Transforming
Primary Care in Canada

Alyssa Watkins (NL)

Imagine that you are a patient living in a town in rural Newfoundland and Labrador with a population of 10,000 people. You do not have a family physician (just as 1/5 of the province’s population does not) and you contract a sexually transmissible and blood-borne infection (STBBI). With no other place to turn, you wander into your local community pharmacy hoping that they may be able to help. Unfortunately, the pharmacist says that there is nothing that can be done unless you see a physician, which means that the next 10 hours of your day are spent in the local emergency room.

Pharmacists have the opportunity to play a vital role in the diagnosis and treatment of STBBIs as primary health-care practitioners in rural communities and urban centres. In the next few years, I plan to use the background education that I have received throughout my PharmD program to pursue a Masters of Science in Pharmacy. In this program, my main area of research will be around the barriers that pharmacies may face while implementing STBBI care into their pharmacies. The resulting impact will hopefully be increasing the accessibility, inclusivity and privacy for patients that contract an STBBI, as well as gaining insight into how these services can be implemented into a pharmacy setting in a way that is sustainable for the business, pharmacist and patients. The population of people contracting STBBIs is on the rise, and I believe that this research is a step in the right direction on the path to delivering these services in the primary care setting and making a real difference in patient lives.

Alyssa Watkins attended the Summit as our student Win a Trip to the Summit award winner. Stay tuned for a report on her experiences!

Amber-lee Carrière (ON)

The future of health care lies in interprofessional collaboration, with all individuals empowered to contribute their expertise to patient care and work to their full scope of practice. Like much of Canada, we face a growing need for obesity management. Obesity management has a tremendous role for pharmacists as the medications are confusing and ever-changing.

To better manage patient wait times and improve the quality of care I was able to connect with an obesity-focused pharmacist in Calgary. We collaborate to keep our learning up to date by sharing trial data and lived experiences. I also work with our dietitian team to streamline diet and lifestyle information necessary to optimize medication use for obesity management. We created a class for patients to provide research-backed recommendations optimizing obesity management and establish realistic expectations for obesity treatments.

We have since shared our experiences and resources with other family health teams. As a pharmacist I have created relevant drug information and in-service presentations for pharmacists, dietitians and prescribers alike. This has driven further collaboration and optimized the role of the pharmacist on the team. Many of our patients present to our obesity group knowing that following discussion with a pharmacist they will then choose a medication best suited to them, and our providers have confidence that the pharmacist is providing the most current and relevant information about medications for our patients.

Brittany Schroeder (MB)

One of my most rewarding experiences in primary care is when I get to work directly with patients assessing medications and making recommendations. Recently, I was involved with a palliative cancer patient with COPD diagnosis. After speaking with patient and wife, I was confident that the patient’s current COPD medication delivery systems were no longer effective. The patient thought it was the end of his life, but met with me for an inhaler technique assessment. Due to current frailty, the patient was not able to use inhaler devices appropriately. After speaking with the physician and making inhaler changes, within one week patient felt that they were living again. The patient and family were so thankful they were given the opportunity to enjoy one more summer together before his passing.

Hannah Kim (ON)

One thing I noticed after the pandemic is that the role of pharmacists became ever-more critical in delivering primary care. One example is expanded scope of practice in ability to prescribe for minor ailments. Just last week, a patient came in looking for help with an uncomplicated urinary tract infection right before leaving town. The onset was abrupt, and she was experiencing great discomfort. After appropriate assessment and counselling she was able to make it to the airport in time. Three days later, she came back just to pay gratitude for saving her time and pain greatly at the time of urgent need. It was a moment of recognition, another swing of inertia to be driven to step up as a leading health-care provider.

Although we achieved the greatest reformations in the past few years, we have also uncovered barriers, and one of them is our siloed health-care system. In order to overcome this, I implemented some strategies with my team. Due to our location, we work closely with the Baycrest Terraces Residence and their staff. Together, we created an environment where physicians can consult us for our opinions in medicine and discuss patient culture test, resulting in the delivery of seamless care. Additionally, for every shift, we call three patients with mobility issues to discuss adherence rates, barriers to it, and how we can enhance it.

The key here is patient engagement and interprofessional collaboration. Together, we can transform the future of pharmacy to manage and even prevent disease more efficiently. Further regulatory reform will allow access to a broader range of primary care services and enhance access to quality care. This will not only add value for patients, but also strengthen professional identity as vital members of health-care teams contributing to the advancement of Canadian health-care system.

Jaclyn Katelnikoff (SK)

Here’s how I’ve been using my education to help pharmacists realize their full potential across the country:

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Joan Cochrane (SK)

Pharmacists are very accessible to the public. We now prescribe for minor ailments. We provide primary care and assessments and refer to physicians if warranted. The current pharmacy design is not conducive to pharmacist/patient interactions.

Imagine the pharmacy area physically separated from the rest of the store by a wall. Patients would have access from outside. The pharmacy is a separate professional environment. This facilitates providing expanded scope services aka providing primary care. Pharmacists will be stationed at the intake area in semi-private desks where patients sit down and talk to the pharmacist. The pharmacist has a computer and phone at the station. This allows for problems with prescriptions to be solved proactively. The pharmacist inputs the patient and prescription information and then the label is printed at the technician area. Technicians assemble the prescription while the pharmacist is patient counselling. This is very efficient.

In SK we can access patient’s lab test results through eHealth. For example, a patient has a prescription for warfarin. We can check eHealth to see if they are going regularly for their INR tests. We can discuss the importance of keeping the INR in the therapeutic range. If they are not, we can contact their physician and recommend changes. With the pharmacist at intake this can happen seamlessly. It is also required that we check eHealth prior to providing minor ailment services. This design makes it easy and seamless. We changed our store design in 2016. Our staff and patients have been very happy. Many medications are only allowed to be sold in pharmacies. With the current pharmacy design, it is difficult for pharmacists to know if someone in the pharmacy area needs help with a non-prescription drug or if they are just on their way to the deli! This design would eliminate the confusion.

Jordin Tilbury (SK)

I recently completed my final fourth year rotation in primary care in Dawson Creek, a city of about 13,000 in northern British Columbia. Like most communities in Canada, Dawson Creek is facing an increasing shortage of primary care providers, making the role of a primary care pharmacist invaluable to the community. Primary care pharmacists are a critical resource for both patients and providers. They can spend time with patients that physicians’ demanding schedules don’t allow, supporting patient education and collaborative decision making. My interaction with a recent patient underscores this point. A man with newly diagnosed atrial fibrillation was referred to the pharmacist by his physician. After a thorough explanation of the risks and benefits of anticoagulation, as well as exploration of the patient’s medication beliefs and health goals, the patient ultimately decided against starting an anticoagulant. Shared decision-making discussions are an important role for primary care pharmacists, who have both the knowledge and time to ensure patients are provided with the information required to make the best decision. In fact, we determined that the physician’s goal for referring was to convince the patient to start an anticoagulant. However, having had the opportunity to spend time with the patient, we understood his strong stance on remaining medication-free. In this way, the pharmacist was able to provide a patient-centred response. My pharmacy degree has provided me with the foundational knowledge and skills required to manage chronic diseases, answer questions with an evidence-based approach, and optimize therapy based on patients’ goals and preferences, which are key components of a primary care pharmacist role. As a soon-to-be pharmacist, I am excited to use my education to help patients thrive and to advocate for the continued integration of pharmacists into primary care teams.

Katherine Harrison (QC)