Notwithstanding the extra effort delivering on the new powers demands, Winston, who is a pharmacist, says that he and his professional staff are now entirely supportive of the decision the Alberta government made to give the profession an expanded role within the health care sector. That reaction was not universal among Sandstone Pharmacies professionals three years ago. Those staff members who did not seem to be comfortable in the new mode of operating have since left the company so they could continue to operate in the more traditional role.
Sandstone Pharmacies is a member of the McKesson Canada-managed IDA buying group. Of the 16 stores in the group, half are in the greater Calgary area and the remainder in rural southern Alberta. They vary widely in size from a 500-square-foot unit, located in a clinic, to the largest at 20,000 square feet. The latter is a recently acquired former Shoppers Drug Mart unit that was put on the market as a result of concentration issues resulting from the Loblaw purchase of the SDM chain.
“Because the demand for more registered technical assistants is currently wildly exceeding supply, our pharmacists often have to fulfill the dispensing as well as the patient consulting role. However, they are not burning out. The satisfaction they derive from utilizing all the skill they have seems to sustain them,” says Winston.
The company has been encouraging all its pharmacists to take the training that qualifies them for additional prescribing authority. Its people have been responding appropriately, says Winston.
It is three years since the introduction of the bulk of the new powers. In that time the new service most frequently sought and delivered has been adaptation of an existing prescription. The most significantly rewarded, in a financial sense, has been the assessment and preparation of a comprehensive annual care plan for patients with complex needs. Such plans often lead to a series of follow-up sessions, all of which are recompensed.
Administering injections is also a relatively high-volume service. That service, of course, peaks in the flu season, but throughout the year there is demand for travel vaccinations, B12 injections and injections for various other conditions.
Over the last three years, income from the new services has steadily grown, says Winston. “It now approaches 80%, in dollar terms of the revenue loss from the last cap the government put on the price of generics in 2011,” he says. “However, some three-quarters of that new income has to be devoted to support additional payroll so that we are some considerable way from regaining our net profit situation.”
There have had to be physical alterations made in the stores to provide privacy for the patient consultation process, notes Winston, but these alterations are all behind the company now.
Winston is pleased with physicians’ acceptance of the new, enlarged role of pharmacists. “Physicians have been most cooperative,” he says. “Those physicians practicing in a group who have a pharmacist on their premises are used to cooperating closely with the profession and, in general, physicians in urban areas seem to have no difficulty in accepting the new pharmacy role. There has been some push-back in rural areas but, where there has been an issue, I have stepped in to manage those relationships personally and in only one rural store has there been a real problem.”
“In general, pharmacists are rather poor at selling the services direct to patients, in-store,” Winston observes. “For that reason we made and distributed an in-store video to promote pharmacist-administered flu shots. We also have exterior signage, and the IDA flyer has carried items focusing on the flu vaccination program. All that has seemed to work. We budgeted a 69% increase in flu shots for this year, and we have already exceeded that.”
There have been some surprises in the way income from the new services would accrue. It was expected that as a result of medication reviews there would be an increase in prescriptions for patients who had been through this process. Winston says that did not happen in his group.
“Patient reaction to accepting the new, enlarged pharmacist role has, on the whole, been very positive,” says Winston. “Some, of course, have been a little surprised,” he adds, “but they certainly appreciate the convenience and, particularly in the case of independent pharmacists, they are used to seeing the pharmacist step out from behind the counter.”
Because of the comprehensiveness of government-provided and employer coverage there are not many of the charges for the new services that have to be borne by individuals.
“However,” says Winston, “ there is a demographic which has grown up with the experience and expectation that virtually all health expenditures are borne by third-party plans, government or otherwise. Some of these patients are surprised that a particular service may not be covered by their particular plan, but it is not a big issue. Patients who travel overseas, for instance, are used to paying for the vaccinations they may need.”
In terms of the future and possible extensions of the currently authorized powers, Winston believes that the first priority should be tweaking the existing powers to remove anomalies. He cites as examples the restrictions on patients who are eligible for medication management assessments and the limitations on dispensing prescriptions involving narcotics in emergency situations such as those presented by last year’s floods in Calgary and High River.