Practice Issues: Do you think it is ethical for pharmacists to “opt out” of providing some of the new clinical services that are funded by provincial drug plans?

ethics and issuesDerek Jorgenson , BSP, PharmDPharmacy and Nutrition, University of Saskatchewan; West Winds Primary Health CentreDo you think it is ethical for pharmacists to “opt out” of providing some of the new clinical services that are funded by provincial drug plans?I talked to a patient who went to three different pharmacies before she found a pharmacist willing to provide a medication review.The poor uptake that has been observed with some of these new clinical services is a complex issue that presents more than just a simple ethical dilemma. There are several complicating factors that must be considered and addressed before we can blame individual pharmacists for choosing not to provide these new provincially funded interventions. However, I do agree that these services cannot be perceived as optional—provided only when pharmacists feel like it or when they have finished all of their other work in the dispensary. In order for our profession to remain relevant and important within the healthcare system, it is vital that we not only begin providing more patient-centred clinical services, but that we also provide consistent services from pharmacy to pharmacy, hospital to hospital, and clinic to clinic. If consumers do not experience consistent service from pharmacists, regardless of which pharmacy they interact with, it will result in confusion and frustration from both patients and other health providers.Although these new clinical services represent a monumental shift in the pharmacist’s role, very few continuing professional development opportunities exist to ensure that pharmacists are competent and, more importantly, confident in providing high quality care. Regardless of whether it is a medication review or minor ailment management, many pharmacists will require some additional instruction on fundamental professional skills such as patient interviewing, documentation, collaborating with physicians, and critical appraisal. As these new clinical programs are launched it is essential that training opportunities be widely available to pharmacists (including those in rural and remote regions) that not only address the logistical details of the new service, but also the foundational professional skills that will be required to deliver high-quality patient care. If these training programs are not provided, it should not surprise anyone that many pharmacists will not feel confident in their abilities and will choose to “opt out” of providing some of the newly funded clinical services.Lack of time and poor remuneration has been cited as an additional barrier to the uptake of many new clinical services within community pharmacies. I personally believe that these are no longer relevant roadblocks, but are often used as convenient excuses for inaction. Karen Riley recently published a research study in the Canadian Pharmacists Journal (May/June 2013) that proves this point. She found that having a designated full-time pharmacist on staff to provide enhanced medication management services, along with some strategic dispensary workflow redesign, generated enough income to cover the pharmacist’s salary and resulted in hundreds of medication reviews performed (along with many other clinical pharmacist services). If we expect pharmacists to simply add these new tasks onto their existing work they will not have enough time, regardless of how much you pay them. However, if the dispensary workflow is adjusted and additional pharmacists are scheduled to provide the clinical services, time and money should not be a factor.The bottom line is that I see this as one of the many growing pains that our profession is experiencing in our quest to redesign our scope of practice and role within the health system. If individual pharmacists are choosing to “opt out” of providing some of the new clinical services, I suspect that the service was simply launched too quickly and not enough time and resources were invested in preparing and training the workforce. If I am wrong and there are legions of pharmacists out there who are simply not interested in providing patient-centred care, this would certainly represent a breach of professional ethics.Please continue to submit your Ethics and Issues questions to derek.jorgenson@usask.ca.

Practice Issues: Do you think it is ethical for pharmacists to “opt out” of providing some of the new clinical services that are funded by provincial drug plans?

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