Patients' needs, in their own words

Dawn Richards, Canadian Arthritis Patients Alliance, Angelique Berg, Hypertension Canada, Anne Marie Wright, moderator, Jan Davison, Bloom Program, Joanne Lewis, Diabetes Association

NOVEMBER 2015 - Pharmacists can do more to capitalize on the “unpatient-like experience” of care in a retail environment, suggested representatives for patient groups at the Canadian Foundation for Pharmacy’s (CFP) annual Pharmacy Forum in November. “The pharmacy experience is a very different experience from the rest of healthcare settings, which actually affords you a lot of opportunities,” said panelist Dawn Richards, Vice-President of the Canadian Arthritis Patients Alliance, and a person living with rheumatoid arthritis.

“The number-one priority for people living with chronic disease is to not have to worry about their illness. Anything that can minimize the ‘patient-like’ experience is welcomed,” she explained. “The comfort level in a pharmacy is quite a bit different from a sterile, medical building. You feel more confident, more in control.”

“People don’t see themselves as patients of pharmacists, but more as customers or clients,” agreed Joanne Lewis, Manager of Diabetes Education at the Canadian Diabetes Association and a Certified Diabetes Educator. “Pharmacists are also less intimidating because they’re not making a diagnosis. It’s more about information sharing.”

In response to the conference’s theme—“What Patients Need: Are We Delivering?—the representatives for the five patient groups offered a number of insights and concrete suggestions, highlighted here.

Jan Davison, patient advocate and Steering Committee Member, Bloom Program (for mental health)

Davison began her presentation by sharing her 22-year journey with bipolar disorder—one that, until relatively recently, did not include relationships with pharmacists. “In all of those years I had gone to a pharmacy once a month. Not once did a pharmacist ask about my diagnosis or offer any help. I didn’t think they knew much more than counting pills and ringing in purchases. It was a drug dispensary and it was intimidating.”

She recalled in particular, returning home after a four-month stay in hospital, about six years ago: “I had so much self-stigma and depression at that point, I could not bring myself to walk down the street to get my prescription. I ended up not getting it in time and two weeks later I was manic again. I’ve often thought, what if I had known the name of the pharmacist?”

As part of the Bloom Program, Davison helps train pharmacists to provide more support to patients with mental illness or addiction, usually over a six-month period. The program is currently a pilot project, funded by the provincial government, that pays pharmacies a monthly fee for each patient enrolled. “I now know the name of my pharmacist, and I learned he has an amazing team of pharmacists. I’ve elevated his status to be part of my circle of care,” said Davison. She suggested that all pharmacists take the following steps to build relationships with patients taking medications for mental illness.

• Gauge body language and emotional state, especially for initial fills. “The person often feels terrified of their diagnosis and people judging them,” says Davison. Pharmacists can establish rapport with a few simple words, such as, “Today might not be a good day for you, but I want you know that we’re here to help.”
• Never say the name of the drug where others may overhear; use a private counselling room.
• Help patients formulate questions to ask at their next doctor’s appointment.
• Offer to be part of the patient’s wellness recovery action plan, which lists healthcare professionals who can be contacted during times of need. “The pharmacist will know what we can safely [do with medications] and he’ll contact the doctor. This is how you can save someone from six months of recovery. This is how you can save a life,” said Davison.

 Dawn Richards, Vice-President, Canadian Arthritis Patients Alliance

Almost all surveyed members of the Alliance (96%) reported going to the same pharmacy, and 87% agreed that pharmacists are important members of their healthcare team. Three out of four (78%) said their interaction goes beyond a simple retail transaction, though just 38% said they always see the same pharmacist.

Patients also value help with insurance coverage, and cite medication reviews as a worthwhile service from pharmacists. Fifty-six percent felt pharmacists are knowledgable about arthritis, and 40% reported that pharmacists are making recommendations to them or docs about medications. Almost a third (29%) agreed that pharmacists could do more. Their suggestions include:

• More information and support regarding drug shortages, biologics and subsequent-entry biologics (SEBs). “We’re finding out that pharmacists haven’t heard of SEBs and don’t know they’re coming,” said Richards.
• Better services for renewals, including online renewals.
• More advice on arthritis, the side effects of medication and the roles of diet and vitamins.
• Use of a counselling room: a “tiny half wall” at the counter is not enough to ensure privacy.

Joanne Lewis, Manager of Diabetes Education and Certified Diabetes Educator, Canadian Diabetes Association

What is one of the greatest opportunities for pharmacists in the area of diabetes care? One-on-one screenings, using a medical device or the CANRisk questionnaire (online or in print), to identify those who are at risk or have undiagnosed diabetes. “Then give follow-up care in the form of a plan of action. Don’t just say they’re at high risk,” said Lewis.

What is one of pharmacists’ greatest challenges? “They struggle with counselling for behaviour change,” noted Lewis, who has trained more than 1,000 pharmacists. This is also the area where patients need the most help, if only to get referrals to other providers. Lewis also recommended:

• Flexible communication formats. “Patients want to be able to choose, whether by email, text, phone or face to face.”
• Closing gaps in coordination of care. “If pharmacists were to ask, for example, ‘When was the last time you had your eyes checked?’ that would really help.”
• Being watchful for depression, which has a higher incidence in people with diabetes.

Angelique Berg, CEO, Hypertension Canada

“Hypertension is an area that pharmacists can own,” stressed Berg. Blood pressure measurements are the single biggest indicator for this asymptomatic condition, yet readings for a single person can vary widely. White-coat syndrome underscores the importance of readings outside the doctor’s office, yet people often don’t take their own blood pressure properly, or use non-validated devices.

“Blood-pressure kiosks in pharmacy are more accurate and can be more effective than in-office assessments,” said Berg. Pharmacists are then ideally positioned to help patients understand why their readings can vary, and what to do about it. Based on focus groups with people who have hypertension, Berg also encouraged:

• More general information on hypertension and its complications. “Almost everyone said they were given no information at the point of diagnosis,” said Berg.
• Screening services or clinics. About 20% of Canadians do not know they have hypertension.
• Knowing the 2015 Canadian Hypertension Education Program (CHEP) Guidelines.
• Enabling accurate blood pressure readings with an on-site kiosk and by selling validated personal devices.

Noah Farber, Acting President and CEO, The Asthma Society of Canada

The majority of people with severe asthma report that their pharmacists demonstrated the proper use of inhaler devices—yet less than half say that pharmacists followed that up with reviews on techniques. “That’s important because over time patients can fall into bad habits,” said Farber.

The province’s MedsCheck program is a good vehicle to enable such ongoing adherence, although not all people with asthma are eligible for the service. For those who are, Farber asked pharmacists to proactively recommend a review, with follow-ups. He also suggested:

• Credentialling as Certified Asthma Educators or Certified Respiratory Educators.
• More proactive recommendations for the use of peak flow meters and spacers, and for flu vaccinations.
• Increased communications with physicians when patients are not refilling their medications.
• More willingness to renew inhalers. “Of all the increased services [under an expanded scope] this is the one that people are most excited about, but it’s happening the least,” said Farber.
• More attention to indoor air quality, particularly for drugstores with a cosmetics department at the front entry. “[The scent of] perfumes is a barrier to your patients with asthma.”