Pharmacy practice: At the tipping point?

Earlier this spring, i had the chance to go fishing on the West Coast with Norm Campbell (you know Norm—he’s a general internist and professor from the University of Calgary, the creator of the Canadian Hypertension Education Program, president of the World Hypertension League and member of the Order of Canada . . . yes, that Norm). After about 8 hours on my brother’s boat catching no fish at all (but enjoying being outdoors), Norm said to me, “You must be so excited. Pharmacists are at the tipping point of making the transition from dispensers of drugs to carers of patients. You have such good evidence for the impact of pharmacist care on patient outcomes.” At first I started to argue with him. Then, sensing that I was losing, I thought, “Maybe he’s right. Perhaps we are at the tipping point.” In his book, The Tipping Point: How Little Things Can Make a Big Difference, Malcolm Gladwell describes the tipping point as “that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”1 Or, to use a term we are more familiar with, “starts an epidemic.” So, are we at the tipping point where patient-centred care has infected us all? In an unscientific poll, I asked a number of pharmacists that question. Their answers were affirmative. Let’s look at why we are at the tipping point: The prodigious evidence base for pharmacist care in many disease areas: You have seen the evidence published here in CPJ and other places. For example, look at the hypertension evidence—it’s very compelling.2 Pharmacist uptake: Pharmacists who have made the change have certainly tipped—they cannot conceive of going back to a drug distribution‒only role. Their patients wouldn’t allow it anyway. “Everyone I talk to says they do “patient-centred care, and that’s exciting. It’s spreading like wildfire. [Now] no one’s avoiding it completely,” says Darcy Milford (Turtle Mountain Pharmacy, Blairmore, AB). “I love what my world has become . . . my outcomes are superior to anything that I could have envisioned a few years ago,” says Lonni Johnson (Winter’s Pharmacy, Drayton Valley, AB). “I’ve seen firsthand the impact that we can have on our patients’ lives and that of their families,” says Janelle Fox (Pharmasave, Bonnyville, AB). Payer recognition and payment: Payers are recognizing and paying for pharmacist care. Janelle Fox remarks that “other health care professionals and government payers/decision makers see the benefit of our impact.” “This wildfire recognition has not stopped within our borders, but we are seeing several countries in Europe, Asia and Australia starting to empower their pharmacists,” notes Murtaza Hassanali (Shoppers Drug Mart, Edmonton, AB). Patient expectation of pharmacist care: “Patients now expect it,” says Rick Siemens (London Drugs, Lethbridge, AB). Has society also reached the tipping point? If you’re not convinced, look at it this way. Think back 5 to 7 years. Would you have ever thought that pharmacists would be vaccinating? Prescribing? Managing ambulatory conditions? And getting paid for it? Janelle Fox says, “I look at how much the profession has changed and grown since [my] graduation in 2006 and even I’m amazed!” That’s a lot of change in a short period of time. Bigger changes than in the last 50 years in the profession. But there are still challenges. Some of the many issues that need to be addressed: Financial viability of patient-centred care: Clearly, with reductions in dispensing fees and the time it takes to provide patient care, the business model for pharmacy has changed. But it needs to remain financially viable. Payment to individual pharmacists: Why can’t pharmacists be paid directly for their care, rather than payments to a pharmacy (which never share those profits with the pharmacists who provide the care)? “We have failed ourselves by not differentiating between a pharmacy and a pharmacist,” says Murtaza Hassanali. Pharmacist fears: “Fears of responsibility, physicians, audits, paperwork, insurance companies, losing jobs,” notes Darcey Milford. Pharmacists need to overcome their fears. Evidence: “We need to continue to build the evidence for pharmacist care and outcomes” (Dean Carlo Marra, Memorial University of Newfoundland, St. John’s, NL). Evidence is the “high road” to change. Perhaps I am manipulating Norm by only allowing him to meet certain pharmacists and by only telling him the good stuff about pharmacists. Or perhaps he’s seeing this from outside the profession, as a physician with a public health and global health perspective? Maybe he is right. . . . Let’s start an epidemic! ■

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