A Medicare@50 blog post by:
Susan Troesch – Clinical Pharmacist
Mid-Main Community Health Centre (Vancouver, BC)
Follow them @Mid_MainCHC

As fall rolls around, I find myself stopping to give thanks for my great fortune. I am grateful to be able to say I love what I do. Not all pharmacists I talk with today tell me that they can say the same, and many often report that they would love to have a job like mine. Many pharmacists are becoming increasingly frustrated at not being able to practice in a way that utilizes the knowledge and skills that they received during their university training. As Canadian Universities’ Faculties of Pharmacy move toward an entry to practice PharmD program, it will become even more important that health care professionals learn to practice collaboratively in the interest of providing the best care for Canadians. Sadly, though I was one of the first pharmacists in a primary health care family practice (in the late 1990s) in Canada, I remain one of very few currently working in British Columbia.

Despite ongoing attempts to expand the scope of pharmacy practice across Canada, and particularly in the atmosphere of shrinking health care budgets, change is slow. In BC, integration of pharmacists into community-based primary health care practice has been especially slow. We look with some envy to our Alberta colleagues who can now obtain prescribing authority and our colleagues in Ontario who have greater opportunities to work on interdisciplinary teams in numerous primary care practices, some in Community Health Centres (CHCs).

Imagine my surprise at being invited to Mid-Main CHC some 15 years ago to chat with the clinicians about a potential integration of pharmacy services into the primary care team. After working for 28 years in a pharmacy with a significant Long Term Care (LTC) and mental health practice, in addition to a neighborhood community practice, my dream was to work on an interdisciplinary primary health care team full-time. My LTC work had allowed me to be involved in the building and workings of some interdisciplinary teams at my LTC practice sites. Through this work, I was able to not only experience the feeling of satisfaction, but also see the benefits in patient outcomes. This was the direct result of team members from different disciplines learning to collaborate and work together. I was hungry for more.

At our first meeting at Mid-Main CHC, I learned that the clinicians were looking for access to cheaper drugs for their clients and were hoping to open a dispensary on site, which would allow for some clinical support as well (a model being used at Vancouver’s REACH CHC at the time). Still in “recovery” from the 1995 Pharmanet roll out in BC, I was looking for a more clinical focus. I did, however, volunteer to help Mid-Main CHC write some proposals for a funding source for a dispensary on-site, but also asked what other clinical activities might be helpful for the practice – nobody knew. Following further discussions, the practice agreed to allow me to provide “volunteer” clinical services for one-half day each week for the next year. I felt that this might allow all of us the opportunity to explore and experience the potential benefits of the pharmacist contribution to the primary care team within a community-based primary health care setting. It was a bit scary walking into the unknown but simultaneously, I was excited about the prospects. Although it took us a while to get to know each other and to begin to work well together (evidence as per EICP is 2 years) we succeeded and have never looked back.

My role at Mid-Mid Main CHC has evolved over time. I began by: providing refill authorization for patients (under a delegated authority); doing medication reviews; answering drug information questions; making evidence-based recommendations regarding pharmacotherapy; and providing smoking cessation support for patients at the health centre. Today my responsibilities includes Chronic Disease Management (CDM) support for the practice (review and proactive recall); wellness promotion and self management support; anticoagulation support; continuity of care support for complex patients; shared care of the frail elderly population; and facilitation of group medical visits. With the encouragement and support of my team, I have attained Certified Diabetes Educator (CDE) status, which also allows me to support our patients with diabetes, especially those who need to start or who are currently using insulin as a part of their management strategy.

I have seen the power of working face-to-face with the other members of the primary care team in a client-focused care environment. When my dispensing colleagues tell me that they would like a job like mine, I encourage them to call a CHC or a physician practice in their area who they feel they might be able to work with, and see if they might be willing to meet over coffee. Working and collaborating together begins with getting together, face-to-face.