Cultural humility is the key to First Nations care • Unique clinical services • Meet the new BCPhA Board
published by the British Columbia Pharmacy Association | bcpharmacy.ca | Volume 25. No. 5
Addictions: The complexities of care
A voice for community pharmacy
Regulatory Compliance Support The BCPhA has developed policy and procedure manuals to support pharmacies in documenting policy and procedures that ensure operational activities are compliant with the regulatory framework governing pharmacy practice.
The BCPhA Regulatory Compliance Bootcamp is now available as an online self-learning program. The cost is $299 plus GST for members and $699 plus GST for non-members. This online course addresses regulatory compliance issues and is designed to help mitigate the risks of penalties associated with audit assessments. It also addresses privacy practices and College of Pharmacists of BC regulations.
Some manuals now available for download by Pharmacy (Corporate) members are:
√ √ √ √ √ √
Community Pharmacy Security Operation of a Community Pharmacy (UPDATED: August 2016)
This course uses real life situations and the errors we have seen in many different audits and is essential for pharmacists, pharmacy managers and owners.
Administration of Injections Methadone Maintenance Incident Management & Reporting
Register online today.
Dispensary Activities (UPDATED: July 2016)
Learn more at www.bcpharmacy.ca/regulatory-compliance-support
BCPhA eTraining • Self-paced learning
Many complimentary programs are available for members
• Interactive elements • Quiz questions • Final assessment
A few programs currently available:
NEW! Genomics for Precision Drug Therapy in the Community Pharmacy
Diabetes Health Coaching Program (CCCEP accredited)
NEW! Issues and Topics in Pharmacy Practice and Regulation
Private Payers: 2015 - the Good, the Bad and the Very Expensive
NEW! Modernized Reference Drug Program
Keeping Seniors Healthy Through Vaccination
Travel Medicine Program (CCCEP accredited)
Integrating Patient Safety Into Your Pharmacy's DNA
Cardiovascular Program Training Course
Pharmacists in COPD Management
SEP/OCT 2016 | VOLUME 25. NO. 5
contents Editor in Chief Angie Gaddy 604.269.2863, firstname.lastname@example.org Senior Editor Matilda Meyers 604.269.2866, email@example.com The Tablet is published by the BCPhA. Views expressed herein do not necessarily reflect those of the Association. Contributed material is not guaranteed space and may be edited for brevity, clarity and content.
12 First Nations health care
BCPhA offices: #1530-1200 West 73rd Avenue Vancouver, BC V6P 6G5 telephone: 604.261.2092 or toll-free in BC: 1.800.663.2840 fax: 604.261.2097 toll-free fax: 1.877.672.2211 e-mail: firstname.lastname@example.org web: bcpharmacy.ca Publication agreement #40810576
On the cover: Outside the Mid-Main Community Health Centre (left to right) volunteer Jeannie Kamins, Dr. Lise Loubert and pharmacist Susan Troesch. The centre fosters a team-based approach to patient care.
20 Addictions care
16 Clinical services
8 Select Standing Committee on
5 President’s Message
Health Association puts forward submission to health committee
12 First Nations Health Care Cultural humility key to quality care for First Nations patients
16 Unique Clinical Services Increasing range of clinical services enhances patient care
20 On the Cover:
Addictions: The complexities of care
24 Meet the BCPhA Board Introducing the 2016/17 Board of Directors
The true value of pharmacy lies in relationships
6 CEO’s Message
Lyme disease: Targeting more than just the bull's-eye
32 Products in Focus
It's time for a new approach to health care in BC
7 Pharmacy Practice Support New regulations leave pharmacists out of medical marijuana distribution
Improving influenza vaccine effectiveness for the elderly with Fluzone High-Dose vaccine
38 Career Listings Find a job in pharmacy
9 Member Services Partnership with Green Shield Canada offers new diabetes training program
34 Canadian Pharmacists Association Supporting enhanced medication optimization for pharmacy patients
31 Smoking Cessation BC's QuitNow makes it easier for pharmacists to help clients quit smoking
A voice for community pharmacy
Got a suggestion for an article in The Tablet? Email email@example.com with your story ideas.
33 Medical Assistance in Dying Unique collaboration necessary bcpharmacy.ca
In the news
New complimentary e-training programs for members
Both will be made up of members of the BCPhA Board. While the e-prescribing/ PharmaNet modernization committee is in the process of setting up, the high-cost drugs/FOD committee has already begun its work.
Over the last few months, the BCPhA launched a number of complimentary e-training programs for members. These include: • “Genomics for Precision Drug Therapy in the Community Pharmacy - Phase 1 results,” presented by Dr. Corey Nislow. • “Issues and Topics in Pharmacy Practice and Regulation,” presented by Suzanne Solven. • “Schedule II Naloxone for Opioid Overdose: What Pharmacists Need to Know,” presented by Robert Pammett.
• “Private Payers: 2015 in Review The Good, the Bad and the Very Expensive,” presented by David Willows. • “The Future of Pharmacy: Student Presentations,” presented by UBC pharmacy students. Access these complimentary e-training programs and more by visiting bcpharmacy.ca/etraining-mem on the member’s only side of the BCPhA website.
New working groups established At its July meeting, the BCPhA Board of Directors agreed to set up two new working groups to examine issues that are now on the Ministry of Health’s radar. The two committees will be an e-prescribing/ PharmaNet modernization committee and a high cost drugs/frequency of dispensing (FOD) committee.
E-prescribing/PharmaNet modernization committee BC Health Minister Terry Lake recently announced that the government will make e-prescribing a priority prior to the next election in May 2017. The Association has agreed to work with the ministry to select several pharmacies to be pilot sites. BCPhA also had a general discussion about the data hub that is being explored as part of the pharmacogenomics project and how it could work for e-prescribing. The Association is hopeful that a number of pharmacies and technology systems will be used in the next phase of the government's pilot project.
• “Modernized Reference Drug Program,” presented by Aaron Sihota.
Here is more about each committee and its work:
The working group is made up of Board members John Tse, Allison Nourse (BCPhA past-president), Julie Ford and David Pavan. High-cost drugs/FOD committee The purpose of this working committee is to review and make
recommendations or suggested changes regarding the current BC PharmaCare High-Cost Drugs policy and Frequency of Dispensing policy. The aim is to meet PharmaCare needs while also maintaining the positive aspects of the policies from a pharmacy perspective. This working group is made up of Board members Randy Konrad (BCPhA president), Chris Waller, Alex Dar Santos (BCPhA vicepresident), John Tse and Linda Gutenberg. Pharmacist consultant Ken Foreman has been engaged by the BCPhA to manage and chair this group. Recommendations were provided to the rest of the Board at the September Board meeting, and if approved, will be forwarded to government for their consideration.
RANDY KONRAD | PRESIDENT
The true value of pharmacy lies in relationships
As I prepared to take on the role of president this September, I found myself reflecting on the 30 years that I’ve been a pharmacist. For most of these years I worked in community pharmacy – both in chain and independent stores. I experienced a variety of ownership structures and now understand and appreciate the different environments in which pharmacists around the province practice. However, what I also noticed during my time as a front-line pharmacist was how similar the working environments actually are. In essence, we put our pharmacy license on the wall and then turn around and start helping people. And I think the strength of the day-to-day relationship between us as an individual pharmacist and our patients is where the true value of pharmacy lies. And that relationship is being practiced successfully in many different environments around BC. This September will be my fourth year on the BCPhA Board. During this time I’ve grown to appreciate the Association much more than I did from just looking at it from the outside. The staff are excellent – they are skilled, hard working and understand what the priorities of pharmacists are. Our Board members also have considerable ability and experience and I am grateful that I can draw on them to help me in the coming year. As well as a desire to give back to the Association, I was also drawn to the role of president because I thoroughly enjoy and respect the discussion that happens each month around our Board table. Before making a decision, our team has a robust discussion that explores new ideas and takes everyone’s views and opinions into account. We’re all pharmacists but we all look at issues with a different perspective and have a contribution to make to the discussion. This diversity and freedom of speech helps the Board make the best decision at the end of the day.
In the coming year, I’m excited to continue the excellent work of the Association – in particular, starting Phase 2 of our pharmacogenomics project in late fall. This project represents an important opportunity to build our relationship with patients. The relationship that BCPhA has with its stakeholders will also be very important during my term as president. I am looking forward to fostering the positive, collaborative relationship we have with government and building our ties with the College of Pharmacists of BC. In the next year we will continue working with government on a number of emerging initiatives and collaborating with the College on projects such as e-prescribing, legislative and regulation updates, drug scheduling and other changes to pharmacy practice. I’ve heard the phrase “healthy tension” used to describe the relationship between an advocacy body and a regulator and I think it’s a great expression. Both bodies understand that while they must look at issues from a different perspective, that does not preclude them from working closely together to find solutions for both parties. I have completed two two-year terms on the College Board of Directors, as well as a three-year term as chair of the Board, in addition to serving on various College committees. These roles helped me understand how the organization operates and I will draw on this knowledge, together with the relationships I developed during my time there, to move our profession forward. I would like to thank outgoing president Allison Nourse for her strong and dedicated leadership over the past year and for the support she will provide us in the coming year during this time of transition.
GERALDINE VANCE | CEO
It’s time for a new approach to health care in BC I am in the regrettable position of knowing my way around the acute care health-care system. Since 2003, I have been the advocate and negotiator for my husband, who has had more than his fair share of chronic health issues (his excuse is that he was born during the last years of the Second World War and the parts weren’t very good). Mostly, he has received excellent care on the all too often trips we have made to St. Paul’s Hospital emergency department, both during surgery and follow-up care.
not an expert in the complex issues related to mental health and addiction. But I do know we need to put more resources towards solving the problem. But, how can that happen? Our health-care dollars are already stretched too thin. Where would more money come from? Well, perhaps, it is not so much a case of more money, but redirecting and using some health-care providers more wisely. We urgently
“Community pharmacists can take on some of the work currently done by family physicians to free up needed time."
However, since my husband started down this road the changes in the primary care system have been profound. Too many excellent, full-service family physicians have left practice and been replaced by part-time physicians who simply don’t provide the continuity of care needed by their patients. Coupled with the dramatic rise of mental health and addiction problems across the province, BC’s health-care situation has reached dire proportions. We tackle some of these issues in this edition of The Tablet in the article "Addictions: The complexities of care" on page 20. In August I got another up-close look at the acute care system when my husband had a gallbladder attack that lasted a week and eventually led to surgery. He languished in hospital for six days waiting for surgery. That was preceded by three trips to the emergency department, where we spent countless hours. I have to say, things seemed much worse than I remember them. The pressure on the ER doctors and nurses and the complex mental health and addictions issues they are dealing with certainly seem greater to this casual observer than they have been in recent years.
The daily news stories about more overdose deaths has become numbing. I applaud the Minister of Health Terry Lake’s acknowledgement that the issue has reached crisis proportions. We simply have to do a better job of addiction prevention, early intervention and treatment. I am not a clinician and certainly
need family doctors to have the time and opportunity to build relationships with their patients and be the community-based resource that deals with many mental health and addictions issues. As it stands, the only way for them to do that is if they stop doing other things. Community pharmacists can take on some of the work currently done by family physicians to free up needed time. The fact that pharmacists did more than 400,000 flu shots last season shows that they can take on some patient care that should simply no longer be done by prescribers. What if BC, like other provinces and jurisdictions, took the rashes and other minor ailments out of the family doctor’s office and had pharmacists provide that care? So much time would be freed up for our physicians to do the work they need to with patients facing complex health issues. The BC Pharmacy Association has long advocated that BC catch up with other jurisdictions and enable pharmacists to treat minor ailments. We did so again in our recent submission to BC’s Select Standing Committee on Health, which can be found by visiting bcpharmacy.ca/submissions-to-government-public-2016. The solutions to the epidemic our communities face with mental health and addictions and the associated stress it puts on the primary and acute care systems will not be found in doing more of the same.
DEREK DESROSIERS | DIRECTOR, PHARMACY PRACTICE SUPPORT
Pharmacists left out of medical marijuana distribution On August 24, 2016, the new Access to Cannabis for Medical Purposes Regulations (ACMPR) came into effect. These regulations replace the Marihuana for Medical Purposes Regulations (MMPR) that originally came into force in June 2013. The original MMPR were deemed unconstitutional by the federal court in the Allard decision on February 24, 2016, and the courts gave the government six months to develop new regulations. The new ACMPR do not include pharmacy as part of the distribution network. No doubt many pharmacists and some pharmacy chains/ banners that were pushing for this provision will be disappointed with this news. Pharmacists are reminded that they cannot obtain or dispense marijuana for medical purposes at this time, other than the two already commercially available cannabis-based medications approved by Health Canada – Sativex and Cesamet. Health Canada did hold out some long-term hope for the involvement of pharmacies in their August 11, 2016, statement, which noted “The ACMPR will continue to be evaluated in an effort to ensure that individuals authorized to access cannabis for their own medical purposes have reasonable access. Health Canada is also committed to studying other models, including pharmacy distribution, to provide access to cannabis for medical purposes.” Health Canada also stated that “Storefronts selling marijuana, commonly known as ‘dispensaries’ and ‘compassion clubs,’ are not authorized to sell cannabis for medical or any other purposes. These operations are illegally supplied, and provide products that are unregulated and may be unsafe. Illegal storefront distribution and sale of cannabis in Canada are subject to law enforcement action.” The first part of the new ACMPR outlines the framework for commercial production by licensed producers who are responsible for the production and distribution of fresh marijuana, dried marijuana, cannabis oil or starting materials such as seeds and plants. These products must be manufactured in secure and sanitary conditions and must undergo quality control assessment and testing. This is essentially no different than the framework for licensed producers under the old MMPR. The second part of the ACMPR is similar to the original set of Marihuana Medical Access Regulations that were in effect between
2001 and March 31, 2014. This part of the ACMPR sets out the rules under which individuals can produce a limited amount of marijuana for their own medical purposes or designate someone else to produce it for them. Parts 3 and 4 of the new regulations are more “housekeeping” type regulations. They deal with transitional provisions related to the activities of licensed producers and consequential amendments to other regulations such as the Narcotic Control Regulations. Under the ACMPR, a patient still requires a medical document to access cannabis products, including marijuana and cannabis oil for medical purposes. The medical document must contain certain information including the daily amount prescribed. Details of the medical documents can be found at hc-sc.gc.ca/dhp-mps/marihuana/ info/med-eng.php Once a person has a medical document they can either register with a licensed producer to obtain fresh or dried marijuana or cannabis oil, or register with Health Canada to produce a limited amount of cannabis themselves or designate someone to produce it for them. Irrespective of how an individual obtains their cannabis, their possession is limited to either a 30-day supply or 150 grams of dried marijuana (whichever is less) or the equivalent amount of another form. Certificates from Health Canada that authorize individuals to produce their own or designate a producer, specify a number of conditions including possession limits and location of production and storage. As you may know, the federal government also established a Task Force on Marijuana Legalization and Regulation to make recommendations on a new legal framework for marijuana. While its focus will mainly be on recreational marijuana, it will also include medical marijuana, as Health Canada’s August 11 statement indicated the new ACMRP measures were temporary. The Canadian Pharmacists Association appeared before the Task Force on August 29 to provide input on a new system, advocating that pharmacist management and dispensing of medical marijuana is in the best interest of patient safety. We’ll continue to keep members updated with any new developments. References are available upon request at firstname.lastname@example.org.
SELECT STANDING COMMITTEE ON HEALTH
Association puts forward submission to health committee This July, the BC Pharmacy Association (BCPhA) made a submission to the BC Legislature’s Select Standing Committee on Health. The all-party committee works to identify ways to maintain a sustainable health-care system in the province. From 2014 to 2015, the committee asked for input and held public consultations on questions around the topics of end-of-life care, health-care services in rural, remote and isolated communities, interdisciplinary teams and addiction recovery programs. Last fall, the committee released its report on physician-assisted dying, and followed up with a report on end-of-life care in May 2016. This summer, the committee regrouped to focus its attention on the remaining three questions of improving health-care in rural communities, interdisciplinary teams and addictions recovery programs. In its submission, the BCPhA offered eight recommendations to help improve the quality of care for British Columbians, whether they reside in rural areas or are facing recovery from addiction. The Association asked the government to begin by first recognizing pharmacists as an important member of the interdisciplinary health-care team. To truly operationalize the role pharmacists can play, especially in rural areas, the government must enable systems, legislation and technology to allow pharmacists to: • practice at their fullest scope possible • expand scope where necessary, and • collaborate fully with other health-care practitioners. Community pharmacists are ready and willing to participate in advancing the government’s e-prescribing project. The BCPhA urged the government to support seven e-prescribing pilots in early 2017 and said it is willing to help recruit pharmacies for the project. Telepharmacies, a much-needed access point for patients in remote areas, must be able to operate. In its submission, the Association asked the government to urge the College of Pharmacists of BC to work with telepharmacy operators and the BCPhA to find solutions. BCPhA also asked the government to support pharmacists’ prescribing for minor ailments in rural communities, which will help increase access to primary care in rural areas.
In its July submission to the BC Legislature’s Select Standing Committee on Health, the BC Pharmacy Association offered eight recommendations to help improve the quality of care for British Columbians, whether they reside in rural areas or are facing recovery from addiction. Pharmacists like (left to right) Tarek Mahmoud, Brittany Swanson and Ron Downey (pharmacy manager and owner), pictured here at Peoples Drug Mart in Port McNeill, located on the northern part of Vancouver Island, are important members of the interdisciplinary health-care team in their rural area.
Community pharmacists are on the front lines of opioid addiction recovery, having been providers of the methadone maintenance treatment (MMT) program for many years. The BCPhA believes community pharmacists are a key provider in helping patients overcome opioid addiction and asked that the government adopt the Association’s five recommendations to change the MMT program. In addition to opioid addiction recovery, as British Columbia faces a public health opioid overdose epidemic, pharmacists have responded by training themselves to be providers and educators of naloxone kits to BC residents. The Association urged the government to increase access to naloxone by covering this antidote through PharmaCare so that cost is not a barrier to helping save a life. To read the full submission, visit bcpharmacy.ca/submissions-togovernment-public-2016.
CYRIL LOPEZ | CHIEF OPERATING OFFICER
Partnership with Green Shield Canada offers new diabetes training program Studies show that pharmacist intervention has a positive impact on patient outcomes. For years the BC Pharmacy Association (BCPhA) has been advocating for payment of pharmacists’ clinical services, whether it be government or private payers. We all know that pharmacists can do “a lot more than pills,” but the first step is always to provide the opportunities and support to enable them to do so. Last year, the BCPhA partnered with Green Shield Canada (GSC) to introduce the Pharmacist Health Coaching – Cardiovascular Program, which pays pharmacists to provide eligible patients support, guidance and coaching to better self-manage their high blood pressure and cholesterol. When the program launched, David Willows, vice-president of strategic market solutions at GSC, said it was “The first example of private payers paying pharmacists for cognitive services.” To date, more than 260 BC pharmacists have taken the required training needed to provide this patient counselling and the next phase of this program will focus on targeting eligible patients. Starting this fall, we will be launching a Diabetes Health Coaching Program for beneficiaries of the BCPhA-sponsored health insurance plan. The plan members include BCPhA office staff and staff of the corporate members who have joined the BCPhA health insurance program. The service will pay pharmacists to provide eligible patients a clinical service that will support better self-management of diabetes.progroup_ad_v3.ai Over the next few years, we4:23:24 anticipate that the nominal 13/11/2008 PM increase in premiums required to fund this service will be more
than offset by overall savings that arise when the plan members (the employees) gain increased control over their diabetes. A training program will be available for BCPhA members at no cost and is CCCEP accredited for 3.0 CEUs. This comprehensive program is broken into four modules: 1. Overview of diabetes 2. Overview of current recommendations for pharmacological treatment of type 2 diabetes 3. Overview of non-pharmacological measures to manage type 2 diabetes 4. C ommunication skills to promote patient self-management. The goal of the service is to empower patients diagnosed with type 2 diabetes to take ownership and responsibility for their overall diabetes control and engage pharmacists to provide guidance and support to patients to improve glycemic control, implement strategies that help improve patient adherence to diabetes drug therapy and offer effective coaching and follow-up to help patients adopt healthy lifestyles. While there is a common misconception that paying for paramedical services such as podiatrists or physiotherapists is at the discretion of the insurance company, it’s actually the employer – or plan sponsor – who can request what’s covered under their insurance plan. That’s significant because it’s critical that we demonstrate not only to health insurance companies but also to employers the importance of pharmacists’ role. GSC is an innovative partner that is helping us make this happen, and they are also BCPhA’s own health benefits company for its staff and corporate members who sign on with BCPhA’s health insurance plan.
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It is our hope that the work we do with GSC will allow us to capture important data to demonstrate the value that we know and advocate: That pharmacists can provide better patient outcomes at a cost-effective price to the system.
DRUG AND POISON INFORMATION CENTRE
Lyme disease: Targeting more than just the bull’s-eye By Dorothy Li, B.Sc. (Pharm.), R.Ph., CSPI, Drug and Poison Information Pharmacist, BC Drug and Poison Information Centre Reviewed by C. Laird Birmingham, MD, M.H.Sc., FRCPC, Muhammad Morshed, PhD, SCCM and William R. Bowie, MD, FRCPC. Lyme disease (LD) in North America is caused by the bacterium Borrelia burgdorferi (Bb). Bb is transmitted in BC by Ixodes pacificus and I. angustus, a blacklegged tick found in valley regions of Vancouver Island, the Lower Mainland, the Sunshine Coast and the Interior. The most common tick found on humans in BC (wood or dog tick) does not carry Bb. In the rest of Canada (east of the Rockies) Bb is transmitted by I. scapularis. Reports of LD in Canada quadrupled between 2009 and 2013, likely due to the spread of ticks in eastern Canada as a result of climate change. The risk of LD in BC is low. Tick infection rates in BC have remained stable and low (<1%) compared to >20% in the northeastern United States.
International Lyme and Associated Diseases Society (ILADS) recommend a longer course of antibiotics. Both recommend early treatment of acute localized LD because over 80% of patients treated for early LD have long-term complete resolution of symptoms. The IDSA recommends oral doxycycline, amoxicillin or cefuroxime axetil as first line and oral macrolides as second line treatment. Parenteral ceftriaxone, penicillin G or cefotaxime are recommended for meningitis, arthritis with neurologic symptoms or treatment-resistant arthritis. Length of treatment depends on LD stage (14-28 days). If antibody testing is indicated, patients should have samples drawn for testing prior to starting antibiotics.
LD has three accepted clinical stages (Table 1). Early localized LD peaks in June to August and presents with an oval or round expanding rash (>5 cm) at the bite site, called erythema migrans (EM). EM is mostly homogenous; less than 10% have a bull’s-eye appearance. Differential diagnosis includes a bacterial infection at the bite site or a hypersensitivity reaction to tick saliva at the bite site usually within 48 hours, less than 5 cm in diameter and resolving within 48 hours.
Chronic Lyme disease
Removing a tick within 36 hours of attachment (the time required for Bb to move from the blacklegged tick gut to it’s salivary glands) minimizes risk of LD. A single dose of doxycycline is 87% effective in preventing LD post-tick bite in areas of high tick Bb infection rates. Prophylaxis following tick bite in BC is not recommended due to low tick Bb infection rates (<1%).
The existence of chronic LD remains controversial, but there is no compelling evidence that it is due to active or previous infection with Bb. Symptoms reported include fatigue, arthralgias, melalgias, paresthesias, insomnia and cognitive impairment. Post-treatment Lyme disease syndrome (PTLDS) is further differentiated from chronic LD where the former refers to symptoms that persist after antibiotic treatment for LD. The incidence of fatigue, cognitive impairment, insomnia, joint pain and numbness in chronic LD is increased in some studies, while others report no difference from controls. Four small and one moderate-sized randomized controlled trials reported little or no benefit of long-course antibiotics for fatigue, pain or neurocognitive function in PTLDS. The IDSA recommends symptomatic therapy (not antibiotics), whereas the ILADS recommends “considering” antibiotics with probiotics in patients with persistent symptoms of LD including using “higher doses, longer durations or combinations of first-line agents,” though this is based on expert opinion only. Some clinicians recommend adding metronidazole to the regimen to disrupt the ‘cystic form’ of Bb, despite no evidence of benefit or the existence of Bb cysts in humans.
The Public Health Agency of Canada recommendations follow the Infectious Disease Society of America (IDSA) guidelines. The
There is no evidence for any of the following adjunctive therapies for LD: methyl B12 injections, Myers infusions (intravenous nutrient
Disseminated LD is diagnosed by antibody testing. It takes approximately two to four weeks for antibody testing to become positive and it may be influenced by prior antibiotic treatment. Antibodies remain high for many years so a positive test can indicate recent or remote infection. Prophylaxis
therapy), ribose powder, andrographis, eleuthero, glutathione, vitamin C, coenzyme Q10, alpha lipoic acid, vitamin B complex, vitamin B6, magnesium, omega-3, omega-6 and NT-factor. Despite the controversy among various groups and guidelines, all emphasize careful differential diagnosis and evaluation for other causes. At the BC Women’s Hospital and Health Centre, a Complex Chronic Diseases Program has been set up to provide care for patients with chronic LD as well as other pain syndromes. Patients with
symptoms compatible with chronic LD sometimes suffer for years, through countless clinical evaluations and tests without a proper diagnosis and effective treatment. It’s important that pharmacists understand the risks of contracting LD and the controversies concerning diagnosis, prophylaxis and treatment so that they can help patients navigate through the conflicting information. References available on request at email@example.com. Comments or DPIC article topic suggestions can be sent to firstname.lastname@example.org.
Table 1: Stages of Lyme disease: STAGE (INCIDENCE RATE)
ONSET POST TICK BITE
Erythema migrans (60-90%), flu-like symptoms (80%)
3 – 30 days
Erythema migrans (60-90%), flu-like symptoms (80%)
Neurologic (3-15%) (neuroboreliosis)
Multiple erythema migrans (15%)
Monoarticular/oligoarticular arthritis (brief attacks)
AV block, myopericarditis
Conjunctivitis, uveitis, papillitis, episceleritis, keratitis
Late arthritis (<10%)
Intermittent/chronic monoarticular and oligoarticular arthritis (knee common) + peripheral neuropathy or encephalomyelitis (rare)
Weeks to months
Months to years
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Greg Shepherd, CEO, Pharmasave Drugs (Pacific) Ltd. 1.800.665.3344 ext. 738 email@example.com
FIRST NATIONS HEALTH CARE
Cultural understanding and humility key to quality care for First Nations patients patients if they didn’t have a reliable way to go into town.” Elhennawy says the help and support of the Seabird Island Band was essential to establishing the pharmacy, in particular Chief Clement Seymour and Carolyne Neufeld, the director of health and social development. Almost immediately, the pharmacy was bustling with patients, referred by the busy medical clinic located next door. While the compounding pharmacy offers a full range of clinical services, a large portion of time is dedicated to comprehensive, one-on-one medication reviews, in order to improve medication adherence, and therefore, health outcomes for patients.
Mostafa Elhennawy is pharmacy manager of the Seabird Island Pharmacy in Agassiz. Prior to this role, Elhennawy spent years working in remote northern BC communities such as Bella Bella, Terrace and Hazelton. Building a rapport with his clients remains his top priority: “There needs to be a relationship between pharmacist and patient. My patients need to trust me as a person before they can trust me as a pharmacist.”
By Angela Poon Seabird Island Pharmacy in Agassiz is one of only a handful of retail pharmacies in BC located on and directly serving the community of a First Nations reserve. It was opened in March 2015 by Mohamed Hasanine and Tareq Youssef, who also own nearby Agassiz Remedy’sRx. Bordered by the Fraser River and surrounded by the scenic mountains of BC’s eastern Fraser Valley region, the Agassiz reserve is home to the Seabird Island Band, a thriving community hub with nearly 1,000 members and dozens of on-site services, including
a daycare, K-12 community school, early childhood development programs, health and wellness programs, a dental clinic and medical clinic. Up until last year, however, those services did not include a pharmacy. “We approached the band office to ask about a pharmacy because it was evident there was a need for this service on site,” says Mostafa Elhennawy, pharmacy manager of Seabird Island Pharmacy. “While downtown Agassiz is only an eight to 10-minute drive, it can be an hour-long walk for those without transportation. There was a real problem with medication adherence because it was so hard to provide this pharmacy service for
“We found many people didn’t know exactly what medications they were taking and why,” says Elhennawy. He noticed patients would sometimes skip their medication for weeks at a time if away from home or unable to get to the nearest pharmacy for a refill. “When I came here, I started working one-to-one with the doctors and nurses to better serve our clients’ needs,” he says. Within the year, medication adherence has jumped to more than 80 per cent, Elhennawy estimates. He says this is a direct result of the unique interdisciplinary health-care model being practiced in the Seabird Island community, which involves daily face-to-face interactions between doctors, nurses and pharmacy staff. “This integrated health-care team is something I’ve never had before,” adds Dr. Marcella Beaulieu, a physician with the Seabird Island Health Centre. “Adherence
Seabird Island Pharmacy in Agassiz is one of only a handful of retail pharmacies in BC located on and directly serving the community of a First Nations reserve. Bordered by the Fraser River and surrounded by the scenic mountains of BC’s eastern Fraser Valley region, the Agassiz reserve is home to the Seabird Island Band, a thriving community hub with nearly 1,000 members and dozens of on-site services.
– and continuity of care – is great with our pharmacist right here. To see our pharmacist and to work with the team directly is much more reliable for our patients’ needs.”
takes time for people to build a rapport with you and try new things to see a difference in their health. It’s not just about taking pills, it’s about a lifestyle.”
Dr. Beaulieu notes that to best serve the health needs of a primarily First Nations community, health-care practitioners need a widespread knowledge of the First Nations Health Benefits program (formerly Canada’s Non-Insured Health Benefits program or NIHB) to ensure medication coverage. Pharmacists also need in-depth knowledge on some of the most common health concerns affecting the community, such as diabetes. For the Seabird Island Health Centre, this includes operating a mobile diabetes team that pays regular home visits to patients, using state-of-the-art diabetes medicine and working closely with the pharmacy team on medication and overall health management.
For Elhennawy, who has spent years working in remote northern BC communities such as Bella Bella, Terrace and Hazelton before settling in the Fraser Valley at Seabird Island Pharmacy, building a rapport with his clients remains his top priority. “There needs to be a relationship between pharmacist and patient,” he says. “My patients need to trust me as a person before they can trust me as a pharmacist. And once you’re in, you’re in.”
“We’re working together to create an action plan for each patient to get the best results,” notes Elhennawy. “We’ve started to see a lot of real success stories in the last six months, especially from patients with diabetes. It
One practical way he works on this service model is through continuous self-education on topics such as traditional indigenous medicine, which he notes is a vital part of providing well-rounded Aboriginal health care. He regularly reads up on the subject and personally partakes in traditional herbal therapies for common ailments such as headaches and stomach troubles to better understand this important facet of medicinal treatment when developing overall drug therapies for his pharmacy clients.
“I’m not here to change my patients’ mindset,” he notes. “I’m here to work with them.” Understanding Aboriginal health care Pharmacists Larry Leung and Jason Min followed an unorthodox career path after graduating from the UBC Faculty of Pharmaceutical Sciences in 2010 and 2008 respectively. With a keen interest in Aboriginal health care, Leung and Min were paired up for a Community Pharmacy Residency at UBC that took them to Bella Coola for a six-week practicum to help develop clinical pharmacy services for members of the Nuxalk Nation. “It opened our eyes to all of the great work being done,” notes Leung. “But we also saw the potential to collaborate with local healthcare workers and pharmacists to improve medication use in the community.” Rather than take on traditional community pharmacy jobs, the pair decided to start their own consulting business, Clinicare Pharmacists, in 2011. The business specializes in improving medication management
FIRST NATIONS HEALTH CARE services, including in remote BC communities, by working in partnership with local pharmacy staff, medical professionals, Aboriginal elders and community members. “Our goal was all about the optimization of the patient’s therapies,” says Leung, who along with Min has travelled to Bella Bella, Mount Currie and other communities over the past five years. “The work that was being done was not unique – it’s what a pharmacist does. But some of these communities just didn’t have that service.” While each community had unique needs specific to its population and location, there was often a common theme – a lack of time and resources. Pharmacies could often be one or two hours away from a reserve community, or were understaffed. While Leung and Min strived to work alongside communities to help develop pharmacy services, the duo quickly realized they had very little information and few tools available to offer the culturally safe care they hoped to provide. The pair felt there was a critical gap for pharmacy students looking to expand their knowledge and understanding of Aboriginal health care. “Pharmacists may lack the understanding of Aboriginal culture and be unaware of the current and multi-generational issues that have contributed to health disparities that we see,” says Min. “In gaining cultural understanding, competence and humility, pharmacists can do their jobs more effectively.” After approaching UBC, the pair introduced an elective course for third and fourth-year pharmacy students called Pharmaceutical Care in Aboriginal Health, which addresses topics such as terminology, the impact of colonialism and residential schools on Aboriginal health, truth and reconciliation, and pharmacy-specific topics related to diabetes, substance abuse and mental health. In addition, they worked with Aboriginal partners at UBC to ensure pharmacy students receive mandatory content on Aboriginal health starting in 2015.
Ashton Penner is a pharmacy assistant at the Seabird Island Pharmacy and a member of the Seabird Island Band. “It’s really convenient for patients. They feel special here,” says Penner of the pharmacy.
Today, the pair work at the UBC Pharmacists Clinic to continue providing medication management services to First Nations communities throughout BC on a larger scale, as well as local patients on site at the Vancouver university. “We took a step back to ask ourselves, ‘What is the goal of what we’re trying to achieve?’” says Leung. “There are more than 200 First Nations communities in BC alone and we only collaborate with a handful; we knew that we wanted to help build pharmacist capacity to better serve the needs of these communities.” Improving health-care services for all patients Despite health-care advancements across Canada, there is an overwhelming sentiment that remains strong among many healthcare professionals – there is still much room for improvement when it comes to delivering pharmacy services to First Nations people. A special session held August 20 in Vancouver on indigenous health, organized by the Indigenous Physicians Association of Canada, along with the Canadian Medical Association, the College of Family
Since it opened in March 2015, Seabird Island Pharmacy has been bustling with patients. It offers a full range of clinical services as well as comprehensive, one-on-one medication reviews, in order to improve medication adherence, and therefore, health outcomes for patients. Here pharmacy manager Mostafa Elhennawy checks the blood pressure of patient Denise LaRock.
Tareq Youssef (left), co-owner of Seabird Island Pharmacy in Agassiz, with pharmacy assistant Ashton Penner (centre) and pharmacy manager Mostafa Elhennawy. Within a year of opening, Elhennawy estimates that medication adherence jumped to more than 80 per cent in the pharmacy. He says this is a direct result of the unique interdisciplinary health-care model being practiced in the Seabird Island community, which involves daily face-to-face interactions between doctors, nurses and pharmacy staff.
Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, featured several recommendations from the Truth and Reconciliation Commission, including the need for specialized training on Aboriginal health issues as well as skillsbased training in cultural understanding and humility. “There is a definite power imbalance in the health-care system that needs to shift,” says Cindy Preston, senior pharmacy lead at the BC First Nations Health Authority (FNHA), the first province-wide health authority of its kind in Canada. “Even though there is good care going on, it can be better.” Preston regularly travels to First Nations communities throughout BC to work with health-care teams to address and improve upon service delivery challenges, including pharmaceutical services. She sees a huge opportunity for pharmacists to become leaders in the movement towards a health-care model that prioritizes cultural safety and humility for all patients. “Because we are a community-based entity, what an
opportunity for the pharmacy profession to step up to start providing better care to all British Columbians.” She cites the complexity of Canada’s colonial history, the multigenerational impact of residential schools on the health and wellness of Aboriginal people, and the deepseated stereotypes that often plague the health-care system as barriers to providing culturally respectful health care. “Developing cultural humility is the process of self-reflection to understand our personal and systemic biases as health-care providers,” says Preston. “Understanding that we as pharmacists don’t understand everything is a very key part to that.” While there are no official certifications in Aboriginal health for pharmacists, all BC health-care providers are strongly encouraged by the FNHA to take the selfadministered online San’yas Indigenous Cultural Safety Training developed by the Provincial Health Services Authority (PHSA) in 2010.
“Indigenous people are the fastest growing population in BC, yet experience the greatest inequities in health and access to care,” says Cheryl Ward, interim director of Indigenous Health and provincial lead of San'yas Indigenous Cultural Safety Training at the PHSA. “The training examines a range of complex issues and aims to increase knowledge, enhance self-awareness, and strengthen the skills of health professionals who work with indigenous people.” To date, nearly 28,000 people in BC have completed the training, but only 158 pharmacists and pharmacy staff have opted in on the course. “Pharmacy is a relationship-based practice,” says Preston. “The more that pharmacists can engage in cultural safety and humility, the more individuals will feel respected. That helps create a better health-care environment where all patients can feel safe and engage in those services more.” To learn more about the PHSA San’yas Indigenous Cultural Safety Training course, visit sanyas.ca.
Unique clinical services enhance patient care at BC pharmacies By Angela Poon More than 30 BC residents have been recommended to see a physician for the treatment or assessment of a potentially cancerous mole, thanks to an innovative new clinic held at 10 London Drugs pharmacy locations this summer. From June 15 to July 16, the pharmacy chain offered one-on-one personal skin checker clinics as part of a pilot program, using Vancouver-based MetaOptima’s noninvasive MoleScope device and partnering with both a local dermatologist (to offer patients a quick diagnosis) and cosmetic brand La Roche-Posay. “This clinic was timely and topical,” says Suzanne Han, pharmacist and manager of managed care at London Drugs. “In summer people are out in the sun, and we wanted to remind patients about the importance of regular mole checks and proper sun protection.” As more BC residents continue to seek enhanced services from their local pharmacy, many pharmacies are offering unique clinical programs like mole checking, cardiovascular health coaching, strep throat programs and diabetes clinics. These programs are designed to improve health awareness, build customer loyalty and alleviate the burden on the province’s overloaded health-care system. London Drugs’ skin checker clinic helps address the dangerous and growing problem of skin cancers in BC. According
Sam Ma, assistant pharmacy manager for London Drugs at West Broadway and Cambie Street, demonstrates the noninvasive MoleScope device used at the pharmacy’s skin checker clinics held from June 15 to July 16. Thanks to the clinics, more than 30 BC residents have been recommended to see a physician for the treatment or assessment of a potentially cancerous mole.
Anoop Khurana, associate owner and pharmacy manager at the Shoppers Drug Mart located at Hastings and Slocan in East Vancouver, last year began offering a rare clinical service to further enhance care for his many diabetes patients. The service provides monofilament testing for neuropathy in the feet, a potentially very serious side effect of diabetes that, over time, leads to loss of sensation, and, in worst case scenarios, foot amputation.
to the Canadian Skin Cancer Foundation, one in every three cancers diagnosed worldwide is a skin cancer, with more than 80,000 cases of diagnosed skin cancer in Canada every year. More than 5,000 of those cases represent the most critical form of skin cancer – melanoma. Apart from receiving immediate positive feedback from patients, who learned about the free skin checker clinics instore and registered for an appointment online, London Drugs was pleased to play an essential part in this important service offering. Of the 148 patients who attended, 10 per cent were recommended for future follow-up and 12 per cent were notified that a physical exam and/or biopsy-excision was required. “At London Drugs, we’ve always been proactive in our approach to wellness,” says Han. “We look for unique services to offer our patients that seem to be of value.” While London Drugs is currently considering the possibility of returning
– and expanding – the skin checker clinic next year, the company is kept busy with a regular rotation of specialty service offerings throughout the year. These include clinics for osteoporosis, flu, smoking cessation, cardiovascular health, and, most recently, oral health, offered for its second year this past spring, to coincide with the Canadian Dental Association’s National Oral Health Month in April. Met with an overwhelmingly positive response in its initial pilot year in 2015, London Drugs decided to bring back its oral health clinic to select Lower Mainland pharmacy locations in 2016, but added a $25 session fee (with $5 donated to the BC Cancer Foundation). Utilizing the VELscope, a hand-held detection device developed by the BC Cancer Agency, a health professional inspected patients in-store for oral tissue abnormalities. Out of the 155 patients seen this year, seven per cent required a reassessment, nearly half of which were referred to the Next Gen Oral Dysplasia
Clinic, managed by the BC Oral Cancer Prevention Program at both UBC and the Pacific Oral Health Centre in Surrey. Twenty per cent of patients were referred to the specialty clinic, many of which were smokers, later required a biopsy. “There are common risk factors known around oral cancers,” notes Han. “We as pharmacists need to practice within our scope and partner with other health professionals to make these unique services available throughout the community.” Following a successful strep throat pilot program at select Shoppers Drug Mart locations from October 2015 to March 2016, several locations chose to continue offering the simple, yet effective, service to clients year-round. Jina Sarkis-Dina, associate owner and pharmacy manager at a Coquitlam Shoppers Drug Mart, has seen the positive impact of this added service. “We found an immediate benefit to patients, and it helped in our optimization of patient
care,” says Sarkis-Dina. “I think this type of service is a definite benefit to the health-care system.” While the need for strep testing is less over summer, during the busy cold and flu season throughout the winter months this type of service can be a huge time saver for both patients and doctors’ offices. Rather than waiting in a crowded medical clinic, patients can be immediately swabbed by a pharmacist to determine whether their sore throat is a simple viral infection or a more persistent bacterial infection requiring a physician-prescribed antibiotic. The service is offered in conjunction with the virtual health-care clinic, Medeo, which has produced the added benefit of increased referral patients at her busy pharmacy, says Sarkis-Dina. “We’re seeing both scenarios,” she says. “Those patients that weren’t able to see a doctor and are walking in, and those that have read online about the service and are referred to our pharmacy by Medeo physicians. To me, this is one of the many ways that we can further our role as pharmacists in the health-care system; it’s all about collaboration with other health professionals.” Anoop Khurana, associate owner and pharmacy manager at the Shoppers Drug Mart located at Hastings and Slocan in East Vancouver, wholeheartedly agrees with colleague Sarkis-Dina.
The non-invasive MoleScope device used by London Drugs at the pharmacy’s skin checker clinics held from June 15 to July 16.
Khurana is a certified diabetes educator and for several years his pharmacy has been offering monthly diabetes clinics. But last year, at the suggestion of David Pavan, pharmacy operations specialist with Shoppers Drug Mart and BCPhA Board member, Khurana began offering a rare clinical service to further enhance care for his many diabetes patients – monofilament testing for neuropathy in the feet. This potentially very serious side effect of diabetes, over time, leads to loss of sensation, and, in worst case scenarios, foot amputation. “Unfortunately, even when patients are managing their diabetes well, the disease can worsen,” Khurana says. “I definitely saw the value in this service, and that pharmacists were uniquely positioned to provide it for patients.” The service has been popular with diabetes patients, eager to manage their progressive disease, says Khurana, who has received very positive feedback, as well as a steady stream of booked appointments. Khurana, who offers his diabetes services at no cost to patients, believes increased clinical services are not only essential for enhanced patient care, but also results in long-term loyalty from patients who trust and rely on their community pharmacy. “As pharmacists, we’re becoming better equipped to manage overall care for patients more than ever before,” says Khurana. “It’s about finding an unmet need in the community, and then collaborating with other health-care providers to have the whole team advocating for the patient.”
Registered dental hygienist Stacey Rhodes-Nesset (left) and Dr. Ken Neuman (centre), a dentist and member of the UBC Faculty of Dentistry, at the London Drugs oral screening clinic. Lily Liang (seated), a pharmacist with London Drugs, consults with a customer.
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21/09/2015 11:52:28 AM
ON THE COVER | ADDICTIONS CARE
Addictions: The complexities of care As early as the 1950s, addiction care in the form of opioid maintenance treatment was on the radar of British Columbian officials. It was a simple but revolutionary concept that suggested supplying addicts with drugs to alleviate the negative criminal and health consequences of their addiction. In 2014, there were a total of 881 pharmacies and 3,136 pharmacists in the province that provided opioid substitution treatment through methadone maintenance treatment or Suboxone. This article takes a closer look at one new pharmacy model and a pharmacist working in a community health centre treating patients with a history of addiction.
By Matilda Meyers The woman was crying when she entered the Pier Health Resource Centre pharmacy in Vancouver’s Downtown Eastside (DTES) with her husband late on a Friday afternoon. She was experiencing severe withdrawal symptoms and urgently needed Suboxone. The woman knew she faced a weekend of heroin use if the pharmacy could not find a solution. Recognizing her distress, staff at the pharmacy took the time to examine her situation and help resolve it. From that moment on, the couple became loyal patients at Pier Health. As time passed the husband started doing some part-time janitorial work at the pharmacy, leading him to find full-time employment elsewhere. “He now has a job, and as a couple they are medically stable,” says Bobby Milroy, the director at Pier Health Resource Centre. “That’s a great scenario and a real win for us.” Successful scenarios such as this can be rare in the field of addictions health care;
patients’ problems are incredibly complex as they often suffer from mental health issues, chronic diseases and homelessness on top of the disease of addiction. There are many differing perspectives on how best to treat them. Given the epidemic of opioid overdoses in BC, officials and health professionals are re-examining how the health system deals with addiction. Pier Health Resource Centre pharmacy opened in August 2015 to address the needs of the homeless and at-risk population in the DTES by providing mental health, chronic disease and social assistance support. The pharmacy has a multi-disciplinary clinical approach with a strong emphasis on solving drug therapy problems both within the pharmacy as well as through regular outreach in the local community. Pier Health also has a part-time nurse, a massage therapist and a housing support worker for patients. Milroy says that society is slowly changing the way it views addiction and how to treat it. “Drugs are a form of self-medication,
The intake booths at the Pier Health Resource Centre are designed to foster conversations and relationshipbuilding between staff and patients.
as opposed to the exclusive problem. Our patients are not partying. It’s not fun. They are simply surviving,” he says. In December 2013, the American Journal of Psychiatry published a UBC study titled “The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing,” a survey of 3,000 tenants living
Bobby Milroy (right), director of the Pier Health Resource Centre, with Natalie May, the first patient who was ever treated at the pharmacy – for an asthma attack. Coincidentally, May was outside the pharmacy having the attack at the same time staff were putting out the “New pharmacy now open” sandwich board for the first time. Although she isn’t receiving regular care from the pharmacy for any particular condition, May does stop by to visit the team quite regularly.
Life on the streets Life on the street is often full of trauma and violence, which can be exacerbated by medical conditions and even traumatic brain injuries. Typically, people are in a more vulnerable state so there is a much higher degree of stress. They use drugs to stay awake and other drugs to calm their anxiety. As a result, they spend more money, which in turn means they must sell medications or drugs or engage in theft or sex work to survive. That means they're more likely to be arrested or be physically assaulted. Life becomes chaotic and unpredictable. “Patients’ situations worsen considerably when they become homeless,” Milroy explains. Milroy says based on both the hotel study and the work of Dr. Julian Somers, an associate professor in the Faculty of Health Sciences at Simon Fraser University, medication adherence for homeless patients is nearly 40 to 50 per cent less than that of patients who have a home. “We need to find mechanisms to effectively support these individuals, to help them achieve the best quality of life possible, and minimize their cost on society. And pharmacy has to play a part in that,” Milroy says. If you sit in the foyer of the pharmacy during a weekday morning it almost resembles a corner coffee shop. Regulars come in to grab a free hot cup of coffee and chat with friends. The pharmacy cultivates a safe, welcoming and stable environment and builds relationships with all local residents, regardless of whether they are customers. “Our goal is to get to know people because it’s not just medication they need,” Milroy says. Inside the pharmacy, patients are invited to sit face-to-face with a member of the pharmacy team at one of the intake booths to discuss their medication needs and their lives. Dr. Keith Ahamad, an addiction physician at the St. Paul’s Addiction Medicine Consult Service, says pharmacists play a vital role in addictions care as they see patients more frequently than any other health-care provider. “It’s hugely important for pharmacists to discuss their response to medications, look at other medications they are prescribed for side effects, talk about psychosocial functioning, and act as a point of contact between the patient and the rest of the health-care team,” Ahamad says.
in single-room occupancy (SRO) hotels in the DTES. Due to their affordability, SROs are often the only alternative to homelessness for low-income individuals in Vancouver and other major cities. According to the study, two-thirds of tenants suffered from an average of three illnesses at the same time. Ninety-five per cent had substance dependence and almost two-thirds were involved in injection drug use. Nearly half of the participants suffered from psychosis, and nearly half of all participants had a neurological disorder. Eighteen per cent of the residents surveyed were HIVpositive, and 70 per cent had been exposed to hepatitis C.
Quality time is key Spending time with patients should be at the centre of addictions care, says Dr. Keith Ahamad, an addiction physician at the St. Paul’s Addiction Medicine Consult Service. He says the system has become far too reliant on medication. “We have a medical system that financially incentivizes volume rather than time spent with patients to discuss what their needs are. It is not patient centred; it’s way too health-care provider centred, and we need to spend time with these people because their problems are very complicated.” Ahamad says pharmacists play a vital role. They see patients more frequently than any other health-care provider. “It’s hugely important for pharmacists to discuss their response to medications, look at other medications they are prescribed for side effects, talk about psychosocial functioning, and act as a
Pharmacy manager Craig Plain, who won this year’s Ben Gant Innovative Practice Award from the BC Pharmacy Association, is praised for his compassionate and personalized care. "It's about building trust with patients and not just filling what the doctor writes," Plain says.
Pharmacist Susan Troesch (centre) and Dr. Lise Loubert (left) speak with a patient at the Mid-Main Community Health Centre. The centre was primarily established to treat people with several chronic conditions, mental health issues, backgrounds of addiction or long-standing chronic pain management with opioids, home-bound seniors, refugees and single parent families with lower socio-economic status. Staff help addicted patients using a more holistic approach to pain management outside of just medication.
point of contact between the patient and the rest of the health-care team,” he says. He believes increasing collaboration and communication between the whole healthcare team would drastically improve care. “In particular for this complicated patient population we need to find a way to work better in teams rather than silos,” Ahamad says. He acknowledges the huge problem of physicians overprescribing opioids and is hopeful the new professional standards on safe prescribing adopted by the College of Physicians and Surgeons of BC in June 2016 will “make doctors stop in their tracks and think about the consequences of their prescribing.” Ahamad says pharmacists can help tackle the opioid epidemic by checking PharmaNet, flagging patients that are on excessively high doses of opioids and contacting the patient’s physician or the College if they are concerned. While he believes the Methadone Maintenance Treatment Program in BC is effective, he feels there is huge room for improvement. This could include subsidizing medications for patients for evidence-based addictions treatment and ensuring that if pharmacists receive the extra daily witnessing fee they must spend time with their patients.
Ahamad thinks the coming years will see a shift away from methadone and towards Suboxone, as it's a simpler medication, with fewer drug interactions and a better safety profile. This will take time and education, however, as it won’t be appropriate for all patients – those who cannot tolerate the side effects of withdrawal necessary to begin Suboxone will need to remain on methadone. He says it will be important to explain to patients how the drugs work and why they’re being prescribed. Because of the prevalence of mental illness and history of trauma, basic counselling skills are essential for pharmacists working in addictions care. “Just knowing how to be gentle and kind to this patient population is hugely important to build that therapeutic relationship, because there is so much stigma associated with addiction,” Ahamad says. Pier Health Resource Centre places immense value on hiring pharmacists that are calm, qualified, experienced, well-trained and have an interest in ongoing education about mental health and addictions. The pharmacy has a staff of three pharmacists, a registered pharmacy technician, four part-time pharmacy assistants, a general manager/community liaison and up to four student interns at any time.
He can focus one-on-one with patients (often for up to 20 minutes each visit) and use the full scope of his knowledge. He's the first pharmacist in BC to administer depo anti-psychosis injections at the pharmacy through a pilot project with St. Paul’s Hospital Department of Psychiatry. The pharmacy will also be starting a clozapine program, which provides an alternative psychosis medication for patients who’ve had no success with standard treatments. The patients will also have access to a nurse who takes a weekly blood sample and monitors side effects. There are plans to open a medical clinic above the pharmacy to help provide a comprehensive hub of services. “We want to push the envelope and try new things," Milroy says. This pharmacy model is expensive, but Milroy says the centre will ultimately be financially viable. To help encourage the future sustainability of the health-care system, Pier Health shares its financials and metrics with the Ministry of Health, the College of Pharmacists of BC and the City of Vancouver. “There is going to need to be a redesign of compensation [for pharmacists], and I want them to know exactly what is happening here,” Milroy explains. “I don’t think we’ve cracked the code yet by any means, but I do believe we have a great opportunity to contribute and to make some kind of breakthrough in the coming years.” The power of interdisciplinary care At the Mid-Main Community Health Centre, pharmacist Susan Troesch works alongside the clinic’s two nurse practitioners and seven part-time physicians. The centre was established in 1988 to support the local patient population struggling to access consistent primary care. This included people living with several chronic conditions, mental health issues, backgrounds of addiction or long-standing chronic pain
management with opioids, home-bound seniors, refugees and single parent families with lower socio-economic status. When Troesch first started working at the non-profit clinic in 1999 she was seeing some patients who were struggling with addictions, some of who were living on the streets. The surrounding community has changed considerably since then to become a middle-class neighborhood. Now, none of the clinic’s patients are homeless. In its early days, the centre operated as a salaried practice, thanks to funding from Vancouver Coastal Health (VCH). In the fall of 2014, following a VCH redesign, the clinic was transitioned to a fee-for-service funding model. This means that the physicians must bill MSP for their services to support the practice financially. Current office visits booked with Troesch are 20 minutes and include educational support, medication reviews, development of a collaborative plan with the patient and preparation of requisitions and prescriptions. A physician joins them at the end of the visit to review and finalize the plan and sign off on any prepared documents.
and those trying to stop or reduce their use of certain medications. “We’re doing a lot of holistic support and trying to encourage people to gradually come off opioids and benzodiazepines,” Troesch says. “That’s an area where pharmacists can be very helpful.” Benzodiazepines – which include Valium and Xanax – are used to treat conditions like anxiety, insomnia and seizures but can cause an overdose when combined with opioids. She remembers in the late 1990s when doctors were encouraged to treat chronic non-cancer pain using narcotics and continuing medication education courses teaching narcotic use were readily available. “Now our goal is to try and get people off narcotics because the evidence is showing us that there is a lot more risk,” Troesch says. In fact, she says the U.S. recently reduced its maximum recommended daily dosage of morphine by more than half, from 200mg per day down to 90mg. Many of the principles recently released by the
U.S. Centers for Disease Control and Prevention in the "CDC Guideline for Prescribing Opioids for Chronic Pain" were incorporated into the new College of Physicians and Surgeons of BC’s guidelines. The College’s guidelines recommend that doctors “always prescribe the lowest effective dosage of opioid medication.” In addition, doses of morphine greater than 50mg per day “warrant careful reassessment and documentation,” and doses greater than 90mg per day “warrant substantive evidence of exceptional need and benefit.” When a new patient requiring addiction treatment or management of non-cancer chronic pain comes to the Mid-Main Community Health Centre they are asked to sign an office narcotic agreement. Based on McMaster University’s "Canadian Guideline for Safe and Effective Use of Opioids for Chronic NonCancer Pain," the agreement involves a Continued on page 30
These days, Troesch’s primary focus is to follow up on and manage patients with chronic conditions such as hypertension, diabetes, heart failure or COPD. However, patients are still booked with her for other reasons such as focused medication reviews, medication management issues, health promotion visits, smoking cessation support, insulin starts, followup regarding recent labs and prescription refills. Troesch also facilitates the group medical visits for multiple patients that happen regularly in the practice. The centre has a common clinical room where the team sits together, which generates a lot of collaboration. “We’re advocating going back to an interdisciplinary care approach to primary care,” Troesch says. “We’ve seen the power of working face-to-face with a team, and it’s pretty hard to go back once you’ve had that experience.” While patients struggling with addiction may be referred to an addictions specialist, the clinic does treat patients with a background of addictions, those struggling with chronic non-cancer pain
Susan Troesch, a pharmacist at the Mid-Main Community Health Centre, believes meeting with patients to engage them in the process is essential. “If you spend time with them, build the relationship and tell them what the expectation is then they’re pretty willing to follow your advice,” Troesch says.
MEET THE BCPHA BOARD
Introducing the 2016/17 Board of Directors We checked in with each of our Board members, both returning and new, to ask them about issues that are pressing for the Association. The BCPhA is governed by a 12-member Board of Directors who set and review the strategic goals of the Association. Of this Board, seven directors are elected and up to five directors are appointed with staggered terms. Each of the directors must be a general member in good standing. Appointed directors must have personal experience, strategic liaisons or other important qualities
which are valuable to the Association and complement the Board’s experience. We’re pleased to introduce this year’s Board of Directors, effective September 1, 2016, which includes incoming president Randy Konrad and vice-president Alex Dar Santos. Two new Board members, Linda Gutenberg and Jamie Wigston, also begin their terms on September 1.
Randy Konrad President, BCPhA Board of Directors | Appointed 2015-2018 Director of Pharmacy for Safeway and Thrifty Foods in BC Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? The strength of having voluntary membership is that pharmacists join because they want to make the Association stronger. I think we should encourage those who are just entering the profession to support us – not only as members but also by getting involved in the work we do. They could sit on committees or attend CE and social events to learn and network with fellow pharmacists. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? Negotiating with government, working closely with the College and advancing the profession. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? Our Board is successful because each member brings a different perspective to the table and we discuss each issue as a group. When you’re sitting at that table with your peers you want to respect the role you have with your Association but you are also guided by the respect you have for your fellow Board members. Where do you see the pharmacy profession in five to 10 years? The ground seems to be shifting all the time and I foresee lots of change and opportunity. We’re going to have to roll up our sleeves and embrace it, while keeping in mind that the strength of the relationship between pharmacists and patients will always define our profession. I think the government views us as strong contributors but we also need to advance our interests in a cooperative way with the many other stakeholders in our world.
Alex Dar Santos Vice-president, BCPhA Board of Directors | Appointed 2016-2019 Pharmacist/Owner, Shoppers Drug Mart, Richmond Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? As community pharmacists on the front lines, I think it is important for all of us to be involved with the Association. That involvement starts with membership but also extends to providing input and expertise as our profession evolves. The BCPhA is very involved in shaping the future of our profession. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? 1. A disconnect between the College of Pharmacists of BC practice reviews and the realities of day-today practice. 2. Continued pressure on community pharmacies by public and private plans. These plans increase pharmacy workload and risk by placing increasingly complicated restrictions on formulary, dispensing quantities and brands (single-source molecules). These issues also impact patient choice and access. 3. Pharmacist prescribing – what would that look like and how will pharmacists be prepared if it comes to fruition. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? It is really important when serving on the Board to be able to compartmentalize one's day-to-day operational thinking with long-term strategy and goals. A strong operator is able to plan for the long term. As someone who wants our profession to be economically viable for the duration of my career and future generations of pharmacists, I try and keep this in mind at every meeting. Where do you see the pharmacy profession in five to 10 years? As I reflect on how I practiced pharmacy 10 years ago, I am sure practice will be significantly different than it is today. The number of cognitive and professional services that have emerged is remarkable. I believe that we will continue on this path and pharmacy practice will be even more exciting and challenging in the years to come. Pharmacists will continue to fill the gap needed in frontline health care.
Allison Nourse Past-president, BCPhA Board of Directors | Elected 2014-2017 National Professional Services Manager, Pharmasave Drugs (National) Ltd. Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? I think it’s great that 85 per cent of BC’s community pharmacists are members of the BCPhA. Pharmacists need to stay united and membership with the Association is one of the best ways to do that. All members should encourage pharmacists who are not members to become one! The Association should always be investigating ways to maximize membership value and increase membership. This mindset will also help retain membership. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? 1. Dealing with multiple insurance plan rules and unique adjudication and documentation criteria. 2. Finding a balance between dispensing and non-dispensing activities. 3. Advocating to patients and payers about the role of the pharmacist and the value of pharmacy services. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address your specific pharmacy needs, yet you must come to the Board with a strategic mindset that advances the profession as a whole? I have always worked in the areas of pharmacy services, strategic planning and innovation. As such, I’m very focused on finding ways to advance the profession as a whole both in my day-to-day job as well as in my role on the Board. Where do you see the pharmacy profession in five to 10 years? I’m hoping that we will finally be able to get eHealth, particularly electronic communication and file sharing with other health-care professionals, up and running. I would like to see the pharmacy profession move to 100 per cent electronic documentation – no more paper! This will allow the pharmacist to focus on therapeutics and not worry about following a piece of paper around the pharmacy. bcpharmacy.ca
Mark Dickson Appointed 2014-2017 | Principal, M.D. Hygieia Advisory, Vancouver Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? Because advocacy associations are only as strong as their membership, the BCPhA should continue to strive for 100 per cent pharmacist membership. Real success, of course, is also found when 100 per cent of members are fully engaged. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? The issues can be summarized as ‘how to do more with less.' Prescription counts and competition continue to climb, practice complexity and scope expansion requires more time and total reimbursement levels decline, while adjudication is more complex. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? For my day job, I am fortunate to enjoy a part-time practice consulting primarily in the strategic pharmacy business and advocacy spaces. I bring a somewhat unique perspective to the BCPhA Board in that I am no longer tied to a particular pharmacy corporation or practice in my day-to-day work. Where do you see the pharmacy profession in five to 10 years? Pharmacy will be more fully integrated with other health-care practitioners, primarily through medical record integration but also through collaborative practices. There will still be “pills in my pharmacy” but given the downward trends in reimbursement, a larger proportion of the pharmacy’s revenue (and therefore pharmacists' salaries) will come through billings for professional services.
Julie Ford Elected 2015-2018 | Pharmacist, Glovers Medicine Centre Pharmacy Pharmacist Instructor, Stenberg College Pharmacy Technician Program, Kamloops Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? The Association should be very proud of its efforts and ability to capture such a large percentage of community pharmacists in BC but we should always be doing the best job we can to attract, involve and retain members. As with any association, membership numbers will ebb and flow depending on career and personal situations but the fact that the BCPhA has been able to capture 85 per cent of community pharmacists is a testament to the quality work of the Association to offer value added services to its members. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? It is imperative that all Board members come to the table with an open mind and the ability to set aside their corporate or personal views. I can honestly say that our current Board does an amazing job of doing this. Personally, I am an independent pharmacist and I live in the Interior of BC so I have the benefit of listening to and being exposed to all types of pharmacists and pharmacies.
John Forster-Coull Elected 2015-2018 | Owner/Manager, Victoria Compounding Pharmacy Ltd., Victoria Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? Although ideal, 100 per cent membership is not a realistic goal. With the majority of community pharmacists already members, we should concentrate our efforts on providing the highest quality and value for existing members. Pharmacists who are not currently members may then see the value in membership. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? PharmaCare and other third party audits, the College of Pharmacists of BC’s increasing regulation of practice, and sufficient remuneration for advanced clinical services. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? I see them as one and the same. We do not practice in a vacuum. The issues that we address as BCPhA Board members are directly relevant to my practice. The main change in mindset is taking a more global approach at the Board level to ensure that we take into account the various practices of all BCPhA members. Where do you see the pharmacy profession in five to 10 years? We are on the verge of a radical shift in what is considered the practice of pharmacy. The increased role of registered technicians, the change to an entry-level PharmD program and an increased professional scope of practice will change the face of the profession as a whole. I’m not sure how these and other changes will play out in five or 10 years but I know it will be quite the ride.
Linda Gutenberg Elected 2016-2019 | Director of Pharmacy, Forewest Holdings Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? Audit proofing the pharmacy, managing drug shortages and managing the changes in PharmaCare policies. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? Much of my job in operations is helping pharmacy managers advance their practice in their specific store, so coming to the Board with the mindset of advancing the profession as a whole is not a challenge. My job helps me to know the specific roadblocks that pharmacists encounter, while implementing advancements in pharmacy practice. Where do you see the pharmacy profession in five to 10 years? I can see that pharmacist prescribing will be done on a regular basis. I am looking forward to helping ensure that this initiative is something that all pharmacists feel they can implement in their practice. Why did you run for a position on the Board? I ran for the Board to support the advancement of our profession while ensuring that the government and the College of Pharmacists of BC recognize the critical impact community pharmacy has on the health outcomes of BC patients. What was your election platform and how do you plan to address the issues that you're passionate about? I believe that a strong voice is vital in advancing the profession in a way that takes advantage of the skills and accessibility of pharmacists. I plan on working with the BCPhA to make sure the College of Pharmacists of BC remains accountable and keeps our profession self-regulated.
David Pavan Appointed 2014-2017 | Pharmacy Operations, Shoppers Drug Mart, Vancouver Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? I believe the Association should strive to do both. As an advocacy organization, the BCPhA represents the interests of the profession and by having a solid member base this will support a stronger voice with stakeholders. It is also important to have our members become involved in their communities on all levels. Pharmacists should engage with their local MLAs and MPs, as well as the communities they practice in, to elevate the profession and promote the value pharmacists bring to the delivery of health care. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on membersâ€™ minds? The questions I get asked the most are around expanded scope of practice, medicinal marijuana and assisted dying. These are also very topical issues for Canadians in general as patients access different options in their health-care journey. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? Surprisingly, the two go hand in hand. My role in supporting Shoppers Drug Mart associate owners allows me to experience the profession of pharmacy in many different practice settings. Any advancement of the profession will benefit the majority of our members practicing on the front lines and that is how I approach my role on the Board. Where do you see the pharmacy profession in five to 10 years? The profession of pharmacy is evolving and I see advancements in technology allowing pharmacists to take a more integrated role in primary care. I see point of care testing becoming a larger focus of what pharmacists do on a day-to-day basis to provide more efficient and better access to health-care services. We are seeing some of these services in community pharmacies already, with INR monitoring, strep throat testing, flu screening and, hopefully very soon, personalized medicine via genetic testing.
Glen Schoepp Elected 2014-2017 | Consultant Pharmacist, St. Anthony's Clinic Pharmacy, Victoria Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? The Association must do both. Recruiting new members gives us access to the diversity of skill sets and professional practice experiences that shape our future, every day. Increasing involvement of existing members will also be important to ensure a proactive expansion of pharmacists' roles in a rapidly changing health-care environment. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on membersâ€™ minds? Members appear most concerned about and interested in workload and workplace stresses, liaison with government and private payers, and the potential for increased scope of practice. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? I think it's really important for Board members to be involved in everyday practice to understand how to best create and modify the Associationâ€™s strategic plan, in order to optimize support for all our members, including individual pharmacists and their employers. So, it's a necessary balance. Where do you see the pharmacy profession in five to 10 years? During the next decade, the profession will have more opportunities for interdisciplinary work because this provides the best health outcomes. I also envision pharmacists gaining more responsibilities in assisting government in managing its limited resources. I expect more individual pharmacists will establish their own businesses to achieve these goals.
John Tse Appointed 2016-2019 | Vice-President, Pharmacy and Cosmetics, London Drugs, Richmond Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? We need greater engagement from existing members and also to seek additional new members, including hospital pharmacists. In this changing industry, it is important that pharmacists, no matter which sector, take a more active role in shaping the future of our profession. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? 1. Workload: the perception that pharmacists are working too hard and not receiving enough compensation. 2. BC is extremely slow in professional scope expansion compared to other provinces. 3. Too much time is spent addressing issues with payments, drug shortages and benefit medication (finding alternative brands or drugs). The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? It is very important to perform day-to-day operations well but it is essential for us to also look ahead to the next two, five and seven years and start preparing for the future. It’s important to take a step back and view the market and external influences on our profession, such as our federal government’s focus on depression, assisted dying and medical marijuana. We always have to anticipate changes, challenges and opportunities. Where do you see the pharmacy profession in five to 10 years? Pharmacists will be an integral part of frontline health care. As the population ages, the demand for immediate primary care will grow. Pharmacists must be part of this team and we must increase our training to prepare for scope expansion. With the advancement of medical and genetic research, a new form of tailored medicine is on the horizon. Given its complexity, pharmacists are in a great position to become the experts in this area. With the new, very costly medications, we can also provide the most cost-effective care for patients. There are some very exciting and potentially challenging times ahead for pharmacists and we must prepare the profession for the new practice expectations.
Chris Waller Elected 2015-2018 | Pharmacist/Owner of Lakeside Medicine Centre Pharmacy, Kelowna. Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? The BCPhA is doing a great job by representing 85 per cent of community pharmacists in BC but there is always room for improvement. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? 1. Pharmacists continue to feel pressure from preferred provider networks. Our profession is changing and we need to start changing with it and get out from behind the counter and be the dispensers of prescription medical advice. 2. Audits continue to be at the forefront of many pharmacists and owners’ minds. The potential for prescription billings that are several months old to be clawed back can be a financial burden for many community pharmacies. 3. T he Modernized Reference Drug Program is a new and exciting area of practice for all community pharmacists. The Association has done a wonderful job of preparing training material and reference sheets for pharmacists to have on hand when patients arrive at their pharmacy. The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? My strength is community pharmacy and understanding how it operates in the BC environment. My fellow board members each have their own strengths and by listening to each other’s opinions collectively, we are able to put forward ideas that truly reflect pharmacy as a whole. Where do you see the pharmacy profession in five to 10 years? I see pharmacists getting more involved in a patient’s health and dispensing health information and recommendations rather than handing out medications. bcpharmacy.ca
Jamie Wigston Elected 2016-2019 | Pharmacist at West End Medicine Centre Knowing that the BCPhA captures more than 85 per cent of community pharmacists in BC, should the Association try to recruit more members and/or increase the involvement of existing members? I think the BCPhA has been doing a great job of recruiting and retaining members. There’s always room for improvement, however, at this point increasing the involvement of existing members is probably a better use of the Association’s time and resources so that we continue to retain the members we already have. Board members act as liaisons to members and represent the Association as a whole. What do you hear as the top three issues on members’ minds? Some (not all) pharmacists being forced to meet quotas on medication reviews and/or adaptations, the lack of remuneration for being required to do increased amounts of clinical services and having a lack of movement on professional fees (in both a community and long-term care setting). The Board of Directors is a strategic advisory group for the Association. How do you balance the challenge of your day-to-day job in which you address pharmacy operations, yet you must come to the Board with a strategic mindset that advances the profession as a whole? When I first read this question I couldn’t think of why there would ever be an issue, however, as I gave it more thought I realized that I couldn’t always put the issues of my day-to-day job at the forefront of my mind and would have to think of my profession as a whole when taking on my role on the Board of Directors. Where do you see the pharmacy profession in five to 10 years? I see the pharmacy profession becoming more and more clinical. With the Association pushing for our ability to prescribe, I see that as not just an end game, but simply a stepping stone to more exciting opportunities within the pharmacy profession. We as pharmacists are slowly becoming a larger part of the health-care landscape, and are finally starting to utilize all of our knowledge and training. Why did you run for a position on the Board? My main reason was so that I could play a bigger role in advocating for pharmacists in BC, as well as possibly bringing a fresh perspective that the Board may not have had.
Addictions care Continued from page 23
risk assessment and discussion with the patient of risk versus benefit. Patients are often booked with Troesch for this. Troesch, the physicians and nurse practitioners talk to patients to find out about them as individuals, including their goals, how the substances they’re using are a barrier to living healthy lives and how this makes them feel. They then suggest a more well-rounded approach to pain management beyond medication. This can include strategies such as regular exercise, meditation, yoga, attending Self-Management BC programs and the importance of eating and sleeping well. “We meet with the patient so they are engaged in the process. We find that is really important,” Troesch says. “If you spend time with patients, build the relationship and tell them what the
expectation is then they’re pretty willing to follow your advice. Gradually we make a plan for titration down or off the drugs, which may take some months, depending on the individual.” If patients do not meet the terms of their narcotic agreement, the clinic may stop prescribing them medication or refer them on, although Troesch says this is extremely rare. The clinic does not have a dispensary onsite and patients choose a dispensing pharmacist when they sign the narcotic agreement. With permission from the patient, Troesch sends this pharmacy a copy of the agreement and asks the dispensing pharmacists to call the clinic if they have any concerns when they’re dispensing the medication or if they see prescriptions from alternate providers.
“They’re part of the team too and the better the collaboration, the better it’s going to be for patient care,” she says. While Troesch has a great relationship with the physicians and nurse practitioners at her clinic, she understands the frustration many other pharmacists feel who don’t have a good relationship with prescribers. She is adamant that the key to improving this situation is getting health-care providers face-to-face to talk about the issues, perhaps over a cup of coffee. “There is a lot of misinformation and concern about the ‘other’ health-care providers, which doesn’t go away unless you talk about it. And this happens best face-to-face,” she says. “That’s how you make a team. And it’s team care that makes a huge difference.”
BC’s QuitNow makes it easier for pharmacists to help clients quit smoking This article is submitted by QuitNow, a program operated by the BC Lung Association. With the lowest percentage of Canadians smoking than ever before, it’s easy to overlook the massive toll tobacco continues to take. Each year, 37,000 Canadians (including 6,000 British Columbians) die from tobacco-related illness, amounting to half a billion dollars in health-care costs in BC alone. In total, around 500,000 BC residents continue to smoke, half of who will die from a smoking-related illness if they do not quit. The good news is that most smokers want to quit (70 per cent) and that there are proven interventions that can help them do so. So when it comes to quitting smoking, what does the evidence say? Research demonstrates that the strongest approach is to combine quit medication with quit counselling. A Cochrane metaanalysis “Treating Tobacco Use and Dependence: 2008 Update” suggests a combined approach can as much as double an individual’s likelihood of success. Similarly, the simple advice from a health-care provider to quit smoking has a big impact. Most smokers may know they should quit, or may even want to quit, but it takes that extra nudge of a trusted professional to actually go for it. Pharmacists are in a unique position to share this advice and recommend specific pharmacotherapy that best suits an individual’s needs. In order to help you help your clients, the BC Lung Association’s QuitNow program offers a range of different services, including:
Professional development BC pharmacists are eligible for QuitNow’s one-day accredited smoking cessation training which covers everything from addiction science, to nicotine replacement therapy (NRT) and prescription medication (Champix or Zyban) efficacy and the basics of motivational interviewing. Note: as an alternative, a local QuitNow health promoter can pay a visit and provide brief training sessions in as little as 10 minutes. A short session will ensure you understand QuitNow’s free services and how to refer clients for professional quit counselling using the online referral program. One-on-one counselling The reality is, however much a pharmacist may want to help, some have neither the time, nor the required privacy in-store, to provide one-on-one quit counselling. That’s where QuitNow comes in. A pharmacist can provide quit medication and refer clients to try the free counselling offered through QuitNow by calling 1.877.455.2233.
"For help to quit smoking, customers and patients in Duncan regularly come to London Drugs to purchase NRT and get important smoking cessation counselling. We’re very happy with the work we’ve been doing with the BC Lung Association for just over a year now, providing monthly in-store clinics to further aid people in their efforts to quit." - Dean Bryson, pharmacist, London Drugs, Duncan, BC
In-store engagement QuitNow’s health promoters are available to provide quit smoking clinics in-store in your pharmacy. Health promoters conduct carbon monoxide breathing tests as a quick and easy way to demonstrate the impact that smoking is having on a patient's health, as well as creating an opportunity to discuss ways they can quit successfully. The more conversations you have as a pharmacist with clients about quitting smoking, the more lives you will save. Contact the BC Lung Association QuitNow team today to find out more information or book an in-store visit at 1.800.665.5864 or firstname.lastname@example.org. References available on request at email@example.com. bcpharmacy.ca
"I believe that smoking cessation counselling is essential in bridging the gap of patients attempting to quit smoking and truly staying smoke-free." - Angela Shieh, pharmacist, Save-OnFoods Pharmacy, Nanaimo, BC
PRODUCTS IN FOCUS
High dose influenza vaccine is effective for elderly patients By Dr. Fawziah Lalji Fluzone® High-Dose influenza vaccine is the newest product approved by Health Canada for the active immunization of adults 65 years of age and older. This trivalent influenza vaccine contains 60 μg of hemagglutinin (HA) per strain rather than the standard dose of 15 μg HA/strain.
In a recent large randomized clinical trial (N=31,989) published in The New England Journal of Medicine, Fluzone® High-Dose showed superior efficacy towards prevention of laboratory-confirmed influenza illness in adults aged 65 and older compared to the Fluzone® standard dose vaccine.
Inflammation and the physiological effects associated with influenza infection is believed to be responsible for triggering serious outcomes such as heart attacks or stroke and can exacerbate existing chronic conditions such as diabetes, renal disease and COPD.
Based on data over two influenza seasons, subjects in the Fluzone® High-Dose arm were approximately 24% less likely to have influenza illness, although local reactions (e.g., pain at injection site, redness and swelling) as well as systemic symptoms (e.g., fever, headache and myalgia) were more common in the high dose arm compared to the standard arm.
Given the broad impact of infection with influenza, the National Advisory Committee for Immunization (NACI) recommends immunization for all adults aged 65 years and older and individuals with chronic illness. This recommendation is based on studies that show that these individuals are at highest risk of influenza-related complications, hospitalization and death. In the last few years there has been growing pressure to find products to improve vaccine effectiveness against influenza in the elderly. This is mainly due to evidence that suggests that vaccine effectiveness against laboratory-confirmed influenza in the elderly is lower than healthy adults 18-64 years of age (49% vs 59%). This may be related to immunosenescence, a decreased response by the immune system to antigens due to aging. This means the elderly have a lower immune response to pathogens and respond poorly to vaccines, rendering them particularly vulnerable to influenza. Several trivalent (TIV) influenza vaccines have been developed in the last five years to try and elicit higher antibody titres in seniors. Two examples are Fluad®, which contains an adjuvant together with the standard amount of influenza virus, and Intanza®, which was administered intradermally – a technique believed to elicit a larger immune response. Fluzone® High-Dose is the newest product on the market for Canadian seniors. It differs from the other two products in that each 0.5 mL contains four times the standard dose of HA/strain of influenza virus. Fluzone® High-Dose has been licensed in the U.S. since 2009, with 50 million doses distributed. This season, an estimated 60% of immunized seniors in the U.S. will use the vaccine.
Adverse events occurred in the first three days post-vaccination and the majority resolved in 72 hours. In a supplementary analysis conducted using data from the large efficacy trial, Fluzone® HighDose was significantly more effective than Fluzone® standard dose in preventing serious cardio-respiratory events possibly related to influenza (rVE, 17.7%; 95% CI, 6.6–27.4%) and serious pneumonia (rVE, 39.8%; 95% CI, 19.3–55.1%). Based on the available evidence, Health Canada and NACI have concluded that Fluzone® High-Dose should provide superior protection compared with standard dose TIV for adults aged 65 and over. For more information on NACI recommendations related to the elderly visit phac-aspc.gc.ca/naci-ccni/flu-2016-grippe-eng.php Canadian estimates for influenza-related hospitalization and deaths every year are around 12,000 and 4,000, respectively. Adults over 65 account for 70% of the hospitalizations and 90% of deaths. Further, influenza-related complications such as cardio-respiratory failure and pneumonia are also common in the elderly. Given these statistics and changing demographics, pharmacists should provide their patients with information on current options for influenza prevention while ensuring they are well informed about health outcomes related to comorbidities and influenza. Licensed products available in Canada for influenza protection for the elderly include the standard dose TIV, Fluzone® High-Dose TIV, MF59-adjuvanted TIV and quadrivalent vaccine. Submitted by Dr. Fawziah Lalji B.Sc. (Pharm.), PharmD., Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia. References are available upon request at firstname.lastname@example.org.
MEDICAL ASSISTANCE IN DYING
Unique collaboration necessary for medical assistance in dying By Dr. Ellen Wiebe Doctors and pharmacists work together in many ways, but perhaps even more closely when providing medical assistance in dying (MAID). Read below to examine how this unique medical situation both aligns with and differs from other similar collaborative efforts. Please note: this table is not comprehensive and is only intended to highlight some of the differences when dispensing medications for MAID. Like other prescriptions, the pharmacy must retain the entire MAID prescription for a minimum of four years. To see an example of the
BC MAID prescription template (for both pharmacy regulatory and PharmaCare purposes) visit the College of Pharmacists of BC's eServices website (member login required). This article was written by Dr. Ellen Wiebe, a Vancouver family physician who provides medical assistance in dying. Dr. Wiebe spoke at a webinar in March for BCPhA members and this webinar is also now available online at bcpharmacy.ca/physician-assisted-dying.
The doctor diagnoses a condition and chooses medications based on that diagnosis.
The prescribing physician must inform the pharmacist that the medications are intended for MAID.
The doctor writes the prescription.
The prescribing physician completes a pre-printed order form that is six pages long and accompanied by a one-page special authority (SA) form for payment. The pharmacist should confirm that the SA form is faxed to PharmaCare for coverage. This SA is usually done within 24 hours. A backup set of medication is also usually ordered.
The pharmacist checks that the prescription is valid, is therapeutically appropriate and is not contraindicated due to other medications or allergies.
The pharmacist also initials the prescription to document that they have confirmed with the prescriber that it is for the purpose of MAID and that the prescriber has obtained patient consent and determined that the patient meets eligibility criteria for MAID.
The pharmacist dispenses the medication with appropriate packaging and instructions.
Drugs for MAID must be dispensed directly to the prescribing physician and both the physician and the pharmacist must sign off on the handover. The MAID drugs must be provided in a sealed, tamper-proof container.
The pharmacy disposes of any medication that has been returned.
Unused MAID drugs are returned by the prescribing physician within 48 hours of the patient's death. The pharmacist documents what was returned and disposes of the returned unused drugs.
The doctor and pharmacist maintain their respective records.
A medical administration record (MAR) for MAID must be completed by the prescribing physician and a copy provided to the dispensing pharmacist. The prescribing physician also sends relevant provincial forms and the BC Coroners Service Report of MAID Death form to the appropriate agencies.
Supporting enhanced medication optimization for pharmacy patients
ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS? Pharmacy members can place free career opportunities listings in this section and on the BCPhA website. We have the best pharmacy job board in BC! For the full listings of pharmacy technician and assistant positions visit the Pharmacy Technician Society of BC website at ptsbc.ca Pharmacist members looking for new career opportunities can post their resumes for free on the Hire-aPharmacist page. To learn more, visit the recruitment section of bcpharmacy.ca
ABBOTSFORD Pharmacy manager, pharmacist and pharmacy assistants - part-time
By Mark Dickson, B.Sc. (Pharm.), MBA As pharmacists we are all too familiar with the process of adding new medications to a patient’s regimen. Increasingly, we are being asked to play a larger role in optimizing medications and in helping patients to stop taking medications that are ineffective or potentially harmful. The Canadian Pharmacists Association (CPhA) is committed to supporting and enhancing clinical decision-making that prioritizes patient needs and health outcomes.
Garden Park Pharmacy is a long-established, friendly community pharmacy seeking a pharmacy manager, pharmacist and pharmacy assistants to join our company. Abbotsford is about a 45-minute drive from Vancouver. We offer competitive wages. No Sunday, Saturday, statutory holidays or evenings. All experience levels and new graduates are welcome. Please send resume to email@example.com, fax 604.746.2825 or call 604.859.3300. Pharmacist - full-time
In the spring, CPhA endorsed the Antipsychotic Deprescribing Guidelines proposed by the Bruyère Research Institute, an Ottawa-based research institute specializing in the health and care of aging people. The guidelines are designed to support interdisciplinary teams of health-care professionals in reducing or ceasing medications that may no longer be effective for elderly patients.
We are looking for pharmacists to join our busy, established community pharmacies. Pharmacist must have a passion for patient care and strong interpersonal skills. Experience with Kroll/WinRx and Punjabi speaking is an asset. All experience levels are welcome. Please send resume to firstname.lastname@example.org or fax 604.856.7178.
CPhA also recently announced a partnership with Choosing Wisely Canada, a national campaign aimed at helping clinicians and patients better engage in conversations about unnecessary tests and treatments. It was spearheaded in 2014 by a team of leading Canadian physicians, in partnership with the Canadian Medical Association, with campaign hopes to encourage smart, effective choices to ensure high-quality care for all patients.
Pharmacist - full-time
Through the CPhA’s support, a pharmacy committee will soon be established to contribute profession-specific tools to the overall Choosing Wisely Canada campaign. The tools will be designed to help prescribers, pharmacists and patients make the best informed choices to ensure that the treatments prescribed are truly having a positive impact on patient health and that they are not causing unintended harm. CPhA will continue to find ways to support patient care in the areas of medication optimization and deprescribing as these practices expand at the community pharmacy level. Mark Dickson is on the BCPhA Board of Directors and was selected as the CPhA representative for two years from 2015 to 2017.
Pharmasave Abbotsford Hospital is a unique pharmacy, offering service to patients inside and outside the Abbotsford Regional Hospital and Cancer Centre. We help patients transition back into the community as well as servicing the pharmacy needs of patients in Abbotsford. We are looking for a full-time pharmacist that can work in our patient-centered pharmacy. We are seeking someone with good communication and customer service skills that can work proactively with our technicians and assistants to provide the perfect Pharmasave experience. Two years' experience as a Canadian pharmacist is required. Kroll experience is an asset. Complete fluency in English is a requirement. Please send resume to info@ pharmasaveabby.com. BURNABY Pharmacist - part-time Looking to hire a permanent part-time pharmacist for an independent pharmacy in Burnaby. Potential to lead to a full-time position. Hours of operation are Mon-Fri 10-6. Knowledge of WinRx is preferred. Must be able to quickly and accurately dispense medications, provide medication reviews and
adequately assess for interactions. Applicant must be a licensed pharmacist in good standing with the College of Pharmacists of BC. Wages will be competitive and based on experience. Please send resume to email@example.com. CAMPBELL RIVER Pharmacist - full-time Pharmasave Health Centre needs a pharmacist to start very soon. The small dispensary is located within a busy medical clinic with excellent support staff in Campbell River on Vancouver Island. The store is open Monday to Friday with a one-hour closure for lunch and no holiday or evening hours. A six-man nursing home depends on our services. Good communication skills are important for the excellent patient care we strive to provide. Does this type of pharmacy appeal to you? If so, please send resume to firstname.lastname@example.org, fax 250.287.3284 or call 250.287.3222. COURTENAY Pharmacist - part-time London Drugs has a part-time opportunity in Courtenay. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, longterm care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Shawn Sangha, pharmacy operations manager at email@example.com. CRANBROOK Pharmacist - full-time Peoples Pharmacy #388, the outpatient pharmacy for the East Kootenay Regional Hospital in Cranbrook, BC is currently seeking a full-time staff pharmacist. Our pharmacy specializes in long-term care, BC renal program, mental health, addiction services, immunization, sterile compounding, pain and wound care and hormone consulting. Please send resume to firstname.lastname@example.org, fax 250.420.4135 or call 250.420.4133. DELTA Pharmacist - full-time We are looking for full-time pharmacists for our Lower Mainland pharmacies. Experience with WinRX/Kroll and Microsoft Office (Word, Excel, etc.) are necessary. The successful applicant is required to have at least one year of experience working in a community pharmacy and to be injection certified. Pharmacists must also have a good working knowledge of PharmaCare and third party billing policies, medication reviews, and experience with blister packing. Pharmacists must be strong communicators, clinically oriented, and willing to further their pharmacy practice and patientcentered care. Wages start at $37/hour. Full medical and dental benefits are provided after a trial period of three months. If interested, Please send resume and cover letter to email@example.com. Pharmacist - part-time A growing independent new pharmacy specializing in patient-centered care. We do dispense methadone but are not your typical methadone pharmacy. Known for our outstandingly efficient operations and loyal patient population, we have created a great environment to work and thrive. Seeking a pharmacist who is highly motivated, with
a strong work ethic, strong customer service skills, good communication & leadership skills, ability to work as a member of a dynamic & energetic team, and most importantly willingness to actively participate in patients’ health-care outcomes. Position is a permanent part-time leading to fulltime. We offer stability, competitive pay structure and a great benefits package. We pride ourselves on our dedication to our employees and interest in long-term relationships. Please send resume to firstname.lastname@example.org. FORT MCMURRAY Pharmacist - part-time Two permanent part-time positions available. Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! Please send resume to Denise Nilsen, regional manager, Pharmacy Operations at denise_nilsen @owfg.com. GRAND FORKS Pharmacist - full-time Join a well-established, progressive, communitybased independent pharmacy. Our pharmacy staff are encouraged to spend time with patients and go beyond the pharmacy counter to actively participate in their patients' health-care outcomes using their professional training. Our pharmacy is currently involved in many patient care initiatives including weight loss and metabolic management using the Ideal Protein protocol, advanced health screening using HealthTab, medication reviews and travel health. We offer a newly renovated pharmacy with two consultation rooms, an exciting work environment, competitive wages and benefits, as well as payment of professional dues and continuing education. Please send resume to email@example.com, fax 250.442.3523 or call 250.442.3515. KAMLOOPS Pharmacist - full-time, part-time Manshadi Pharmacy is looking to hire a fulltime and part-time (up to 30 hrs/week or more) motivated pharmacist to work in a well-established, independent retail pharmacy. Experience working in a busy pharmacy is a requirement. We specialize in diabetic care, compounding and home health care products. Great team that supports our pharmacist. We prefer a long-term commitment. Kamloops is a great place to be. We are close to two ski hills, Sun Peaks and Harper Mountain, and dozens of nearby lakes. Good community to raise a family with all needed amenities. New grads are welcome to apply. Please send resume to Missagh Manshadi, pharmacist/owner at missagh@manshadipharmacy. com, online at manshadipharmacy.com, fax 250.434.2527 or call 250.574.0111.
working with interdisciplinary teams and facility staff, while balancing the day-to-day operations of the pharmacy. If you are a highly motivated and enthusiastic individual with great interpersonal skills and a strong clinical background, please send resume to firstname.lastname@example.org. KEREMEOS Pharmacy manager - full-time Forewest Holdings Inc., doing business as Pharmasave #250, needs a pharmacist/manager. This position offers the right candidate a fantastic work/life balance, with the potential to become a part owner/partner. The store is open from 9am to 6pm Mondays to Fridays, from 9am to 5pm on Saturdays and closed on Sundays and holidays. This position offers an above average compensation package for the right candidate. If you would like to discuss this very exciting and rewarding opportunity with a fantastic growing and forward thinking company, please forward your cover letter and resume to Todd Gehring, pharmacy operations coordinator at email@example.com. LADNER/TSAWWASSEN Pharmacist - part-time Pharmasave in Ladner/Tsawwassen is seeking a BC licensed pharmacist for part-time work (two Saturdays per month). We offer competitive compensation, an excellent working environment and flexible hours, with no evenings. The goal of our pharmacies is to become an integral part of the community by focusing on patient care and building relationships with area health-care providers. It is essential that candidates possess strong interpersonal skills and have a commitment to providing exceptional customer service in a team environment. Experience with Kroll and compounding is an asset. Please send resume to firstname.lastname@example.org. LAKE COWICHAN Pharmacist - full-time, part-time Currently seeking part-time/full-time pharmacist. Please send resume to email@example.com. LANGLEY Pharmacist - full-time Seeking a highly motivated, charismatic, driven pharmacist. This position is best suited for individuals with a well-developed business acumen and excellent clinical service skills. Starting wage $43-45/hr depending on experience, and quarterly performance bonuses. Qualifications: Bachelor of pharmacy, licensed to practice in BC, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency (Kroll), experience/certification in geriatrics is an asset but not required. Hours: 36 hours/week. Please send resume to firstname.lastname@example.org. Pharmacist - part-time We are looking for a part-time, permanent pharmacist for Saturday and Sunday from 10am2pm. Please send resume to ms0361@store. medicineshoppe.ca or fax 604.510.3141 Pharmacist - part-time
KELOWNA Pharmacist - part-time Part-time pharmacist position with Remedy’sRx Specialty Pharmacy in Kelowna. We service longterm care, retirement homes and group homes through our dedicated pharmacies. You must enjoy
Co-op Pharmacy in Langley is accepting applications for a part-time pharmacist. We provide an excellent pharmacy practice environment with personal growth and career development opportunities. We offer an attractive compensation and benefits package. If you are highly motivated
to provide excellent pharmacy care and customer service, please send resume to pharmacymgr@ otter-coop.com or fax 604.856.3101.
you are looking for a great work environment with a strong clinical role coupled with dispensing, interdisciplinary collaborative focus, competitive pay and consistent enjoyable work, please send resume to email@example.com.
MAPLE RIDGE Pharmacist - full-time, part-time, relief
We are looking for a full-time/part-time/relief pharmacist for a small, independent compounding pharmacy in the Lower Mainland. Experience with WinRx preferred but will train right candidate. Must be injection certified, authorized to dispense Methadone, good knowledge of PharmaCare and third party billing, clinically oriented, enjoy doing medication reviews, strong verbal and written communication as well as organizational skills, able to perform in a fast-paced environment, must be flexible and a team player, and be business minded with a patient-focused attitude. This is an ideal position for someone looking to further their knowledge of pharmacy and grow with a company. Above average compensation and benefits. Please send resume to firstname.lastname@example.org.
Pharmacist - full-time Overwaitea Food Group, one of Western Canada's leading food and consumer-goods retailer, operates more than 110 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! We have an opening for a pharmacist position at our store in Parksville. Please send resume to Sammy Lee, B.Sc. (Pharm), R.Ph., regional manager, pharmacy operations at sammy_lee @owfg.com.
NAKUSP Pharmacy manager - full-time
Pharmacist or pharmacy manager position available in picturesque Nakusp. Try a change of pace in this beautiful and relaxed West Kootenay town located only 2.5 hours from the Okanagan. Enjoy skiing, hiking, fishing and the famous hot springs in this spectacular unspoiled lakeside paradise. Talk about job satisfaction. Come practice in a community which really appreciates its pharmacists. Work as an integral part of the healthcare team, where you get the support you need to practice patient-oriented pharmaceutical care. You control your schedule and vacation (no evenings, Sundays or holidays). Competitive wages and benefits. Please send resume to pp321@pdmstores. com, fax 250.265.2218 or call 250.265.2228.
Pharmacist - full-time Looking for a pharmacist to work with a great team in a newly renovated, spacious pharmacy and dispensary. Please send resume to Ron Downey, owner at email@example.com.
strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency. Flexible hours including some evenings and weekends. Store hours: Monday through Sunday 8am â€“ 10pm. Please send resume to Larry Chow, associate/ owner at firstname.lastname@example.org or call 250.624.9656. QUALICUM BEACH Pharmacist - full-time Pharmasave Qualicum Beach is looking for a highly motivated pharmacist to join our team. We are a unique, community-based pharmacy that provides services such as specialty compounding, travel health consultations and diabetes education. Are you a dynamic pharmacist interested in providing a high level of care to your patients? The successful applicant must have the following qualifications; BC pharmacist license, excellent customer service skills, be able to multitask and work in a fast-paced setting, must be able to supervise and have good decision-making skills, have certifications for methadone and injections, be comfortable doing medication reviews. We offer competitive wage and benefits. Please send resume to Briana Barker, pharmacist/owner at briana@qualicumpharmasave. com, online at qualicumpharmasave.com, fax 250.752.3479 or call 250.752.3421. SALMON ARM
Pharmacist - part-time
Pharmacist - part-time
Part-time staff pharmacist needed for three days per week in a busy pharmacy in downtown Salmon Arm. No evenings or Sunday shifts. Focus on pharmacy services and injection services is required. Previous compounding experience is preferred. Please send resume to Linda Gutenberg, director of pharmacy at email@example.com or call 604.315.3273.
If you are a licensed pharmacist who is looking to provide patient-focused care within a strong team environment, then this opportunity may be for you. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please submit resume online at sobeyscareers.ca.
Pharmacist - part-time
Pharmacy manager - full-time
London Drugs has a part-time opportunity in Nanaimo. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Shawn Sangha, pharmacy operations manager at firstname.lastname@example.org.
Pharmacist - part-time
We are looking for a full-time pharmacy manager in Surrey. The person must possess at least two years' experience with Kroll. Must have adequate knowledge for medication reviews, blister packing, third party and PharmaCare billing. Must be fluent in English and Punjabi. Qualified and trained in injecting flu shots, with experience in methadone dispensing. Competitive salary. If interested, please send resume and cover letter to pharmacy177@ gmail.com.
NEW WESTMINISTER Pharmacist - full-time Key responsibilities include: checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting and collaboration with pharmacy assistant to accurately dispense prescription medications. Qualifications: Bachelor of Pharmacy, license to practice in the province seeking employment, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency. A flexible schedule with some weekends and evenings. Please send resume to email@example.com. NORTH VANCOUVER Pharmacist - full-time, part-time We require part-time or full-time pharmacist for busy, independent North Vancouver pharmacy. If
Overwaitea Food Group, one of Western Canadaâ€™s leading food and consumer-goods retailer, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! Part-time, permanent (32-40 hrs/wk) pharmacist position available at 555 Central Street in Prince George. Starting rate is $47.20. Please send resume to Livia Chan, regional manager, pharmacy operations at livia_chan@owfg. com. PRINCE RUPERT Pharmacist - full-time Duties and responsibilities: Checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting, participation in SDM programs including cognitive/enhanced services as these programs may evolve over time and as required by the business, collaboration with pharmacy assistant to accurately dispense prescription medications. Desired skills and experience: Bachelor of pharmacy, license to practice in the province seeking employment, superior interpersonal skills,
Pharmacist - full-time, part-time Mandarin-speaking pharmacist wanted. Independent pharmacy in Surrey looking for a full or part-time pharmacist. Must be proficient in Kroll and PharmaClik as well as pharmacist professional services such as medication reviews, injection training and methadone maintenance program. Hours and wage are negotiable. Please send resume to firstname.lastname@example.org or fax 778.293.2274. Pharmacist - part-time, relief Pharmasave located in South Surrey is looking for a part-time pharmacist. Kroll experience is mandatory. Please send resume to email@example.com, fax: 604.385.1177 or call 604.385.1175. VANCOUVER Pharmacy manager - full-time Private pharmacy in Vancouver looking for an enthusiastic and experienced pharmacist to become a business partner and work as the
pharmacy manager. The candidate must be energetic, friendly and patient-focused. Capable of enhancing operational efficiency, business value and have the ability to manage day-to-day pharmacy operations independently. Also, must comply with the provincial/federal pharmaceutical regulations at all times. A minimum of two years of experience in retail pharmacy, preferably as pharmacy manager, is required. Please email your resume and a letter explaining why you think you would be ideal for this opportunity. Please send resume to firstname.lastname@example.org. Pharmacist - full-time Full-time community pharmacist position in East Vancouver. Punjabi/Hindi speaking is an asset. Must be familiar with Kroll and have at least two years’ experience. Please send resume to pdhillon1@ me.com. Pharmacist - full-time The BC Drug and Poison Information Centre (DPIC) in Vancouver is looking for nurses and pharmacists to be trained as specialists in poison information (SPI). SPIs are front-line staff who manage poison and drug exposure calls from the public and healthcare facilities throughout BC by telephone, 24 hours per day. Please send resume to Debra Kent, clinical supervisor at email@example.com. VERNON Pharmacist - part-time London Drugs has a part-time opportunity in Vernon. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, longterm care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Shawn Sangha, pharmacy operations manager at firstname.lastname@example.org. VICTORIA
OPPORTUNITIES ACROSS BC Pharmacist - part-time Advance your pharmacy career with the Overwaitea Food Group, a Canadian-owned company that operates under multiple banners: Save-On-Foods, Coopers Foods, Overwaitea Foods, PriceSmart Foods, and Urban Fare. With over 115 pharmacies in over 50 communities across BC and Alberta, and growing into Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality, patient-centered care. We offer an attractive compensation package and our extensive benefits package is one of the industries finest. We have positions available in Kitimat & Creston, Parksville, Prince George, Quesnel, Grand Forks, Fernie, Fort Nelson, Prince Rupert & Campbell River. Floater pharmacist positions are also available. New grads are welcome to apply. Please send resume to email@example.com. Pharmacy technician – full-time - Please send resume to firstname.lastname@example.org or call 604.444.9347. LOWER MAINLAND Pharmacist - part-time London Drugs has a part-time opportunity in the Lower Mainland. Join a clinical and patientfocused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Shawn Sangha, pharmacy operations manager at email@example.com.
OPPORTUNITIES OUTSIDE BC ALBERTA
Are you looking for an opportunity with an established independent pharmacy chain that is looking to grow and expand its focus on patient care, and clinical specialization? We take patient follow-up to a whole new level. We are looking for energetic pharmacists who want to practice their full scope of clinical skills and help us bring top-notch health care to our customers. Heart Pharmacy IDA, owned by Naz Rayani, is looking for an engaged, clinically-oriented and outgoing fulltime pharmacist to work at our unique community pharmacies. Please send resume to jobs@ victoriapharmacy.com.
Pharmacist - full-time
Attractive opportunity for a full-time, parttime or relief pharmacist in Victoria. Excellent wages, health benefits, great hours in a friendly neighborhood pharmacy. Please send resume to firstname.lastname@example.org or call 250.818.1468.
SASKATCHEWAN Pharmacist - full-time Advance your pharmacy career with Save-OnFoods. With over 100+ pharmacies in over 50+ communities across BC and Alberta, and growing in Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality patient-centered care. Our pharmacy team members are made up of hardworking people who thrive in a demanding and changing environment and are deeply committed to their patients. We offer: Friendly, professional and supportive work environments; flexibility, stability and great compensation packages; opportunities to develop your leadership skills, expand your scope of practice and advance your career. Pharmacist positions available in: Regina & Yorkton. For more information on career opportunities, please send resume to Livia Chan, regional manager, pharmacy operations at email@example.com.
PHARMACY TECHNICIANS AND ASSISTANTS
Pharmacist - full-time
Pharmacist - full-time, part-time, relief
communities across BC and Alberta, and growing in Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality patient-centered care. Our pharmacy team members are made up of hardworking people who thrive in a demanding and changing environment and are deeply committed to their patients. We offer: Friendly, professional and supportive work environments; flexibility, stability and great compensation packages; opportunities to develop your leadership skills, expand your scope of practice and advance your career. Pharmacist positions available in: Winnipeg, Manitoba. For more information on career opportunities, please send resume to Livia Chan, regional manager, pharmacy operations at firstname.lastname@example.org.
The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We are a leading-edge food and consumer goods retailer known for our belief that wellbeing is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health-related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Please send resume to email@example.com. Pharmacy assistant – part-time - Please send resume to firstname.lastname@example.org. GRAND PRAIRIE, AB Pharmacy assistant - part-time - Please send resume to email@example.com. MANITOBA
For the full listings of pharmacy technician and assistant positions visit the Pharmacy Technician Society of BC website at ptsbc.ca
ABBOTSFORD - Pharmacy technician - full-time Please send resume to firstname.lastname@example.org or fax 604.856.7178. BARRIERE - Pharmacy technician - full-time Please send resume to Regan Ready, pharmacist/ Pharmacy operations manager, at regan@teamrx. net or DonaIlida@telus.net or call toll-free 1.855.99. REGAN. BURNABY - Pharmacy assistant – full-time - Please send resume to email@example.com. CLEARWATER - Pharmacy technician - full-time, part-time - Please send resume to firstname.lastname@example.org, fax 250.674.0056 or call 250.674.0059. CRANBROOK - Pharmacy technician - full-time Please send resume to peoplespharmacy@telus. net, fax 250.420.4135 or call 250.420.4133. DEASE LAKE - Pharmacy technician - full-time Please send resume to Alan Williamson, owner at email@example.com.
Pharmacist - full-time
DELTA - Pharmacy assistant - full-time - Please send resume to firstname.lastname@example.org.
Advance your pharmacy career with Save-OnFoods. With over 100+ pharmacies in over 50+
GOLD RIVER - Pharmacy technician - parttime - Please send resume to Colleen, owner at
email@example.com, fax 250.285.3375 or call 250.285.2275.
SIDNEY - Pharmacy technician - full-time - Please send resume to pharmacy manager at rx205@ forewest.ca, fax 250.656.2235 or call 250.656.1148.
HUDSON HOPE - Pharmacy technician - full-time - Please send resume to Alan Williamson, owner at firstname.lastname@example.org. KAMLOOPS - Pharmacy technician - full-time, parttime - Please send resume to Missagh Manshadi, owner/pharmacist at missagh@manshadipharmacy. com, online at manshadipharmacy.com, fax 250.434.2527 or call 250.574.0111. KELOWNA - Pharmacy technician - full-time Please send resume to Merrie-Jean.Mulhern@ remedysrxsp.ca.
SIDNEY - Pharmacy assistant - part-time - Please send resume to pharmacy manager at rx205@ forewest.ca, fax 250.656.2235 or call 250.656.1148. SURREY - Pharmacy assistant - full-time - Please send resume to email@example.com. SURREY - Pharmacy assistant - full-time - Please send resume to firstname.lastname@example.org. SURREY - Pharmacy assistant - part-time - Please send resume to Todd Gehring, pharmacy operations coordinator at email@example.com.
KEREMEOS - Pharmacy assistant - part-time Please send resume to Todd Gehring, pharmacy operations coordinator at firstname.lastname@example.org. LANGLEY - Pharmacy technician - full-time - Please send resume to email@example.com or fax 604.608.3230 LANGLEY - Pharmacy assistant - part-time - Please send resume to Todd Gehring, pharmacy operations coordinator at firstname.lastname@example.org. LANGLEY - Pharmacy assistant - part-time - Please send resume to email@example.com or fax 604.856.3101. LOGAN LAKE - Pharmacy technician - full-time Please send resume to Regan Ready, pharmacist/ pharmacy operations manager, at regan@teamrx. net or DonaIlida@telus.net or call toll-free 1.855.99. REGAN.
VALEMOUNT - Pharmacy technician - full-time Please send resume to Regan Ready, pharmacist/ pharmacy operations manager, at regan@teamrx. net or DonaIlida@telus.net or call toll-free 1.855.99. REGAN. VANCOUVER - Pharmacy technician - full-time Please send resume to firstname.lastname@example.org. VANCOUVER - Pharmacy assistant - full-time, part-time - Please send resume to mjsrxmanager@ gmail.com. VANCOUVER - Pharmacy assistant - parttime - Please send resume to Jeff (manager) at email@example.com VANCOUVER - Pharmacy technician - full-time Please send resume to firstname.lastname@example.org or fax 604.608.3230. VICTORIA - Pharmacy technician - full-time - Please send resume to email@example.com.
MAPLE RIDGE - Pharmacy assistant - part-time Please send resume to alouettepharmacy@gmail. com or fax 604.467.3714. MASSET - Pharmacy technician - full-time - Please send resume to Alan Williamson, owner at ps214@ shaw.ca.
VICTORIA - Pharmacy assistant - full-time - Please send resume to Dr. John Forster-Coull, owner at firstname.lastname@example.org, online at wecompound. com, fax 250.388.5191 or call 250.388.5181.
MCBRIDE - Pharmacy technician - full-time - Please send resume to Regan Ready, pharmacist/pharmacy operations manager, at email@example.com or DonaIlida@telus.net or call toll-free 1.855.99.REGAN.
WEST KELOWNA - Pharmacy assistant - fulltime, part-time - Please send resume to Elizabeth McIntyre, pharmacy manager at firstname.lastname@example.org, fax 250.769.2054 or call 250.769.2014.
MIDWAY - Pharmacy technician - part-time - Please send resume to Cris Bennett, pharmacy manager/ owner at email@example.com, fax 250.449.2867 or call 250.449.2866. NANAIMO - Pharmacy technician - full-time, part-time - Please send resume to Kevin Cox, pharmacist/manager at firstname.lastname@example.org, fax 250.390.5732 or call 250.390.5730. NEW AIYANSH - Pharmacy technician - full-time Please send resume to Alan Williamson, owner at email@example.com or call 604.926.5331. NEW WESTMINSTER - Pharmacy technician - fulltime - Please send resume to pdm128@pdmstores. com or call 778.928.1067. PORT COQUITLAM - Pharmacy assistant - full-time, part-time - Please send resume to nazshah2011@ gmail.com, fax 604.944.5548 or call 604.944.5544. SICAMOUS - Pharmacy technician - full-time Please send resume to Regan Ready, pharmacist/ pharmacy operations manager, at regan@teamrx. net or DonaIlida@telus.net or call toll-free 1.855.99. REGAN.
BUSINESS OPPORTUNITIES Are you thinking of selling your pharmacy? Overwaitea Food Group may be interested. If you would like more information, please contact firstname.lastname@example.org. Forewest Holdings partners with local pharmacists and currently owns 34 Pharmasave locations. We have been partnering with local pharmacists for more than 30 years. We are currently looking for opportunities to acquire more community pharmacies in BC and Alberta. Please contact us if you are ready to sell all or part of your store. Forewest is also always looking for pharmacists who would like to become part owners of a pharmacy. Under the Forewest program you become a shareholder of your store and receive your full prorata share of its income in addition to your normal salary. We have several ownership opportunities available at this time. Please contact Don Fraser, CEO and president, at email@example.com or 604.788.9315. Peoples Drug Mart is an established and proven pharmacy banner that will make your pharmacy business more successful and profitable. We provide outstanding marketing support and services for a low monthly fee. Unlike other banners, Peoples Drug Mart does not charge a percentage of sales. Our belief is that the profits from your hard work should stay in your business. With Peoples, you get the best of both worlds, outstanding support and services, and the ability to maintain your profits. If you are interested in purchasing, selling or opening a new pharmacy, please contact Frank Cucca toll free 1.877.450.6006, ext 18 or 604.619.4846 or firstname.lastname@example.org. ABBOTSFORD - pharmacy for sale/partnership A pharmacy in Abbotsford is seeking a partner or an Arabic speaking pharmacist to take over. Average RX count 65/day for the year 2016, as of last month. The Rx count for July was 87/day. Asking price 300K until October 2016. Thank you and good luck. Please email email@example.com. UCLUELET - pharmacy for sale Owner retiring. Well-established business with growth opportunity for young, entrepreneurial pharmacist(s). Flexibility with purchase agreement and hours worked. Please contact hport@ukeecable. net or 250.726.4342. VANCOUVER - pharmacy manager and business partnership opportunity Private pharmacy in Vancouver looking for an enthusiastic and experienced pharmacist to become a business partner and work as the pharmacy manager. The candidate must be energetic, friendly, patient-focused, capable of enhancing operational efficiency and business value and have the ability to manage day-to-day pharmacy operations independently. Also, must comply with the provincial/federal pharmaceutical regulations at all times. A minimum of two years of experience in retail pharmacy, preferably as pharmacy manager, is required. Please email your resume and a letter explaining why you think you would be ideal for this opportunity to firstname.lastname@example.org. Only qualified applicants will be contacted.
Hire the Best Pharmacists & Pay Less ShiftPosts is an online service connecting pharmacies to relief pharmacists across Canada. Our online platform allows pharmacy managers to create a shift, add money and find a pharmacist within minutes. If you are a pharmacy manager that needs relief pharmacists on demand, without expensive agency fees, sign up or request a demo at
Hire the Best Each pharmacist has a rating, which you can view before you hire to pick the best match. We’ve filtered the most exeptional pharmacists out of thousands that applied.
Customization Set your location, hourly rate, shift duration and systems used and ShiftPosts will connect you with the pharmacists best suited to you.
Cost Savings The average pharmacy can save over $2000 a year by using ShiftPosts. When clients switch to our service, they reduce their relief pharmacist costs by up to 50%.
Payments + Invoices ShiftPosts takes care of payments, invoices and notifications. Simply add money using your PayPal account or INTERAC e-Transfer®.
Sign up at www.shiftposts.com/signup or call 1-877-SHIFT-01 (toll free) or email email@example.com Are you a pharmacist that wants to work when you want, where you want, at the rate you like? Sign up today at www.shiftposts.com/pharmacist
INTERAC® e-Transfer is a registered trademark of Interac Inc. PayPal is a registered trademark of PayPal, Inc.
BC Lions Canucks Car rental Cineplex Hotels around the world PNE and Playland Show tickets and much more!
Affinity BCPhA prescribed member discounts
BONUS: Credits back, accessories, waived fees $100 in cash and credits for new activations* $50 bill credit for upgrades/renewals* A free Gel Skin Case for your smartphone* No activation fee Free shipping in Canada Free SIM card
• 3GB of data • Unlimited Canada-wide calling • Unlimited text, picture and video messaging in Canada • Voicemail 25 • Caller ID, call conference, call waiting
• 5GB of data • Unlimited Canada-wide calling • Unlimited calling from Canada to US** • Unlimited text, picture and video messaging in Canada • Voicemail 25 • Visual Voicemail • Caller ID, call conference, call waiting
Est. retail value $95/month
Est. retail value $115/month
*A new activation means either transferring from another wireless provider or opening a new account with TELUS with a brand new phone number on a new 2-year contract and is eligible for the $100 bill credit. Upgrades/renewals means that you are an existing TELUS customer signing up for a new 2-year contract and is eligible for the $50 bill credit. All bill credits will be applied to your account over a 5-month period if you are eligible. You must be subscribed on our plan for at least 6 months or an additional cancellation fee equivalent to the applicable bonus credits/cash will be applied. The free Gel Skin Case is only available whlie supplies last. **Canada to US calling is not US roaming, it is when you place a call while you are in Canada on the TELUS network to a US phone number.
24 - 32%
15 - 50%
Affinity Rx price: $8 per ticket Regular price: up to $11.75 per ticket
Upper bowl tickets starting at as low as $47.50
15 - 25% Affinity Rx price: $8.50 per ticket Regular price: up to $11.99 per ticket
Visit our website for more offers! • Car rentals around the world • Financial services • Hotels around the world • Musicals, shows and restaurants • PNE/Playland • Retail products and services • Sporting events (BC Lions, Whitecaps, Vancouver Giants) • Subscriptions
HOW TO ACCESS THE DEALS Log into www.bcpharmacy.ca and go to the Member Benefits - Affinity Rx section or email firstname.lastname@example.org