Transcript Pharmacists contribute to the health care system by

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By Louise
Louise Cooney
Cooney
• Medication administration, maximize benefits, minimize
adverse effects, and drug interactions
• Primary role is to ensure that medications are taken
effectively and appropriately
• Can recommend an over-the-counter (OTC) product for pain
relief, demonstrate the proper use of an asthma inhaler, and
help patients manage their diabetes.
• Advise on medication storage, missed doses, and what foods
or activities to avoid.
Pharmacists contribute to the health care system by:
• Compounding, preparing and dispensing drugs
• Medication histories and maintaining patient drug
profiles
• Safety counselling to patients and caregivers
• Making recommendations to prescribers and other
health care professionals for adjustments to patients’
drug therapies
• Providing non-prescription drugs,
natural health products, prenatal
products, health care aids and
devices
• Managing minor illnesses
• Providing referrals and advice on
health promotion and wellness
• Home visits
• Educating and supporting patients and caregivers
about home administration of IV drugs
• Education on self-management of diseases
• Hosting disease management and immunization
clinics
• Palliative care to improve symptom control
• Monitoring and adjusting doses of drugs such as
blood thinners (anticoagulants) and cholesterollowering medications
• Expanded role for pharmacists
• Certain provinces have approved pharmacist
prescribing with varying scopes of authority
– Not meant to replace physician care
• Expanded roles for pharmacists:
1. Prescribing OTC drugs to treat minor, self-diagnosed
disease conditions such as a rash, a cough or diarrhea
2. Start, adjust, continue or discontinue a medication in
collaboration with a doctor thus increasing time efficiency
for physicians
• Neighbourhood pharmacies, clinics, supermarkets,
chain pharmacies and department stores.
• Requires both professional capability and business
management skills
• Requires broad range of medication knowledge
including prescribing and non-prescribing products
• Offer additional professional services such as surgical,
home care and athletic supplies, and self-diagnostic
machines and kits.
• Also practice on primary health care teams, in longterm personal care homes, or specialize in such areas
as geriatric pharmacy.
• Work in specialize fields such as oncology, cardiology, psychiatry,
dialysis, infectious disease, critical care, paediatrics and
geriatrics.
• Working with the hospital team
• Monitoring/evaluating patients’ drug therapy while in the
hospital
• Counselling patients about their medication before discharge
• Educating physicians and other health care workers
• Overseeing the selection, purchase and distribution of drugs
used in the hospital
• Ensuring safe and efficient distribution of drugs
• Development of best practice protocols
• Work with researchers to develop,
manufacture, & market prescription & nonprescription meds
• Provide quality control
• Act as liaison with government, or provide
drug information, technical correspondence or
educational materials to the public and health
care professionals
• May also work as pharmaceutical sales
representatives.
• Employed in the federal and provincial
governments
• Monitor the distribution of scheduled drugs
(poisons, narcotics)
• Administer various drug plans and health care
programs; develop pharmaceutical policy, or
work in a laboratory.
• The armed forces also employ pharmacists in
military health care facilities in Canada and
overseas.
• Many work at Canadian universities in the
areas of teaching and research, or in health
advocacy and professional organizations.
• Also work for the provincial licensing and
regulatory organizations responsible for
ensuring that pharmacists practice according
to the provincial laws and regulations.
• There are approximately 31,000 pharmacists
in Canada working in 8,394 licensed
pharmacies.
• In 2007, pharmacists filled 422.6 billion retail
prescriptions costing $20.7 million
• Bachelor of Science in Pharmacy: 4 year program (preceded by at least a year
in science)
– Biomedical sciences (anatomy, histology, biochemistry, specific diseases and disorders, health issues,
organic chemistry, microbiology, pharmacology, physiology)
– Pharmaceutical sciences (bio pharmaceutics, pharmacokinetics, medicinal chemistry, drug
metabolism, toxicology, pharmaceutics)
– Therapeutics
– Pharmacoepidemiology
– Pharmacoeconomics
– Pharmaceutical care
– Statistics
– Communication and interprofessional relations
– Law and ethics
– Social and administrative pharmacy issues
– Role of pharmacy in the health care system
• Masters or Doctorate in Pharmacy: usually go into research or teaching
• Ten Canadian universities offer degrees in pharmacy.
• Pharmacists are licensed and regulated by Pharmacy
Regulatory Authority (PRA)
• Must have provincial accreditation
• Licensing:
– Hold a degree in pharmacy from a Canadian university
(or the recognized equivalent)
– Successfully have passed a national board exam by the
Pharmacy Examining Board of Canada (PEBC)
• have practical experience through an
apprenticeship/internship program
– Fill language requirements related to fluency in English
or French
– Meet all licensing requirements and renew license
annually
The approval process and distribution
of medications
• Drugs are the fastest growing component of
health care in Canada and have had a huge
impact on improving the health of Canadians.
• Approximately 22,000 drug products are on the
market today.
• In 2006, pharmacists filled 422 million retail Rxs
• Drugs are now the second largest healthspending category after hospitals
– Forecast to make up 17% ($25 billion) of total health
expenditures in 2006, compared to 13% ($10 billion)
10 years ago.
Health Canada Review
• All drugs sold in Canada (both manufactured &
imported) must be authorized by Health Canada.
• About 4,400 drug submissions are made to
Health Canada each year but only about 80 are
for new drugs.
• A Priority Review Process for life threatening or
severely debilitating conditions (e.g., cancer,
AIDS, Parkinson’s disease) when there is no
effective drug on the Canadian market.
Special Access Program (SAP)
• Access to drugs not currently available in
Canada for conditions with serious or life
threatening
• Conditions where conventional therapies have
failed, are unavailable or not suitable.
• Pharmaceutical companies have the right to
decide whether, and under what conditions, to
provide the drug to the patient
Controlled Drugs & Substances
• Drug Strategy & Controlled Substance
Program (DSCP)
– Controlled Drugs & Substances Act (1997)
– Controls import, export, distribution and
possession of narcotics & controlled
substances
Drug Scheduling
• National Canadian drug scheduling model
ensure consistent conditions of sale across the
country.
• National Drug Scheduling Advisory Committee
(NDSAC) responsible for provincial scheduling.
• Determining factors for scheduling:
– Potential for dependency, adverse reactions,
interaction, etc.
4 Canadian scheduling categories:
• Schedule I — available only by prescription
and provided by a pharmacist
• Schedule II — available only from a
pharmacist; must be retained in an area with
no public access
• Schedule III — available via open access in a
• pharmacy (over-the-counter)
• Unscheduled — can be sold in any store
without professional supervision
Distribution
• Community pharmacies:
– Purchase either from the manufacturer
itself or from drug wholesalers
• Hospital pharmacies:
– Generally use group-purchasing
organizations to buy drugs at negotiated
rates.
Price Review
• Patented Drugs: The Patented Medicine Prices
Review Board (PMPRB) regulates the prices
• Operates under the Patent Act and is
independent of Health Canada.
• Patentees are required to file price and sales
information twice a year for each dosage
strength form of all patented medicine.
• PMPRB has right to reduce excessive prices
• PMPRB collects comparative price data from
the U.S. and six European countries.
Listing on Provincial Formularies
• Individualized provincial drug plan for
reimbursement
• Public drug plans account for 45% of
expenditures on Rx drugs.
• Drug accessibility varies widely between the
provinces,
• Some drugs receive a restricted listing if
special monitoring is required or their cost is
high.
Common Drug Review
• The Common Drug Review (CDR) (2002)
– A rigorous process for reviewing and recommending new, approved
drugs for listing on F/P/T formularies.
– Consists of an appraisal of the best clinical evidence and a listing
recommendation from the Canadian Expert Drug Advisory Committee
(CEDAC).
• The drug plans continue to make the final formulary listing
decision.
• A target timeframe of 20-26 weeks has been set for the
review process.
• Private drug plans have access to the recommendations when
making their own listing decisions.
Manitoba Pharmacare Program
• Provides drug cost assistance to eligible
Manitobans who do not have coverage
under a federal or other provincial
program.
• Is income based
– Deductible is calculated based on the total
adjusted family income
DPIN
• DPIN (Drug Programs Information NETWORK) – started
in 1994
• A database containing prescription drugs and it connects
Manitoba Health and all pharmacies in Manitoba to a
central database maintained by Manitoba Health.
• Uses:
– Information about pharmaceutical dispensations,
– Prescriptions identified as potential drug utilization problem,
non-adjudicated claims, and ancillary programs and non-drug
products is captured in real time for all Manitoba residents
(including Registered First Nations), regardless of insurance
coverage or final payer.
• DPIN facilitates payment administration for
eligible drug costs, incorporating functions
such as real-time adjudication, and collects
high-quality data on all prescriptions issued to
Manitobans
• The DPIN system also checks each prescription
against drug history to help protect
Manitobans from adverse drug interactions
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