EVOLVING SCOPE OF PRACTICE IN THE PHARMACY PROFESSION Nerkeza Andjelic Christina MacNeil Leila Bonakdar Dan Zhou

T OPICS C OVERED IN THE P RESENTATION I NCLUDE : Background of the Pharmacy profession Regulation of Pharmacists and Pharmacies Evolving Scope of Practice Positive & Normative Analysis Controversies voiced by other health professionals What UK pharmacists are proposing Winners & Losers Further Suggestions

E XPERTS IN DRUG THERAPY … Pharmacists Pharmacist’s practice is patient – focused.

P HARMACISTS … Have Training in …. Drug therapy How medications work Side effects of drugs Interactions between medications How to minimize side effects with drugs Delivery method to increase efficacy Perform … Compounding, preparing and dispensing of medications from a prescription Providing natural health products and non- prescription medications Taking medication history. Providing guidance and advice. Delivering convalescent aids, medical appliances and equipment.

C ANADIAN P HARMACISTS * P RACTICE IN … Community Pharmacies “retail” Hospitals Pharmaceutical Industry Regulatory & Advisory Insurance Academia Federal & Provincial Gov’t Other 22,37371% 5, % 3,87213% * Vacancy of 10% especially in rural areas

P HARMACISTS AND P HARMACIES ARE REGULATED AND LICENSED BY … Self- regulatory body - the College of Pharmacists of British Columbia The provincial government defines the College role by… Provincial Legislation: Health Professions Act (HPA – 2009) Pharmacy Operations and Drug Scheduling Act (PODSA) Framework Professional Practice (FPP) Professional Practice Policies Other pieces of legislation such as ….

P HARMACISTS AND P HARMACIES ARE REGULATED AND LICENSED BY … Federal Legislation: Food & Drugs Act and Regulations Controlled Drug and Substances Act (CDSA) Narcotic Control Regulations Benzodiazepines and Other Targeted Substance Regulations Precursor Control Regulations

P HARMACISTS AND P HARMACIES ARE REPRESENTED BY …. The Canadian Pharmacists Association (CPhA) National Association of Pharmacy Regulatory Authorities (NAPRA) Canadian Association of Chain Drug Stores (CACDS) Canadian Society of Hospital Pharmacies The International Pharmaceutical Federation The Canadian International Pharmacy Association (CIPA) Pharmacy Examining Board (PEBS) of Canada

P HARMACY T ECHNICIANS …. At this time are not in a regulated profession; pharmacists assume their liability Training and qualifications vary from “on the job” training to certificates in school or distance education Move is to regulate the profession under the College of Pharmacists Motivation is coming from the Pharmacists

P HARMACISTS ARE SEEKING AND GETTING APPROVAL TO INDEPENDENTLY … Adapt prescriptions (dose and substitutions on some medications) Renew some types of prescriptions Prescribe certain types of drugs Administer drugs by injection or inhalation Screen for the diseases, order tests, monitor Education/advice/support of patients and caregivers (home visit and palliative care)

H OW D ID THE “S COPE OF P RACTICE ” E VOLVE ? Governments created a superstructure legislation setting out uniform provisions governing all health professionals and their activities The special content required for each specific profession is by Schedules or Regulations Health professionals no longer own their skills and must obtain the right from the government to engage in risk-related activities Governments reserves the right to make future changes

N ORMATIVE A NALYSIS Economic Efficiency Increased access for people Decreased cost to taxpayer for service Increased productivity of professional workforce Increase supply of pharmacists Fairness and Equity Increased access for people Principles of natural justice observed Paternalism – Protecting the Public Information asymmetry

P OSITIVE A NALYSIS Effective lobbying by pharmacy associations & NAPRA Public … the voters

A VIDEO : Y OUR LOCAL PHARMACY

W INNERS W ITH C HANGES IN S COPE OF P RACTICE Government (Health Authorities) Decrease cost Increase healthcare efficiency Gain popularity amongst interests group

W INNERS W ITH C HANGES IN S COPE OF P RACTICE Pharmacists More power and influence 1) Prescribe medication or at least participate in drug selection 2) Involved in direct patient care Financial benefits 1) Purchase decisions 2) In the future, prescription fee?

W INNERS W ITH C HANGES IN S COPE OF P RACTICE Pharmacies Pharmaceutical Industry Both are in business to sell drugs and generate a profit

W INNERS W ITH C HANGES IN S COPE OF P RACTICE Patients More convenient to access medications Time saving Get more medication therapy information

L OSERS W ITH C HANGES IN S COPE OF P RACTICE Patients If pharmacists can prescribe independently, are patients really safe? Could pharmacists be influenced by drug companies?

L OSERS W ITH C HANGES IN S COPE OF P RACTICE Physicians Lose occupational power An ability to maintain role-task boundaries by establishing legal control over certain occupational tasks. Leader position is changing in new healthcare model.

L OSERS W ITH C HANGES IN S COPE OF P RACTICE Insurance Companies (in the short term) Well documented in UK that more claims for prescriptions and increase payments … Eventually insurance companies charge a co- payment resulting in less prescriptions and more visits to physicians (substitute) … which has effect to creates more losers …. patients, pharmacists, pharmaceutical industry and a winner.. physician

F URTHER S UGGESTIONS …. All pharmacy technicians need to be regulated before any expanded scope of practice for pharmacists can occur Being “Regulated” implies a lot of factors to safeguard the public which don’t currently exist The plan is for technicians to perform additional duties currently performed by pharmacists There should not be any “grandfathering” of existing technicians because of the substantial changes in duties

F URTHER S UGGESTIONS …. Investment, enhancement and access to medication management system The publics medication profiles need to be uploaded into a Pharmacare system for the province Physicians and pharmacists need access to a sophisticated drug management software and incentives for maintaining While waiting for e-health … drug software can add lab results and summary of health conditions and known allergies promote inter-disciplinary teamwork between physicians and pharmacists

F URTHER S UGGESTIONS …. Drugs on formularies need to be tendered and contracted nationally by the government Cannot leave drug prices up to the Pharmacies – it is a conflict of interest (It works very well in Australia and New Zealand ) Pharmacies are first businesses; their objective is to increase their profits Government oversight on how pharmacies are performing and adhering to policies

F URTHER S UGGESTIONS …. Regulations for Pharmacies & Associations 70% of pharmacies are chains … are the chains directing Canada’s health policies? Stop Internet-based pharmacies from exporting drugs Monitor ownership of pharmacies Ensure that pharmacies providing health care services does not conflict with NAFTA Prevent pharmacies from advertising and self- promotion. Physicians are not allowed Prevent pharmacy associations from including Pharmaceutical Industry as members Stop pharmacists receiving “gifts” from Industry

F URTHER S UGGESTIONS …. Governments need to get the incentives right … To encourage pharmacists to consult with physicians and not create another silo To encourage physicians to consult with other health professionals To encourage other forms of treatment To manage people medications more effectively especially the elderly To promote input and referral to drug information management systems To promote physicians to manage and monitor chronic diseases