{"id":1050,"date":"2012-01-31T23:47:51","date_gmt":"2012-02-01T07:47:51","guid":{"rendered":"https:\/\/blogs.ubc.ca\/phar330\/?p=1050"},"modified":"2012-01-31T23:48:21","modified_gmt":"2012-02-01T07:48:21","slug":"pharmacists-have-no-place-in-a-dispensary-2","status":"publish","type":"post","link":"https:\/\/blogs.ubc.ca\/phar330\/2012\/01\/31\/pharmacists-have-no-place-in-a-dispensary-2\/","title":{"rendered":"Pharmacists have no place in a dispensary."},"content":{"rendered":"

Pharmacists have no place in a dispensary. Period.<\/strong><\/p>\n

 <\/p>\n

History of the Profession:<\/strong><\/p>\n

In the past, pharmacists were masters of their domain, they would prepare compounds from scratch, double check their own work, and frequently owned their own businesses.\u00a0 Like many other industries however, in recent decades the profession has changed.\u00a0 As new diseases are discovered,\u00a0 old diseases are better understood, the number of drugs available to treat these have steadily increased.\u00a0 With this increased understanding, and increased availability of drugs, the number of individuals with regular or recurring prescription drugs has drastically increased.\u00a0 This has demanded increases in efficiency and scale of dispensaries in communities.\u00a0 This is not uncommon, the streamlining of professions like pharmacy is akin to the implementation of machines in factories to increase productivity.\u00a0 It only stands to reason then, that as the sheer volume of prescriptions that are written increases, the community pharmacy industry will find ways to improve efficiencies.<\/p>\n

 <\/p>\n

What Pharmacists do (Currently):<\/strong><\/p>\n

As it currently stands, community pharmacists have 3 main roles in pharmacy. The first is assessing the appropriateness of therapy for an individual, this cognitive work is unique to our profession, and because of our specialization in training, we are, bar none, the most proficient profession at doing this. Secondly, is counselling the patient on the medication, this is also a unique skill that only pharmacists can perform, as we receive more training and education on doing this than any other profession. Thirdly, is we physically check prescriptions, ensuring that from point of entry, to point of sale, the drug that was prescribed is in the correct bottle, and goes to the correct patient.\u00a0 This portion of our job can be done by anyone who can read a doctor\u2019s writing, and who has enough visual acuity to compare tablets in a stock bottle to those in the dispensed bottle.\u00a0 Pharmacists are no better trained to do this than any technician.\u00a0 Depending on the pharmacy, the third role of pharmacists can easily take up the majority of the pharmacists time, with the time dedicated to assessing therapy and counselling being severely limited.\u00a0 Consider the following: the vast majority of community pharmacies are owned by large corporations, with the minority being privately owned stores.\u00a0 The current business model for community pharmacies is based on the volume of prescriptions dispensed, and not the quality of care.\u00a0 Additionally, most of these large companies are publicly traded companies, which forces huge emphasis on them to cut costs and maximize profits wherever possible.<\/p>\n

 <\/p>\n

The problem:<\/strong><\/p>\n

Community pharmacy in general is trending towards a business model wherein they can accomplish selling the most number of prescriptions, at the least cost to themselves.\u00a0 As I already stated, the third role of the pharmacist (technical role) occupies the majority of the pharmacists time in most community pharmacies; and this role is easily replaceable.\u00a0 What we have already begun to see is the training of technicians who will perform the coveted task of \u201cfinal check\u201d on prescriptions. \u00a0Simply put, this job is to ensure that correct product is in the correct bottle for the correct patient.\u00a0 Herein lays the problem.\u00a0 Large corporations have the right idea.\u00a0 There is no reason that pharmacists should be performing this role; we are no more proficient checking prescriptions than a technician, and yet we hold monopoly on it, and expect 2x-5x the salary for it.\u00a0 Who can blame these large companies for lobbying to have this power relinquished by pharmacists? From a business standpoint, they can eliminate more than 50% of the pharmacist\u2019s workload in the community pharmacy, by replacing them by equally capable, and much cheaper, technicians.<\/p>\n

 <\/p>\n

The flaw of current practice model:<\/strong><\/p>\n

So what does this mean for pharmacists?\u00a0 It means that the fundamental model of community practice is going to change.\u00a0 The problem is that pharmacists exist in a bizarre loophole of how they are financially renumerated.\u00a0 The vast majority of pharmacists in community are in one of two situations. They either work for a pharmacy (private or corporate) or own their own pharmacy.\u00a0 Either situation is faced with the same dilemma.\u00a0 On one hand, the pharmacy in which a pharmacist may work is reimbursed by the volume<\/span> of prescriptions sold, which are paid for by the government via pharmacare.\u00a0 On the other hand, the pharmacists themselves are paid salary by the pharmacy they work for.\u00a0 Therefore, for pharmacists to protest against the implementation of registered technicians, they are going against their employers best interests.<\/p>\n

What this results in is two bodies lobbying the college of pharmacists for conflicting changes to the territory of physically checking prescriptions.\u00a0 The pharmacists want to protect their monopoly in this area, and the companies who own the pharmacies want to employ skilled technicians to do it for cheaper. The result is a profession which is at war with itself.<\/span>\u00a0 When pharmacists are involved in selling prescriptions, they are inescapably stuck in a tug-of-war between good business vs good healthcare.<\/p>\n

 <\/p>\n

What is the solution?
\n<\/strong>
\nGet pharmacists out of the dispensary.<\/span><\/p>\n

As I already stated, the majority of the pharmacists work currently is performing the \u201cfinal check\u201d on prescriptions.\u00a0 Pharmacist should not be doing this for 3 main reasons:<\/p>\n

1) Technicians can do the exact same job for cheaper (like it or not).<\/p>\n

2) Being responsible for the \u201cfinal check\u201d ties pharmacists inexorably to the current business model which requires high volume of prescription sales. This generates the conflict of interest between pharmacists and the employers.<\/p>\n

3) This is not what they are trained for, and is an inefficient use of pharmacists as a resource.\u00a0 In current practice the two roles we are actually trained for: Therapy assessment <\/span>and Counselling<\/span>, are SECONDARY to checking prescriptions.\u00a0 Pharmacists are the experts at counselling, and therapy assessment, NOT physically checking prescriptions.\u00a0 Perhaps more importantly however, is the fact that because of current business models, these important skills \u00a0of pharmacists are woefully underutilized.\u00a0 Were pharmacists able to provide adequate therapy assessment and counselling to every patient, the adherence to medications, quality of life, and savings to healthcare system would be extraordinary.<\/p>\n

How do we accomplish this?<\/strong><\/p>\n

It is a simple as passing legislation which mandates that \u201cbefore any prescription can be filled, it must be signed by both a physician (prescriber) AND pharmacist (assessed proper therapy)\u201d.\u00a0 One such model of this would place the pharmacist in the medical clinic, right across the hall from the physician.\u00a0 For instance:\u00a0 A patient comes in, sees the physician, gets diagnosed with a strep throat, the doctor writes a prescription for antibiotics, and the patient leaves, walks across the hall to the pharmacist. The pharmacists takes the prescription, assesses the appropriateness of it, evaluates the patients other medications, and then counsels the patient on the antibiotics right then and there.\u00a0 After counselling, the pharmacist signs off on the prescription, which the patient can take to any dispensary, and have filled. At this point the prescription has been assessed for appropriateness and the patient has been counselled.\u00a0 The patient goes to a pharmacy, and the technicians which work there count the correct number of tablets from the correct bottle, perform a final check, and dispense it to the correct patient.<\/p>\n

With this model, pharmacists are now able to perform the job they are trained to do, and because they are situated in the same geographic location as the prescribing physician, they are much more apt to communicate as a team, resulting in better healthcare.<\/p>\n

There are many different possible models of payment for pharmacists with this model.<\/p>\n