Marc Kealey Online

Imagine your child has asthma and needs careful instruction on using an inhaler. Your aging parent needs guidance managing multiple medications. You are a diabetic seeking advice on drugs or medical devices, or a smoker ready to adopt a cessation program.

Now imagine those services available, easily and conveniently, from a familiar health care provider right in your neighbourhood – a trusted professional you already see dozens of time a year.

Ready? It’s your pharmacist.

A breakthrough new role for the pharmacist in health care delivery is one of the transformative changes to Ontario’s drug system introduced recently by the McGuinty government, targeted to take effect this fall. It’s the initiative that stands to touch the lives of more Ontarians most often – and the one with the greatest promise to improve the efficiency of health care delivery, lessen primary care costs and reduce wait times.

Pharmacists stand ready to work with the government and take on their new role. But while the province’s plan to pay pharmacists for providing direct patient care services is laudable, other changes proposed in the Transparent Drug System for Patients Act could threaten the sustainability of community pharmacy. Pharmacists are prepared to counsel patients – but if the viability of their pharmacy businesses is undercut by other measures, they could be doing so on the province’s street corners.

Keying on pharmacists as appropriate providers of front-line health care is a wise move by the government. It’s built not only on the training, skills and capacities of the profession, but on public understanding, acceptance and demand.

Just over a year ago, a Decima survey showed Ontarians overwhelming trust their pharmacists, understand the importance of consulting them with questions about prescription and over-the-counter medications, appreciate the pharmacists’ role in ensuring patients take medication properly and avoid drug interactions, and recognize that pharmacists’ expertise assists them to avoid illness or hospitalization.

Across Ontario, pharmacists continue to earn and strengthen that trust and understanding. Every day, 10,000 pharmacists have 1.6 million interactions with patients in the province’s community pharmacies, hospitals, long-term care facilities, and clinics.

The pharmacist-patient relationship is ubiquitous and powerful. The value of this crucial piece in health care delivery is at last being recognized – and strategically leveraged by the province as it asks pharmacists to do more by providing professional services that go well beyond dispensing.

When a patient consults with a pharmacist – acting on the knowledge that an issue or question about managing a chronic disease, taking multiple medications without harmful interactions, or adhering to a prescribed drug program can be handled efficiently, authoritatively and professionally by that health care provider – pressures on many other points in the health care system can be eased. A patient whose needs are met by a pharmacist is one less person in a physician’s waiting room, a crowded emergency ward or a high-demand clinic.

Equally important, the province promises to institute long-awaited new opportunities for pharmacists to be integrated into primary care models such as Family Health Teams. Working more closely and with greater connectedness with other health care providers will bring pharmacists closer to patients, streamline and localize the delivery of services, and minimize delays and duplication.

To enable pharmacists to provide these professional services, the province will provide compensation to them. It has agreed to set up a new Pharmacy Council to permit appropriate fees to be negotiated. Pharmacists will seek a fee schedule that fairly reflects the value of the services they provide, and the savings their work brings to the province’s health care costs.

In addition, the province proposes to increase the dispensing fee paid to pharmacists for filling prescriptions. An increase of $4 is suggested – a level that reflects today’s costs of distributing and dispensing drugs.

But in spite of these positive steps toward compensating pharmacists for their valuable work, other changes in the province’s new drug scheme represent potential threats to the well-being of community pharmacy. In particular, ending the payment of rebates and incentives to pharmacists by generic drug companies may not be counterbalanced by the new sources of income.

To date, the province has been vague in detailing the financial impact of all its changes on the sustainability of pharmacy enterprises. This has sparked concerns among some pharmacists that when all the new changes are taken into account, their business models will no longer be workable. For some pharmacies – especially in rural and remote communities where the pharmacist may be the only health care provider – staying in business may not be an option.

The image looms large of a pharmacist, ready to make a much-needed contribution to the transformation of health care in Ontario, ready to counsel appreciative patients, but unable to financially support the pharmacy enterprise within which these services can best be provided.

Ontario pharmacists are ready for change. They look forward to working with the government to bring it forward successfully. Addressing their concerns about the sustainability of pharmacy is the key to making it happen, for the benefit of pharmacists, patients and the health care system we all value.