Archive for the ‘Advocacy’ Category
Pharmacists are Canada’s most accessible health professionals.
Pharmacists are Canada’s most accessible health professionals and play an important role in promoting, maintaining and improving the health of the communities they serve. Health promotion is now firmly on Ontario’s healthcare agenda and there is both an opportunity and a need for community pharmacists to become more involved in delivering public health services.
Every day Ontario pharmacists work as advocates for health. They support self help. They are local and accessible and provide patients with important health advice. Pharmacists promote health not just by advising on the proper use of medicine but also by counseling patients in areas such as diet, sexual health, and reducing tobacco and alcohol consumption.
Health spending is increasing at a rate far greater than other provincial government spending. As the population ages and the prevalence of chronic conditions increases the growth in new diagnoses for chronic conditions such as hypertension, diabetes, and arthritis actually exceeds Ontario’s population growth. The increase in diagnoses of chronic conditions is a key driver of health spending growth in Ontario.
As front-line health care providers, Ontario pharmacists are uniquely positioned to help the Ontario government achieve its objectives to improve health outcomes and control costs in our healthcare system. By helping patients comply with treatment regimens, by providing counseling on lifestyle changes, by helping to reduce the complications associated with chronic conditions and by ensuring symptoms are properly managed, Ontario pharmacists can make a big difference in improving the health of Ontarians.
Patient health management is a health care intervention that allows patients to be more involved in managing their own health outcomes. By engaging in patient health management both public and private health insurers can commit healthcare resources to keep people well and to manage diseases and conditions in a manner that avoids the costly complications associated with chronic conditions. Effective patient health management programs contain health costs by reducing the need for other more costly health care interventions. It also helps the elderly maintain independence and keeps our aging population as healthy as possible through prevention, early detection, and proper management of symptoms.
Physicians know what needs to be done to provide appropriate care consistent with clinical practice guidelines, but often lack the tools, the resources, or the time to do it. Pharmacy-based patient health management addresses this issue with significant health care delivery advantages. Involving patients in their own health management increases the patient’s sense of ownership and control (patient centered care). Patients are able to remain healthy, active & productive members of society for longer through greater disease control. There is increased compliance and adherence to treatment and, with improved patient health outcomes health care costs are contained.
In many jurisdictions pharmacists are recognized as key members of primary care teams. In the United Kingdom, the Department of Health recently launched a program for pharmaceutical public health by publishing Choosing Health Through Pharmacy. The U.K Minister of Health describes this as “a commitment to publish a strategy for pharmaceutical public health in 2005 which will expand the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities.” In North Carolina, the City of Asheville took a proactive approach to contain its rapidly rising employee health costs by instituting a pharmacy-driven patient health management program that was so successful in improving health outcomes and containing costs that it is now being replicated in major cities across the country
Community pharmacists in Ontario are ready, willing and able to increase their involvement and contribution to public health in collaboration with government, physicians and other health professionals. Pharmacist-based patient health management can achieve better health outcomes. The results are healthier patients, and more cost-effective use of precious health care resources.
Ontario pharmacists are ready for change.
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.
Remarks from Solutions in Drug Plan Management Discussions
Here is my speech entitled “A Challenge for Innovation”, the entire document is reproduced below.
Adam Radwanski in the Globe – “Drugstores poised to become true health-care hubs”
Another interesting article by Adam Radwanski in today’s Globe and Mail.
But now Dalton McGuinty’s government is positioned to leap to the front of the pack in transforming the profession.
Not only has it empowered pharmacists to perform certain services traditionally restricted to doctors – such as giving vaccinations and prescribing some medications – but it has the chance to provide a groundbreaking incentive to take on those tasks, turning pharmacies into health-care hubs.
Before Christmas, the Ontario legislature unanimously passed Bill 179, which permits pharmacists (along with nurses and nurse practitioners) to perform services normally limited to doctors – services they have already begun to provide in other provinces, including British Columbia, Quebec, Alberta and New Brunswick.
Pharmacists have been poised to assume a leadership role in healthcare in Ontario for decades. The lure of rebates has been the single biggest reason why community pharmacists (either independent or part of a chain) have never really fully engaged in a scope of practice that would sincerely garner public trust in their role as part of the health team.
The McGuinty government has done more for the profession in the past 6 years through landmark legislation like the passage of Bill 102, which gives pharmacists the opportunity to assume a rung in the ladder of primary care through Meds Check. It also passed Bill 171 which increased the scope of practice for Pharmacist techs which has opened the door for pharmacists to assume an even greater role as Mr. Radwanski points out through the recent passage of Bill 179.
There is much more work to do. Long Term Care and Specialty Pharmacists play a vital role in the health care of patients and their issues need to be addressed. Hospital pharmacists have long been a part of primary care teams among health professionals. Moving pharmacists out of the basement of hospitals and onto floors, so to speak, has been a boon for patient care.
The opportunity exists through all the drug reform initiatives that are occurring across the country for pharmacists to rise to the occasion and fill a role that patients want for them to be a competent part of their health care team.
Adam Radwanski on Pharmacy in the Globe.
Here is a link to an interesting article written by Adam Radwanski in Sunday’s Globe and Mail.
The Truth about Cross Border Drug Importation
There was a time when Canadians thought that a free flow of goods and services between Canada and the United States was the sign of prosperity and good neighbourliness. There was a time when free trade was a battle worth fighting because some might have thought that Canada would be the net loser in a battle between the richest and most powerful nation on earth who would never yield sovereignty on trade to any country. And now, as Canadians, we face a challenge equal to the election fight in 1988 on Free Trade and that is the little understood issue of cross border re-importation of drugs from Canada to the United States.
To add perspective, in the past 10 years or so, there has been the proliferation of mail-order and internet sales of prescription medications from Canada to the United States. On the surface, this might appear to be a good way for enterprising Canadians to make good on the sale of what is widely known as ‘cheaper’ Canadian prescription medications to Americans. This occurs ostensibly because Canada’s Patented Medications Prices Review Board (PMPRB) regulates prices in this country at a level that is about fifty percent cheaper for the same patented medications in the United States. In short, the practice of selling these drugs to the United States has made some people in Canada very wealthy. And what’s wrong with that? Well plenty if you consider what the ramifications are.
The United States has a problem with its prescription drug policy. It can’t seem to fix it at home, so lawmakers in Congress and in many States across their Union are looking outside the United States to fix that problem. In the summer 2006, a piece of Legislation was introduced in the US that allowed a 90 day supply of prescription medications to be purchased by American patients and brought back to the United States without any problem. That was just the start. Recently a bi-partisan piece of Legislation was introduced in the US that will allow the bulk re-importation of prescription medications to the United States compliments of enterprising Canadian supply companies who can source the medications that Americans want at the expense of Canadian patients.
Let’s delve into this deeper. The highly regulated world prescription drug business is based on population. Canada is 2% of the world’s business, so, it is allotted a 2% quota per se on the amount of prescription medications. Consider for a moment that the United States legislation on the free flow of cheaper Canadian meds can make their way to the US through bulk re-importation and we, as Canadians, are faced with the potential for supply shortages on chronic or other meds.
If you don’t think its real, think again.. Recently supply shortages for oral contraceptives in Canada are being realized. Consider that US Internet Pharmacy Global Americana has increased its profitability to 34% based largely on imports from Canadian sources and that the fastest growing target group is no seniors as you might have suspected, but young people wanting cheaper priced pharmaceuticals – you get the picture.
Canadian pharmacy organizations are quite rightly concerned about this issue and have weighed in on this matter loudly. Our reasons are based on our obligations to our patients in Canada and, frankly, on the right thing – to ensure an adequate supply of Canadian prescription medications for Canadians.
This issue is complicated because it crosses so many policy areas – health, international trade, foreign affairs and industry.
But looking at the issue on the whole there are basically 3 areas of major concern to Canadians. They are:
- The Canadian prescription drug supply cannot withstand an all out onslaught of US patients wanting cheaper Canadian priced meds. Imagine if we, in Canada, at 33 million people went to Iowa, a State of 3 million people and said ‘ hand over your meds’? This is what we’re dealing with in the face of this new US legislation. In fact, an authoritative report out of the University of Texas at Austin recently published suggested that if this Legislation in the US was allowed to proceed, American patients could wipe out Canada’s drug supply in 38 days. Think about that for a moment – in one month our quota would be gone. That’s not a trade issue that’s outright lack of respect for our system,
- The proliferation of greed – counterfeit medications have increased as a direct result of this practice. In fact, in a recent crackdown in the United States, lawmakers seized a shipment of meds at the border at Detroit and uncovered 19 million dollars worth of counterfeit meds. That meant that several million Americans would not be receiving counterfeit meds and as a consequence lost millions of dollars in this scheme. The very real threat continues with much of the ‘booty’ going to nefarious organized crime elements in off shore locations.
- In much of our advocacy efforts, we have concurred with Giuliani Partners who in 2005 readily opined that if the practice of wholesale bulk importation was allowed to proliferate a new threat could emerge and that would be through terrorism via this re-importation scheme. Today it’s counterfeit drugs from crime gangs in off-shore locations – tomorrow it may be anthrax or cyanide from a terrorist element. Think about that for a moment.
We have brought our concerns to several State legislatures and Congress. We continue to fight this issue back home plying pressure on the federal government to move legislation of its own that will ban the practice of internet pharmacies selling to US patients and to ban outright any attempt to bulk importation. We have met recently with the federal Minister of Health, Tony Clement who has informed us that this issue is a high priority for him. In the meantime, we are taking our fight right to Washington with visits there in the coming weeks. Our goal is to protect the interests of Canadians patients and ensure that our supply and our system remains intact and Canadian.
U.S. Expert’s perspective on bulk export of Canadian Prescription Drugs
In response to the growing concerns over the cross-border prescription drug trade, an event was hosted at the National Press Club where Dr. Marv Shepherd, an expert on the importation of drugs from the University of Texas, spoke to a Canadian audience about the negative impact of drug exports to the US.
We have been voicing concerns for the past two years about the detrimental impact of the spread of cross-border trade in prescription drugs, and more specifically drug re-importation into the United States via Internet pharmacies.
“Our message to the government of Canada is to move quickly to ban all export of prescription drugs, said Marc Kealey. “This will in effect eliminate the potential risk to the Canadian supply of prescription drugs, and as importantly, eliminate the potential risk on patient safety due to the unregulated internet pharmacy trade.”
Prescription drugs are a highly political issue in the U.S. because of their high prices and cases of Americans going across the border to Canada for treatment or to buy drugs have been growing.
One of the biggest problems associated with importation is people never know exactly where the drugs are coming from. There is no guarantee that imported drugs are safe. Just because there is a Canadian flag on the website, doesn’t mean that the source of the drug is from Canada. Therein lies the problem for Americans – who may not be certain that the drugs they receive via Internet Pharmacy may be real.
A country with 33 million citizens should not be supplying the prescription needs of a country with 280 million,” said Kealey. “Raiding Canada’s medicine cabinet will not solve health care problems in the U.S.”
This has been the ongoing message that Marc Kealey has delivered to media and to stakeholders across the country and in several states in the United States, including Texas, Maine, Florida, Rhode Island, Michigan, Illinois, Nevada and Vermont.
Remarks from 5th Annual Health Policy Summit
Here is my speech entitled “Cross-border Prescriptions and the Impact on Canadian Health Care“, the entire document is reproduced below.
