical barriers still limit uptake of pharmacist-led lab testing, including lack of reimbursement for tests and the chain of responsibility for abnormal test results. “If a patient has some sort of abnormal lab result, somebody has to do something about it,” he said. “But even if we were called to do something about it, we don't have the scope of practice to actually prescribe something to address that issue.”Johal also questioned whether B.C. 's medication review program—first introduced in 2011—was ever structured in a way that allowed the province to meaningfully evaluate patient outcomes.Still, Johal argued the examples he shared showed pharmacists were already identifying patients who were routinely interacting with the healthcare system, but still falling through gaps in chronic disease management.“Service has fallen short of its goal of improving patient outcomes,” said Johal, citing from an article previously published by the college. “It’s time for a change.”

Pharmacists are seeing the gaps in care. So how can they close them?

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