Clinics in Vancouver are beginning to take advantage of a program that allows utilization of the services of clinical pharmacists in their clinic on a rotational basis. Allied health resources have been centralized in the Interprofessional Team (IPT) structure, and pharmacists can also be colocated within clinics, if requested. The result has been a win-win scenario, welcomed by both doctors and patients.
Clinics with the necessary space can have the pharmacists within their physical clinic, while those who can’t accommodate this arrangement are still able to participate.
“You can colocate virtually,” explains Saori Yamamoto, CNM for PCN 3 of the Vancouver Division. “Your pharmacist would be at a different location, but their time would be dedicated to you.”
In addition to facilitating the colocation, the program provides assistance with overhead, orientation and training.
Ruby Sangha has been a pharmacist for 26 years, spending most of that time doing clinical work at VGH. She transferred to primary care about a year ago, and has spent each Wednesday since December working at Fraser Street Medical. She believes that the program provides value to clinics.
“Family doctors are extremely busy and there’s not always enough time in the day to tackle some of the issues that patients are bringing up,” says Sangha. “We can answer some of those questions, we can do the lit search.”
Sangha’s hospital work has prepared her for any challenges that may arise.
“I can do this,” she says. “I’ve done it for 19 years.”
Sangha says that on a typical day at Fraser Street Medical she’ll see five or six patients.
“Initial appointments are usually around an hour, with pre-emptive work being done beforehand,” she says.
Accessing Care Connect, PharmaNet and, if possible, the office EMR helps the clinical pharmacist understand the patient’s medical history.
“I’ll meet with the patient, interview them, discuss their needs, and get their perspective,” says Sangha. “I’ll attempt to determine if there is room for improvement in terms of medication optimization and then present that information to the doctor.”
Sangha observes that some patients are discharged from hospital without truly understanding why their medications have changed. In such cases, she thinks that one on one time with pharmacists provides true value.
“One of the benefits is being able to go over some of those things with the patients,” she says. “I do a bit more digging in order to figure out the whys and hows.”
Yamamoto also sees benefits for the patient.
“Perhaps they can’t afford their medication,” she says. “The clinical pharmacists don’t dispense the medication, but they can suggest options that the patient could then discuss with their doctor. Sometimes these options are more affordable or have less side effects.”
Sangha believes in incorporating patients’ thoughts on the medication they receive.
“They’re at the forefront of primary care,” she says. “We need the patient to buy into those decisions, it can’t be a one-sided thing.”
She’s found patients to be grateful for the additional time and care, and speaks of a particular patient that she recently worked with.
“A patient of mine had a procedure that was done not too long ago that created some complications in her life,” she recalls. “I found there was a level of mistrust before I jumped into the picture. I was able to recognize that there was a need to go slow and build a relationship.”
Yamamoto agrees. “It’s patient-centered care,” she says. “It empowers patients to have a choice.”
Sangha enjoyed the team-based model employed during her years at the hospital, and is pleased to see this dynamic at play within primary care. She’s also grateful to be in a position where she can utilize her experience to help shape an evolving system.
“After 19 years with the hospital, I felt like a primary care network position was an opportunity to use my experience to help mold this program,” she says. “The pharmacy program is being led by UBC in conjunction with Fraser Health, so there is structure on hand already, but I think our experience comes into play on some of the smaller aspects of the role.”
Sangha says that things have been picking up of late and is excited for the trend to continue.
“There are currently six pharmacists within the Vancouver primary care network, and all of us come with strong experience,” she says. “The more exposure we get within doctors’ offices, the more we can showcase what we’re able to do. I think our range of experience and perspectives allow us to open doors and make a difference by getting more involved in patient care.”
Direct communication with Saori Yamamoto and Ruby Sangha
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