The Tablet - April/May 2014

International Pharmacy Graduates • BCPhA Conference Preview • Asthma Awareness Month

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A Voice For Community Pharmacy

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Pharmacy Day at the Legislature

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THE TABLET

APR/MAY 2014

Editor-in-Chief Kathie Taylor 604.269.2863, kathie.taylor@bcpharmacy.ca

|

VOLUME 23. NO. 2

contents

Senior Editor Elise Riedlinger 604.269.2866, elise.riedlinger@bcpharmacy.ca Advertising Sales Shannon Ward, OnTrack Media 604.639.7763, tablet@ontrackco.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.

5 Sue Taylor

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: info@bcpharmacy.ca web: www.bcpharmacy.ca Pharmassist: 1.800.667.2190 For confidential counselling referral for employment or addiction related assistance

22 International Pharmacy Grads

16 Pharmaacy Day

Publication agreement #40810576

On the cover: BCPhA Pharmacist members, Board directors and staff, UBC Faculty of Pharmaceutical Sciences students and Dean Dr. Michael Coughtrie celebrated Pharmacy Day on the steps of the Legislature, March 24, 2014.

Features

Columns

Regulars

14

BCPhA Annual Conference 2014 A preview of this year’s event

6

President’s Message Inspiration through networking

5

Meet Sue Taylor Canadian Diabetes Association

16

On the Cover:

7

CEO’s Message Pharmacists have real solutions to health care woes

8

DPIC Drug-induced tinnitus

12

10

Pharmacy Practice Support Medication Review Services – PharmaCare Policy revisions

Clinicare Pharmacists Treating diabetes

27

Career Listings Find a job in pharmacy

Pharmacy Day at the Legislature Pharmacist Awareness Month

20

PharmaCare Audits Submission to government

22

International Pharmacy Graduates Making their mark in Canada

26

Asthma Awareness Month The vital role of pharmacists

11

Member Services Six things for you to consider

Got a suggestion for an article in The Tablet?

Email info@bcpharmacy.ca with your story ideas.

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Apr/May 2014

A voice for community pharmacy

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SMALL TALK

In the news Regulatory Compliance Support A new page has been created on the BCPhA’s website to provide members with information about a variety of compliance issues, including actions being taken to help address prescriber prescription errors and issues, an article on informed consent, and the Policy and Procedure Manuals.

The new Methadone for Maintenance Policy and Procedure Manual is now available for download by Pharmacy (Corporate) members. This manual is intended to support you in fulfilling your obligations under pharmacy practice legislation (other legislation is excluded) and build standard operating procedures for your practice, and is meant to be modified according to your pharmacy’s individual practice. Other manuals available are Dispensary Activities, Operation of a Community Pharmacy, and Administration of Injections.

Log in as a member at www.bcpharmacy.ca and go to Pharmacy Practice Support – Regulatory Compliance Support to learn more.

BCPhA Board elections Nominations for three positions on the BCPhA Board of Directors closed on March 15, 2014, with a total of 11 candidates nominated for election. Biographies of the nominees are now available on the BCPhA website, by logging into the members' side and going to About BCPhA – Board of Directors – Board Elections.

Innovation in health care The Honourable Rona Ambrose, federal Minister of Health, spoke to The Vancouver Board of Trade on March 21 about The need for innovation in health care, particularly in terms of making the health care system more sustainable in the coming decades.

In her remarks, the minister said she believed that pharmacists are “an underutilized resource.”

Head table guests at the luncheon were (left to right): Barbara Grantham, president and CEO, VGH/UBC Hospital Foundation; David Ostrow, president and CEO, Vancouver Coastal Health; Diane Finegood, president and CEO, Michael Smith Foundation for Health Research; Kip Woodward, chair, Vancouver Coastal Health; Geraldine Vance, CEO, BC Pharmacy Association; David Crawford, vice president, The Vancouver Board of Trade; The Honourable Rona Ambrose, Minister of Health, Government of Canada; and Craig Hemer, partner, Boyden Global Executive Search and director, The Vancouver Board of Trade.

All BCPhA members were sent a letter and ballot papers in March. The deadline for returning them by mail or in person to the BCPhA offices is April 15, 2014, by 4:30pm.

We look forward to introducing you to the new Board members in the June/July issue of The Tablet.

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MEET SUE TAYLOR, CANADIAN DIABETES ASSOCIATION

Meet...Sue Taylor Regional Director, BC and Yukon, Canadian Diabetes Association On a professional level, I’m looking forward to continuing to promote the Diabetes Charter for Canada. The need for the Diabetes Charter for Canada has never been more clear. Diabetes is a public health issue of epidemic proportion.

Across Canada, people living with diabetes frequently experience stigma, a lack of public awareness, and misunderstanding about the disease. This is particularly important for those populations with a high prevalence of diabetes or who have special challenges related to diabetes management. These include specific ethnocultural populations and especially Aboriginal peoples, people with low incomes, the elderly and young people.

On World Health Day, April 7, 2014, the Diabetes Charter for Canada was officially unveiled.

Developed by the Canadian Diabetes Association with the support of approximately 200 people from across Canada including those living with diabetes, caregivers, health care providers and government officials, the Charter is a document that supports a shared voice for the diabetes community. It presents a common vision through a set of principles that confirm the commitments of the diabetes community concerning diabetes prevention and management, support and care.

Sue Taylor talked to the BC Pharmacy Association about the Charter, how pharmacists can support patients with diabetes, and what drives her in her role as regional director, BC and Yukon, for the Canadian Diabetes Association (CDA).

What would you like to accomplish in the next five years?

On a personal level, I plan to participate in the Vancouver Marathon in May 2014, and travel throughout the wonderful province of BC to learn about my new home province.

Our vision for the Charter is a country where people with diabetes live to their full health potential. It will ensure that people who live with diabetes are treated with dignity and respect; direct advocacy for equitable access to high-quality diabetes care and support; and enhance the health and quality of life for people who live with diabetes and their caregivers.

You can visit www.MyDiabetesCharter.ca to sign the Charter.

What do you consider your greatest achievement?

I hope I have yet to reach my greatest achievement. When I think of Sir Frederick Banting, co-discoverer of insulin, who earned a Nobel Prize in his early 30s, I have some catching up to do. One of the things I am most proud of is being a founder of a family resource centre in Cambridge, Ontario. When my children were younger, a group of grassroots individuals partnered to create a centre for parent education and kids play. The centre is still in operation after 30 years and continues to grow and thrive. I am also proud of my work with the CDA that continues to make such significant strides in research, education, services and advocacy for people with diabetes and I’d

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like to think that over my 20 year tenure, I have contributed to that success.

What is your motto?

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

- Maya Angelou What role do you see for pharmacists in the management of diabetes?

Effective management of diabetes is a team effort. The CDA recommends pharmacists as integral members of interdisciplinary care teams for effective diabetes care. Pharmacists are a trusted resource for people with diabetes, enabling them to get timely answers to questions, particularly when their physician may not be available.

Pharmacists help patients understand their medications, manage side effects and coordinate drug regimens that are sometimes quite complex. As a first or early point of contact, a pharmacist can also direct a person with diabetes to other members of the health care team who have more specific expertise to address the individual’s concerns.

Pharmacists also serve as volunteers on the CDA’s professional sections and national advocacy council and are involved in key projects such as the development of our clinical practice guidelines (guidelines.diabetes.ca).

Apr/May 2014

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DON COCAR

|

PRESIDENT

Inspiration through networking An invitation to the BCPhA Annual Conference

As you’ve seen

in recent member emails and on our website, the BCPhA Annual Conference is fast approaching! This year, we’re heading to The Fairmont Chateau Whistler from May 22 to 24.

So why should you leave the comfort of your hometown to join us in the beautiful resort village of Whistler?

The main reason I go to our annual conference is always networking with my pharmacy peers, sharing our experiences and our challenges.

I’ve heard people say they don’t want to divulge anything about their competitive advantage, and there’s no reason you should. But I know I leave every conference feeling inspired, and with new ideas just from talking with colleagues and meeting a few new faces.

Stephens promises to bring us vital insights needed today in order to operate tomorrow’s retail pharmacy.

He’s followed by Jim Danahy, who heads a firm specializing in medication adherence, pharmacy unit profitability, M&A and valuation.

In collaboration with the University of Saskatchewan and UBC, his team created AdherenceTrack©, the first patient-centred scorecard to benchmark and track medication adherence in community pharmacies.

“At the end of the day, our annual conference is all about having fun, networking and learning.”

The same goes with the vendors and suppliers you’ll meet at the trade show on the Thursday night. Salespeople are always “in the know” about the business climate in their field. I see them as allies because they’re valuable resources in the pharmacy sector. Sometimes they also have innovative products for my business that keep me competitive within our field.

Beyond the networking, the education opportunities are a great reason to head up to Whistler. None of us should ever stop learning more about our profession and the business, and these conferences are a great way to learn and earn some CE credits.

This year is all about Making It Happen: Implementing Best Practices.

In the past our themes have been about what could or might happen in the future: now we’re saying we have so many things in place, let’s use them and make sure we’re using best practices.

Our keynote speaker, Doug Stephens, will look at The Future of Retail Pharmacy, from staffing and store design to technology and marketing – and how each will change dramatically in the months and years ahead.

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Our Partner Sponsor, the College of Pharmacists of BC, is making a presentation on the new focused practice review. Other session topics include subsequent entry biologics, reproductive health, and community pharmacy’s role in personalized medicine. You can see the full schedule on page 14 and learn more at www.bcpharmacy.ca/conference.

Another highlight of the conference is the chance to honour some of our truly outstanding members during Friday evening’s award gala. Hearing what they have accomplished, and why they are being recognized at the BCPhA Pharmacy Awards, is always inspiring!

At the end of the day, our annual conference is all about having fun, networking and learning. We often live in silos, talking only with our fellow pharmacy staffers and our patients, and don’t get the chance to come up to breathe, or recharge our batteries very often.

Here’s your chance to enjoy the company of your peers, the educational components of the conference, and one of our province’s most beautiful settings.

Hope to see you in Whistler!

GERALDINE VANCE

|

CEO

Pharmacists have real solutions to our health care woes

There is an old saying that you are either part of the solution or merely another player who is part of the problem. March was national Pharmacist Awareness Month and for the BCPhA it was time to bring into sharp focus the fact that pharmacists want to be part of the solution. Community pharmacy has recommendations that can make an immediate impact on access and financial sustainability challenges that our governments face.

In March 2013 the Association released seven clinical services proposals that we believe can save millions of dollars in the health care budget. Also, our proposals will improve patient care and access to primary care services. Our discussions with other players in the health care system have largely been supportive of our recommendations. But frankly, our engagement with elected and government officials has not moved our recommendations forward to the degree we would have liked.

results. Even New Zealand found this to be true. The place so famous for tackling drug pricing through every draconian measure possible had to rethink its single-minded focus on drug costs and find another way – and the way includes involving pharmacists in patient medication and disease management.

In our policy paper, Facing the Future Together, released on March 20, 2014, we make the case for why pharmacists have much to offer in terms of managing prescription drug costs by working with patients to ensure they are taking their medications properly. We also believe pharmacists should be doing more to help address the pressures in the primary care system.

“Patients have the right to expect that all their health care providers will work in genuine partnerships and minimize the fragmentation of care they receive.”

Other provinces are taking advantage of what pharmacy has to offer. Saskatchewan, Alberta and Nova Scotia allow pharmacists to prescribe for minor ailments. And in March of this year, New Brunswick put legislation forward to allow for this and other opportunities for pharmacy to address universal problems with mounting health care costs and declining access to care for those who need it.

So, for this year’s Pharmacist Awareness Month, we thought it was important to provide context to demonstrate why governments should turn to pharmacy as a partner to solve key problems. The story of escalating provincial drug budgets is not as simple as it might seem.

The real truth is volume and types of medication are driving drug budgets upwards, not drug prices.

All the data shows that a relentless push by governments to drive commodity drug prices downwards will yield no long-term, lasting

But pharmacists can’t do any of this on their own, nor should they.

Collaboration with others in the health care team, notably physicians, is key. Patients have the right to expect that all their health care providers will work in genuine partnerships and minimize the fragmentation of care they receive. It is well past time we stopped looking at the health care budget as a series of self-interested budget lines, and at other practitioners as competitors.

I continue to be impressed by the creativity and innovation pharmacists demonstrate when it comes to looking for new ways to meet their patients’ needs. Across Canada pharmacists are making a major contribution to patient care and managing scarce health care dollars. We have more to do and are ready to work with government to find new solutions to old problems.

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Apr/May 2014

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DRUG AND POISON INFORMATION CENTRE

Drug-induced tinnitus

By Raymond Li, B.Sc. Pharm., M.Sc.

Tinnitus affects 360,000 Canadians of all ages, with half experiencing a significant decrease in their quality of life. Tinnitus has many causes and many medications can cause tinnitus. May is Speech and Hearing Awareness Month.

The aim of this article is to help pharmacists understand how medications can cause tinnitus, and how to help their patients avoid it.

Tinnitus (from the Latin “tinnire”- to ring) is the perception of sound in the absence of a corresponding external acoustic stimulus that is not due to psychosis. Tinnitus is a symptom, not a disease.

Tinnitus can be objective (detectable by others by auscultation, usually caused by turbulent blood flow or muscle contraction), or subjective (“phantom” noises heard only by the patient, usually the case with drug-induced tinnitus). Tinnitus varies in intensity, duration, and can be experienced as ringing, buzzing, clicking, explosive, vocal or musical sounds.

The auditory pathway and sound perception Sound waves travel through the auditory canal to the ear drum, causing the tympanic membrane and then the bones of the middle ear to vibrate. These small bones are connected to the spiral-shaped cochlea, where vibrations are transduced to nerve impulses that travel to the brain via the spiral ganglion and eighth cranial (auditory) nerve. These nerve impulses are processed by the auditory cortex and associated areas of the brain. Tinnitus can arise from a disturbance along any part of the auditory pathway. Causes include vascular or anatomical abnormalities, tumours, autoimmune reactions, trauma, excessive noise, infection, emotional stress, and chemical and drug exposure.

Drug-induced tinnitus and mechanisms Drug-induced tinnitus (DIT) can result from ototoxicity (along with hearing loss, vertigo, and hyperacusis) due to damage to the inner ear or auditory nerve as the only symptom or with the other symptoms. However, DIT does not always involve ototoxicity.

DIT, like other phantom perceptions, is thought to be caused by an imbalance between sensory input (bottom-up) and attentional and control processes in the brain (top-down). As such, DIT can be induced by cochlear dysfunction with or without damage (bottom-up), CNS dysfunction (top-down), or both. DIT may be

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direct (e.g. cochlear toxicity from aminoglycosides) or indirect (e.g. sympathetic activation with antihypertensives, benzodiazepine withdrawal). Exact mechanisms remain unclear for many drugs, and multiple mechanisms may be involved even with a single drug.

The list of medications associated with tinnitus is extensive.

Causality and mechanisms are well established for some drugs (aminoglycosides, ASA, loop diuretics, platinum antineoplastics) but for others the evidence is limited to case reports.

Some common drugs associated with tinnitus* (bold indicates higher risk) • Angiotensin agents (ACE inhibitors, angiotensin receptor blockers) • Antidepressants (tricyclic antidepressants, SSRIs, bupropion, venlafaxine) • Antimicrobials (aminoglycosides, fluoroquinolones, isoniazid, macrolides, tetracyclines) • Antineoplastics (vinca alkaloids, cisplatin, carboplatin) • Beta blockers • Calcium channel blockers • Diuretics (loop diuretics, thiazides) • Isotretinoin • Phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil) • Quinine derivatives • Salicylates and NSAIDs (*Please visit www.dpic.org/healthcare-professional for more information.)

Ototoxicity risk factors and prevention Although DIT does not always result from cochlear or auditory nerve damage, care should be taken to avoid ototoxicity whenever possible. Drug levels in the inner ear are likely the most important factor for developing ototoxicity. High dose or high cumulative dose, prolonged therapy, reduced elimination, low serum albumin, and dehydration can increase inner ear exposure.

Genetic predisposition, advanced age, in utero exposure, existing sensorineural impairment, electrolyte imbalance, dehydration, fever, and concomitant or prior exposure to other ototoxic substances or excessive noise also increase vulnerability.

General recommendations for preventing ototoxicity include: • Avoid ototoxic drugs when possible, especially in patients with existing sensorineural impairment and when hearing is essential for quality of life.

• Use the lowest effective dose and duration.

• Avoid multiple ototoxic drugs.

• Avoid medication interactions that could elevate the serum level of any drug that causes tinnitus or ototoxicity.

• Adjust doses for renal and hepatic impairment if needed.

• Ensure proper hydration and nutritional status are maintained during medication use.

• Monitor renal function.

• Ask about symptoms including dizziness, hearing loss, and tinnitus regularly. Patients may not volunteer a history of tinnitus.

• Measure hearing before, during, and after treatment with highrisk ototoxic drugs.

• Protect patients from excessive noise exposure.

Treatment Tinnitus can result from an underlying disease so non-drug causes need to be excluded first. Drug-induced tinnitus may resolve when the offending agent is stopped or when the dose is reduced, but recovery may be prolonged (weeks to months) or in some cases it

may be permanent. If the underlying cause(s) cannot be reversed, treatments specific for tinnitus, the symptom, can be tried.

Non-drug treatments such as hearing aids and cochlear implants for hearing loss, sound therapy (e.g. frequency masking devices), and behavioural therapy are the mainstays of tinnitus treatment.

Various pharmacological agents aimed at modulating neuronal excitation (benzodiazepines, anticonvulsants, antidepressants, NMDA antagonists, antiarrhythmics), improving circulation (gingko biloba extract, nimodipine, vardenafil), or scavenging free radicals (melatonin, zinc) have been studied and the results, in general, are disappointing. Some of these treatments have been reported to cause or worsen tinnitus. However, individual patients may benefit from treatment. Drug therapy for associated symptoms such as depression or insomnia should also be tried when indicated.

Summary Tinnitus is a complex disorder associated with various diseases and medications. Once non-drug causes have been excluded, the offending agent should be reduced or stopped. If it must be continued serum levels of the drug should be measured when possible. Non-pharmacological treatments are the mainstay of therapy for persistent, troublesome tinnitus, though some patients may benefit from specific drug therapies.

References are available at www.dpic.org

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Apr/May 2014

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DEREK DESROSIERS |

DIRECTOR, PHARMACY PRACTICE SUPPORT

Medication Review Services – PharmaCare Policy revisions

Many of you may be wondering

why there are so many changes happening with the Medication Review Services program.

We have the revised Medication Review Services (MRS) Policy and revised form requirements in the PharmaCare Policy Manual along with the eligibility change that only prescription drugs and insulin qualify. All of these changes came into effect on April 1, 2014.

Additionally, PharmaCare and the BC Pharmacy Association continue to work together to refine the Medication Review Services policy, including patient eligibility criteria, with a view to improving patient outcomes.

Further changes to the policy may be announced later this year. The eligibility requirements continue to be reviewed jointly by PharmaCare and the Association.

There are a variety of reasons for the changes but for the most part they focus on two major areas of concern:

Changes such as these ensure that, within the finite resources available, Medication Review Services are focused on the patients for whom the service will deliver the greatest benefit. It is recognized that eligibility criteria based solely on the number of prescriptions a patient is taking is not an ideal method of targeting the services to the patients who will benefit the most. A much more robust eligibility criteria would likely focus on chronic conditions rather than number of medications.

1. The changes to the policy manual and forms are intended to address a significant lack of clarity in the original policy manual that led to a lack of understanding of the documentation requirements and as a result a number of significant audit problems for pharmacies.

2. The change in the eligibility requirements that eliminates OTC products and restricts eligible prescriptions to Schedule 1 drugs and insulin only is intended to help ensure that Medication Reviews are targeting the population that can benefit the most and help keep the program financially sustainable over the long term.

As a reminder, the key aspects of the changes to the policy manual are: clarification of the required activities for each type of Medication Review Service, clarification of the documentation requirements for each type of Medication Review Service, and improved language. With respect to the forms, the key changes involve simplifying and standardizing MRS documentation.

To help support our members with these policy changes, we've created templates of the revised Best Possible Medication History and Drug Therapy Problem Forms. These forms are available on the members' side of the BCPhA website under Pharmacy Practice Support – Medication Review Services.

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It is important to note that while OTC medications have been removed from the eligibility criteria they should still be included on the Best Possible Medication History (BPMH) form and discussed with the patient. You will have also likely noticed that on page 2 of the BPMH form (Health Care Professionals section) in the Clinical Need for Service section there continues to exist two of the options that refer to OTCs as follows: has a medication regimen that includes one or more non-prescription medications has a medication regimen that includes one or more natural health products While OTCs and natural health products are not of themselves eligible medications, their use along with at least five prescription drugs could still be part of the clinical need for the service.

CYRIL LOPEZ, CHIEF OPERATING OFFICER

Six things for you to consider

Sometimes it can be difficult to keep up with – or remember – the many benefits offered by and activities underway at the BC Pharmacy Association. Here are six items for your consideration!

Professional Liability Insurance: You need to have professional liability insurance at all times as a condition of maintaining your registration as a “practising pharmacist,” even during maternity leave or other absences, unless you advise the College and move to the non-practising category. Members sometimes ask to suspend membership during their maternity leave without realizing that they need insurance even if they are not actively practicing.

Consulting: Whether you’re a consultant-pharmacist or an employer looking to engage a pharmacist on a consulting basis (not as an employee) you should review the tests that CRA adopts to ensure employers are not trying to evade their contributions to Employment Insurance and the Canada Pension Fund. The test has six criteria, but the rule-of-thumb is simple: if you work like an employee and act like an employee, you must be an employee. If you still think it’s worthwhile to have this arrangement, please get tax advice from an expert: don’t rely on others’ practice or narrative.

Financial Literacy & Wealth Management: The end of tax season is a good time to fine-tune your financial affairs. (As an employed pharmacist, did you download your 2013 certificate detailing the taxdeductible malpractice premium amount included in your membership fee?) Your membership provides two complimentary financial affairs benefits: a session with Glenn Schoenroth of RBC Dominion Securities or with Financial Literacy Council. Whether you’re a new graduate, staff pharmacist or owner, NEW learn how to maximize the value of that tax refund!

Conference: Our annual conference in May is garnering strong support from our members, pharmacy manufacturers and service providers.

We realize that every pharmacy sector faces increasing economic pressure, which makes this level of support to our members even more appreciated. Together with our Partner Sponsor, the College of Pharmacists of BC, we hope to see many of our members learning about the future of retail pharmacy, genomics for drug therapy, travel medicine and many other fascinating topics.

OSCE Readiness Program: In our discussions with other organizations about supporting international students and pharmacists who want to join pharmacy, we were made aware of this program run by MOSAIC and conducted by trained pharmacist educators. The program includes mock OSCE sessions, intercultural communication, competencies and other workplace protocols. If you know someone who might benefit please have them contact Lynda Dassiuk at 604.254.0244.

Pharmacy Innovation Fund: We would like to acknowledge our major partners (Bayer, GSK, Merck and Sanofi) who support the BCPhA Pharmacy Innovation Fund. The recent Pharmacy Day in Victoria was possible, in part, by the fund. The fund was established in 2010 and has underwritten the start-up of the Administration of Injections Program (2009), the pharmacy practice development (2011) workshops on Medication Review Services, methadone maintenance transition grant (2014) and the advocacy and policy initiatives in 2013/14. The fund underwrites long-term initiatives that need investment in change management and carry higher risk in their development stages.

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Apr/May 2014

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CLINICARE PHARMACISTS

Treating diabetes with everything and the kitchen sink

By Larry Leung and Jason Min

It is safe to assume

that most pharmacists have provided care to a patient living with diabetes. Diabetes and prediabetes are becoming increasingly prevalent and are now estimated to affect more than nine million Canadians. We know diabetes is a chronic disease that can require an extensive and complicated medication regimen, especially if you include the treatment of any diabetes-related issues like peripheral neuropathy or persistent albuminuria.

While we see many patients in our practice with chronic diseases such as asthma and hypertension, we get the most physician referrals for the medication management of diabetes. We recently had a patient with very poorly controlled diabetes that resulted in multiple visits to improve the patient’s understanding of his medications and to optimize his care.

Our patient was a 55-year old south-Asian male diagnosed with type 2 diabetes one year ago. He was seen by an endocrinologist in the past but has been unreliable in making regular visits. He was referred to us by his family physician and presented at our initial visit with the following measurements: • Blood pressure 115/80 mmHg • Low-density lipoprotein (LDL) 1.92 mmol/L • Total cholesterol 4.10 mmol/L • Hemoglobin A1c 12.4% • Estimated glomerular filtration rate (eGFR) 90 mLs/min • Albumin/creatinine ratio (ACR) 10 mg/mmol He was taking the following medications: • Gliclazide MR 60 mg (Diamicron) – 2 tablets once daily • Metformin 500 mg (Glucophage) – 2 tablets twice daily • Atorvastatin 20 mg (Lipitor) – 1 tablet once daily • Trandolapril 1 mg (Mavik) – 1 capsule once daily The patient was described as “needle-phobic,” and would prefer to stay on oral treatment if possible. He does not check his blood sugars at home. He wonders if there is a possibility of increasing his current

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Before making any recommendations, the physician had the following questions for us: • What are the A1c lowering potentials of the medications used in diabetes?

• What is the evidence for combination therapy in this patient?

• What is the appropriate method of adding insulin to this patient’s regimen?

Here are our responses: What are the A1c lowering potentials of medications used in diabetes?

Medications that are used in diabetes can be divided into four broad categories: 1. Insulin secretagogues that stimulate beta-cell insulin release, increase peripheral glucose utilization, and decrease liver glucose production: sulfonylureas (SUs) (glyburide, gliclazide) and meglitinides (nateglinide, repaglinide).

2. Drugs that decrease hepatic glucose production and increase insulin sensitivity of tissues: biguanides (metformin) and thiazolidinediones (TZDs) (pioglitazone, rosiglitazone).

• Fasting blood glucose (FBG) 18.2 mmol/L

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medications or adding another oral agent. The patient has not had a previous cardiovascular event, such as a myocardial infarction or stroke. On a quick overview of this case, it was clear that the priority would be to try and achieve better sugar control given his high fasting blood glucose and his high A1c results.

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3. Drugs that delay digestion of complex carbohydrates: alphaglucosidase inhibitors (acarbose).

4. Drugs that increase insulin secretion by increasing incretin: dipeptyl peptidase-4 inhibitors (DPP-4) (saxagliptin, sitagliptin, linagliptin) and glucagon-like peptide-1 agonists (GLP-1) (liraglutide, exenatide).

In clinical trials, metformin, all SUs, repaglinide, and TZDs had the greatest A1c lowering potential ranging from 1-1.5%. By comparison, acarbose and nateglinide had lower average decreases of <1%.

Liraglutide has an A1c lowering potential of 0.8-1.4% while the DPP-4 inhibitors have the potential of 0.4-0.8%.

What is the appropriate method of adding insulin to this patient’s regimen?

Table 1 – Summary of common oral antihyperglycemic medications

Class/Medication

Relative A1c lowering

Risk of hypoglycemia

Cost

Weight (weight loss vs neutral vs gain)

Metformin

√√√

√√√

√√√

√√√

Sulfonylureas (glyburide, gliclazide, glimepiride)

√√√

x to xx

√

√√ to √√√

DPP-4 Inhibitors (sitagliptan, saxagliptan, linagliptin)

√

√√

√ to √√

X

GLP-1 Receptor

√ to √√

√√

√√

XX

Alpha-glucosidase inhibitors (acarbose)

√

√√√

√√√

√

Insulin

√√ to √√√

√ to XX

√ to XX

√ to XX

Antagonists (liraglutide, exenatide)

An Advantage

√√√

Neutral

√√

√

A Disavantage

X

XX

Source: http://www.rxfiles.ca/rxfiles/uploads/documents/Diabetes-Agents-Outcomes-ComparisonSummary-Table.pdf What is the evidence for combination therapy in this patient?

DPP-4 inhibitors are approved for use as monotherapy, but they are often used in combination with other antihyperglycemics. We have seen a rise in DPP-4 use in the past few years, but they lack long-term safety and efficacy data. The SAVOR-TIMI 53 trial compared saxagliptin (Onglyza) vs placebo on cardiovascular (CV) outcomes and showed statistically significant reductions in A1c with therapy, but it neither reduced nor increased the risk of CV death, nonfatal myocardial infarction (MI), or nonfatal ischemic stroke. Unfortunately, there was a statistically significant rise in hospitalization for heart failure with saxagliptan with a number needed to harm (NNH) = 143 patients over 2.1 years. It is unclear whether the other DPP-4 medications have similar outcomes to saxagliptan.

Recently, we have seen a few cases where endocrinologists prescribe both a DPP-4 inhibitor and a GLP-1 agonist in combination, despite both classes of medications having similar mechanisms of action. When we looked into the evidence for this regimen we found it to be an “off-label” strategy without enough evidence to support its use and would not recommend it at this time.

With an A1c of 12.4%, the most appropriate action would be to start intermediate-acting insulin (NPH, Humulin-N). Insulin should be initiated in patients who present with marked hyperglycemia (A1c 8.5%). If the patient was a newly diagnosed diabetic with an A1c <8.5% and was motivated to take action, lifestyle modifications alone may be appropriate as the first step for three months before any drug-therapy.

Intermediate-acting insulin is often provided first given its low cost and better patient acceptability. However, with a duration of action of 14-18 hours, patients may require twice daily dosing. Bedtime dosing is often given first at 5-10 units or 0.1-0.2 units/kg.

The patient will then increase their bedtime insulin by two units every 3-4 days until the fasting blood glucose in the morning is between 4-7 mmol/L. The insulin will continue to be adjusted and rapid-acting insulin may be added at mealtimes depending on the patient’s post-prandial blood glucose.

Our patient was already taking maximum doses of metformin and gliclazide. We reviewed the potential benefits and risks of using DPP-4 inhibitors and GLP-1 agonists as the only available oral alternatives and were able to convince him that insulin was the best option given the current evidence. We recommended insulin NPH 10 units at bedtime to start and to titrate accordingly. With the addition of insulin we were able to discontinue his gliclazide, which he appreciated. After one year of close follow-up and insulin adjustment, the patient eventually achieved an A1c of 7.8% and was on a downward trend.

What do you see in your practice? Do you have patients who would benefit from better control of diabetes or might benefit from insulin?

Larry Leung and Jason Min are directors of Clinicare Pharmacists Inc. and Lecturers at the University of British Columbia. They have a passion for interdisciplinary care and the development and implementation of innovative clinical pharmacy services in the community. They do not have any disclosures or conflicts of interests to report.

Insulin is often used in combination with metformin to limit weight gain and to reduce the required insulin dose. The FINFAT study demonstrated the combination helps to overcome insulin resistance and showed decreases in risk of stroke, MI, and all-cause mortality. Triple therapy with insulin, metformin and a SU can be used, but this combination is generally avoided due to increased risks for hypoglycemia.

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CONFERENCE PREVIEW

Join us at the BCPhA Annual Conference 2014 in Whistler!

Keynote session: The Future of Retail Pharmacy

This year at the end of May, the weather will be getting better and the golf course – and your pharmacy colleagues – will be calling your name at the BCPhA Annual Conference in Whistler!

What better place to earn your CE-Plus credits, learn the latest in pharmacy developments, and network with your peers than the beautiful Fairmont Chateau Whistler?

On Thursday, May 22, the conference begins with a bang during the Mardi Gras-themed trade show and networking night, which features more than 30 exhibit booths, great food and exciting door prizes.

Friday night honours the outstanding pharmacists who are the recipients of this year's BCPhA Pharmacy Awards at a gala dinner.

Earn your CE-Plus credits during educational sessions and panel discussions on both Friday and Saturday, covering a range of topics relevant to both the business and practice of pharmacy.

The following page includes the session titles and schedule – for more information on each speaker and session, please visit www.bcpharmacy.ca/conference.

Are we witnessing the death of the store or its astonishing rebirth? Are we seeing the beginning of the true Golden Age of retailing? It’s a topic of ongoing and passionate debate in all retail sectors. One thing is certain: the store of the future will be vastly different from the store of today, and nowhere will these changes be more apparent than in retail pharmacy.

In this year’s keynote session, Doug Stephens, one of the world’s foremost retail industry futurists, will show you the pharmacy of tomorrow.

Stephens’ intellectual work and thinking have influenced many of the world’s best-known retailers, agencies and brands including Target, Home Depot, Disney, Crayola, WestJet and Air Miles. Prior to founding Retail Prophet, he spent 20 years in the retail industry, holding senior international roles including the leadership of one of New York City's most historic retail chains.

Stephens is the author of The Retail Revival: Re-Imagining Business for the New Age of Consumerism, the consumer technology contributor on App Central TV, and the retail contributor for CBC Radio Canada.

Session: The Only Best Practice That Matters In a fast-paced presentation, Jim Danahy will make an evidence-based case for medication adherence to be elevated to the highest priority in every community pharmacy. A third generation retailer, Danahy grew up around his family’s independent pharmacy. After holding executive positions with major retailers and consumer goods companies, he founded the retail productivity firm CustomerLAB in 1994. Danahy is the founding Director of the Center for Retail Leadership, Schulich Executive Education Centre in the Schulich School of Business at York University. He sits on the board of the Retail Advertising and Marketing Club of Canada and is chairman of the board of Hope Air.

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CONFERENCE PREVIEW

Thursday, May 22 (Evening)

6:00pm to 9:00pm

Mardi Gras Trade Show and Networking

Friday, May 23

7:30am to 8:30am

Breakfast

8:45am to 9:00am

Welcome Address – BCPhA President Don Cocar and CEO Geraldine Vance

9:00am to 10:15am

Keynote Session: The Future of Retail Pharmacy – Doug Stephens

10:15am to 10:30am

Break

10:30am to 11:45am

The Only Best Practice That Matters – Jim Danahy

12:00pm to 1:30pm

Plated Lunch

1:45pm to 3:15pm

Community Pharmacy and the Focused Practice Review: The Challenge and Opportunity – Presented by the College of Pharmacists of BC

3:15pm to 3:30pm

Break

3:30pm to 5:00pm

Privacy and Informed Consent Workshop – Sara Levine and Drew McArthur OR Panel Discussion: Innovations in Drug Plan Management – Green Shield Canada, TELUS, and Pacific Blue Cross; facilitated by Sam Louie

6:00pm to 10:00pm

Reception and Awards Dinner

Saturday, May 24

7:00am to 8:15am

Breakfast

8:30am to 10:00am

Privacy and Informed Consent Workshop – Sara Levine and Drew McArthur OR Subsequent Entry Biologics: A Primer – Dan Martinusen

10:00am to 10:15am

Break

10:15am to 11:45am

Joint Action on Joints – Alison Hoens and Dr. Marie Westby OR A Lifetime of Reproductive Health – Dr. Unjali Malhotra

12:00pm to 1:30pm

Plated Lunch

1:45pm to 3:15pm

Community Pharmacy's Role in Personalized Medicine – Corey Nislow, Ron Reid and Mark Kunzli OR Skin is In: Dermatology for Pharmacy – Dr. Simon Wong

3:15pm to 3:30pm

Break

3:30pm to 5:00pm

No Longer Non-Insured: Understanding the New First Nations Health Authority’s Health Benefits Program – Joe Gallagher and John Mah OR Travel Medicine – Dr. Darin Cherniwchan

5:15pm to 5:30pm

Closing Remarks – Sam Louie and BCPhA CEO Geraldine Vance

Learn more and register at www.bcpharmacy.ca/conference.

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PHARMACY DAY 2014

Pharmacy Day at the Legislature On March 24, and for the very first time since it was built in the 1890s, the BC Parliament Building had a pharmacy located within its venerated walls. The occasion was Pharmacy Day at the Legislature, hosted by the BC Pharmacy Association to demonstrate the important role pharmacists play in the province’s health care system.

More than 25 pharmacists volunteered to be on hand to interact with Members of the Legislative Assembly (MLAs), government officials and legislative staff in a one-of-a-kind pharmacy exhibit.

Set up in the legislature, the exhibit featured a replica dispensary to help our visitors understand there’s a lot that happens between pick-up and drop-off. MLAs and staff learned about PharmaNet, adaptations and renewals, and blister packaging. Some even tried their hands at dispensing medications, carefully handling the Smarties that were used as pills.

In another corner, pharmacists explained the benefits to patients of Medication Review Services, while across the room they gave background on – and provided – immunizations such as tetanus, influenza and pneumococcal.

A final station focused on three of the Association’s clinical services proposals: Asthma Consultation Service, Self-monitoring of Blood Glucose (SMBG) in Type 2 Diabetes, and Community Pharmacist-Led Anticoagulation Management Service.

Apr/May 2014

Pharmacy Day was made possible with the help of many pharmacists who volunteered their time and contributed supplies, and the support of the Pharmacy Innovation Fund.

Dr. Doug Bing, the MLA for Maple Ridge-Pitt Meadows, read the proclamation that officially marked March 24, 2014, as Pharmacy Day in British Columbia.

Amy Ku, B.Sc.(Pharm.), M.B.A.

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The day concluded with an evening reception attended by close to 100 people, including nearly 40 MLAs. Health Minister Lake delivered remarks at the reception.

In the afternoon, the BCPhA and pharmacists were welcomed and introduced in the Legislative Assembly by Health Minister Dr. Terry Lake.

“The event was very well organized, with engaging activities in a very well thought out mock pharmacy. Over the evening reception, I’ve had numerous MLAs telling me what a great learning experience it was. I am overjoyed to see pharmacists actively voicing concerns, demonstrating the values we can bring to the system, and asking for changes. In my 25 years as a pharmacist, this is probably the first time I truly felt empowered to address our cause.”

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Throughout the day, Board members, staff and volunteers held meetings with cabinet ministers, MLAs and key government officials.

www.bcpharmacy.ca

The pharmacist is in! Pharmacist Ahmed Abouelazm; Jane Shin, MLA, Burnaby-Lougheed; pharmacist Lienny Thio; and BCPhA Board member Nadeem Zia in the dispensary.

PHARMACY DAY 2014

BCPhA Board member Julie Ford talks to Jordan Sturdy, MLA, West Vancouver-Sea-to-Sky, as he rolls up his sleeve for an injection.

BCPhA director Julie Ford welcomes Health Minister Dr. Terry Lake into the pharmacy exhibit; in the background pharmacist JD Puri explains the dispensary to George Heyman, MLA, Vancouver-Fairview.

Pharmacists Walter Puglak and Donovan Walters; Hon. Norm Letnick, Minister of Agriculture and Chair of the Select Standing Committee on Health; and Bryce Wong, BCPhA manager, pharmacy practice support (left to right).

Mike Farnworth, MLA, Port Coquitlam, talks with BCPhA CEO Geraldine Vance and BCPhA vice-president David Pavan.

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PHARMACY DAY 2014

Facing the Future Together: Medication cost control short-lived without better use of pharmacists Each year, as part of Pharmacist Awareness Month, the BCPhA focuses its efforts on demonstrating the role pharmacists can and should play in the health care system. In addition to raising awareness about the key role pharmacists play currently, we want to engage policy-makers and key health care stakeholders in a dialogue about how best to use the expertise of pharmacists moving forward.

In March, the Association released a policy paper called Facing the Future Together. The paper makes six recommendations focused on ways to better use pharmacists’ expertise to meet demands for access to primary care services. It also provides recommendations on how to improve collaboration between pharmacists and other health care practitioners.

The six recommendations made in the report are: •

That the Government of British Columbia continue to support the expansion of pharmacists’ scope of practice to realize the full benefit of pharmacists’ education and training.

•

That the Ministry of Health, in partnership with the BC Pharmacy Association, create a joint “Pharmacy Services Committee” with representation from both parties to improve patient care and the professional satisfaction of pharmacists.

•

That the Ministry of Health, in collaboration with other public payers, prepare and publicly release an annual consolidated pharmacy expenditures and trends report.

•

That the Ministry of Health support the implementation of the clinical services proposals presented to government by the BC Pharmacy Association in March 2013.

•

That the Ministry of Health, in collaboration with the BC Pharmacy Association and the Doctors of BC (BC Medical Association), establish physicianpharmacist quality circles.

•

That the Government of British Columbia, in collaboration with the BC Pharmacy Association and other relevant stakeholders, update provincial legislation to reflect developments in e-health.

Derek Desrosiers, BCPhA director, pharmacy practice support; BCPhA CEO Geraldine Vance; Dr. Michael Coughtrie, Professor and Dean, UBC Pharmaceutical Sciences; and Simon Gibson, MLA, Abbotsford-Mission (left to right).

The full report is available at www.bcpharmacy.ca/policy

Pharmacist Amy Ku explains the blood pressure check station to George Heyman, MLA, Vancouver-Fairview.

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PHARMACY DAY 2014

BCPhA Board member Greg Shepherd spoke to Breakfast Television host Jody Vance about the five things your pharmacist can help you with.

BCPhA Pharmacist members Tamer Mahmoud (top) and Julianna Fang were featured in their local papers as part of Pharmacist Awareness Month.

Pharmacist Awareness Month In addition to the activity around Pharmacy Day at the Legislature and the release of the policy paper, pharmacists across the province participated in local media opportunities to promote Pharmacist Awareness Month. A media release focusing on “The five ways your pharmacist can help you” emphasized the expertise and accessibility of community pharmacists, and highlighted immunizations, Medication Review Services, adaptations and renewals, preparing for travel, and the Medications Return program.

A number of BCPhA members were featured in print, radio and TV interviews in their communities, including Eric Sollid on Mountain FM in Trail, Thomas Lee on 89.7 Sun FM in Duncan, and Ken Dye on Q101 FM in Merritt.

Pharmacist Julianna Fang was interviewed for the South Delta leader, while Tamer Mahmoud was also featured in the Chetwynd Echo.

Additionally, BCPhA Board member Greg Shepherd brightened up Breakfast Television, while Board member Julie Ford hit the airwaves on her local Kamloops TV station, CFJC TV. You can find links to many of these stories at www.bcpharmacy.ca/your-pharmacist.

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AUDIT SUBMISSION

PharmaCare Audits update

Our last issue of The Tablet devoted a considerable amount of space to the issue of PharmaCare audits, and for good reason. It is now the number one practice issue for community pharmacy and audit recoveries are costing some members hundreds of thousands of dollars. The following is an update of what has transpired since the February/March issue of this magazine.

In late February, the BCPhA made a submission to the Minister of Health and his officials that included seven key recommendations: Recommendation 1 – The audit recovery penalty should be proportionate to the infraction and respect the principle of substantial performance of contractual obligations

Recommendation 3 – Electronic records must be accepted

Recommendation 5 – Audit process must be fair and transparent with a defined appeal process to ensure due process is assured

In the event an audit determines a recovery for a physician-sourced or PharmaNet entry error where there is reliable evidence that the pharmacist duly filled the prescription, ingredient costs should not form part of the recovery. Only the applicable fees should be assessed as the penalty.

PharmaCare policies should be updated to reflect current legislation and practice related to the validity of electronic records. The current practice of mandating that pharmacies keep and be able to provide original paper prescriptions as confirmation of a valid prescription being issued by a practitioner is outdated and in contravention of other legislation/ regulations. The technology now exists to ensure electronic records are tamper-proof and meet audit standards.

Recommendation 2 – Audit statistical sampling methodology must be improved

Recommendation 4 – Third party evidence should be an integral audit verification process

Recommendation 6 – Restructure the Audit Review Committee

The PharmaCare sample reliability factor should be increased to 98% from 95% and a reduced margin of error of +/- 3 points.

The statistical sampling and extrapolation methodology should be clear, public and demonstrably reliable and consistent among all audits.

Evidence from the third party unrelated prescriber should not be ignored. Any pharmacy that is audited should be provided with the opportunity to search for and provide missing documentation that was not available while the on-site audit was being conducted.

The current Audit Review Committee should be reconstituted to ensure there is an independent representative, whether from government or outside parties within pharmacy. Its role and powers should be clearly defined within a fair and transparent process of objection and appeal.

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Pharmacies must be provided with a reasonable notification that an audit will be conducted (30 days), a definition of the steps and stages in the audit process, and the opportunity to understand the issues and provide information that answers the questions being raised. Also, there needs to be a set time within which the Draft Audit Report and Final Audit Report should be delivered. Finally, there should be a clear objection and appeal process.

Recommendation 7 – Joint pharmacist education process Create a shared education initiative focused on improving pharmacists’ procedures and processes related to service delivery and record-keeping. Establish a Pharmacy Education Committee that promotes and encourages continuing training, business and professional development and practice management skills.

The complete submission is available on the BCPhA website under Pharmacy Practice Support – Regulatory Compliance Support.

We were encouraged by a positive response from the Ministry of Health, and a willingness to discuss the Association’s recommendations. We look forward to meeting with ministry officials within the next few months.

After our submission was delivered to the minister, we asked members about whether our recommendations were consistent with your experiences and opinions about PharmaCare audits.

What we learned was that while only about a third of respondents had experienced a PharmaCare audit, the key issues in our submission were 100 per cent consistent with their experiences. All agreed that if our recommendations were accepted by PharmaCare, they would have been helpful to members’ audits, and all agreed with the recommendations.

During the Association’s review of the PharmaCare audit issue, it became clear that almost half of audit recoveries were due to defective prescription orders such as unsigned renewals in long-term care facilities, unsigned or undated prescriptions, or prescriptions stamped by prescriber and not including handwritten direction for daily dispensing.

The Association has been working with the College of Physicians and Surgeons of BC and the Doctors of BC (formerly the BC

Medical Association) to enlist their support in reminding prescribers of requirements of a “valid” prescription, including the need for a “wet” signature.

The College of Physicians and Surgeons has been particularly supportive, appealing to its registrants in an eblast and the January/ February issue of the College Connector to “recognize and respect the reality that pharmacists are obligated by law to insist on wet signatures on prescriptions until e-prescribing through PharmaNet is implemented.” This message was reinforced by the Doctors of BC in an e-newsletter sent to its members in mid-March.

We are also working closely with the College of Pharmacists of BC to clarify the Health Professions Act Bylaw 6 –

Prescriptions, under the Community Pharmacy Standards of Practice. This bylaw defines the requirements of a prescription, and PharmaCare auditors rely on College bylaws, regardless of what has become common practice or generally accepted.

Members will have received the notice from the College clarifying its position on the requirements of a valid prescription, and the information a pharmacist or pharmacy technician may provide if the prescriber has not.

This notice may be useful as a reference when questions arise during a PharmaCare or private payer audit. It is available on the College’s website at www.bcpharmacists. org/news_events/news/news/345.php

Preventing non-compliance While the BCPhA’s submission focuses on unclear regulations and unreasonable audit processes and penalties, there is also an important role for staff pharmacists to prevent penalties by ensuring compliance.

Staff pharmacists play a key role in the overall viability of the pharmacy where they practice. They must ensure compliance with the payer’s regulations for every transaction and understand that the payer can legitimately have requirements that are different from the CPBC. One is about payment standards, while the other is about practice standards.

While your pharmacy peers and the College might accept the exercise of professional judgment and the lack of some administrative detail, the payer is not bound to do so.

If the payer requires certain information (like prescriber name and profession on the MRS form) and a specific process to be followed to make a valid claim, then the staff pharmacist has to comply.

Audit recoveries due to non-compliance of payer’s regulations could deter owners from supporting new services and that is an avoidable tragedy.

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INTERNATIONAL PHARMACY GRADUATES

International pharmacy graduates – making their mark in Canada Every year newly-registered pharmacists enter the job market,

Rike Baker-Liepe

anxious to begin building their careers and make their mark in the practice of pharmacy.

Today, almost half of them are international pharmacy graduates (IPGs), a significant change from just a few years ago when only about a quarter of newly-registered pharmacists were from overseas, and despite “pharmacist” being removed from the list of preferred professions for immigration purposes.

Some qualified as a pharmacist before coming to Canada, many worked for pharmaceutical manufacturers, and some are Canadians who chose to study abroad.

What they all have in common is the desire to work in community pharmacy in BC, and the challenge of navigating the obstacles involved in achieving the competencies for practice in Canada and landing that all-important first position in pharmacy.

Recognizing that the BCPhA could play a significant role in helping IPGs – as we do with UBC students before and after graduation – the Association is now working in collaboration with members who joined as IPGs and organizations that support international pharmacists and other immigrants who want to become pharmacists in BC. We also collaborate with the Canadian Pharmacy Practice Program, presented under the auspices of the Division of Continuing Pharmacy Professional Development at UBC. The classroom sessions are run in the spring and fall of each year, followed by a 12 and 1/2 -week practicum.

This program is highly responsive to the needs of IPGs working towards their licensure in Canada, as demonstrated by an 87 per cent success rate in licensing examinations by program alumni.

We are now in the planning stages of building a website dedicated to the needs of IPGs, with information and resources about becoming a licensed pharmacist, jobs in BC, developments in pharmacy practice, economic issues facing the profession, and other issues specific to IPGs. The objective is to provide potential immigrants and international graduates with the roadmap to becoming a pharmacist.

But what’s it like to be a pharmacist from or trained in another country and now working in BC? We chatted with three members with very different backgrounds. Here are their thoughts on their experiences, the challenges they faced, and the advice they’d give others.

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Rike Baker-Liepe

Where were you born, and where did you go to university?

I was born in a small town called Ratzeburg in northern Germany. After graduating from high school, I went to study at the Philipps University of Marburg, Hessen, Germany.

What made you interested in pursuing pharmacy as a career?

I was fascinated by the human body and its biochemistry, so pharmacy and how medications can help, support and work in the human body was an easy decision. Mind you, never did I dream of studying straight chemistry for almost four years!

Why did you decide to move to Canada?

I was always intrigued by foreign students at school to look beyond my own horizon. There was a wish growing within me to explore more of the world and other cultures. Besides travelling, I entertained this idea of going abroad for one year – or so I thought. During my first visit to Vancouver in ‘97, I had so many positive encounters and experiences with people over here that I decided to come back the very next year – and the year after that. And of course, BC’s breathtaking nature rounded the picture very nicely. Finally my decision was made and my bags were packed for Canada.

What did you have to go through to gain your qualifications to work in BC? I started off by volunteering for the First Nations and Inuit Health Branch at Health Canada, where I learned about the history of the Canadian health care system and could contribute to setting up specific drug utilisation evaluations in different populations. At the same time I started to study for the Evaluating exam, prepared my immigration papers and tried to adjust from being a tourist to a regular work life.

Well, being a foreign newcomer, don’t expect to pass exams on your first try! This was the hardest lesson to learn and get past for me.

However, with my strong German determination I eventually passed all of the requirements. After the Evaluating exam came half a year of internship at a community pharmacy in Merritt. And finally, I wrote my Qualifying Exam, passed the OSCE, an English language skill test and the Jurisprudence exam.

information, get together with other students for studying and learning, consider programs like MOSAIC and look for mentors.

I was lucky to have experienced most of this and I would like to thank Sharon Kerr from the College of Pharmacists, Ken Dyer as my preceptor, and Maike Lorenzen as my mentor and friend for all of their great support.

One question that is likely asked often by international pharmacy graduates is “why do I have to do all this?” and the simple answer is: “You’ve got to be up to snuff.” The Canadian standard and reputation is very high, and we want to keep that up!

Mohamed Hasanine

What did you find to be the biggest challenge or difference when adjusting to life in BC? My biggest challenge - and this is meant in a positive way - was that each day I had to ask a thousand questions like, how does this work over here?, how do I do this?, where do I need to go?, what is the word for this? or how do I say that? I remember my poor brain being so tired every night that it seemed to have forgotten all my English.

Did you work in pharmacy before moving here? What was the biggest difference professionally?

I worked for 10 years in Germany in community pharmacies and taught for three years at colleges for pharmacy technicians. A big change was that here in Canada the pharmacist profession receives a higher recognition than in Germany. With that we have more responsibilities, for example, counselling to a much higher degree than in my home country, where every package comes with a monograph-like information leaflet and often patients just want to read this on their own. However, the biggest difference is the competency of a pharmacist being acknowledged by the physician society here in Canada.

What do you miss most about where you lived before?

The get-togethers with my family and the easy, flowing and playful use of my own language. For many, learning another language might be easy, but getting to the point of not having to think about words, joking and bantering is a long undertaking.

What’s your current position?

I am working as a part-time pharmacist in two pharmacies in Victoria.

What’s next for you?

Winning over the better half of myself and going out into my pharmacy community to give talks and presentations. One of my long-term goals would be to become a Certified Diabetes Educator.

What advice would you give to other international pharmacy graduates?

My advice for foreign-trained pharmacists is to come with an open mind and a strong determination to learn. Contact people and the College for

Agassiz Remedy’s Rx Pharmacy team including Mohamed Hasanine, Francis Standerwick, Anne Evans and Tareq Youssef (left to right).

Where were you born, and where did you go to university?

I was born and raised in Egypt, and graduated in 1999 from pharmacy school at Zagazig University.

What made you interested in pursuing pharmacy as a career?

I knew I wanted a career that would fit my personality, bring me happiness, and provide the opportunity to help people. Pharmacists, as the most accessible health care provider, can play a vital role providing optimum care to patients almost any time.

Why did you decide to move to Canada?

Initially, I came to Canada to earn my PharmD degree and practiced as a clinical pharmacist. However, I was inspired by Dr. Shakeel Bhatti to bring the clinical practice into the community setting, which I’m currently able to achieve serving the Agassiz-Harrison community.

What did you have to go through to gain your qualifications to work in BC? To gain license in Canada any IPG needs to get his credentials evaluated and write an evaluating exam via the Pharmacy Examining Board of Canada (PEBC). Then we go through the same process as Canadian graduates, with qualifying exams and the Provincial Jurisprudence exam. I found the Canadian Pharmacy Practice Program at UBC was very helpful for that process.

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What did you find to be the biggest challenge or difference when adjusting to life in BC?

in the dispensary. The job developed my interest in pharmacy, which eventually drove me to try and become a pharmacist.

Rain! I came from a very sunny country where it might rain for only a few weeks a year.

Why did you decide to move (back to) to Canada?

Did you work as a pharmacist before moving here? If so, what was the biggest difference professionally?

My pharmacy career encompassed different aspects of pharmacy practice, starting as a hospital pharmacist, then moving to the pharmaceutical industry and finally landing as a community pharmacist in Canada. The concept of “public administration” and how the profession is regulated here is the major difference, but actual daily pharmacist tasks are very much the same.

I had a few reasons: the desire to see more of my parents was definitely one of them. I also felt my wife, who is Scottish, would have better opportunities in her profession (nursing) than she had in Britain. Also, while I had always been able to find work in the UK, it was becoming apparent that the employment opportunities there in pharmacy were becoming worse by the year and wages are going down, and I didn’t feel confident about the long-term future of pharmacy in the UK. I feel there are more opportunities in Canada, plus the challenge of becoming a pharmacist here appealed to me.

What do you miss most about where you lived before?

Family and food.

What’s your current position?

Pharmacy manager and owner at Agassiz Remedy’s Rx Pharmacy.

What’s next for you?

I have a great passion for my profession and am very optimistic about the clinical changes happening right now. My goal is to lead that change for more clinical and in-depth patient care and develop collaborative practice models with other health care professionals.

What advice would you give to other international pharmacy graduates?

You have the education and the skills to provide collaborative patient care, and there is a real need for all pharmacists to play a vital role with other health care providers to better take care of BC residents, so stand up for your profession and show the public how valuable you are for their health.

James McCullogh

What’s been your biggest success so far?

Agassiz Remedy’s Rx Pharmacy won the Agassiz-Harrison Business Excellence Award in Service for 2012 after only being open for 10 months. It was great recognition for the whole team for their dedication and sincere effort to help the Agassiz-Harrison community.

James McCullogh Where were you born, and where did you go to school?

I was born in Birkenhead, England, and my parents immigrated to Canada when I was a baby (I have dual citizenship but definitely consider myself Canadian). I grew up in Victoria, and completed my B.Sc. in Biology from the University of Victoria. I went travelling in the United Kingdom and settled in Glasgow, Scotland, where I decided to apply to pharmacy. I obtained my pharmacy degree from the University of Strathclyde in Glasgow in 2007.

What made you interested in pursuing pharmacy as a career?

While at the University of Victoria, I had a summer job at Rowley’s PCI, a long-term care pharmacy, doing deliveries and also working

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What did you have to go through to gain your qualifications to work in BC? A lot! I had to complete all the PEBC examinations and the three-month structured internship program, which I did at Peoples Drug Mart in Fairfield Plaza in Victoria. I will always be grateful for the support the ownership (the Rayani family), my preceptor Mario Bruno-Bossio, and the staff at that store gave me! It was very difficult to complete the exams while still working full-time in the Scotland (I co-ordinated writing the PEBC exams while visiting my family in Victoria) but I managed to complete everything and register with the College in August of 2013. I still found it puzzling (and expensive!) that I had to take an English test given my background.

What did you find to be the biggest challenge or difference when adjusting to life back in BC? Even though I grew up in BC, I had lived the past 10 years in Scotland and have found it difficult to leave my friends, in-laws, and work colleagues behind. I do plan to go back there for a holiday though.

Did you work before moving here? If so, what was the biggest difference professionally?

Yes, I worked as a community pharmacist in Glasgow and other parts of Scotland for five years. I find the major differences to be due to the nature of the health care systems. In Scotland all prescription costs are covered by the government: there are no deductibles, insurance companies, etc., which obviously makes the dispensing process much faster and easier. There are also more medications available by prescription, including dressings, emollient creams, nutritional supplements and medications we consider to be over-the-counter in BC, such as acetaminophen. Having worked in a system of free health care I would say the amount of waste can be shocking to say the least.

UK pharmacies typically dispense many more prescriptions than Canadian ones – due to more things being available on prescription and a general poorer state of health, at least in Glasgow, in my opinion. Finally, there are no long-term care pharmacies in Britain, so nursing homes are serviced by community pharmacies, which also presents a challenge.

Where do you work now?

I’m a staff pharmacist at Bahr’s Peoples Drug Mart in Victoria.

What’s next for you?

I would like to become a successful pharmacist here in BC and continue to establish relationships with patients (which I have found it to be easier to do here!).

What advice would you give to other international pharmacy graduates?

Definitely prepare yourself for a difficult, yet ultimately rewarding, journey. I would urge anyone thinking of undertaking the process to make sure they have the finances in place to do it. I was very lucky to have family support, which enabled me to successfully achieve my goal of becoming registered in BC. Having completed the IPG process and seen also what UBC students are taught in their pharmacy degree, I can say that the standard of knowledge and skills of BC pharmacists is extremely high and anyone registered with the College of Pharmacists of BC will be able to make a positive contribution to the public and the profession as a whole.

THE RIGHT MIX Evolution happens and we’ve been there!

Pharmacy practice continues to expand in scope. Wynward is here to support that progress. In collaboration with BCPhA, Wynward recognizes the need to be responsive on emerging trends, while at the same time delivering The Right Mix on product, price, and service experience for your insurance needs.

wynward.com

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MAY IS ASTHMA AWARENESS MONTH

The vital role of pharmacists in asthma management

By Robert Oliphant, President and CEO, Asthma Society of Canada

May is Asthma Awareness

It is estimated that the total annual cost of asthma care in Canada is well over half a billion dollars, with the major costs being medications, followed by physician visits and hospital treatment. Misdiagnosed, poorly treated and poorly managed asthma represents the lion’s share of asthma-related health costs.

Month, with World Asthma Day being observed on Tuesday, May 6, 2014.

Each year, the month of May provides community-based pharmacists with the opportunity to highlight their role in asthma management with their patients, in their places of business and in their communities.

The Asthma Society of Canada has long recognized the important role pharmacists play in helping both newly diagnosed and long-term patients improve their quality of life. Many people with asthma report that pharmacists are the health care providers that they interact with most in their daily management of asthma and, as such, are critical in helping patients control their chronic illness.

Low mortality, but high morbidity Between 250 and 300 Canadians die each year from asthma. It is estimated that more than 80 per cent of those deaths could be prevented with proper asthma education and management.

Most people, however, live with their disease a long time. Patient studies reveal that many asthma patients perceive their illness to be controlled, but when questioned appropriately, are actually living with uncontrolled asthma.

People with uncontrolled or poorly controlled asthma are at the greatest risk for a serious, lifethreatening asthma exacerbation. The goal of symptom-free living is the shared responsibility of patients, their families, health care providers, asthma educators and society as a whole.

Three million Canadians have asthma Asthma is one of the most common chronic conditions affecting Canadians with 8.5 per cent of those over the age of 12 having been diagnosed with this respiratory disease.

Approximately 300,000 British Columbians suffer from asthma and its prevalence continues to grow slowly but steadily.

While it affects people of all ages, it is the most common chronic disease among children, with 15.6 per cent of children between the ages of four and 11 years, and 11.7 per cent of youth between 12 and 19 years of age having been diagnosed with asthma. It is the largest cause for emergency department visits of children in Canada and a leading cause of hospitalization.

Asthma not only presents a serious burden to those who suffer with it, but also to society.

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Despite advances in understanding the disease, and the availability of more efficacious medications, asthma is still a major cause of morbidity. This is often a result of underdiagnosis, under-treatment, lack of public understanding and knowledge about the disease, and inadequate asthma supervision.

Community pharmacists are key players in asthma management Pharmacists are in a pivotal position to contribute to the overall management of asthma. Pharmacists play a key role in

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educating patients by providing information on the types and purposes of asthma medications, demonstrating how to use inhaled medications properly, providing information about peak flow meters and other devices useful for asthma management, questioning patients about their written asthma management plan and monitoring use (or not!) of medications by individual patients.

Several studies over the last three decades have clearly shown the therapeutic and economic value of pharmacist-delivered asthma education, assessment and monitoring. Better care has been shown to lead to better asthma control, which leads to improved quality of life, and reduced hospital care and physician visits.

Most asthma patients visit pharmacists on a monthly basis to fill their prescriptions. These visits provide the best opportunity for on-going asthma care by knowledgeable health care professionals.

Allergies count, too While the right medication delivered in an effective manner is critical, it is only one part of asthma management. Environmental control measures are also important to avoid or eliminate factors that trigger asthma flare-ups. Pharmacists can ask patients about their household environments, outdoor activities and other personal triggers and may suggest that they seek further medical advice regarding allergy control.

This May, the Asthma Society of Canada and the National Asthma Patient Alliance encourage every pharmacist to take special effort with their asthma patients. It could save a life.

CAREER OPPORTUNITIES

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. Job postings for pharmacy technicians and assistants are also distributed by the Pharmacy Technician Society of British Columbia (PTSBC). A new enhancement to the best pharmacy job board in BC! 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 Pharmacist – part-time Immediate opening for a part-time pharmacist, three days a week, 24 hours total. We are an established pharmacy serving the community for more than 30 years with a strong, loyal customer base. We also serve the renal population for Abbotsford, Mission and Chilliwack. We are looking for individuals with good communication skills and a team player who is interested in delivering good patient care. Competitive wage and benefits package. Please send resume via email to pdm076@pdmstores.com.

Pharmacist – part-time Pharmasave is looking for a part-time pharmacist (weekends) who has been practising for at least two years. The pharmacy is located inside the Abbotsford Regional Hospital. Remuneration paid according to experience. Please send resumes to info@pharmasaveabby.com, fax 604.870.2955 or please call 604.853.6696.

Pharmacist – part-time Our pharmacy, located in a medical building, is looking for a pharmacist two days per week. We offer competitive wages in an excellent work environment. Shifts are flexible, no evenings, and only one in four Saturdays. Applicants must have strong customer skills and work well with coworkers in a busy environment. Preference for local applicants. Please send resumes to mtdrugs@telus. net or fax 604.859.7651 or please call 604.859.7651.

Pharmacy technician – full-time We are presently accepting applications for a full-time registered pharmacy technician. The opening is for Monday to Friday with no evenings or weekends. We offer a very competitive compensation package. Please send resumes to info@pharmasaveabby.com, fax 604.870.2955 or please call 604.870.5600.

ARMSTRONG Pharmacist – full-time We are independently owned pharmacies in the North Okanagan region seeking a

clinically orientated pharmacist. Our vision is to have pharmacists completely separate from dispensing functions in order to focus on clinical interventions and follow up with patients. We have great relationships with our patients, local physicians, and other members of the community health care team. We are seeking a pharmacist who is willing to continue to foster and build these relationships. Experience what it's like to work with a team that will fully support you in developing new and creative ways to improve the health of our community while making full use of our growing scope of practice. We offer great hours and a competitive wage and benefit package. Please send resumes to Dwight at Armstrong Pharmacy and Wellness Centre by emailing gaarscott@gmail.com.

FRASER VALLEY

Pharmacy technician – full-time

Pharmacist – full-time

Independent pharmacy in the North Okanagan seeking pharmacy technician. Candidates must be fully registered with the College of Pharmacists of BC. Excellent communication skills and experience with being part of a team is required.

We are currently changing our workflow to have a patient-focused pharmacy experience, and we intend to fully implement the scope of practice of a pharmacy technician. To apply, please send resumes to armstrongpharmacy@telus.net.

London Drugs has a full-time opportunity in Gibsons. 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 resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

BURNABY Pharmacy assistant – full-time Pharmacy assistant position available in a neighbourhood-oriented retail pharmacy in Crystal Mall, Metrotown area. We are proud of our top level of customer service, hence, we have very good rapport with our clients. Potential candidate must possess a diploma of pharmacy assistant program from an accredited institution, and has excellent customer service skills.

Cantonese speaking ability is highly preferred.

Mostly weekdays, no evenings, no stats. Please send resumes to crystalpharmacy@hotmail.com or fax 604.433.2830.

FORT ST. JOHN Pharmacist – full-time Full-time pharmacist needed for our service and patient-focused pharmacy. Do you enjoy working with a team of dedicated pharmacists, assistants and nurses and like the idea of true 'ownership'? Would you welcome the chance to develop close relationships with patients and collaborate with physicians and health care professionals? Our services include travel medicine; compounding; fittings for compression stockings, breast prosthesis; foot, wound and ostomy care through our nursing suite. A short commute, varied recreation & cultural activities and airport access for vacations. We're seeking a capable and innovative individual who believes excellent pharmacy practice is a worthy pursuit and that the profession is on the verge of a wave of opportunity to contribute to our province’s health. Please send resumes to mc_ftstjohn@ unipharm.com or please call 250.261.9598.

www.bcpharmacy.ca

Pharmacist – full-time, part-time Pharmasave Steveston Village is now accepting resumes for both a full-time and a part-time pharmacist position for its new sister location in the Fraser Valley. The full-time position is for 3040 hours per week and the part-time position is for 20-30 hours per week. The candidate should be friendly, outgoing, and be fluent in English.

The ability to speak a second language would also be an asset. Experience not necessary but must be a fast learner and quick to adapt. To learn more or to apply for the position, please submit resume in confidence to Peter Tong at stevestonpharmasave@gmail.com.

GIBSONS

GRAND FORKS Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

KAMLOOPS Pharmacist – full-time Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum

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balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www.rexallcareers.ca.

London Drugs has a part-time opportunity in Kamloops. 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 resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

Pharmacy technician – full-time The role of the pharmacy technician is to aid the pharmacy in the production of prescriptions and provide optimal customer service.

Participate actively in growing prescription and OTC sales. Candidates must have registered pharmacy technician certification and maintain registration with CPBC. Please send resumes to kay.sajid@loblaw.ca or apply online at www. drugstorepharmacy.ca. Fax 1.866.628.5329 or phone 1.905.216.6010.

LANGLEY Pharmacist – part-time Pharmasave #003 is looking for a part-time pharmacist to cover a maternity leave position.

We are looking for a pharmacist that is proficient with WinRx, has injection training, and is committed to performing medication reviews and other Rx services such as adaptations. We prefer a pharmacist with at least one year of experience and familiarity with nursing homes. For more information, please send your cover letter and resume to Sameer Premji, pharmacy operations coordinator, at spremji@forewest.ca.

KIMBERLEY Pharmacist – full-time We are a new pharmacy that opened in the last year and offer a variety of services including non-sterile compounding, injection, travel vaccines, natural health, lifestyle programs, hormone consultations, pain and wound care consultations. We are now expanding our services into LTC. The successful candidate would be experienced in LTC, or highly motivated to implement their clinical skills. Some travel would be required in neighboring communities for proper servicing of the homes. A bonus structure is offered for building the business and retention on a yearly basis. The preferred candidate would be experienced in compounding and natural health. Training is available. Hours of operation are Monday to Friday 9:30am6pm and Saturday hours in the future. Salary/ benefits to be negotiated. For more information, contact Michelle Gray, pharmacist owner, at

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PRINCE GEORGE

MISSION

London Drugs has a full-time opportunity in Prince George. 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 resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

Pharmacist – part-time

Pharmacist – part-time

KELOWNA

grayspharmacy@remedysrx.ca, call 250.427.0038 or fax 250.427.0039, www.remedys.ca.

Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www.rexallcareers.ca.

NANAIMO Pharmacist – full-time London Drugs has a full-time opportunity in Nanaimo. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling 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 resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

Pharmacist – part-time

Pharmacist – full-time

SALMON ARM Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

SALT SPRING ISLAND Pharmacist – full-time

Costco Pharmacy in Nanaimo is looking for a part-time pharmacist. Costco Pharmacy operates 65 pharmacies in eight provinces across Canada.

Our pharmacies provide an environment that enhances patient care. Costco offers great salary, benefits and opportunities. If you are seeking a challenging and rewarding career in a professional retail pharmacy, we are looking for you. The qualified candidates will be highly motivated to provide excellent pharmacy care and customer service. If you are interested in a great opportunity, please apply by emailing or faxing your resume to Ed Toth, pharmacy operations manager, at etoth@costco.com or fax 425.427.7735 or please call 604.444.9344.

Pharmasave on Salt Spring Island has an opening for a full-time pharmacist. If you dream about living in one of the most vibrant and beautiful Gulf Island communities in British Columbia while still maintaining an interesting and rewarding career, then you should consider joining our team of experienced and dedicated professionals. We offer a competitive compensation and benefits package and the opportunity for a truly great lifestyle.

Our standards are high and we aim to offer our customers the best service and pharmacy counseling available. Come and find out why The New York Times calls Salt Spring Island one of the "gems" of the Pacific Northwest. Please send resumes to gary@saltspringpharmasave.com or please call 250.537.5534.

PENTICTON

SIDNEY

Pharmacist – part-time

Pharmacist – full-time

London Drugs has a part-time opportunity in Penticton. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling 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 resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

Active, patient focused, community pharmacy needing full-time personable pharmacist. We are a busy, primarily senior-oriented pharmacy located on Vancouver Island. This is a very rewarding position with many facets of pharmacy practiced including injection authority, medication reviews, adaptations and methadone maintenance treatment. Our hours of operation are Monday through Friday 8am-8pm, Saturday 9am-6pm and Sunday 11am-5pm. We offer a competitive salary with holiday pay, medical, dental, vision extended health benefits, life insurance, matching

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retirement plan, license renewal and BCPhA membership provided. For those motivated, interested individuals, please send resumes to Bob Reddig, pharmacy manager, at rx205@ forewest.ca or fax 250.656.2235 or please call 250.656.1148.

SURREY Pharmacy manager – full-time Pharmacy manager needed for independent community pharmacy. Friendly environment. We offer a competitive wage. Must be able to work some weekends. Please send resumes via fax to 604.543.4433 or please call 604.543.6677.

Pharmacy manager – full-time Managing pharmacy operations and maintaining a cohesive working relationship with staff, your focus includes: promote Rexall’s image through leadership in community business groups, and health and wellness initiatives; recruit, train, motivate and evaluate pharmacy staff to ensure efficient operations; ensure company standard procedures, policies and regulations are followed; and ensure the store achieves financial growth.

The position is Monday to Friday, 8am to 4pm; you may be asked to carry the on-call phone once every 5-6 weeks. Your role: in-depth med reviews; pharmaceutical care assessment and follow up; medication administration consult; client and nursing care in-services; participate in patient care and medication management committees; and dispensary processing. Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www.rexallcareers.ca.

Pharmacy technician – full-time Immediate opening for a pharmacy technician.

Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist/manager at nafisam@telus.net or fax 604.325.3276.

VANCOUVER Pharmacist – full-time Medical Pharmacies Group Ltd. is seeking a clinical consultant pharmacist. We specialize in providing pharmacy services to retirement homes and extended care facilities. The pharmacist is responsible for providing innovative pharmacy services and clinical expertise that provides safe medication management and optimizes effective drug therapy outcomes for residents.

Participates in multi-disciplinary resident care and makes recommendations to care providers.

The consultant is required to build and maintain excellent customer relations. Applicant must be able to travel to various locations in the Lower Mainland. Pharmacists with long-term care and clinical experience are highly preferred. Geriatric Certification is an asset. Please email cover letter/ resume to Alvin Singh, clinical lead pharmacist BC, at asingh@medicalpharmacies.com.

Pharmacist – full-time We are looking for full-time pharmacists for our Lower Mainland pharmacy. Experience with WinRX/Kroll and Microsoft Office (Word, Excel, etc.) are necessary. The successful applicant is required to have at least one to two years 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, knowledge of 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 and increases steadily with experience. Full medical and dental benefits are provided after a trial period of three months. Please send resumes to shafik@wescanapharmacy.com.

Pharmacist – full-time As a growing company, NAZ and Wellness group of pharmacies is seeking a pharmacist for its Vancouver location. We are an independent, community-based pharmacy group that provides patient-centered practices. We enjoy excellent relations with other health care providers to ensure the best possible care for our patients. We offer the autonomy of an independent pharmacy with the stability, competitive wage and benefits package of the large chain stores, without the micromanaging and corporate layers. We pride ourselves in our dedication to our employees and interest in long-term relationships. The ideal candidate will have a minimum of one year pharmacy experience and excellent customer service skills. Cantonese and/or Mandarin language skills are an asset. Please send resumes to Nafisa, pharmacy manager, at nafisam@ telus.net or fax 604.325.3276 or please call 604.603.7923.

Pharmacist – full-time, part-time We are looking for a full-time or part-time pharmacist for our Vancouver location. Fluency in Punjabi/Hindi would be an asset. We are part of a clinic with a family practice. Normal medication dispensing duties with a focus on medication management and building close relationships with patients. Our hours are 10am-6pm Monday to Friday, 10am-4pm Saturday. We are an innovative and progressive pharmacy. Potential business opportunities for a creative pharmacist. Please send resumes to hr@cloudpharmacy.ca, apply online at www.cloudpharmacy.ca or please call 1.877.331.4411.

Pharmacist – part-time Part-time pharmacist position available.

Experienced in retail pharmacy, exceptional communication and organization skills, familiar with Telus RxA or RxT program, and able to work productively as a member of a dynamic team. If required, willing to work at two different pharmacy locations, both in the Lower Mainland.

Please, no phone calls about this job. Please send resumes to ymm@yyoung.com or fax 604.630.1001.

Pharmacy technician – full-time Immediate opening for a pharmacy technician.

Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist/manager at nafisam@telus.net or fax 604.325.3276.

Pharmacy assistant – full-time, part-time We are looking for full-time or part-time pharmacy assistants. Fluency in Punjabi/Hindi would be an asset. Knowledge regarding PharmaCare and

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other third-party special authority processing is considered a major asset. Duties include: normal entry and filling using Kroll software, blister packing and inventory management.

Our hours are 10am-6pm Monday to Friday, 10am-4pm Saturday. We are a new, innovative pharmacy looking for creative individuals. Please send resumes to hr@cloudpharmacy.ca, apply online at www.cloudpharmacy.ca or please call 1.877.331.4411.

Pharmacy assistant – full-time We are looking for full-time pharmacy assistants or registered pharmacy technicians for our Lower Mainland pharmacy. Experience with WinRX and Microsoft Office (Word, Excel, etc.) are assets. Start date is immediate upon hiring.

Compensation is between $12-18 depending on the applicant’s experience. Medical and dental benefits are provided after a trial period of three months. If interested, kindly send a resume and cover letter to shafik@wescanapharmacy.com.

Thank you!

VERNON Pharmacist – full-time Shoppers Drug Mart in Vernon, BC is looking to hire a full-time pharmacist. The position is 28-30 hours a week with full-time benefits.This allows you a great working environment with lots of time to enjoy everything else Vernon has to offer. Vernon is only 40 minutes from Kelowna and offers year round fun with our lakes, ski hill and great surrounding area. We provide many clinical services at our store including injections and medication reviews and routinely reach out into the community to promote our profession.

Our ideal candidate would be willing to pursue all these clinical services while providing outstanding customer service and being a great team player.

If you are looking for a rewarding pharmacy position in the Okanagan I would love to talk to you. Please forward for resume to asdm2271@ shoppersdrugmart.ca.

Pharmacy technician – full-time The role of the pharmacy technician is to aid the pharmacy in the production of prescriptions and provide optimal customer service.

Participate actively in growing prescription and OTC sales. Candidates must have registered pharmacy technician certification and maintain registration with CPBC. Please send resumes to kay.sajid@loblaw.ca or apply online at www. drugstorepharmacy.ca. Fax 1.866.628.5329 or phone 1.905.216.6010.

VICTORIA Pharmacy manager – full-time The pharmacy manager is responsible for managing store pharmacy operations and maintaining a professional and cohesive working relationship with the front store manager and staff. They are a catalyst in the execution of a superior patient care experience that translates into an environment that ensures people make the healthiest choices quickly, easily and confidently. Qualifications: BC pharmacy license; experience in retail pharmaceutical systems and dispensing procedures (e.g., Nexxsys); ability to maintain optimum balance between the

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profession and business of pharmacy; strong financial acumen; excellent communication and organizational skills; strong patient satisfaction orientation, leadership and decision-making skills; previous pharmacy management experience (preferred). Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www. rexallcareers.ca.

OPPORTUNITIES ACROSS BC

OPPORTUNITIES OUTSIDE BC

ACROSS BC

CALGARY, AB

Pharmacist – full-time, float

Pharmacist – full-time

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. Victoria Peoples Pharmacies owned by Naz Rayani are looking for an engaged, clinically oriented and outgoing full-time pharmacist to work at our unique community pharmacies. Please send resumes to jobs@victoriapharmacy.com.

The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

Pharmacist – full-time

Pharmacy technician – full-time

We are seeking a full-time pharmacist to join our Peoples Drug Mart location in Victoria, BC. Our store has an elderly population base and is located adjacent to physicians’ offices and walk-in medical clinics. We are seeking the following skills: ability to work collaboratively with physicians and staff; ability to counsel patients on the use of OTCs; ability to perform medication reviews; and ability to communicate effectively with elderly patients. Candidates with injections authority are encouraged to apply. Please send resumes to sunil@sparklit.com or please call 250.818.1468.

Float position available. Medical Pharmacies has an exciting opportunity in a specialized longterm care setting. This position is unique and will give the successful candidate the opportunity to gain experience in our pharmacies located in Surrey, Vancouver, and to a lesser extent Kelowna. The right candidate will embrace our leading technology and clinical services and must be licensed with the College of Pharmacists of BC. Good communication skills and being a strong team player are required. Long-term care experience is an asset, but not necessary. Great potential for career advancement. Responsibilities include institutional dispensing; checking orders, data entry, and other dispensing tasks. Please send resumes to Curtis Fieseler, regional director of operations, at cfieseler@medicalpharmacies. com or fax 250.717.1565 or please call 250.317.6823.

Pharmacist – full-time

Pharmacy technician – full-time Pharmacy technician required to work at Victoria Peoples Pharmacy, owned and operated by Naz Rayani. Our focus is on patient-centered practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please send resumes to jobs@victoriapharmacy.com.

NORTHERN BC

Pharmacy technician – full-time

Pharmacist – full-time, relief

Victoria Rexall has an immediate opening for full-time pharmacy technician. We offer a very competitive compensation package. Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www.rexallcareers.ca.

Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to Neerav Joshi, talent acquisition consultant, at njoshi@rexall.ca or apply online at www.rexallcareers.ca.

WEST VANCOUVER Pharmacy technician – full-time, part-time Pharmacy in West Vancouver is seeking a pharmacy technician for a part/ full-time position. Kroll, compounding and naturopathic experience will be an asset. Good benefits and remuneration package based on experience. Please e-mail your resume if you have these qualities to bisophra77@gmail.com.

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www.bcpharmacy.ca

FORT MCMURRAY, AB Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

LETHBRIDGE, AB Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re 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. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

RED DEER, AB Pharmacist â&#x20AC;&#x201C; full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. Weâ&#x20AC;&#x2122;re 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 beneďŹ ts package for full-time pharmacists is one of the industries ďŹ nest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

BUSINESS OPPORTUNITIES

us a call. Our only priority is you and your success!

Contact Dave Reston, CEO, Pharmasave PaciďŹ c, phone 604.575.5730 or 1.800.665.3344, email dreston@pharmasavebc.ca.

Are you thinking of selling your pharmacy?

OVERWAITEA FOOD GROUP may be interested.

If you would like more information please contact us via email at pharmacybuyer1@gmail.com.

PEOPLES DRUG MART is an established and proven pharmacy banner that will make your pharmacy business more successful and proďŹ table. 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 proďŹ ts 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 proďŹ ts. If you are interested in purchasing, selling or opening a new pharmacy, please contact Frank Fidyk at fgďŹ dyk@ telus.net or please call 778.678.6717.

Rewarding ownership opportunity â&#x20AC;&#x201C; Surrey

WHAT IS IMPORTANT TO YOU IS IMPORTANT TO US. PHARMASAVE is the best choice for independent business in BC. Maintain your freedom while having access to the most comprehensive retail and professional programs in the industry and our strong national brand. We are a true cooperative, 100% member-owned and governed.

BeneďŹ t from owning your own business and also share in the economic advantages of a strong group of over 500 stores. Be an owner in an organization that delivers all of its proďŹ ts directly back to you, the shareholder. If you are a store owner and would like to consider opportunities with Pharmasave, or a pharmacist interested in purchasing a pharmacy, or are planning on selling your business, please give

Enjoy the best of both worlds and be in business for yourself instead of by yourself. Unique business opportunity for the right person.

Seeking a pharmacist/partner for Surrey, BC area.

Please call 604.543.6677 to learn more.

Partnership â&#x20AC;&#x201C; Vancouver Currently operating a busy pharmacy with large blister pack clientele. Would like to collaborate with other business owners and expand. We have a strong IT and construction team looking for opportunities. Please send resumes to hr@ cloudpharmacy.ca or please call 1.877.331.4411.

Welcome to the BCPhA! Pharmacist (General) members: Patrick Akhnouh, Mohamed Awad, Patrizia Berra, Akhil Bhai, Melanie Bogdan, Janet Chan, Paul Chan, Elena Chau, Lokita Chaudhari, Cindy Chen, Monica Cheng, Hyunsoo Choi, Daphne Chow, Jeremy Comba, Alnoor Datu, Matt Del Nin, Gaurav Dhankhar, Nindy Duggal, Mahmadamin Dukandar, Smita Dutta Adhikari, Mohamed El Sheshtawy, Karim Ghobrial, Shane Gill, Ada Ho, Yvonne Ho, Muhammad Iqbal, Ayaz Jaffer, Anakhanom Kabirnoshanagh, Frough Khakpour, Sonia Lalli, Angela Lane, Hyunjin Lee, Jihyun Lee, Brent Liston, Wendy MacDougall, Jacklyn McDonald, Lauralei Morante, Amr Moustafa, Cynthia Moya, Emma Navarro, Dwain Nottebrock, Brian Oster, Dhara Parikh, Se-young Park, Aakash Patel, Bhumikaben Patel, Nishant Patel, Sameerkumar Patel, Mehran Qaaboos, Maged Radwan, Sonia Rambarran, Heather Robinson, Kamran Salehi, Lovejeet Sarwal, Betty Smith, Tack Hun Song, Anita Sorensen-Wessel, Carol-Lynne Sturdy, Afshin Talaie, Jo Han Tan, Albert Thibeault, Thao Thiphavong, Ricky Tsui, Claudia Wagner, Sajad War, Christopher Wiebe, Brenda Willmann, Helen Wong, Jason Wong, Mena Yaft, Fu Yun Yang, Stephanie Yeboah, Kelly Yee, David Yemchuk and Shan Yi.

Pharmacy (Corporate) members: Cates Medicine Centre, Costco Group (14), Rexall #7174, and Yyoung Medicine Mart Main.

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Join us May 22 to 24 at The Fairmont Chateau Whistler.

Visit www.bcpharmacy.ca to register now!

Partner

Thank you to our sponsors: Diamond

Platinum

Gold

Silver

at

Bronze

Exhibitors: Adams Cambie Insurance Ltd., Almirall Limited, Bayer Inc., BC Drug and Poison Information Centre, Beiersdorf Canada Inc., Bio-K+ International Inc., College of Pharmacists of British Columbia, Desante Financial, Galenova, Green Shield Canada, Heel Canada Inc., Hydralyte Canada, Jamp Pharma Corporation, Janssen Inc., Johnson & Johnson Consumer Healthcare, Johnstone’s Benefits Inc., LifeScan Canada Ltd., Lundbeck Canada, Mallinckrodt Pharmaceuticals, McKesson APS, MEDISCA, Merck, Novartis Pharmaceuticals Canada, Odan, Pacific Blue Cross, Pascoe Canada, PCCA Canada, Pendopharm - division of Pharmascience Inc., Roxon Medi-Tech, Scotiabank, Takeda Canada Inc., TELUS Health, Trudell Medical International, Wynward Insurance Group, Xenex Laboratories Inc.