Abstract
Dr. Derek Jorgenson's session on the State of Primary Health Care in Canada was a call to action for Canadian pharmacists.
In this compelling session, Dr. Jorgenson, a clinical pharmacist with West Winds Health Centre in Saskatoon and coordinator of clinical pharmacy services at the Saskatoon Health Region, said pharmacists have been enjoying a decade of prosperity because of their high earning potential and great job opportunities. But the flip side of this reality is that there is complacency in the profession, and patients are suffering because of a medication management crisis in the primary health care system.
“Do any of you feel guilty about this decade-long period of prosperity?” Dr. Jorgenson asked delegates. “The people we care for haven't been experiencing this same period of prosperity.”
Using a study published in Pharmacotherapy in 2006 that reviewed 565 consecutive adult admissions over a 12-week period to a Canadian hospital, Dr. Jorgenson showed that medication mismanagement is a serious reality, with 24.1% of all admissions being drug-related, 72.1% of drug-related admissions being preventable, and 80% of drug-related admissions being of moderate severity. “This is completely unacceptable,” Dr. Jorgenson commented. “How did things get this bad?”
And while he said that pharmacists can't assume all the blame for this crisis, they can't be complacent about it either. “We have to stand up and take responsibility and fix this problem.” The dilemma, Dr. Jorgenson added, is that pharmacists are still working within a system designed for a profession that dispenses and compounds.
Resources
Samoy LJ, Zed PJ, Wilbur KW, et al. Drug-related hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy 2006;26:1658–86.
Semchuk W, Taylor J, Sulz L, et al. Pharmacist intervention in risk reduction study: high-risk cardiac patients. CPJ 2007;140:32–37.
Blueprint for Pharmacy, Draft 4.2. Ottawa, ON: Canadian Pharmacists Association; 2007. Available: www.pharmacists.ca/content/about_cpha/whats_happening/cpha_in_action/blueprint_consult.cfm
It is this system that needs to evolve to a point at which pharmacists spend more time providing care and less time providing product. Dr. Jorgenson said that even though the strength of pharmacists lies in their accessibility to patients, pharmacy practice hasn't evolved beyond this.
“It's fascinating how little has changed,” Dr. Jorgenson said. “One hundred years later we are trained to provide care, but we're still working in the same infrastructure of 100 years ago — of being a dispenser.”
According to Dr. Jorgenson, there are 4 pharmacy practice models in primary care. These include pharmacists providing primary health care within the community pharmacy, managing clinics, working as consultants to primary health clinics or family medicine practices, and working within interdisciplinary primary care teams. Dr. Jorgenson says that about 99% of pharmacists are still working within the first of these 4 models. He showed that these practice models are very effective, though, citing the “Pharmacist Intervention in Risk Reduction study: High-risk cardiac patients,” published in the Canadian Pharmacists Journal earlier this year. This study showed that pharmacists working with physicians had a significant role in improving the therapy of high-risk vascular patients. “The PIRR trial published in CPJ proves these models work,” Dr. Jorgenson said.
To further emphasize his point that these practice models need to be fully adopted, Dr. Jorgenson said that, while pharmacists continue to work mainly dispensing product, the expanded role of regulated pharmacy technicians is also becoming a reality — as is centralized dispensing of chronic medications, virtual pharmacists, telepharmacy, and prescription vending machines.
“There will be little need for dispensing pharmacists in the future,” Dr. Jorgenson insisted. “This is the bottom line, and we must transition to providing patient care.”