Expanding role of pharmacists bridges care gaps, contributes to better health outcomes

New regulations across the country are allowing pharmacists to provide enhanced levels of service to their patients, including vaccinations, prescription renewals, medication reviews and lifestyle and wellness support. istockphoto.com

For its 14,000 residents and the many thousands of people who visit each summer, Sylvan Lake, Alberta, has a lot to offer. However, there is one important exception: like many smaller communities, there is no hospital or acute care centre. And for most residents, seeing the doctor means taking time off work, which isn’t always possible.

Fortunately, the province’s advanced approach to the practice of pharmacy has helped bridge the gap, making many essential health-care services more accessible. For his patients, says Todd Prochnau, the pharmacist-owner of two Shoppers Drug Mart locations in Sylvan Lake, “it’s made a huge difference.”

For example, Prochnau and his team have provided comprehensive smoking cessation services since 2011, and often receive referrals from local physicians and the public health office. He works with patients to develop a quitting plan aligned with their habits and lifestyle and then provides ongoing follow-up support. “If we decide that prescription drug therapy is most appropriate, based on my assessment and our discussion, I’m able to prescribe it at the same time,” he says.
Patients don’t have to make an additional trip to the doctor for a prescription, which means they can get started on drug therapy earlier, Prochnau reports. Despite the well-documented difficulty of beating nicotine addiction, many of his patients have been able to quit for good.

Similarly, when Prochnau provides travel health consultations, he can prescribe the appropriate medications and vaccinations and administer the vaccines at the same time. The one-stop service ensures there is no temptation to be less than fully protected, even with the usual time-stress of preparing for a vacation.

While Alberta has led this evolution, the role of pharmacists across the country has expanded dramatically over the last decade. In collaboration with physicians and other health-care professionals such as dieticians, pharmacists now deliver services such as chronic disease management, immunizations and wellness programs. In some regions, pharmacists are also authorized to prescribe for certain symptoms and conditions and to extend refills for chronic medications, with the scope of authority varying by province.

In addition to greater convenience and earlier access to care, the result is improved outcomes for patients. In fact, a study in which Prochnau participated found that hypertension was significantly better controlled when pharmacists were able to prescribe medications for their patients along with providing education and lifestyle support.

Hypertension affects about 7.5 million Canadians. However, because patients usually don’t experience any symptoms until there are serious complications, it can be difficult to stick with treatment. “You typically don’t feel sick – it’s more like you are treating a number,” Prochnau explains.

As drug therapy experts, pharmacists can educate patients about why treatment is so important, while helping them optimize their drug therapy, minimize side effects and ensure their treatment is working effectively through regular monitoring.

Research shows that without this kind of ongoing support, Canadians struggle with following their doctor’s instructions. Six months after receiving a prescription, only about 50 per cent are taking their medication as directed, says John Papastergiou, a Shoppers Drug Mart pharmacist in Toronto.

Patients often stop taking their medication because they experience unwanted side effects, he explains. “But if they check in with their pharmacist instead, they’ll often find that the solution is simple – even just taking medication at a different time or with food may solve the problem.”
Medication reviews, a pharmacy service that is covered by many provincial health-care plans, can help ensure that patients are following their doctor’s instructions, receiving optimum benefit from their treatments, and aren’t at risk of drug interactions or adverse effects. “We sit down with the patient and do a comprehensive evaluation of all prescription and over-the-counter medications, and then discuss why they’re taking these medications and any issues they may be experiencing,” says Papastergiou.

It is not uncommon to find that patients are taking medications prescribed years before for conditions they no longer have, or are taking multiple medications that do the same thing, he says.

Automatic refill reminders can also make a difference, he says. “Patients tend to forget. With some drugs, such as anti-coagulants, missing even one or two doses is potentially dangerous.”

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