A new role for pharmacists: Medication counselling aimed at optimizing expertise Some pharmacists have recently seen the scope of their professional services undergo a significant change, as they are now permitted to bill for specific medication-related counselling. RCCM asked Ontario pharmacist Ken Burns about this expanded role and its overall impact on the delivery of health care. Q: Why was it felt that the role of pharmacists needed to be expanded? KB: The pharmacist’s role has been expanding for many years. This most recent expansion has come about as a result of three different factors. Firstly, the skills of pharmacists extend far beyond knowledge of pharmacology and therapeutics and into disease management. Secondly, the demand for these skills mirrors the need of the broader health care system—namely, the need for a multidisciplinary approach that provides quantity, quality, and efficiency in service delivery. Finally, there is the ubiquity of pharmacists. As a profession, pharmacists are very accessible in all regions of the province, and often keep extended hours. Q: Could you provide a brief description of this recent expansion of the pharmacist’s role—specifically, allowing pharmacists to bill for certain counselling services? KB: In Ontario, pharmacists have been allowed to charge for many professional services for quite some time. It is relatively recently, however, that the Ontario Ministry of Health and Long-Term Care has recognized the value of pharmacist interventions and attempted to build a process that could provide a consistent and valuable service to patients, with the potential to be integrated into developing models of interdisciplinary care. The MedsCheck program was introduced in April 2007 as an important first step. It sought to fill a gap in patient and clinician knowledge surrounding medication use. It’s essentially a medication reconciliation that ensures that the patient, the pharmacist, the physician, and any other primary care provider has an accurate and consolidated list of all the patient’s drug treatments. This includes over-the-counter and herbal or “natural” products. It ensures that everyone is aware of how the medications are to be taken and what they are for. It has been demonstrated that this is an important tool for patient safety and can play a role in achieving the best possible outcomes. MedsCheck can be followed by MedsCheck Follow-Up for those occasions when an update may be necessary. Q: Is a further expansion on the horizon? KB: The next step is a pilot project for MedsCheckConsult, a logical step in utilizing the pharmacist more effectively. It will target the interaction between the pharmacist and the physician in an attempt to utilize the skills of both clinicians to arrive at better outcomes. Q: What services and groups of patients does MedsCheck cover? KB: All Ontarians who take three or more prescription medications for chronic conditions are eligible for MedsCheck and the MedsCheck Follow-Up. The next step, MedsCheck Consult, will become available in pilot sites over the coming months. The pilot will ensure that when MedsCheck Consult becomes available more broadly, it will be integrated more effectively. Q: What direct benefits, if any, does MedsCheck provide to patients? KB: With the MedsCheck service, the patient has a one-onone talk with a pharmacist. The discussion covers all the treatments the patient is using to try to remain healthy, And ultimately results in a comprehensive list to be used by the patient and anyone else on the health care team. As a result, there should be no confusion or misunderstanding about what each treatment is for and how it should be used. The patient keeps and can carry this list so that it is available when needed. Q: Does this significantly change the role of the pharmacist in the health care team? KB: Pharmacists have always answered questions about patients’ medication use and helped them to understand what their medications are for and how to use them. What this expanded role begins to do is integrate that work with the rest of the health system into what is probably the most important building block in patient care—accurate and complete health information. This is only one part of the pharmacist’s knowledge base, but it is the logical first step in providing value and opening the door to a greater and more effective use of the pharmacist. Therefore, the significance of this is not only how much it changes the pharmacist’s role, but also that it introduces a significant process of bringing the skills of pharmacists to the public. Q: How can home and community care providers benefit from the pharmacist’s new role in terms of overall patient care? KB: The pharmacist has much to contribute. In addition to providing care directly to patients, the knowledge and information input into the system by the pharmacist will help physicians, nurses, home care, and other health providers provide more effective assessment and develop a better care plan. It will also help create a more accurate and comprehensive follow-up within a multidisciplinary approach. Q: How can home/community care providers and pharmacists best work together? KB: It is clear that for any members of the health care team to work effectively together there must be an understanding of everyone’s roles, skills, and abilities, as well as openness to the changes the health system must undergo to meet increasing demand for services. Communication before, during, and after new programs or services are introduced is essential. Fortunately, pharmacists already have close working relationships with many clinicians. Formalizing these and providing a structure to work under will only make these relationships work more effectively.