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By By Louise Louise Cooney Cooney • Medication administration, maximize benefits, minimize adverse effects, and drug interactions • Primary role is to ensure that medications are taken effectively and appropriately • Can recommend an over-the-counter (OTC) product for pain relief, demonstrate the proper use of an asthma inhaler, and help patients manage their diabetes. • Advise on medication storage, missed doses, and what foods or activities to avoid. Pharmacists contribute to the health care system by: • Compounding, preparing and dispensing drugs • Medication histories and maintaining patient drug profiles • Safety counselling to patients and caregivers • Making recommendations to prescribers and other health care professionals for adjustments to patients’ drug therapies • Providing non-prescription drugs, natural health products, prenatal products, health care aids and devices • Managing minor illnesses • Providing referrals and advice on health promotion and wellness • Home visits • Educating and supporting patients and caregivers about home administration of IV drugs • Education on self-management of diseases • Hosting disease management and immunization clinics • Palliative care to improve symptom control • Monitoring and adjusting doses of drugs such as blood thinners (anticoagulants) and cholesterollowering medications • Expanded role for pharmacists • Certain provinces have approved pharmacist prescribing with varying scopes of authority – Not meant to replace physician care • Expanded roles for pharmacists: 1. Prescribing OTC drugs to treat minor, self-diagnosed disease conditions such as a rash, a cough or diarrhea 2. Start, adjust, continue or discontinue a medication in collaboration with a doctor thus increasing time efficiency for physicians • Neighbourhood pharmacies, clinics, supermarkets, chain pharmacies and department stores. • Requires both professional capability and business management skills • Requires broad range of medication knowledge including prescribing and non-prescribing products • Offer additional professional services such as surgical, home care and athletic supplies, and self-diagnostic machines and kits. • Also practice on primary health care teams, in longterm personal care homes, or specialize in such areas as geriatric pharmacy. • Work in specialize fields such as oncology, cardiology, psychiatry, dialysis, infectious disease, critical care, paediatrics and geriatrics. • Working with the hospital team • Monitoring/evaluating patients’ drug therapy while in the hospital • Counselling patients about their medication before discharge • Educating physicians and other health care workers • Overseeing the selection, purchase and distribution of drugs used in the hospital • Ensuring safe and efficient distribution of drugs • Development of best practice protocols • Work with researchers to develop, manufacture, & market prescription & nonprescription meds • Provide quality control • Act as liaison with government, or provide drug information, technical correspondence or educational materials to the public and health care professionals • May also work as pharmaceutical sales representatives. • Employed in the federal and provincial governments • Monitor the distribution of scheduled drugs (poisons, narcotics) • Administer various drug plans and health care programs; develop pharmaceutical policy, or work in a laboratory. • The armed forces also employ pharmacists in military health care facilities in Canada and overseas. • Many work at Canadian universities in the areas of teaching and research, or in health advocacy and professional organizations. • Also work for the provincial licensing and regulatory organizations responsible for ensuring that pharmacists practice according to the provincial laws and regulations. • There are approximately 31,000 pharmacists in Canada working in 8,394 licensed pharmacies. • In 2007, pharmacists filled 422.6 billion retail prescriptions costing $20.7 million • Bachelor of Science in Pharmacy: 4 year program (preceded by at least a year in science) – Biomedical sciences (anatomy, histology, biochemistry, specific diseases and disorders, health issues, organic chemistry, microbiology, pharmacology, physiology) – Pharmaceutical sciences (bio pharmaceutics, pharmacokinetics, medicinal chemistry, drug metabolism, toxicology, pharmaceutics) – Therapeutics – Pharmacoepidemiology – Pharmacoeconomics – Pharmaceutical care – Statistics – Communication and interprofessional relations – Law and ethics – Social and administrative pharmacy issues – Role of pharmacy in the health care system • Masters or Doctorate in Pharmacy: usually go into research or teaching • Ten Canadian universities offer degrees in pharmacy. • Pharmacists are licensed and regulated by Pharmacy Regulatory Authority (PRA) • Must have provincial accreditation • Licensing: – Hold a degree in pharmacy from a Canadian university (or the recognized equivalent) – Successfully have passed a national board exam by the Pharmacy Examining Board of Canada (PEBC) • have practical experience through an apprenticeship/internship program – Fill language requirements related to fluency in English or French – Meet all licensing requirements and renew license annually The approval process and distribution of medications • Drugs are the fastest growing component of health care in Canada and have had a huge impact on improving the health of Canadians. • Approximately 22,000 drug products are on the market today. • In 2006, pharmacists filled 422 million retail Rxs • Drugs are now the second largest healthspending category after hospitals – Forecast to make up 17% ($25 billion) of total health expenditures in 2006, compared to 13% ($10 billion) 10 years ago. Health Canada Review • All drugs sold in Canada (both manufactured & imported) must be authorized by Health Canada. • About 4,400 drug submissions are made to Health Canada each year but only about 80 are for new drugs. • A Priority Review Process for life threatening or severely debilitating conditions (e.g., cancer, AIDS, Parkinson’s disease) when there is no effective drug on the Canadian market. Special Access Program (SAP) • Access to drugs not currently available in Canada for conditions with serious or life threatening • Conditions where conventional therapies have failed, are unavailable or not suitable. • Pharmaceutical companies have the right to decide whether, and under what conditions, to provide the drug to the patient Controlled Drugs & Substances • Drug Strategy & Controlled Substance Program (DSCP) – Controlled Drugs & Substances Act (1997) – Controls import, export, distribution and possession of narcotics & controlled substances Drug Scheduling • National Canadian drug scheduling model ensure consistent conditions of sale across the country. • National Drug Scheduling Advisory Committee (NDSAC) responsible for provincial scheduling. • Determining factors for scheduling: – Potential for dependency, adverse reactions, interaction, etc. 4 Canadian scheduling categories: • Schedule I — available only by prescription and provided by a pharmacist • Schedule II — available only from a pharmacist; must be retained in an area with no public access • Schedule III — available via open access in a • pharmacy (over-the-counter) • Unscheduled — can be sold in any store without professional supervision Distribution • Community pharmacies: – Purchase either from the manufacturer itself or from drug wholesalers • Hospital pharmacies: – Generally use group-purchasing organizations to buy drugs at negotiated rates. Price Review • Patented Drugs: The Patented Medicine Prices Review Board (PMPRB) regulates the prices • Operates under the Patent Act and is independent of Health Canada. • Patentees are required to file price and sales information twice a year for each dosage strength form of all patented medicine. • PMPRB has right to reduce excessive prices • PMPRB collects comparative price data from the U.S. and six European countries. Listing on Provincial Formularies • Individualized provincial drug plan for reimbursement • Public drug plans account for 45% of expenditures on Rx drugs. • Drug accessibility varies widely between the provinces, • Some drugs receive a restricted listing if special monitoring is required or their cost is high. Common Drug Review • The Common Drug Review (CDR) (2002) – A rigorous process for reviewing and recommending new, approved drugs for listing on F/P/T formularies. – Consists of an appraisal of the best clinical evidence and a listing recommendation from the Canadian Expert Drug Advisory Committee (CEDAC). • The drug plans continue to make the final formulary listing decision. • A target timeframe of 20-26 weeks has been set for the review process. • Private drug plans have access to the recommendations when making their own listing decisions. Manitoba Pharmacare Program • Provides drug cost assistance to eligible Manitobans who do not have coverage under a federal or other provincial program. • Is income based – Deductible is calculated based on the total adjusted family income DPIN • DPIN (Drug Programs Information NETWORK) – started in 1994 • A database containing prescription drugs and it connects Manitoba Health and all pharmacies in Manitoba to a central database maintained by Manitoba Health. • Uses: – Information about pharmaceutical dispensations, – Prescriptions identified as potential drug utilization problem, non-adjudicated claims, and ancillary programs and non-drug products is captured in real time for all Manitoba residents (including Registered First Nations), regardless of insurance coverage or final payer. • DPIN facilitates payment administration for eligible drug costs, incorporating functions such as real-time adjudication, and collects high-quality data on all prescriptions issued to Manitobans • The DPIN system also checks each prescription against drug history to help protect Manitobans from adverse drug interactions Questions???