“Patients are better off as a result of the easier access they have to services that pharmacists can provide at their numerous and convenient locations. When pharmacists act as fully integrated parts of the health care system they help bring about system efficiencies,” says Carpenter.
The widening of the scope of authorized pharmacists’ interventions with patients began in Alberta in 2007 with the passage of the first tranche of enabling legislation. That scope has been progressively increased since. The establishment of a new schedule for the remuneration of pharmacists in 2013 provided the appropriate incentive for pharmacists to take advantage of their new powers.
Alberta Pharmacists’ Association and Alberta College of Pharmacy took the lead in pressing for an expanded role for pharmacists and then for appropriate remuneration for delivering these services. Neighbourhood Pharmacies (formerly the Canadian Association of Chain Drug Stores) played a supportive role to the pharmacy organizations of Alberta and other provinces in their negotiations with governments. It has also played a continuing role in disseminating information on what is developing in each jurisdiction as well as carrying out research, on a national basis, on the results of pharmacists’ exercise of their new powers.
“It is hard to overestimate how much patients value accessibility when dealing with issues that pharmacists now can address,” says Carpenter. “Think of the situation of a young mother dealing with an infant with diaper rash. Of course, she is time pressed, and the prospect of having to make an appointment at a doctor’s office, making the trip there, waiting in a possibly crowded room with an unhappy child is daunting. Compare that with the opportunity to take her child at her own convenience to a likely nearby pharmacy and getting prompt attention there,” Carpenter cites as an example of what can now occur in Alberta.
Equally convincing, she suggests, in demonstrating the value of the pharmacy option, would be the obligation of an elderly patient, likely vulnerable to infection and possibly having difficulty with travel, having to make his way to a physician’s office for a flu shot and waiting among the other patients for the shot that he could get on demand at a neighborhood pharmacy where he was likely to be going in any event to pick up a prescription.
“The number of flu shots administered by pharmacists in Alberta has virtually doubled every year since the authority to administer injections was introduced,” says Carpenter. “Nothing could better illustrate how much patients value the convenience this service offers. These figures also demonstrate to all in health care that when the elements in it work together the result is better care for the patient.”
The total numbers of remunerated pharmacist-delivered patient interventions is also becoming impressive. Carpenter reports that since the current remuneration schedule for these services was introduced midyear in 2012, Alberta pharmacists had, up to the beginning of December this year, filed over 2 million payment claims.
A further demonstration of the increasingly significant role community pharmacy can play in the total health care system is evident in both Alberta and Prince Edward Island, where community pharmacy in both provinces has augmented public health distribution of vaccine for these flu injections.
The increasing time pharmacists are spending with patients is, of course, requiring pharmacies to devote more attention to time management. Carpenter says pharmacy as a whole is becoming increasingly sophisticated in how it addresses this issue. Pressure on pharmacists’ time is causing more pharmacies to utilize registered technicians. The availability of these staff members is growing, as recently introduced courses are graduating students in significant numbers now.
It is also gratifying, says Carpenter, that pharmacy schools across the country are adapting their programs to include instruction on the knowledge and skills that the expanded role for pharmacists require. Carpenter suggests that there likely will be a move within the pharmacy profession and within individual community pharmacy firms to see some degree of specialization in relation to the new services they elect to provide.
The increased interaction between pharmacists, physicians and other health care professionals that occurs under the new regime increases the importance of drug information systems. The pace at which these systems are developing differs among provinces, but Carpenter says their importance and the urgency of their being available are recognized by everyone concerned. E-prescribing is also developing at different rates, province by province, but it facilitates the pharmacist/physician communication process.
Neighbourhood Pharmacies, as well as continuing to act as the national proponent of the extension of pharmacists’ powers, is managing research that will record what has been achieved so far and point in the direction of what is likely possible for the future. Carpenter lists the projects that are now under way:
• Establishing the benefits of the new pharmacist powers to the whole health care system.
• Demonstrating the individual value of each of the programs now being offered to patients.
• Examining the new powers from the patient perspective — what has the patient experience been and how have patients benefited in terms of both outcomes and convenience.
In Canada as a whole, pharmacist empowerment is taking place everywhere, but not yet in other provinces to the same extent as it has in Alberta.
Commenting on experience to date, Carpenter says: “From the patient point of view, having pharmacists as part of the care-providing team helps provide the best quality of care for the patient. When all the health care professionals are able to deliver to the full extent of their professional scope and work cooperatively together, that improves both accessibility and likely outcomes.”