Role of pharmacists: When we compare experiences, we inspire each other

Zina Ali and Alexandre Chadi—two Quebec pharmacists—come from the first cohort of the Advanced Primary Care Pharmacist Training Program, established by the Association of Faculties of Pharmacy of Canada (AFPC). After 12 weeks of diverse and varied learning and four weeks of an internship in a medical clinic (she in British Columbia, he in Ontario), they have a lot of ideas swirling in their heads: Ali for the two GMFs where she works in Vaudreuil-Soulanges, west of Montreal, and Chadi for the community pharmacy where he works in the Parc-Extension area of Montreal."The training motivated me a lot,” said Chadi, who has since invited the pharmacist from the CLSC de Parc-Extension to a meeting. “We are going to work on delegation forms to strengthen our cooperation,” said the 30-year-old, who chairs the local pharmacists' table, where he wants to forge links between professionals in community pharmacy and those in GMF, by opening up to other healthcare providers in the area. “I see more concretely what interprofessional collaboration can look like in the field.”Meanwhile, Ali collaborates with her British Columbian internship tutor on note templates for diabetic clients. “The more patients I see, the more tasks I am given and the less time I have for followup notes,” explained Ali. The 28-year-old professional is also considering presentations on good medication practices intended for the medical teams of her two GMFs and plans to contact community pharmacists in Vaudreuil-Soulanges to establish monitoring delegations and increase their collaboration. “Creating projects takes time and energy, but Rome was not built in a day,” she said enthusiastically.This new PSAC program is a pilot project launched with the financial support of Team Primary Care, a federal initiative that aims to “accelerate the implementation of transformative changes” on the front lines in Canada while facilitating collaborations between health professionals. In this case, the AFPC course aimed to equip the 14 pharmacists selected throughout different provinces (half working in the community, the other in medical clinics) to help them “take advantage of the expansion of the unique scope of practice, knowledge and skills of primary care pharmacists.”Read: UBC launching new diploma in pharmacy leadershipThe first part of the program was demanding, requiring a personal investment of 10 to 12 hours per week. It required: readings of scientific literature on interprofessional collaboration, communication, leadership, project management and conflict resolution, online modules on pharmacist skills; and solving complex clinical problems, discussions between trainees on concrete cases, brainstorming activities on the profession and interdisciplinarity practice.Reflections and perspective Chadi and Ali, who were both supported by their employer, were not discouraged. “When you're in practice, it's difficult to step back. There, for four months, I was able to think about the inclusion of the community pharmacist in the care team, the sharing of medical information, the role of different allied health professionals, different clinical services, etc.,” said Chadi.The 14 participants were able to compare their fields of practice. “It varies a lot from one province to another,” noted Ali, who benefits from an advanced practice agreement in partnership with one of the two GMFs where she works. “It gives me some leeway on the prescription. In British Columbia, they don’t have that.” Since June 1, 2023, pharmacists in B.C. can prescribe medications to treat 21 minor ailments, “but this is not yet really implemented. They can’t wait,” she observed. Beyond that, “our role in the clinic is essentially the same: review of complex files, monitoring and adjustment of medication.”Envy towards QuebecOverall, “the other pharmacists were jealous of Quebec. Autonomous adjustments, prescriptions for minor conditions, these are newer elsewhere in Canada,” pointed out Chadi, who realized that the Quebec Health Record (DSQ) is not such a bad tool. “We criticize it a lot because it remains limited and there is a lack of information, but we can still establish collaborations with it. In Ontario, their DSQ is only accessible for certain patients and not all the reports and results are there,” something he noticed during his internship at the Bruyère Family Medicine Center in Ottawa, which supports 20,000 patients. His internship supervisor, a pharmacist who works full-time in this large GMF, cannot issue prescriptions for minor conditions or for laboratory tests. “He makes suggestions and the doctor countersigns his requests, but for him, it was not a barrier to collaboration. When trust is there, the doctor follows his recommendations and his countersignature is an opportunity to discuss the patient,” said Chadi, inspired by the leadership exercised by this experienced pharmacist within his clinic. “He does a lot of medical education. It produces good practice forms and encourages doctors to make good use of medicines. And it works! Benzodiazepine prescriptions, for example, I saw very little during my internship.”Read: Finding your Niche: Making an impact in diabetes careChadi was particularly impressed by the amount of information available to his peers in the clinic. “There is so much information that we don't have in community pharmacies. The EMRs are super-comprehensive. This shows a need to better share this information between our communities, in both directions. Because we also have a lot of information in our pharmaceutical files, particularly on adherence to treatments.” At the Bruyère Family Medicine Centre, Chadi participated in meetings of the multidisciplinary mental health team, made up of social workers, psychiatrists, nurse practitioners and the pharmacist. “They can spend an hour discussing the course of action for a patient. In the community too, we can get involved,” he said, mentioning the diabetes clinic set up within the pharmacy where he works, which brings together a nurse, a dietician and a kinesiologist. “The difference is that the community pharmacist is certainly part of the patient's care team, he plays a role, but he is not involved in the major decisions.”Be creative With a little hindsight, Ali feels that the AFPC program allowed her to see, in a concrete way, what an ideal GMF practice can look like. “It showed me what I want to do on the field. In the clinic, we can be a good relay point and we can promote the role of the community pharmacist to the medical team,” she said, emphasizing that these communications cannot be done by fax. “It takes face-to-face meetings to get to know each other.”The program nourished Chadi's thoughts on interdisciplinary collaboration. “We still work in silos, but we are dependent on each other. The next step is to be interdependent, to clarify the roles of each person to determine who is the most relevant stakeholder for the patient. To do this, we must open dialogue, build relationships of trust, not by fax or telephone,” he said. “We need face-to-face meetings to reduce the fear of others,” he added. “You have to act as a leader, be creative and think territorially. The field of possibilities is wide. We must identify opportunities, set out to create interprofessional care trajectories, and try it!”Read: Finding your Niche: Relief pharmacy offers variety, flexibility

Role of pharmacists: When we compare experiences, we inspire each other

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