MAY 2021 – Carlene Oleksyn, manager-owner of Mint Health + Drugs: Meridian in Stony Plain, Alberta, has literally flipped her pharmacy around to better serve patients.
Pharmacists are the first point of contact for patients as they enter the store. “It’s a way to engage patients right away to resolve problems and it’s a holistic way of looking at the patient,” says Oleksyn, who opened the pharmacy in 2012. “It’s about meeting patients and forming relationships.”
The pharmacist-first approach has not been widely adopted in community pharmacy, but it needs to be, she adds. “It is nearly impossible to identify drug therapy problems with only a patient profile and a prescription hard copy in front of you. The vast majority of problems are not discovered because of a lack of discussion with the patient. Assessment of the patient, not just the patient’s profile, is essential.”
The pharmacists at the front-of-store intake stations welcome patients, review their prescription and, if applicable, check their care plan, which is a billable service in Alberta. “The model requires a new way of thinking,” notes Oleksyn. The pharmacists consider the nature of the patient’s problem and ask key questions of themselves and the patient. Is the problem acute? What exactly needs to be assessed? What are the patient’s goals? What sort of follow up needs to be done?
Top-of-scope practice
To help meet patients’ needs, the pharmacy offers a systematic blood pressure monitoring service, timely adjustments of prescription medications to help patients reach their target, a follow-up service for complex patients starting new medications and chronic disease monitoring to encourage patient engagement and self-care. Some of this is done by appointment, but much is done at the intake stations when patients present. All pharmacists in the practice are active prescribers, filling in gaps in health care and providing assessment and prescribing for minor illnesses. Last but not least, pharmacists take full advantage of their authority to order and interpret lab tests to support clinical decision-making and engage patients in reaching their goals.
“The one thing our pharmacists do little of is the technical check on prescriptions,” says Oleksyn. The technical check is done by a registered pharmacy technician after a pharmacist has completed their clinical review and consultation with the patient, including patient counseling.
The separation of duties allows each health professional to practice to their full scope, notes Oleksyn, who has been practising for more than 25 years. “Efficiency is about more than getting scripts out the door.”
While the COVID-19 pandemic has changed the way pharmacists connect with patients, it has not slowed them down. “There is a lot more follow-up over the phone. There is more virtual care,” says Oleksyn.
The practice model has improved patients’ health outcomes. A recent retrospective study by researchers at the University of Alberta, entitled “Impact of a ‘Pharmacist First’ innovative workflow plan in patients with hypertension and/or diabetes” and published in May 2021 in the Canadian Pharmacists Journal, found significant reductions in systolic and diastolic blood pressure among the pharmacy’s patients.
Business benefits, too
Business has also benefitted. “Our business has grown from nothing to a thriving team,” notes Oleksyn. Today, the team includes five pharmacists, two registered technicians and two assistants. Two pharmacists, sometimes three, are on duty at any one time.
New pharmacy graduates are also excited to join the team. They are often disillusioned with the traditional service approach, notes Oleksyn. “The profession only changes practice by practice.”
For pharmacies looking to embrace this practice model, she advises a strong leader and advocate needs to be in place. “Otherwise, you revert back to what is comfortable.’
Oleksyn, who has a certificate in travel health, also runs a travel clinic. The impetus for this service: filling a void in the community. Appointments usually run 60 to 90 minutes, and there is no need for patients to see a physician first. Full travel assessment services are offered as well as prescribing medications and vaccinations, and administration of injectable products. Before the COVID-19 pandemic, the clinic would see patients all day long.
In 2021, Oleksyn was named the M. J. Huston Pharmacist of Distinction, an honour awarded by the Alberta College of Pharmacy to a pharmacist who has demonstrated leadership and advanced the profession through a commitment to innovation, continual professional development, and quality patient care.
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