Tuesday, May 24, 2011

Cutbacks may jeopardize safety

I would have to complete over 150 med reviews per month to make up for revenues lost due to government cutbacks.

Sue had been taking Cymbalta for fibromyalgia when she became acutely aware of an oft-forgotten ill-effect while visiting Paris. Contemplating the magnificent Eiffel tower as though it were a mere “peanut butter sandwich” (not her favourite), she realized something had gone askew.

“I would rather feel the pain than a lack of feeling,” she told me. “Will you help me wean off this dreadful thing?”

So I did some sleuthing, whilst looking at all of Sue’s meds, and had her come in for a chat thus meeting the requirements of a med review, and billing tax-payers $60. Next, I proceeded to get a new prescription for the half-strength capsules, billing the $70 consultation fee with the aim of eventually stopping the mood-blunting-culprit completely, and I intend to do a follow-up in a month for a $15 fee.

Instead of adding to our work load, would it not be much simpler to just compensate us for what we already do?

It is ironic that I completed my very first med review and consultation—according to the new B.C. government requirements—on the eve of the damning Vancouver Sun article pointing out that Canadians pay top dollars for generics, with B.C. taking the hit.

Yes, UBC researchers say that if the rest of Canada followed Ontario’s model for generic drug pricing, we could save nearly $1.3 billion a year. But the study does not take into account new money some provinces are giving pharmacies to help compensate for services like patient consultations and medication reviews. In fact, it only serves to reinforce in people’s minds the idea that pharmacists work for free.

In all I spent about half an hour—between dispensing—doing some research, phoning up the drug company and printing out interesting reading material for my patient on what to expect upon Cymbalta withdrawal.

Loss of Cymbalta sales aside, my first med review and consultation has been a most rewarding experience, as helping others always is. But from a business perspective, my mind is blown away by the impossible number of med reviews (over 150 per month) that would go to make up for lost yearly revenues due to government cutbacks.

And while I can understand the need to separate our professional allowances from product reimbursements, I am afraid that the need to candy-wrap what most of us have already been doing on a daily basis in order to justify billing, may be leading to inadequate compensation. Ultimately, pharmacists are being asked to do more (in paper-work requirements) for less, and patients are still under the illusion that the most readily accessible professional lives on air alone.

This is perhaps why some pharmacists will be tempted to cheat the system, a maddening phenomenon that I suspected could happen but did not expect to encounter so soon…

A few days after my med review, I was filling a prescription for a new patient when I noticed that her profile included a recent med review allegedly performed at another pharmacy. Curious about how she had found the whole process, and eager to compare this with my own experience, I asked how the med review had been, only to meet with a blank stare.

“What’s that?” the woman asked—no, she is not on Aricept.

“You mean the pharmacist did not sit you down last month to go through all your medications with you …?” I queried in disbelief.

The woman looked at me in alarm afraid she had been billed for something she had not asked for… “ Well no… the pharmacist did nothing different than what she always does…

While not excusing the pharmacist, I can totally understand why someone might be tempted to bill without sitting the patient down for 20 minutes. Yet her unethical demeanor is highly detrimental to the profession and very unfair for those of us who are trying to do things right. Ultimately, abuse of this sort could result in the government pulling back its offer.

But there may be another alternative.

Instead of adding to our work load, would it not be much simpler for the government, private insurers and private payers to just compensate us for what we already do?

Being fully aware that it is not I who will be paid, but the business, I should still be able to bill every time I counsel a patient on a new prescription, every time I phone a doctor to clarify a dosage or to change an order. I should bill, as my doctor does, for every telephone consultation and not just for sit-down med reviews. I should be paid (the business compensated) fairly for every justifiable refusal to fill, and not only when the patient is a Pharmacare subscriber.

True, in B.C. we are currently reimbursed for adaptations and renewals, but adaptation requires lengthy documentation. Also, some physicians are instructing us not to adapt.

And so, until both the government and the public can better appreciate all the hidden work that we do to improve health outcomes, all walk-ins with queries shall be escorted to the Consultation Room. Phone callers will be asked to make appointments.

Yes, patients’ best interests must always come first. But if business is stressed and pharmacists overworked, patient safety will be jeopardized and the interests of no one at all will be served.

Written for the Canadian Healthcare Network under the title "My first paid med review: Professionally satisfying, financially unjustified" on May 24 2011.

Thursday, December 09, 2010

Pharmacy Profession changing by Force?

Pharmacists deserve a more democratic governing model.Written by Cristina Alarcon on November 3, 2010 for CanadianHealthcareNetwork.ca

I hope Manitoba pharmacists realize just how lucky they are. Their Governing Body, The Manitoba Pharmaceutical Association, is one of a kind, a pearl to be prized…

As reported for Drugstore Canada by Judy Waytiuk, Manitoba pharmacists are one of the only Canadian health professions with individual voting authority over their practice regulations. This is unlike the rest of Canada, where the regulatory body consults on, sets and implements practice changes.

And so, lucky Manitoba pharmacists get to voice their concerns on important issues ranging from technicians’ scope of practice, to prescribing authority, to a position on inducements.

Input is not merely advisory in nature, and pharmacists get the respect they deserve…

True, the Manitoban-democratic-approach can potentially slow down and—to the horror of policy drafters—squash brilliant initiatives. But pondered delay is not only salutary, it is essential.

Sure, asking for full membership participation in proposed regulatory changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.
Never is this truer than when clouds loom dark on the horizon, something not uncommon in British Columbia… where, in fact, an event of unprecedented importance took place this year….

Welcome to Vancouver EGM 2010
At the petition of 500 community pharmacists, an Extraordinary General Meeting (EGM) was convoked by the College of Pharmacists of British Columbia and held in Vancouver on July 13, 2010. Over 160 pharmacists from across the province took great pains to be present in order to voice their concerns over regulatory changes that will make technicians a new class of College registrant, authorizing them to perform final prescription checks and take verbal orders from physicians.

Highlighting this event was the resignation of Board members Doug Kipp and Bev Harris, who courageously stepped down—later to be re-elected in landslide wins—so they could speak out freely against College policy changes, bypassing a newly reinforced rule requiring all Board members to “Speak with One Voice” .

Later, the tidy Board-approved minutes would fail to capture the lively exchange that transpired on that historical July evening when over 160 pharmacists took the College to task, leaving those who were there with a taste of Orwellian Double-Speak…

There, a resolution was presented calling on the Board to “reconsider its decision to establish the profession of Regulated Pharmacy Technicians for community pharmacy”. It was supported and passed by an overwhelming majority.

Attendees were reminded, lest they forget, that due to the College’s overriding mandate to protect the public the vote would be only advisory in nature. However, they added, results would be given “due consideration” at the next regularly scheduled Board meeting in September. Pharmacists did not hold their breath.

Come September…
On August 1st, just weeks after the EGM and over a month before the much-awaited September Board meeting, Ministerial approval of revised HPA Bylaws (inclusive of regulated pharmacy technicians) came into force. The changes will allow the College to bulldoze ahead in the New Year as planned, leaving pharmacists with the impression that “due consideration” of their resolution had never really been intended at all.

Having previously resigned her position, Bev Harris attended the September 24th Board meeting as an observer. “It all took about 30 seconds,” she told me.

The BC College of Pharmacists’ Board consists of elected members and non-pharmacist government appointees. At this meeting, one non-pharmacist moved the motion that the College go ahead as planned with technician regulation. This was seconded by another government appointee. The majority voted in favour, and so, it was…

No discussion ever took place.

And so it is that, in spite of unresolved concerns, the final step in the approval process regarding the legislative authority to register pharmacy technicians as registrants of the College of Pharmacists of BC is now complete.

After only eight months of training, technicians will be allowed to perform final med checks and take verbal orders. Meanwhile, pharmacists’ concerns—ranging from liability, to employment loss, to patient safety—remain unaddressed.

In all fairness, the College has expressed the need for “further communication and support to help manage change”. However, there is something terribly wrong with a professional governing body that appears to listen but fails to act on the concerns of its registrants, seeking instead to impose change by force. Alienation is the only possible outcome.

Re-education anyone?

Sure, asking for full membership participation in proposed regulatory changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.

If anything, a more democratic governing model would ensure that our yearly dues were better spent. It would also shield the governing body against perceptions (however unfounded) of government run amok.

An ecological blind spot

There is a huge effort today to protect the physical environment from the unintended effects of human activity. We have international agreements and national policies to reduce global warming by curbing excess carbon, produced as human beings pursue their material wellbeing.
On a smaller scale, we each do our best to turn off the taps, turn down the lights, use public transport, cut down on the fumes, recycle, recycle, and definitely not flush any medicines down the sink – especially not the brain-altering or endocrine-disrupting kind. Yes, we are constantly seeking ways to reduce air and water pollution, and in Canada, the Environment Act even allows citizens to bring civil action when the government is not enforcing environmental laws.....
(to read more click on title above)

Thursday, October 21, 2010

Choice impacts Everyone!

Humans are notably inconsistent beings, which may account for the contradictory attitudes we currently see to the phenomenon of suicide. On the one hand, every effort is made to prevent people taking their own lives; there are safety barriers on bridges, crisis hotlines, suicide prevention programmes in schools. At the same time there are organised campaigns for assisted suicide and other forms of euthanasia to be sanctioned by law.

According to euthanasia advocates, we have the right to end our lives, and as autonomous individuals, each one should choose whether to live or die. There are people, it’s true, who think that autonomy and choice are too good to be wasted on just anyone. Someone commenting on a National Post blog recently insisted that “a 90 year old suffering dementia who is also blind, deaf and unable to walk is no longer a person.” The implication is that the infirm can have the time of their death chosen for them- by someone else of course.

Yet autonomy and choice do lend respectability to the pro-suicide campaign because, when not used as mere buzz words, they are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Autonomy, however, is only part of the human story. No man is an island, and, as part of the universal human family, both the way we choose to live and the way we die does have an impact on others.

To read more click on title above.......