FEBRUARY 2022 - During the first year of the pandemic, eight LMC Pharmacy locations in Ontario conducted more than 26,400 MedsCheck services — a 45% increase over the previous year. That translates into an average of 275 reviews per month, or more than 60 per week per site. LMC Pharmacy is also lifting well about its weight. During the most recent fiscal year (ending March 31, 2021), this group of eight pharmacies — out of a total of 4,682 pharmacies in the province — conducted 11% of all MedsCheck for Diabetes annual reviews and 37% of all follow-ups. Pharmacies bill Ontario’s MedsCheck program $75 for a MedsCheck for Diabetes annual review and $25 for each follow-up.
How do they do it?
Alicia Chin, LMC Pharmacy
“At our core, we are a consultative service pharmacy with a specialization in diabetes,” says Alicia Chin, President and Director of LMC Pharmacy. “And we have an amazing, caring, professional team focused on medication-therapy management. I am very grateful that they share the vision for a collaborative, consultative service model.”
While she agrees that LMC’s focus on diabetes helps set the stage, other community pharmacies can also reap the rewards, says Chin. “If we can successfully grow our consultative services by investing in dedicated staff and refining our processes for diabetes, you can too – and for even more therapeutic categories, in response to your patient base or your pharmacists’ interests. Having consultations as its own dedicated service line is professionally satisfying, profitable, and very impactful for patients and our profession alike.”
LMC Pharmacy sites are co-located with LMC Healthcare clinics, Canada’s largest specialist care provider in diabetes and endocrinology. Endocrinologists and local GPs refer patients to the pharmacy for comprehensive medication assessments, medication and device training, education, care plans, titrations and other services, including immunizations and drug administration.
“Patients seeing an endocrinologist tend to have uncontrolled diabetes and co-morbidities. By the time patients are referred to us, their healthcare issues may be significant, and their medication assessments often identify many drug-therapy problems,” says Chin.
LMC Pharmacy has locations in GTA, Ottawa, London and Barrie, and is staffed by a team of Certified Diabetes Educator pharmacists and diabetes-specialized assistants, pharmacy students and interns. The pharmacists typically work in their offices conducting private, one-on-one consultations with patients, usually by appointment. The busiest locations may have up to six staff at a time conducting consultations. “A few years ago we began to pivot our staffing levels and operations so pharmacists can spend the majority of their time doing consultative activities as opposed to dispensing,” says Chin.
Efficiency is also key. For example, a template library streamlines documentation of MedChecks and other paid services . The templates also save time by using macros for common phrases and responses.
The teams operate in a collaborative-care setting with access to an electronic medical record and the provincial Clinical Viewer/OLIS system. Access to lab results has been key for assessing efficacy of treatments, guiding titrations and creating personalized care plans.
First-time patients, who may be referred by a physician or request pharmacist services directly, spend 30 to 60 minutes with the pharmacist for a comprehensive medication assessment to identify and solve drug-therapy problems. Chin recalls one patient referred by a doctor because they could not figure out why the A1c wasn’t going down despite multiple increases in insulin. During an injection technique assessment, the LMC pharmacist discovered the patient was not injecting their medication correctly, resulting in the patient not getting any insulin for almost a year. Other “decoded” cases have involved patients mixing up their medications, resulting in frequent hypoglycemic episodes and hospitalizations.
Follow-up appointments are scheduled for 15 to 30 minutes based on clinical and education needs. “Patients benefit from education, assessments, care plans and recommendations that evolve with them over time. The pharmacy team takes its cues from the patients themselves, helping address their current concerns, from side effects and interactions to affordability and caregiver training,” says Chin.
Since the start of the COVID-19 pandemic, most appointments have been virtual, by phone or online. “While not all consultations are suitable for virtual care, patients have expressed their appreciation for the increased accessibility, convenience, and time savings. Virtual appointments also help caregivers and family members by allowing them to join sessions remotely,” says Chin.