Give us a seat at the primary care table, pharmacists ask

Barbara Sibbald

Canadian pharmacists want to be paid for providing in-depth counselling to consumers. But if they are paid for the service, typically at a rate of $90 per hour, where will the money come from?

The Canadian Pharmacists Association (CPhA) says it has some ideas about potential funding sources for its proposed “wellness program”: the public purse, private insurance and consumers' pockets.

In June, CPhA President Ron Elliott met with Roy Romanow, head of the Commission on the Future of Health Care in Canada, to discuss the program and other issues. The association is also consulting with provincial ministers of health and insurance companies.

“This is not the same as counselling involving a prescription,” Elliott told CMAJ. During the 30-to-40 minute wellness sessions, pharmacists would review medications being taken, discuss disease management and teach people to use devices such as inhalers and blood glucose meters.

In the long run, says Elliott, a pharmacist-run wellness program would save money. “If a pharmacist can help the patient understand more clearly, there will be fewer visits to the emergency room and to the physician's office. Everyone wins.”

A CPhA report presented to Human Resources Development Canada in May determined that pharmacy is evolving toward “a more clinical role that emphasizes pharmacists' knowledge of pharmacology to improve patient health outcomes, and away from simple assurance that the drug dispensed is what the doctor ordered.” It urges a “collaborative overlap” between physicians and pharmacists, arguing that this would result in better patient outcomes and lower costs.

Elliott says pharmacists are the most accessible primary health care provider and they are largely an untapped source of advice. He says the major barrier to this expanded role is the current fee structure used to compensate community pharmacists. “Patients tell us that their doctors don't have the time to explain,” says Elliott, a pharmacist in St. Thomas, Ont. “Because of this they come to see us with a shoebox full of meds they don't understand.”

He thinks the wellness program proposed by the CPhA would be most useful for people with chronic health conditions.

No studies specifically demonstrate that this type of program is needed, but Health Canada reports that 19% to 28% of hospital admissions for patients over age 50 are due to medication problems.

Several Canadian pharmacists already offer counselling services, and Elliott says some insurers cover the cost because the counselling “helps get people back to work more quickly.” In BC, women who have access to emergency contraceptive pills directly from specially certified community pharmacists pay a $25 consultation fee for professional services, in addition to the drug cost and dispensing fee. In Ontario, a new provincially funded antismoking campaign pays pharmacists for providing counselling.