Transcript Business Communication - CAPA

Physicians Assistants and Pharmacists:
Working Together
Lieutenant Commander Joe Dagenais B.Eng BSP PharmD CD
Canadian Forces Health Services
Services de santé des Forces canadiennes
Learning Objectives
1. Describe the factors that lead to Pharmacist scope of
practise changes in Canada.
2. Outline the various changes in Pharmacist scope of
practise.
3. Describe the pharmacy principle of Pharmaceutical
Care.
4. Identify practise areas/ issues where collaboration
between Physician Assistants and Pharmacists may
occur.
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Current Canadian Health Care System
Problems:
1. Accessibility (disadvantaged populations)
2. Care outside of business hours
3. Wait times
4. Non-optimized health promotion including patient
involvement and self-management
5. Appropriate use of health care providers and resources
6. Chronic care management
7. Mental health care
8. Elderly and end-of-life care
9. Questionable fiscal effectiveness and sustainability
Canadian Academy of Health Sciences, 2014
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Collaborative Care
• Multiple health workers from different professional
backgrounds provide comprehensive services by
working with patients, their families, caregivers and
communities to deliver the highest quality of care across
settings. (WHO)
– collaborative care models ensure (based on the needs of the patient):
• the right professional;
• the right setting; and
• at the right time. (CAHS 2014)
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Relationship: Models of Care and Scope of
Practice
Canadian Academy of Health Sciences, 2014
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Barriers to Collaborative Practice
Canadian Academy of Health Sciences, 2014
Canadian Forces Health Services
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Without Clear SoP
• Role confusion, competition among various HCPs,
workplace tension, lack of trust, decreased professional
identity, under/ over utilization of HCPs.
• Difficult for employers to optimize existing HR and
assemble appropriate skill mix due to unclear
understanding of education and the translation of
knowledge into actual practice.
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Health Council of Canada, 2005
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Understanding a Pharmacist’s
SOP
Ontario Pharmacy Act 1991 (2009)
Scope of Practice of pharmacy is:
a) the custody, compounding, dispensing and prescribing
of drugs;
b) the provision of health care aids and devices;
c) the provision of information and education related to the
use of anything mentioned in clauses (a) and (b); and
d) the promotion of health, prevention and treatment of
disease, disorders and dysfunctions through monitoring
and management of medication therapy.
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Pharmacist Controlled Act
1. Dispensing, selling or compounding a drug or
supervising the part of a pharmacy where drugs are kept.
2. Administering, by injection or inhalation, a substance
specified in the regulations.
3. Prescribing a drug specified in the regulations.
4. Performing a procedure on tissue below the dermis.
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Ontario Regulation 302/12
Services de santé des Forces canadiennes
Pharmacist SOP By Province
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Canadian Pharmacists Association
UNDERSTANDING HOW
PHARMACISTS THINK
Pharmacy Education
• Anatomy, physiology, pathophysiology, pharmacology,
medicinal chemistry, toxicology, pharmacokinetics
– CV, psychiatry, oncology, pain, endocrinology, neurology,
gastroenterology, bone/ joint, infectious disease, hematology,
immunology/ transplant, dermatology, ENT…
• Patient assessment
• Critical appraisal, communication, self-directed learning,
group processes
• Healthcare systems
• Nutrition
• Laboratory analysis
• Pharmacoepidemiology
• Practical Experience (Hospital/ Community)
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College of Pharmacy University of Alberta
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Pharmaceutical Care
“Pharmaceutical care is a patient-centered practice
in which the practitioner assumes responsibility for
a patient’s drug-related needs and is held
accountable for this commitment”
-Requires:
- the patient’s cooperation and coordination with the patient’s other
health care providers.
- rational decision-making process (Pharmacotherapy Workup)
- Identify drug therapy problems (current or potential)
- Develop care plan/ recommendations
- Follow-up evaluation
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
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Drug Therapy Problem
“…are undesirable events or risks experienced by the
patient that involve or are suspected to involve drug
therapy and that inhibit or delay him/ her from achieving the
desired goals of therapy.”
1.Unnecessary drug therapy
2.Needs additional drug therapy
3.Ineffective drug
4.Dosage too low
5.Dosage too high
6.Adverse drug reaction (drug/drug, drug/food, drug/test)
7.Non-adherence
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
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Pharmacotherapy Workup
Two questions:
1.Is the patient’s problem caused by drug therapy?
2.Can the patient’s problem be treated with drug therapy?
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–
–
–
Indication
Effectiveness
Safety
Adherence
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
Canadian Forces Health Services
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Pharmacotherapy Workup
Indication:
Indication
Drug Product
Dosage regimen
Outcomes
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
Canadian Forces Health Services
Services de santé des Forces canadiennes
Pharmacotherapy Workup
Indication:
Effectiveness
Indication
Drug Product
Dosage regimen
Outcomes
Safety
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
Canadian Forces Health Services
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Pharmcotherapy Workup
Effectiveness
Signs & Symptoms
Abnormal Lab Values
Labs
Goals of Therapy
Indication
Drug Product
Dosage regimen
Clinical
Effectiveness
Outcomes
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
Canadian Forces Health Services
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Pharmacotherapy Workup
Safety:
Signs & Symptoms
Abnormal Lab Values
Labs
Goals of Therapy
Indication
Drug Product
Clinical
Effectiveness
Dosage regimen
Outcomes
Toxicity
Safety
Adverse Drug Reaction
Labs
Clinical
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
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Pharmacotherapy Workup
Adherence:
“…someone who is not able or willing to take an
appropriate, effective, and safe medication as intended”
The patient:
- does not understand instructions
- prefers not to take medication
- forgets
- too expensive
- cannot swallow or self-administer
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
Canadian Forces Health Services
Services de santé des Forces canadiennes
Drug Therapy Problem
1.
2.
3.
4.
5.
6.
7.
Unnecessary drug therapy
Indication
Needs additional drug therapy
Ineffective drug
Effectiveness
Dosage too low
Dosage too high
Safety
Adverse drug reaction
Non-adherence
Adherence
 Recommendations to other healthcare providers
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide.
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Hospital or Outpatient Practices
EXAMPLES OF WHERE WE
CAN WORK TOGETHER
Collaborative Practice Examples
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Medication reviews
Medication consults
Diabetes clinics
Travel medicine
Chronic Care
Adherence issues
Smoking cessation
Academic Detailing
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Medication Reviews/ Consults
• 65 yrs or older: >5 or more medications:
– 13% private households
– 53% healthcare institutions
• 87% of pharmacist recommendations accepted
• Reviews:
– Present and past therapies
• drug, dose, frequency, duration, efficacy/ side effects
– Patient’s expectations from drug therapy
– Recommendations provided
• Deliverable: consult note
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Services
de santé
des20,
Forces
Health
Reports,
Vol.
no. canadiennes
1, March 2009 • Statistics Canada
Travel Medicine
• Collaborative practice
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–
–
–
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Physician
PA
NP
RN
Pharmacist
• Preventative medication
– Immunizations
– Anti-malaria medications
– Information/ Education
• With/ without collaborative prescribing agreement
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Complete appropriate form for Personal Travel or Deployment Travel. Attach form in email to:
+Travel Medicine@CF H Svcs C (A) Halifax
Immunization nurse will contact you to book appointment.
Present for booked appointment with immunization nurse in office 4054 of Bldg S80 clinic (bring your
immunization book). Necessary vaccines will be administered, and prescriptions (e.g. antimalarials) provided to
present to pharmacy to be filled.
For personal travel, immunization nurse will provide you
with traveler health advice
For deployment, you will meet with PMED
for:
•
•
•
Mission specific brief
Force Health Protection Recommendations
Clothing dip if required
See CDU clerk: QL 6A Med Tech, PA or MO can confirm medical fitness for deployment.
If necessary, book appointment with your doctor.
If you take chronic medications, ensure you obtain a prescription to bring
to pharmacy to fill a deployment supply of your medications
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Chronic Care
• Diabetes
– A1C (-2.1% vs -0.9%, P = .03)
• HTN
– SBP (-9.3 mm Hg)
• CV
– LDL ~0.44 mmol/l reduction
• INR (physician vs pharmacist)
- 71% vs 81% of visits
- 65% vs 73% time in therapeutic range
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Diabetes Clinic
• Collaborative Practice:
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Sponsoring physician
Nurse/ PA
Dietician
Pharmacist
•
•
•
•
Certified Diabetes Educator
Interpret lab tests
Provide recommendations on initiating and altering DM drug therapy
Advances in DM drug therapy
• With/ without collaborative prescribing agreement
(delegated acts)
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Adherence
• Financial
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–
–
–
Drug plan assistance
Cheaper drug or dose
De-prescribing
Dispensing fees
• Frequency
• Formulation (taste, size)
• Patient education
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Smoking Cessation
• Pharmacist: RR 0.77 compared to advice to quit
• Behavioral counseling
• Medication education/ Prescribing
– NRT
– Bupropion
– Varenicline
• Prescribing
• Follow-up
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Conclusions
• Pharmacists are more than simply dispensers.
• Evidence shows our involvement in collaborative teams
leads to improved patient care.
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Questions?
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References
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Nelson S, Turnbull J, Bainbridge L, et al. (2014) Optimizing Scopes of Practice: New Models for a New Health
Care System. Canadian Academy of Health Sciences. Ottawa, Ontario.
Baranek PM. (2005) A Review of Scopes of Practice of Health Professions in Canada: A Balancing Act. Health
Council of Canada. Toronto. Ontario.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: the clinician’s guide. 2004
Maxwell-Alleyne A, Farber A. Pharmacists’ Expanded Scope of Practice: Professional obligations for physicians
and pharmacists working collaboratively. Ontario Medical Review. Apr 2013; 17-19.
Tannenbaum C, Tsuyuki T. The Expanding Scope of Pharmacists’ practice: implications for physicians. CMAJ
2013;
Young S, Bishop L, et al. Comparison of pharmacist managed anticoagulation with usual medical care in a family
medicine clinic. BMC Family Practice 2011, 12:88
Garton L, Crosby J. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with
physician management using international normalized ratio stability. J Thromb Thrombolysis (2011) 32:426–430
Kennedy A, Chen H, et al. Improving Population Managemet through Pharmacist-Primary Care Integration: A Pilot
Study.
Carter B, Rogers M, et al. The potency of team-based care interventions for hypertention: A meta-analysis. Arch
Intern Med. 2009;169(19):1748-1755
Santschi V, Chiolero A, et al. Impact of Pharmacist Care in the Management of Cardiovascular Disease Risk
Factors.Arch Intern Med. 2011; 171(16):1441-1453.
Choe HM, Mitrovich S, et al. Proactive case management by a clinical pharmacist: a randomized controlled trial.
Am J Manag Care. 2005;11:253-260
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