Inside This Issue - News
Role of Rx in health care scrutinized at CACDS
June 16th, 2014
by Alasdair McKichan
VANCOUVER, British Columbia – A session billed as “The Big Debate” formed the centerpiece of the Canadian Association of Chain Drug Stores (CACDS) 2014 Annual Conference.
The motion being debated was: “Be it resolved that pharmacy is a key member of the health care team.” The protagonists in the debate, staged in parliamentary style, were both seasoned journalists with a particular interest in health care.
André Picard is the public health care reporter for the nationally distributed daily The Globe and Mail. Jeffrey Simpson is a national affairs columnist for the same paper. Simpson has recently published a book that takes a critical look at the working of Canada’s health care system.
There was perhaps more agreement than argument between the debaters on pharmacy’s position in Canada’s health care regime. They differed mainly on the approach pharmacy should take to gain the role it is eager and equipped to fill.
Picard took the position that Canadian pharmacy was an outsider looking in on the system. It should, he maintained, put on its “Big Boy Hat” and, in its interaction with governments and with other health care professions and in its positioning with the public, fight more vigorously for its deserved position.
That position includes being appropriately remunerated for patient counseling on their drug regimes and their devices, education on their disease states and even home visits for the inspection of the medicine cabinets of infirm patients. Physicians do not have the inclination, and often not the training, to fulfill these functions. To free up pharmacists’ time for cognitive services there should be much more reliance on technical support and probably a reorganization of community pharmacy’s typical business model.
Simpson, responding, pointed out that it could not be said that the public does not appreciate pharmacists’ contribution. Polls show that they earn a high degree of trust from the public — along with physicians and farmers, in contrast to the low trust the public has in politicians, lawyers and, he felt bound to record, journalists. There is, however, quite strong belief within a sector of public opinion that pharmacy should become part of a fully nationalized system, a sentiment that is quite likely to increase with the aging of the population and the sharp increase in consumption of drugs that eventuality implies.
The public notes that Canada has the second-highest costs of drugs in the world. It questions those prices and the value being delivered. Simpson used the militant approach Ontario pharmacists and CACDS took in attempting to win public support in opposing the Ontario government’s action to reduce drug prices a year or two ago as an example of how not to act in the public forum.
“It was,” said Simpson, “as bad a piece of corporate action as I have seen. You don’t play defense against the government, if you expect to win,” he added.
The approach Simpson favored was to cooperate with, rather than confront, the other professional groups in the health care system in designating roles. He saw the growing practice of pharmacies inviting physicians to share or locate in adjoining space as being very positive. Discussions with governments should be conducted in a collegial, not a confrontational, mode.
Throughout their continued dialogue Simpson and Picard maintained their respective positions on the best way for pharmacy to achieve more appropriately remunerated responsibility: vigorous activism in Picard’s view, urgent and well informed cooperation with all the actors in the sector, in Simpson’s.
As Simpson pointed out, the challenges facing the whole Canadian health care system continue to grow. Currently, 14% of the Canadian population is over 65. In 10 years that figure will be 26%.
The implications for the national drug bill are obvious. Simpson proposed that one realistic way of dealing with the threatening costs would be to have a national prepaid drug plan for seniors organized in a way similar to that which finances the Canada Pension Plan. Premiums would be paid during citizens’ working life and drug costs with suitable deductibles, would be reimbursed after contributors reach 65.
In the discussions with the audience that followed the speakers’ interchange, some of the significant issues raised were:
• The most fruitful way of reducing future health care costs would be to address more forcefully those social determinants of health that patients have some control over. Pharmacists along with other health professionals can make a substantial contribution in patient counseling on the subjects in which they have relevant knowledge;
• In the U.S., generics account for 80% of prescriptions. In Canada the corresponding figure is 60%. That gap can be closed.
• Canada is a relative laggard in amassing evidence in relation to drug effectiveness. Is there a role for pharmacists in this function?