1. PPF- Atlantic Summit on Healthcare and Drug Cost Sustainability Perry Eisenschmid CEO, Canadian Pharmacists Association October 30, 2014

2. Challenge

3. Opportunity

4. Enigma 

5. Help from Pharmacists

6. Obstacles

7. Success Factors

8. Introduction  Healthcare in Canada at a crossroad  The role of pharmacists  The benefits of pharmacists being involved in managing chronic disease  What is holding pharmacy back?

9. Status of Health Care in Canada  16 million Canadians live with chronic disease  Indirect costs alone - $122 billion in 2010  PHAC – 58% of annual spending is for chronic diseases

10.  15% of Canadians do not have a family physician  61% of Canadians do not receive preventative care reminders  Canada is ranked LAST out of 11 countries on how readily patients can get an appointment with their regular family physician  RESULT: more Canadians in emergency rooms instead of being managed in the primary care sector Managing Chronic Disease

11. Leveraging Accessibility  The 9000 Points of Care Report highlighting how better use of pharmacists could impact our healthcare system:  1.3 million ER visits and 500,000 hospitalizations could be prevented  6.3 million hours of physician time freed up over 3 years  $7-9 billion can be saved through improved access and use of cost-effective medications

12. Pharmacists Scope of Practice in Canada

13. Health Care Innovation Working Group  Enhanced use of pharmacists  Minor Ailments  Medication Reviews  Immunization  Chronic Disease Management

14. The Role of Pharmacists  Prevention and Screening Services  High Cholesterol (in pharmacy testing)  Diabetes- in pharmacy A1C testing  High Blood Pressure-in pharmacy monitoring and follow-up

15. The Role of Pharmacists  Immunization Services  Monitoring important disease markers  Initiate, modify and monitor drug therapy

16. The Role of Pharmacists  Performing Comprehensive Medication Reviews  Patient assessment  Appropriateness, effectiveness, safety and convenience  Drug therapy problems  Care planning  Collaborating and communicating with HCP  Evaluating, documenting and following up

17. Is There Evidence for the Effectiveness of Pharmacists?  Recent research article in CMAJ:  hypertension management by pharmacists was superior to the usual care provided by physicians and nurse practitioners. (Ross Tsuyuki et al)  Numerous studies are available that demonstrate that pharmacists management of chronic disease are cost effective and produce positive patient outcomes

18. Value for Services Toolkit  Wellness services  Medication reviews  Minor Ailments  Prescription-related services  Comprehensive medication management

19. What is holding pharmacy back?  Fee for dispensing main source of revenue for pharmacists  Reimbursement mechanisms are short-term focused and not linked to outcomes  Payment for non-dispensing services  Public and private drug plans

20. Moving Forward  Pharmacists as a primary care provider  Formal referral system  Multi-sectoral discussions need to continue, that incorporate interests of patients, health care providers and employees