Tablet Nov/Dec 2016

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Mid-life pharmacy services • Naloxone: What pharmacists need to know • Compliance training moves online

tablet

published by the British Columbia Pharmacy Association  |  bcpharmacy.ca  |  Volume 25. No. 6

Community pharmacies in rural B.C.

A voice for community pharmacy

NOV/DEC 2016


BCPhA eTraining

Earn your CEs with more than 20 programs now available online. • Growing library of programs • Complimentary and paid programs • Self-paced learning • Interactive elements • Test questions • Additional resources

A few programs currently available:

Coming soon:

• Modernized Reference Drug Program

• Diabetes Health Coaching Program

• Travel Medicine Program

• Exploring the Innovation in Non-Insulin Glucose Lowering Medications for Type 2 Diabetes

• Schedule II Naloxone for Opioid Overdose • Regulatory Compliance Bootcamp • Private Payers: 2015 - The Good, the Bad and the Very Expensive • Proton Pump Inhibitors • Seasonal Influenza Update - 2016/17

• Smoking Cessation: Practical Implementation • Subsequent Entry Biologics (Biosimilars): A 2016 Update • The Building Blocks for Effectively Promoting Vaccine Services • Integrating Patient Safety into your Pharmacy's DNA

• Issues and Topics in Pharmacy Practice and Regulation • Cardiovascular Program Training Course

www.bcpharmacy.ca/etraining


THE TABLET

NOV/DEC 2016  |   VOLUME 25. NO. 6

contents Editor in Chief Angie Gaddy 604.269.2863, angie.gaddy@bcpharmacy.ca Senior Editor Elise Steeves 604.269.2866, elise.steeves@bcpharmacy.ca 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.

14 Compliance training

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: bcpharmacy.ca Publication agreement #40810576

On the cover: Kaslo Community Pharmacy owner and manager Ward Taylor is the primary point of contact for many patients in the small, rural community of Kaslo, B.C.

22 Mid-life pharmacy services

16 Rural pharmacy

Features

Columns

Regulars

12 Naloxone

5 President’s message

10 Meet Joe Gallagher

What pharmacists need to know

14 Compliance training BCPhA helps pharmacies ensure regulation adherence

16 On the cover:

Rural pharmacy: Providing continuity of care in rural B.C.

22 Mid-life pharmacy services Patients seek alternative treatments for age-related symptoms

24 Hemochromatosis The pharmacist’s role in helping identify sufferers

Securing a national presence for pharmacy

CEO, First Nations Health Authority

26 Career listings

6 CEO’s message

Find a job in pharmacy

Prescribing for minor ailments could make a difference

7 Member services Guiding your association forward

8 Pharmacy practice support Medication Review Program needs updating

9 Advocacy Reaching B.C. policy makers

26 Canadian Pharmacists Association The federal files

A voice for community pharmacy

Got a suggestion for an article in The Tablet? Email info@bcpharmacy.ca with your story ideas.

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SMALL TALK

In the news More patients reach cholesterol goals with help of pharmacists: study

BCPhA vice-president gives flu shot to health minister

A new study in the Sept./Oct. 2016 issue of the Canadian Pharmacists Journal (CPJ) shows the impact pharmacist care can have on lowering cholesterol. Patients who were assessed, given tests, prescribed their cholesterol-lowering drugs and followed up by their pharmacist, were three times more likely to reach their cholesterol goal than patients receiving usual care and a pamphlet. The study provides strong evidence that allowing pharmacists to prescribe drugs and order lab tests, among other steps in patient care, can lead to positive health outcomes, said study authors Dr. Ross Tsuyuki and Dr. Glen Pearson, both pharmacists and professors of medicine at the University of Alberta.

The BC Pharmacy Association (BCPhA) vice-president Alex Dar Santos (right) kicked off the official start of the 2016/17 flu season this October by publicly administering Health Minister Terry Lake’s influenza vaccine.

BCPhA pharmacist (general) members now receive a complimentary issue of the CPJ as part of the Association’s membership in our national pharmacy organization.

The BCPhA participated in a media event on Oct. 26 at Royal Jubilee Hospital in Victoria along with the Ministry of Health and other health-care providers. Each year the Association participates to highlight the role pharmacists play in providing care to British Columbians. The Ministry of Health highlighted the importance of visitors to health-care facilities getting their flu shot and reminded the public that the vaccine not only protects you, but also the people who are most vulnerable.

BCPhA makes submission to Select Standing Committee on Finance and Government Services In September, the BCPhA put forward its recommendation to the Select Standing Committee on Finance and Government Services for the 2017 Budget. In our recommendation, the Association called for expanding the scope of pharmacists to improve access to care in rural and remote areas, promoting virtual care hubs through strong, interdisciplinary collaboration and leveraging technology.

In addition to the launch event, pharmacists across the province reached out to offer flu shots to their respective Members of the Legislative Assembly (MLAs) as part of BCPhA’s MLA Outreach Program. Resulting local media coverage is also important in reminding the public of the accessibility and convenience of getting a flu shot at a community pharmacy.

Read the full submission online at bcpharmacy.ca/submissions-to-governmentpublic-2016.

There are now more than 3,650 pharmacists in B.C. authorized to give injections, and more than 95 per cent of pharmacies have at least one authorized pharmacist.

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Comment period closes Dec. 18 on security bylaws and pharmacy fee increases At its Sept. 16 Board meeting, the College of Pharmacists of BC approved revisions to the Pharmacy Operations and Drug Scheduling Act (PODSA) bylaws for a second public posting together with PPP-74: Community Pharmacy Security. These measures are aimed at enhancing pharmacy security. For more than a year, the BCPhA has been working on this issue with other stakeholders and the College to address our members’ concerns. We appreciate the College’s consideration and incorporation of some of our comments into the current version of the security bylaws. The current amendments are now posted for public comment until Dec. 18, 2016. If you wish to comment on the current bylaw amendments, you may make your own submission to the College and/or Ministry of Health. Members should read both the draft bylaws and the revised PPP-74, which outline requirements for both protection of patient information and access to Schedule I, II and III drugs. The BCPhA will continue our work on increased clarity around these bylaws and make another submission by the Dec. 18 deadline. The College Board also passed a fee increase for both individual registrants and pharmacies. While individual registrants will not have the ability to comment on the fee increase, pharmacy fees are specified in a schedule of the PODSA bylaws, which means any changes are now posted for public comment. Registrants who have concerns about these proposed increases should make their submission by Dec. 18, 2016, to the College and/or Ministry of Health by following the steps listed on the College’s website.


RANDY KONRAD | PRESIDENT

Securing a national presence for pharmacy

We are in the midst of a fascinating time for the pharmacy profession in Canada. National pharmacare, drug access and the epidemic of opioid abuse are just some of the big issues on the national agenda that affect pharmacy in some way. In such changing times, it is more important than ever for our profession to have a strong pan-Canadian advocacy voice to respond to these matters. This is what membership with the Canadian Pharmacists Association (CPhA) offers. I’m pleased to report that the BC Pharmacy Association (BCPhA) has once again renewed its membership with CPhA. BCPhA Board member Mark Dickson continues to be our association’s representative to the CPhA, and I thank him for his work in this role. You can read Mark’s latest column on page 26 of this issue of The Tablet to find out what CPhA is focusing on right now. Our association first joined CPhA in 2014 when the national association adopted its new governance and membership model. The new model aimed to improve the ability of provincial and national pharmacist associations to work together in the best interests of the profession. On Oct. 18, I had the pleasure of attending a federal pharmacy lobby day at Parliament Hill in Ottawa. Organized by CPhA, this event was designed to introduce the pharmacy profession – and the organizations which advocate on its behalf – to a parliament that is relatively new. It can be a daunting experience to meet with government officials, but it is essential that BCPhA is represented and that our profession has face time with the key decision makers on health care in Canada. When it comes to relationship building, there is no substitute for making these real-life connections and speaking to officials firsthand about our experiences as pharmacists.

I also had the chance to network with fellow pharmacy leaders from across the country on Oct. 17, prior to the lobby day. As well as helping us to forge stronger ties with each other, the training session enabled us to freshen up our advocacy and communication skills and allow us to get the most out of our time with Members of Parliament (MPs). On the lobby day itself, I met with several MPs and senators to discuss various policy issues that affect our profession and its ability to deliver quality care across the country. Our three main topics were the health accord, medical marijuana and opioid abuse. We now have several follow-up meetings scheduled for here in Vancouver. This event was a vital opportunity to increase the profile of pharmacists with the government and opposition MPs and officials. It positioned us as leaders and influential advocates when it comes to health-care discussions. For me personally, the event also confirmed the importance of BCPhA’s own government relations program. At a provincial level, the BCPhA’s MLA Outreach Program is positioned to help ensure pharmacy’s voice is heard here in B.C. This program encourages BCPhA members to meet with their local Members of the Legislative Assembly (MLAs) to discuss issues of importance related to pharmacy and health care in their ridings. While we do our best to advocate strongly for the advancement of pharmacy, there are also times that we need to be realistic and adjust our approach. We are heading into an election year here in B.C., when the government has limited funding left to spend on health care. Therefore, it’s a matter of working cooperatively with the government and tempering our expectations about what is possible right now. You can read more about BCPhA’s government relations program on page 9 of this issue of The Tablet.

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GERALDINE VANCE | CEO

La belle vie Prescribing for minor ailments could make a difference

All who know me, know I am nuts for France – Paris, in particular. I love the fact that the French are fiercely loyal about their culture and language, have a strong commitment to family and community and yet, enjoy the pleasures of each day. Their healthcare system is one of the best in the world. Can Canadians even imagine a place where every doctor is able to make house calls? As I was waiting in a Parisian pharmacy the other day (I picked up a bug on the plane on the way over for my holidays), I had a glimpse into how we could deal with the urgent issue of access to primary care in our own country.

After lots of questions the pharmacist assured the parents this was something that was likely to go away on its own, and it wasn't serious. She recommended they get a cream to make it feel better. No, they didn't need to go to the doctor, the pharmacist told the parents, it would all be fine. Isn't this exactly what we need our pharmacists to be doing? Wouldn't having pharmacists look after minor ailments make sense and keep people out of doctors' offices? Of course it would.

“A radical notion? I think not. Let's push our politicians to take small, concrete actions that could ease up the growing problem in our primary care system.”

On the surface, pharmacies here in France look like places from times gone by. They are small and almost nothing you would want is on display; everyday items such as Advil, cough drops and eye drops are all behind the dispensary. How old fashioned this seems on first blush. But in fact, the stern, white-coated pharmacists play the role Canadian pharmacists have long been advocating for. They really are a patient's first point of contact with the primary care system. I have long thought pharmacists and pharmacies should act as primary care triage centres. In France, they do just that. As I waited in line to get my cough drops I watched an exchange between a pharmacist and two parents with their little girl. The little girl had developed a rash on her face. The pharmacist asked the parents all the right questions: How long had it been there? Had she had anything like this before? Had she eaten anything unusual? Was it itchy? Was it anywhere else on her body?

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That's why the BCPhA has recommended that pharmacists be given the responsibility of prescribing for minor ailments in rural communities in B.C. A radical notion? I think not. Let's push our politicians to take small, concrete actions that could ease up the growing problem in our primary care system. You can read more about the challenges some of our members face in rural communities on page 16 in this issue of The Tablet. Many pharmacists are already making a huge difference in their patients’ lives and are standing in as the first point of contact in places that are facing critical shortages of health-care workers. Prescribing for minor ailments is just one more part of this puzzle.


CYRIL LOPEZ  |  CHIEF OPERATING OFFICER

Guiding your association forward The BCPhA needs member feedback to continue delivering effective services We are already two months into our new fiscal year, which started on Sept. 1. The past year is fast disappearing in the rear-view mirror. As we focus on the year ahead, we’re determined to deliver a compelling value proposition to our pharmacist, pharmacy owner and student members. We are keenly aware that you have a choice to make every year when you renew your membership. We want your decision to remain the same – to continue to support your professional association. With a membership of more than 85 per cent of community pharmacists working in different practice environments across B.C., we know we can never take your perception of the BC Pharmacy Association’s value for granted. We cannot afford to simply pat ourselves on the back for a job well done. Although we’re ambitious in our goals, we strive to be sensitive to each unique member’s expectations of us. We believe we’re on the right path, but have to admit we cannot meet everyone’s expectations. For example, we’re not a trade union and the pharmacy sector is heavily regulated. Knowing this is the environment we operate in, our aim is to bring you programs, services and benefits that you need. Our top priority is to advance the professional role and economic viability of members. Through a collective association of professionals, we are the unified voice for pharmacists and pharmacy owners. We speak on behalf of the sector to influence public policy. Individually, it would be much more difficult to make that happen. This past year we were busy in the arena of advocacy. From the Pharmacy Operations and Drug Scheduling Act (PODSA) Bill 6 amendments, the Health Professions Act Standards of progroup_ad_v3.ai 13/11/2008 PM Practice amendments, to supporting the4:23:24 Medical Beneficiary and C

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Pharmaceutical Services Division’s Modernized Reference Drug Program, the Association worked hard to ensure community pharmacy’s voice was heard and understood by decision makers. We also recognize the importance of supporting professional development so you can do your job better. We have focused on developing skills-training webinars (such as Regulatory Compliance Bootcamp, travel medicine, anticoagulant therapy management, cardiovascular risk management) that can be accessed online at your convenience. We added those to our ever-growing library of eTraining resources on the members’ side of our website. Many members say knowing they can call our help desk on practice issues such as payer adjudication is also a tangible benefit. And because associations are constantly pursuing new knowledge and opportunities for the profession, the BCPhA has committed to finding a future for pharmacists in pharmacogenomics. We finished Phase I of our research project that demonstrated community pharmacists could play a key role for patients in pharmacogenomic testing. Demographics are shaping our future, too. Entry-to-Practice Doctor of Pharmacy (PharmD) graduates might have a different perspective on the value of membership in the BCPhA. Our student members have already asked the question about future job opportunities in community pharmacy. As the professional community for pharmacists in B.C., we intend to continue engaging with students to better understand their needs and concerns, so that we remain their affiliation of choice. But it’s not just students. We want to make your interactions with us more efficient as we upgrade our channels of communications and our relationships with you. We cannot shape our future alone: we need your help in guiding us forward. Our member survey is coming to you this fall. Please take a moment to share with us your perspective, advice and insight so we can all continue to grow the Association’s strength and membership by delivering compelling value.

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Almost 50 years ago – on May 22, 1968 – the Association’s constitution was certified with only 685 pharmacists. We’ve increased our membership more than four-fold with more than 3,100 pharmacists. We will have much to celebrate in May 2018.

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DEREK DESROSIERS  |  DIRECTOR, PHARMACY PRACTICE SUPPORT

Medication Review Program needs updating The environment in which we find ourselves practicing pharmacy continues to evolve. What that means, at least from one perspective, is that patient programs designed and implemented years ago may no longer be appropriate or effective in today’s environment. One example of such a program is PharmaCare’s Medication Review Program. Initially, that program did not have any outcome measures associated with it. It was simply created to be an inventory of all medications a patient was taking. However, anecdotally and from academic reviews, it appears the program is not providing its expected value to the health-care system and to individual patients. Some patients who are receiving medication reviews are not benefitting from the service, while others who could benefit are either ineligible or are not receiving the service for another reason. We need to do a better job of directing such services to patients who will benefit the most. As well, it’s important the service delivers the best possible value for money to the health-care system. The BC Pharmacy Association (BCPhA) has been working closely with the Medical Beneficiary and Pharmaceutical Services Division (MBPSD) of the Ministry of Health and the Neighbourhood Pharmacy Association of Canada (NPAC) on a plan to revamp the current Medication Review Program. Working with the government, we’ve come up with a draft program proposal that adheres to the following nine principles: 1. Measurable outcomes – Services provided to patients must have measurable and transparent outcomes. Key Performance Indicators will be identified and monitored. 2. Targeted services – Services will be targeted to patients who will benefit most from receiving those services. Patients selected to receive services will have an identifiable health need, such as a chronic condition, rather than be identified by using a proxy such as the number of medications they are taking. 3. Relationship building – The provision of services by pharmacists will not only continue to foster the relationship

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between the pharmacist and patient, but also strengthen the relationship between pharmacist and prescriber or other members of the patient’s care team. 4. Alignment with Ministry of Health strategic plan and priorities – Services should be aligned with the Ministry of Health 2016/17 – 2018/19 Service Plan and Setting Priorities for the B.C. Health System. 5. Quality assurance – Patients will receive meaningful, highquality services. An emphasis on quality may result in pharmacists who provide the improved services to become accredited or undergo specialized training to enhance specific skills required to deliver these services. 6. Accessibility – The Ministry recognized that pharmacists are among the most accessible health providers in the province. All community pharmacies in B.C. should be provided with an opportunity to deliver these services, but individual pharmacies will have to decide whether they want to participate. 7. Education – In addition to service delivery, consideration should be given to educating patients, pharmacists and prescribers about the value of the services being delivered. 8. Demonstrable value – Services must demonstrate value to the health system. Pilot projects may be considered to test initiatives. 9. Funding – The funding model must provide appropriate compensation for the service provided. This may likely involve rethinking existing fee for services. Pharmacy’s specific proposal has been submitted to MBPSD for its review and consideration. We expect to be engaged in a working meeting with the Ministry this fall with hopes that we could begin a phased implementation of a new program within the next six months. Stay tuned to the BCPhA website and other communication vehicles for further updates and details as this project progresses.


CHERIE PAYNE  |  ADVOCACY

Reaching B.C. policy makers BCPhA members help MLAs understand how policy impacts practice

How to get involved with the MLA Outreach Program You can play a valuable role in helping to educate MLAs and election candidates, as well as local politicians, about the range of expertise community pharmacists provide. There are a number of ways to contribute to the effort to build relationships with government decision-makers as a member of the BCPhA. We work with individual pharmacists to:

Coquitlam-Burke Mountain MLA Jodie Wickens (left) discusses children’s health and school vaccination programs with BCPhA member David Wang.

This year BC Pharmacy Association (BCPhA) members and staff held 20 meetings with cabinet ministers and local Members of the Legislative Assembly (MLAs) to put a human face on the policy issues that affect community pharmacy. We also met with senior political advisors and department officials to present the expanded role pharmacists can play in providing British Columbians with improved access to primary care. May 9, 2017, is the date of the next provincial election. Political parties will be presenting their campaign platforms, seeking input from stakeholders, and working to promote the issues that matter most for the future of the province and for the voters of B.C. Now is the time to work with other health professionals and patient advocacy groups to make sure that health care is a key priority for each candidate running. As primary care leaders, BCPhA members know that the province could get more value from its health-care budget by leveraging the expertise of community pharmacists. Expanding pharmacists’ authority to prescribe would greatly increase access to primary care – particularly in rural and remote regions of the province.

• host pharmacy tours locally in the riding • raise awareness of current business and practice issues through letter writing campaigns • invite politicians and their advisors to speak at local community events • partner with other health organizations to build coalitions around shared policy goals • share pharmacists’ expertise through op/eds, letters to the editor and media stories in local outlets. If you’re currently involved in these activities in your own community, we’d love to hear from you. We can support you with background materials and briefings on key issues as well as outreach training. Our MLA Outreach Program currently has 125 pharmacists enrolled. We help support them as they reach out to local politicians to invite them to tour pharmacies, visit constituency offices, and draft letters to government officials about how decisions in Victoria are affecting pharmacy practice in B.C. This May, there will be 87 ridings with returning and new candidates seeking support, up from 85 in the last election. Having multiple pharmacists in each riding available to speak with MLAs and candidates will increase our ability to raise awareness of pharmacy issues in the province. We invite you to become a participant in the MLA Outreach Program in order to reach the current and future decision-makers in your community. If you are interested in getting involved with the MLA Outreach Program, please contact Director of Advocacy & Stakeholder Engagement Cherie Payne at cherie.payne@bcpharmacy.ca or 604.269.2868 to add your voice.

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MEET JOE GALLAGHER

Meet...Joe Gallagher Chief Executive Officer, First Nations Health Authority Your work led to the transfer of First Nations health services from the federal government to the newly created FNHA in 2012. Why was this transfer so important?

Joe Gallagher is Coast Salish, of Tla'Amin First Nation ancestry and serves as CEO of the First Nations Health Authority (FNHA). Over the past decade, Gallagher was a lead negotiator in the successful transfer of federal health services to First Nations control. This work – a first for Canada – led to the formation of the FNHA, and Gallagher has led the organization since its inception in 2012. A senior health leader for the past 10 years, Gallagher has more than 25 years of experience in community development, intergovernmental affairs and negotiations. Throughout his career, he has worked with all levels of government, First Nations communities and organizations in both rural and urban settings. Gallagher holds a degree from the University of Victoria and promotes First Nations teachings and perspectives of health and wellness. He holds the ancestral name Kwunuhmen, "One with vision." The Tablet asked Gallagher about his views on First Nations health care in Canada and how community pharmacists fit into this landscape.

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The transfer was important because it enables First Nations decision-making related to the health and wellness services in their communities. The transfer of services from Health Canada is only one part of the picture. As a provincial body, FNHA has a strong interest and ability to focus on a First Nations population health agenda, and therefore, also has the opportunity to influence the provincial conversation about First Nations health and orient the strategic direction of health care in B.C. as it relates to First Nations. There was a recognition by both provincial and federal levels of government that they cannot address the gaps in health outcomes of First Nations peoples without First Nations being directly involved. There was agreement that the creation of a First Nations institution built by First Nations for First Nations is the way forward. What has been the greatest achievement of the FNHA since its inception? Some achievements in our first three years of operations have included improved service standards in areas such as emergency response and health benefits (formerly Non-Insured Health Benefits). The province-wide declaration on cultural safety and humility, and shifting the narrative paradigm from sickness to wellness in many conversations, through championing the First Nations Perspective on Health and Wellness, are some more examples. Innovative partnerships that are having transformative impact include our growing relationship with the Coroners Services

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of British Columbia and increasing their cultural safety by respecting First Nations customs around death and dying. The FNHA is in a unique position in that we can partner with regional health authorities, the provincial and federal government, as well as tertiary health institutions and innovate for better health services for First Nations and Aboriginal peoples in B.C. Ultimately, the flexibility and opportunity for First Nations to design and deliver local health services that will meet their needs and create a more integrated health system on the ground is a big step in the right direction.

What is cultural humility? It is a process of self-reflection to understand personal and systemic biases. Cultural humility is about pausing in the moment to question our assumptions. Questioning our own assumptions enables us to develop and maintain deeper and more respectful relationships based on mutual trust. Cultural humility also involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience. Cultural humility leads to cultural safety. Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances between providers, such as pharmacists, and clients inherent in the healthcare system. It contributes to an environment free of racism and discrimination, where people feel safe when receiving health care.


What are the priorities for the FNHA in the next five to 10 years? FNHA’s priorities start and end with enhancing First Nations decision-making for health and wellness at the individual, family, Nation and population health levels. An important part of this work is shifting the axis of control from providers back to families as well as reinvigorating our traditional practices, which kept us well for thousands of years. As an organization we are focused on becoming the best health and wellness partner we can be for individuals, families and our provincial and federal partners. To achieve this, we must make progress on improving the quality of health-care services for First Nations, both those that we deliver and those that are accessed by First Nations through the provincial system. A key FNHA lever to increasing quality is to hardwire cultural safety and humility into health care for all British Columbians.

In July 2015, all B.C. health authority CEOs signed a Declaration of Commitment to advance cultural humility and cultural safety within their health service organizations. The declaration gave us all permission to act. Partnerships with professional associations and colleges are fundamental to hardwiring cultural safety skills into our greater health system. Transformation of health programs and services and the seamless integration with provincial services is necessary and exciting work. We have strong regional and community networks, and enabling agreements will set the stage for this next phase of transformation and innovation. What role do community pharmacists play in the lives of First Nations people? Pharmacists and pharmacy technicians are one of the first points of contact for health care, making their role a key touch point for many clients. Pharmacists have

an estimated 2,953 interactions with First Nations clients per day. Are there any unique challenges with First Nations health care that pharmacists can help with? Pharmacists can improve the provision of culturally safe health services to First Nations clients by learning about colonization, residential schools, systemic racism, discrimination, stereotypes, health inequities and the social determinants of health, and its impact on First Nations people. San’yas Indigenous Cultural Safety (ICS) training is an eight-hour online course provided by the Provincial Health Services Authority (PHSA). Nearly 28,000 people in B.C. have completed the training, but only 158 pharmacists and pharmacy staff have opted in on the course.

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NALOXONE: WHAT PHARMACISTS NEED TO KNOW

Life-saving naloxone now available without a prescription By Robert T. Pammett, B.Sc., BSP, M.Sc. In April 2016, British Columbia declared a public health emergency due to the rise in drug overdoses and deaths from opioid use. From January to August 2016, there were 488 deaths due to illicit opioid use in the province, an increase of over 60 per cent from the same period in 2015. The rate of death due to overdose is now nearly twice that of the rate of motor vehicle deaths in B.C. This is partly due to the recent increase in availability of very potent opioids in illicit markets, including fentanyl, which is approximately 100 times more potent than morphine. Due to the strength of these drugs, very small quantities have the potential to cause overdose, with opioid naïve people at higher risk. Opioids can even be laced into other illicit drugs, making any illicit drug use especially dangerous. People who use prescription opioids are also at risk of overdose; especially elderly people, those taking more than 90mg of morphine (or morphine equivalent dose) per day and those who are also taking an opioid in combination with benzodiazepines. Making naloxone more available to the public has been identified as one strategy to manage this significant public health crisis. Pharmacists have a large role and opportunity to participate in the appropriate distribution of this medication. Naloxone Naloxone is a competitive antagonist of opioid mu receptors, which will temporarily reverse the effects of opioids in the body.

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This medication can restore breathing and prevent anoxic brain injury and death from opioid overdose. The medication works by displacing the opioid (such as morphine, heroin and fentanyl) from the body’s opioid receptors, and blocks them from having an effect for a short time. It works very rapidly (typically in two to five minutes) and is very safe. Adverse effects caused by the drug seem to be due to acute opioid withdrawal, as it has no apparent pharmacologic action in the absence of opioids. There is no abuse potential of naloxone (using it will not make a person “high”), and there is no evidence indicating it increases risk-taking behaviour (such as using more opioids) in people who use illicit drugs. Unfortunately, the short half-life of the medication causes it to only last for 30 to 90 minutes, shorter than the duration of action of some opioids. In these situations, the naloxone wears off, and the original overdose can return. This makes it extremely important for the person to be monitored carefully, hopefully in an acute care setting, during this time. Naloxone availability Take Home Naloxone programs have been successful in the past as the majority of overdoses happen in the presence of others, and the quick use of naloxone allows for the reversal of overdose. The BC Centre for Disease Control, as part of their Take Home Naloxone Program has trained almost 10,000 people in the use of naloxone, and distributed close to 11,000 kits since 2012.

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As of Mar. 22, 2016, naloxone was available without a prescription through community pharmacies in B.C. Pharmacies could sell this medication, bundled with the required material for administering the drug (such as syringes, alcohol swabs and nitrile gloves) without limit to anyone requesting it. It was made Schedule II (behind the counter) to ensure that people wanting the drug were appropriately trained on its use as part of the sale, not so that pharmacists could act as a gatekeeper for naloxone. There are currently intramuscular and intranasal formulations of naloxone available in Canada. Intramuscular (IM) naloxone requires the medication to be drawn up into a syringe from a glass vial or ampoule before the medication can be injected into a large muscle (typically the thigh, arm or buttocks). Intranasal naloxone is much easier to administer (simply spray into the nostrils of the person in need), but is much more expensive than the intramuscular version. A prefilled IM auto-injector device may also be coming to the market in Canada in the near future. As of Sept. 21, 2016, regulations were changed to allow for naloxone to be available outside of pharmacies in B.C. This change to unscheduled status is intended to make the drug more available to the public, although pharmacists will still have an important role in the training and distribution of naloxone.


Continue to provide breaths until the person is breathing on their own

Source: www.towardtheheart.com/naloxone

Education Pharmacists in community pharmacies should train and provide naloxone to people who may be at risk of opioid overdose, or who may know someone who may benefit from having the medication accessible. Without proper training, the medication might be misused or not administered properly, resulting in a failure to reverse the opioid overdose. The BC College of Pharmacists ran multiple training sessions for pharmacists in the spring of 2016 to provide them with the education to properly train people on the identification of opioid overdose and proper use of naloxone.

Robert T. Pammett is the research and development pharmacist - primary care for Northern Health and an assistant professor (partner) with the UBC Faculty of Pharmaceutical Sciences. He is also a BCCDC Take Home Naloxone site coordinator and recently presented CPhA’s online webinars on Naloxone for Opioid Overdose – What Pharmacists Need to Know.

If no response after 3-5 minutes give another injection

For more information visit www.towardtheheart.com

Key points to remember Opioid overdose looks like: • Shallow or no breathing • Vomiting, gurgling • Unresponsive to stimuli (noise or pain). Responding to opioid overdose: • IM injection of naloxone is performed by drawing up the 1mL (0.4mg/ mL) dose from an ampoule or vial, and inserting the needle through the clothing into a large muscle group: - Quadriceps - Deltoid - Gluteus. • Intranasal naloxone is administrated by spraying the dose (4mg) directly into the nostril. • Doses of naloxone should be re-administered every three to five minutes if there is no response until emergency medical services arrive. There are many resources available to support patient training. For more information, please refer to bcpharmacists.org/naloxone and towardtheheart.com/naloxone. Pharmacists have an important role in the safe distribution of this lifesaving medication. Don’t be afraid to discuss the use of this medication with patients who you think might benefit from it. Approach the conversation in an honest, non-judgmental manner, emphasizing that naloxone is a safety precaution that we hope won’t need to be used, but that having it available might save someone’s life.

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REGULATORY COMPLIANCE

Compliance training moves online Association helps pharmacies ensure regulation adherence through self-guided training course

By Angie Gaddy Todd Dew had been hearing about payer audits rivalling in the hundreds of thousands of dollars. As the pharmacist-owner of Hogarth’s Clinic Pharmacy in Vernon, Dew knew that the pharmacy profession had been in the habit of focusing on patient care almost at the exclusion of detailed paperwork and records required by private payers and PharmaCare auditors. “You can’t afford to stay in business and be sloppy,” Dew says. So when he heard about the BC Pharmacy Association’s Regulatory Compliance Bootcamp, he immediately signed up. The program helps pharmacy owners and managers understand how to mitigate risks of penalties associated with audit assessments, as well as addressing practices around patient privacy and College of Pharmacists of BC regulations. In August 2016, the BCPhA began offering Regulatory Compliance Bootcamp as an online self-study program for any member to take at a time convenient for them. Dew took the original face-to-face Bootcamp in October 2014. After completing it, he began reviewing his pharmacy’s workflow processes and implemented a monthly audit process. In May 2016, he also sent two of his staff members to the BCPhA’s Pharmacy Claims Compliance Officer (PCCO) Training Program in Kelowna, which is designed to train pharmacy technicians or assistants to become a pharmacy’s compliance officer. Pharmacy technician Amanda Essery attended BCPhA’s Pharmacy Claims Compliance Officer (PCCO) Training Program in Kelowna.

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Hogarth’s now runs monthly mini audits, in which staff pull samples from the current month and the same month from the previous year. The staff use the audits as a way to do self-evaluations and gauge improvement, based on the BCPhA training materials. “Doing this has made me sleep a little better at night, because I’m not worrying about what is or isn’t happening at the pharmacy,” Dew says, laughing. “The staff have really embraced the program. We really wrapped our brains around accountability.” For Nicole Bush, a Hogarth’s pharmacy assistant new to the pharmacy sector, running monthly mini audits has been a way for the team to build camaraderie. She and a colleague both attended the compliance officer training and serve as the pharmacy’s check-and-balance team. “It’s not about finding people’s mistakes,” Bush says. “It’s about making sure we’re

all accurately doing the same thing and following the procedures. Everyone gets right behind you, and there’s no blame placed. We make it a team effort.” Bush says she does the majority of locating prescriptions, organizing them and running self-audit checks. The team pulls prescriptions for narcotics and emergency refills, as well as regular prescriptions along with medication reviews and high-cost drugs. “Once you get the system in place, it’s really easy,” she says. “You just have to make time and set aside a person to do it.” Amanda Essery, a regulated pharmacy technician, also attended the compliance officer training. “I learned a lot of details that, being in the pharmacy industry for a few years, I didn’t think were as important, and now I know how important they are,” she says. The role as compliance officer is perfect for both of them.

“I like the little tiny details, like looking at a prescription and finding and putting everything together,” Essery says. “It’s like a little puzzle with all these pieces that have to match. And if they don’t match then it’s not a full puzzle.” Both Essery and Bush say individuals beginning to implement the compliance process shouldn’t fear they’ll get in trouble, and that it requires the owners to lead the charge. “If we don’t have compliance in place so much money can be taken back, which can cost jobs. The pharmacy might have to close,” Essery says. When everything is done right, things run smoothly for the pharmacy and the staff. “Everything is in place, and you’re not stressed about it.” Interested in taking BCPhA’s Regulatory Compliance Bootcamp online? Log on to bcpharmacy.ca for more details.

The team at Hogarth’s Clinic Pharmacy includes (left to right) pharmacist Jamie Nicolson, pharmacist Mark Pastro, pharmacist and owner Todd Dew, pharmacy technician Amanda Essery, pharmacy technician Miranda Coleridge, and pharmacy assistant Jennifer Luszcz.

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ON THE COVER | RURAL PHARMACIES

Pharmacists provide continuity of care in rural communities BCPhA members Judy Phillips and Ward Taylor are each making a huge difference in the lives of their patients in rural B.C. By Elise Steeves Recently discharged from the hospital, a patient stumbled into the Lumby IDA Pharmacy. As pharmacist Judy Phillips sat him down, she discovered burns on his scalp from being electrocuted. Titanium plates in his skull from a motorcycle accident many years ago had transferred the current through his body. Her patient had no family physician, and there was no doctor working that day in this small town of 1,700 people in the northern Okanagan Valley. There had been no follow up from the hospital. And on that hot summer day, he could have easily overheated. Phillips gave him a dermal wound cleanser, Polysporin to apply to the burns and ibuprofen to help with the pain and inflammation. She also made sure he knew to stay hydrated and cool and that he could call her for anything at all. “Here I am – with no tools except OTCs – to deal with a still critical individual,” Phillips recalls. “These are the types of things I’ve had to deal with because there was no other caregiver at the time but me.” Like so many rural communities in B.C., Lumby is facing a health-care crisis. Lumby lost two doctors this past year and has only one practicing physician, who covers not only the village of Lumby, but serves the area east towards Nakusp, two

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Pharmacy manager Judy Phillips says that rural pharmacists need to be given the option to prescribe for minor ailments.

and half hours away. The public health unit is only open Monday to Friday from 9 a.m. to 4 p.m. and the closest hospital is 30 minutes away. As Lumby’s only community pharmacy, Phillips and her team find themselves constantly dispensing emergency refills or helping patients get access to physicians or other health-care providers in Vernon.

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“The pharmacy becomes a triage per se,” Phillips says. “Where else can the patients go? They come to us.” As the first point of care in rural and remote communities, community pharmacies play a critical role for patients who have limited access to physicians. This summer, the BC Pharmacy Association (BCPhA) made four


Lumby IDA Pharmacy staff (left to right) pharmacy technician Krista Reader, pharmacy manager Judy Phillips and pharmacy assistant Michelle Kneller make a real difference in patients’ lives in this small, rural community.

recommendations to the B.C. government to help improve health care in rural, remote and isolated communities. One of these recommendations includes asking that pharmacists be able to prescribe for minor ailments in rural communities. Minor ailments Minor ailments mean lab tests are not needed to diagnose the condition; that treating the condition as a minor ailment will not mask underlying more serious health conditions; that medical and medication histories can reliably differentiate more serious conditions; and that only minimal or short-term follow-up with the patient is necessary.

Improving health care in rural, remote and isolated communities BCPhA recommendations to the Select Standing Committee on Health In July, the BCPhA submitted a number of recommendations on health-care sustainability to B.C.’s Select Standing Committee on Health. A key area was addressing health-care services in rural and remote areas. The Association made four recommendations on rural health care to the provincial government: • I ntegrate community pharmacists into the provincial rural health care planning process. • Modernize and align the community pharmacy rural incentive program. • Deploy technology to address the unique challenges of rural areas • Implement prescribing authority for minor ailments in rural communities To read the submission with all recommendations, visit bcpharmacy.ca/ submissions-to-government-public-2016.

Phillips says her hands are often tied when a patient comes into the pharmacy, has no doctor and their prescription says “no refills.” She often finds herself issuing 14 days of an emergency supply, but that’s all she can do.

have the knowledge base, but right now our hands are tied.”

Rural Practice Subsidiary Agreement (RSA) was established.

What is rural?

“Rural pharmacists need to be given the option to prescribe for disease states that the College deems appropriate,” Phillips says. These include common conditions like headaches, back pain, insect bites, diaper rash, cold sores, acne, athlete’s foot, heartburn or indigestion and nasal congestion. “We have the abilities, we

In 2001, the Joint Standing Committee on Rural Issues (JSC) was established, with representation from both the provincial government and Doctors of BC, to develop strategies to look at the challenges associated with providing physician services to rural communities across the province. Through the JSC’s efforts, the

The agreement designates 183 rural communities in the province where practicing physicians are eligible to receive financial incentives. Eligibility for the RSA is determined by evaluating a community’s level of isolation, using criteria such as number of designated specialties within 70 km, number of general practitioners within 35 km, community size and distance from a major medical community. The communities

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First point of contact Recently, one of Phillips’ elderly patients, who is blind, called in the early afternoon in a panic. She had been watering her plants on her deck and a wasp had snuck inside her soda can and stung her when she took a sip of the cola. She had an anaphylactic reaction, but luckily had the pharmacy on speed-dial. “I grabbed the EpiPen, and literally ran the four blocks to her house,” Phillips says. When she arrived, the woman was in distress so Phillips injected her with the EpiPen and called 911. The ambulance took more than half an hour to arrive. “Had I not been there, she wouldn’t have survived.” Pharmacy manager Judy Phillips (left) talks to patient Jeannie Fox outside of Lumby IDA Pharmacy.

are separated into four groupings from “A” to “D,” with “A” rankings receiving the highest level of incentives to attract and retain physicians. In 2010, under the framework of the Pharmacy Services Agreement, the Province committed $1.6 million in an Enhanced Rural Incentive Program to enhance support to community-based pharmacy in rural B.C. Under the program, qualifying pharmacies receive a subsidy for each claim below a specific threshold. To qualify, pharmacies must apply for the program, and meet the following criteria: be the only pharmacy in the community; the next nearest pharmacy must be at least 25 km away; and the number of PharmaCare claims submitted by the pharmacy must not exceed 1,700 per month. Pharmacies with lower monthly claim volumes receive a larger subsidy for each claim. No subsidy is paid if PharmaCare-paid claims for a particular month exceed 1,700. The subsidies, calculated and paid monthly, are based on a sliding scale with a minimum of $3 and a maximum of $10.50 per claim. As part of its recommendations to government on rural health care, the BCPhA is asking the Ministry of Health to modernize and review this program. The

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Association recommends the 183 rural communities included as part of the RSA be adopted as part of the eligibility criteria for the community pharmacy rural incentive program. There should be alignment in location eligibility criteria for prescriber and pharmacist incentive programs. Phillips agrees with the alignment of pharmacy rural incentive program to the RSA, but believes the RSA itself needs a review as well. Since May of this year, Judy has been working to lobby politicians, drafting letters and fundraising with the health society to see if they can change Lumby’s rural designation. Because of its proximity to Vernon, Lumby is currently listed as a “D” community, which means physicians working there receive fewer incentives than the rest of those in the RSA. “Salmon Arm is a city with a hospital but is declared more rural than us,” Phillips says. There’s word that new physicians have been recruited there because the salary is higher. “Not only do we need to get a doctor here, but we need them to stay. Retention issues are huge. Lumby has been left out in the cold in terms of proper rural designation,” she says.

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In addition to Phillips, the pharmacy has two part-time pharmacists, one of whom focuses on blister packing and deliveries. When they deliver, Phillips and her team have been known to take out their patients’ garbage or bring along treats for their dogs. Phillips has even driven a patient who was suffering from shingles all the way to Vernon because she didn’t have a family physician in town and her partner refused to drive her the 30-minute trip to the hospital. Even prior to the recent loss of two physicians, there were days where this rural area didn’t have any coverage because none of the doctors worked full-time. Phillips says patients struggled getting x-rays and lab results with locum physicians assisting for short periods of time. “It’s very staggered and fragmented care,” she says of the state of rural health care in B.C. Other remote communities with telepharmacies face an uncertain future, with the possibility that many may close due to impending regulatory changes that take effect on Jan. 1, 2017. Phillips says community pharmacy in rural areas isn’t just about dispensing medications to patients. “It goes so far beyond pharmaceuticals,” Phillips says. “It’s also such an incredible social impact that we’re making on the fibre of our small community.”


Where everybody knows your name: Adding a personal touch to pharmacy in the village of Kaslo In a village of 1,000 people, it’s not hard to locate the only pharmacy in Kaslo, B.C. Situated along the main street of restored buildings from the late 1800s, Kaslo Community Pharmacy has a view of Kootenay Lake and is nestled in a valley surrounded by stunning snow-capped mountain peaks.

Ward Taylor, the pharmacy manager and owner, plays an important role in providing primary health-care services to this tiny community in the West Kootenays.

“They’re trying to make it better,” Taylor says. “But as a pharmacist, the onus falls on you to be there for your patients. I didn’t feel like I could ever take time off.”

Kaslo has struggled to keep a rotation of locum physicians since its long-time family doctor retired a few years ago.

Janice Pawlik is a patient at Kaslo Community Pharmacy and calls Taylor her “go-to guy.” In addition to battling cancer in the past, Pawlik recently broke two bones in her ankle, and after the

Pharmacy manager Ward Taylor owns a second pharmacy in the rural community of New Denver, B.C., about 45 minutes away, and often provides services there via telepharmacy.

Patient Janice Pawlik says pharmacy manager Ward Taylor is her “go-to-guy” for her health-care needs, particularly when Kaslo was struggling to keep a regular rotation of physicians.

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RURAL PHARMACIES

surgery developed complex regional pain syndrome (CRPS). “Ward is easy to talk to, and really compassionate. He tells me detailed information about drugs or medications that I can take, that sometimes don’t really get explained,” she says. “Sometimes you get a sheet of medication explaining the side effects but Ward goes beyond that.” Taylor’s personal relationships with patients go a long way in ensuring quality care. Recently, a patient came into Kaslo Community Pharmacy with a new prescription from a locum physician. The woman had suffered from anxiety for a long time, and tried a variety of medications with no success. The physician had suggested lithium as an offlabel indication for anxiety, but Taylor was immediately concerned. “I knew the patient well, from her history of medications to her lifestyle, and didn’t think lithium was a good fit,” he says.

The patient was very active and had concerns about her weight, and lithium’s side effects can include fluid retention and lethargy. Taylor explained his reservations and suggested an alternative medication to discuss with her physician. He says the patient has already called him three times since switching medications to say thank you. “She tells me she feels better than she has in 20 years and that it’s made a profound difference in her life and her family’s life.” Taylor also says because he gets to know patients on a deeper level, he’s found he’s more likely to bring his personal experiences into counselling. Taylor’s pharmacy has a private, soundproof consultation room. “At risk of sounding corny, many of my patients become more than just a customer, they’re like a family member coming to you. You really just want to see them get better.”

Kaslo Community Pharmacy resides on the main street in the village of Kaslo, which is located in the West Kootenays.

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Originally from Regina, Saskatchewan, Taylor completed his pharmacy degree in 2009 but didn’t find job satisfaction working in chain pharmacies in the city. When he made the switch to pharmacies in smaller communities and his purchase of the Kaslo Community Pharmacy in 2012, things changed. “It gave me what I always thought pharmacy was,” he says. “You get to be a part of peoples’ lives and they’re happy to see you, instead of just arguing with you or rushing out with their ‘script.” Taylor plans to make his roots in Kaslo. “The main benefit of being in a small community is the personal contact, really getting to know people and becoming a part of their life – and them becoming a part of yours,” he says. “It makes for extreme job satisfaction and a higher level of care.”


Rural communities in B.C. supported by pharmacy The Rural Practice Subsidiary Agreement (RSA) designates 183 rural communities in B.C. where practicing physicians are eligible to receive financial incentives. Eligibility for the RSA is determined by evaluating a community’s level of isolation, using criteria such as number of designated specialties within 70 km, number of general practitioners within 35 km, community size and distance from a major medical community. The communities are separated into four groupings from “A” to “D,” with “A” rankings receiving the highest level of incentives to attract and retain physicians.

11 14

The following map shows the 50 communities within the “A” ranking that also have community pharmacies. These communities often rely on pharmacists as critical first points of contact for many patients. Note: Lumby is not included in the list of “A” communities shown here, but is designated as part of the RSA in the “D” category.

33 30

37 45 27

39

21 43 22

4 15 17 50

A Communities​ 1. 100 Mile House 2. Alert Bay 3. Ashcroft/Cache Creek 4. Burns Lake 5. Chetwynd 6. Christina Lake 7. Clearwater 8. Cranbrook 9. Creston 10. Dawson Creek 11. Dease Lake 12. Elkford 13. Fernie 14. Fort Nelson 15. Fort St. James 16. Fort St. John

16 23 29 5 10 47

40 17. Fraser Lake 18. Gold River 19. Golden 20. Greenwood 21. Hazelton 22. Houston 23. Hudson's Hope 24. Invermere 25. Kaslo 26. Kimberley 27. Kitimat 28. Lytton 29. Mackenzie 30. Masset 31. McBride 32. Nakusp 33. New Aiyansh

34. New Denver 35. Port Hardy 36. Port McNeill 37. Prince Rupert 38. Princeton 39. Queen Charlotte 40. Quesnel 41. Revelstoke 42. Salmo 43. Smithers 44. Sparwood 45. Terrace 46. Tofino 47. Tumbler Ridge 48. Ucluelet 49. Valemount 50. Vanderhoof

35 36 2

31 49

1 3

18 46 48

7 41

28 38

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MID-LIFE PHARMACY SERVICES

Aging gracefully A growing number of British Columbians are seeking alternative treatments at pharmacies for age-related symptoms

By Angela Poon As a well-respected compounding pharmacy located in the affluent and bustling community of Kitsilano in Vancouver, Vita Vie Pharmacy owner Hanna Habdank serves a large percentage of baby boomers – and beyond – seeking to improve their quality of life.

medications into account. Often times, this involves working closely with physicians to ensure continuity of care.

“The oldest lady I serve regularly is 90 years old,” says Habdank, whose eldest patient seeks complementary treatments such as herbal remedies from her Vancouver pharmacy. “She tells me her doctor says to her, ‘You don’t want to accept the fact that you’re old,’ and – Hanna she simply says to me, “No, I don’t!’”

“Most of the time, prescriptions are the suggested approach, but often patients can still feel better through other recommendations such as vitamins, herbs and amino acids that can support their treatment and slow down aging,” she

symptoms of menopause for many decades in the U.S. and Canada, it has more recently become a hotly debated topic in the medical community. A landmark scientific study from the U.S.-based Women’s Health Initiative published in 2002 stated there were a greater number of risks than benefits for the millions of women currently prescribed synthetic HRT, leading many physicians, medical organizations

“It’s all about prevention, prevention, prevention – especially when considering age-related issues such as osteoarthritis, dementia or cardiovascular diseases.”

In Habdank’s experience, this attitude towards aging and quality of life is becoming prolific among her long-time customers, many of whom are seeking individualized treatments such as hormone replacement therapy (HRT) to help with PMS management or the effects of aging in menopause and andropause. “I find it very, very much needed in the population of aging baby boomers,” she notes. “Aging is a part of life, and an area where we often need some guidance.” In addition to filling standard prescriptions, Habdank offers comprehensive, personalized consultations to her customers seeking complementary treatments to ensure an effective treatment plan is created that takes all current conditions and

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Habdank, Vita Vie Pharmacy notes. “It’s all about prevention, prevention, prevention – especially when considering age-related issues such as osteoarthritis, dementia or cardiovascular diseases.” While Habdank stocks a wide range of supplements, up to 90 per cent of her compounding business is focused on bioidentical hormone replacement therapy (BHRT), in which plant-derived molecules mimic the molecules that are produced in the human body and can be prepared into a variety of different applications. “Very often, this is why my patients have come to me,” she says. “They send their sisters and friends. It has improved the quality of life for many, many women.” While synthetic HRT has been a common treatment for women experiencing

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and female patients to no longer support the popular treatment. While both the U.S. Food and Drug Administration (FDA) and Health Canada continue to support HRT products – and many women are still prescribed synthetic hormone therapy – there has been a growing trend toward the alternative approach of BHRT, which has increased in popularity since the early 1990s. A plant-based product designed to mimic the naturally occurring hormones found in women’s bodies, BHRT is available through doctor-prescribed pharmaceuticals, but is also often acquired through custom compounding pharmacies. “There’s a growing demand for these services,” says Mark Chambers, pharmacist


at Lakeside Medicine Centre Pharmacy in Kelowna. “Our customers want options. They want to decide to use conventional therapies or explore something more tailored to their personal circumstance, based on what their needs are and what their decisions are with their prescribers.” Chambers notes offering these enhanced clinical services requires both extra time with customers, as well as additional training and certifications in both Canada and the U.S. to provide the highest level of competency in terms of hormone therapy. “With both conventional prescriptions and supplemental therapies, our pharmacy follows a unique format,” says Chambers. “We have cubicles or pods where the patient sits down and we counsel them on first point of contact, which creates a good environment to discuss the compounded preparations we’ve provided in detail.” While Lakeside has traditionally serviced a high percentage of seniors, due to its close proximity to Kelowna General Hospital and nearby care homes, Chambers notes there is a growing clientele seeking relief for midlife issues, such as mood swings, insomnia, bone loss and fatigue. “We have many customers tell us, ‘You brought my life back,’” he says. “I believe the majority of our patients feel very good about aging and experiencing it gracefully.” For Dr. Bal Pawa, a Vancouver-based physician who trained and worked as a pharmacist for six years before launching into medicine full-time, the need for a holistic approach to aging, hormone health and wellness was so evident, it led to her establishing the first Vancouver-based integrated hormonal clinic, the Westcoast Women’s Clinic. “We recognized the need for a wellness model clinic, as our current system of health care operates on the illness model,” says Pawa, who co-founded the clinic with Dr. Nishi Dhawan in 2001. “We take the time to look for the root cause of the symptom.” With certifications in women’s health from the North American Menopause Society, the International Hormone Society, as well

Vita Vie Pharmacy owner Hanna Habdank says many of her long-time customers are seeking individualized treatments such as hormone replacement therapy to help with PMS management or the effects of aging in menopause and andropause.

as training in gut health from the Institute of Functional Medicine, Pawa provides in-depth assessments of her patients’ hormonal needs to provide services to women of all ages for PMS, perimenopause, osteoporosis and mild mood disorders, among others. Based on her pharmacy background, Pawa notes there is great opportunity for all pharmacists to work alongside physicians in proactively treating midlife issues for women, in the forms of risk assessment, patient education and nutritional supplements. “I think pharmacists have a wonderful knowledge base that is often underutilized,” she says. And while the vast majority of age-related treatments at both Westcoast Women’s Clinic and many compounding pharmacies cater primarily to female patients, hormone

specialists agree there is a growing demand for customized therapy for men as well. “While it’s still a female-predominant service,” Chambers says, “there’s an increasing interest in men’s health as well.” Habdank has found a similar surge in male inquiries, and notes often times wives, sisters and friends have encouraged the men in their lives to pursue complementary treatments. “Middle-aged men are often very stressed people,” she says, adding that many of her clientele include high-level professionals and executives seeking supplemental or hormonal therapies for a wide range of issues such as insomnia, stress and anxiety, low energy, as well as age-related decrease in sexual function. “There can be great benefit to both women and men when it comes to addressing hormonal health.”

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HEMOCHROMOTOSIS

The Celtic curse Hereditary hemochromatosis and the pharmacist’s role in helping identify sufferers By Carlyn Volume-Smith, B.Sc.(Pharm.), M.Sc., PhD Hereditary hemochromatosis (HHC) is an inherited disorder, which causes patients to absorb too much iron from their diet. This excess iron then accumulates in the patient’s body, causing deposits in organs and joints. Individuals with HHC who are suffering from the effects of iron overload often remain undiagnosed until organ damage or other negative effects impact their longevity and quality of life. As one of the most accessible health-care providers, pharmacists can play a key role in identifying patients who may suffer from iron overload due to HHC. HHC is a recessive disorder that is commonly seen in persons of Celtic and Northern European heritage. In Canada, it is estimated the disorder affects up to one in 300 people. Not all patients with the gene mutations suffer from iron overload, but for those that do, early intervention can prevent long-term consequences. Patients usually present in mid-life, when body iron stores have accumulated and negative effects start to be felt. In some cases, a family history of severe liver disease (cirrhosis and/or liver cancer), arthritis and diabetes may be present. Onset in males is usually earlier than in females, who may be at lower risk due to pregnancies and menstrual blood losses which can deplete iron and prevent symptoms of iron overload. The pharmacist’s role Community pharmacists are often among the first health-care providers approached by patients suffering from the diverse and non-specific symptoms of iron overload. Accordingly, pharmacists are positioned to intervene when they are suspicious of HHC

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and can refer the patient to their family physician for assessment and diagnosis. In some cases, patients may seek the assistance of a pharmacist in an effort to self-treat before proceeding to their family physicians. Unfortunately, some remedies for iron overload symptoms can harm HHC sufferers over the long term. For example, advising regular dosing of acetaminophen could harm an already damaged liver. Similarly, recommending iron supplements or multivitamins containing iron can aggravate iron overload in an already dangerous situation. The following are common indicators of iron overload that pharmacists may recognize in their patients: • Arthritis and joint pain (in particular the first two joints of the first two fingers) • General tiredness • Changes in mood, anxiety or depression • Chest pains and shortness of breath • Impaired sexual function or infertility • Loss of body hair • Tanned or grey skin discolouration. When presented with middle aged or older individuals (in particular males) seeking treatment for two or more of the symptoms outlined above, pharmacists should ask the following questions prior to recommending over-the-counter therapies: • First, is the individual of Celtic or Northern European heritage? • Is there a history of severe liver disease, arthritis and/or diabetes in the family? If the answers to these questions are positive, there is merit in referring the

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patient to their physician for additional testing to rule out HHC. Once HHC and iron overload is diagnosed, the primary treatment is regular removal of blood (phlebotomy). Phlebotomies prompt the body to mobilize excess iron stored in joints and organs to make new red blood cells to replace those that were taken. Phlebotomies occur on a regular basis (e.g., weekly) until such time that serum ferritin and transferrin saturation reach reasonable levels. Though alterations in diet cannot treat iron overload, patients are also advised to avoid dietary iron which can negatively affect iron build-up. Once iron stores are normalized, HHC sufferers typically require phlebotomies every three to four months as maintenance therapy. Regular blood donation can be used in some cases as maintenance therapy. Dr. Carlyn Volume-Smith is a licensed pharmacist and a Canadian Hemochromatosis Society board member. She believes that community pharmacists can play a vital role in patient health through their accessibility and the strong therapeutic relationships that they have with their patients. The Canadian Hemochromatosis Society (www.toomuchiron.ca) is a registered nonprofit society that works to promote early diagnosis of hemochromatosis through increased awareness of the disorder in both the medical community and public. The CHS is also an information resource for individuals and families affected by iron overload and helped develop the “Iron Tracker” app to assist patients in managing their condition.


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CPHA

CAREER LISTINGS

ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS?

The federal files

Pharmacy members can place free career opportunities listings in this section and on the BCPhA website. We have the best pharmacy job board in BC! For the full listings of pharmacy technician and assistant positions visit the Pharmacy Technician Society of BC website at ptsbc.ca Pharmacist members looking for new career opportunities can post their resumes for free on the Hire-aPharmacist page. To learn more, visit the recruitment section of bcpharmacy.ca

By Mark Dickson, B.Sc. (Pharm.), MBA ABBOTSFORD

The BC Pharmacy Association (BCPhA) supports its members by advocating at a provincial level. Meanwhile, the Canadian Pharmacists Association (CPhA), of which BCPhA is a member, has the primary role of advocating for issues at a national level and in areas that are federally regulated. The following are some current issues where CPhA plays an active role at the federal level: Acetaminophen regulation The recent announcement by Health Canada of relatively minor changes in acetaminophen packaging and labeling regulations was the outcome of an extensive consultation process. Early desired proposals were to remove acetaminophen from all combination products, move acetaminophen 500mg to prescription status and limit all OTC acetaminophen to 24-count packages. CPhA played an active role in advocating for the needs of reasonable patient access to acetaminophen as balanced with the risks of liver toxicity. Next up in this area will be recommendations on changes in management of OTC codeine products. Medical marijuana A federal framework for regulation of recreational marijuana is expected this fall. Of particular interest to pharmacists is the more nuanced discussion around medical marijuana. True medical use of marijuana (as opposed to the easy access “pot shops” we currently see popping up all over the country) would require considerable standardization and regulation if dispensed by pharmacists in pharmacies. This is currently not allowed under the Access to Cannabis for Medical Purposes Regulations (ACMPR). While much of this work will fall to the National Association of Pharmacy Regulatory Authorities (NAPRA) and the provincial regulators, CPhA continues to be consulted and will advocate for patients and good pharmacy care in this space.

Changes in the Canadian and international pharmaceutical markets have contributed to ongoing medication shortages across the country. While pharmacy teams work to meet the supply needs of their patients, Health Canada continues to wrestle with how better to manage supply on the national level. Unfortunately, no quick solution is evident and CPhA will continue to be the voice of pharmacists in these discussions at a national level. To learn more about the CPhA’s position on these and other federal issues, check out pharmacists.ca.

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We are looking for pharmacists to join our busy, established community pharmacies. Pharmacist must have a passion for patient care and strong interpersonal skills. Experience with Kroll/WinRx and Punjabi speaking is an asset. All experience levels are welcome. Please send resume to cmhjobs@ outlook.com or fax 604.856.7178. Pharmacist - part-time Pharmasave Abbotsford Hospital is a unique pharmacy, offering service to patients inside and outside the Abbotsford Regional Hospital and Cancer Centre. We help patients transition back into the community as well as servicing the pharmacy needs of patients in Abbotsford. We are looking for a full-time pharmacist that can work in our patientcentered pharmacy. We are seeking someone with good communication and customer service skills that can work proactively with our technicians and assistants to provide the perfect Pharmasave experience. Two years experience as a Canadian pharmacist is required. Kroll experience is an asset. Complete fluency in English is a requirement. Please send resume to info@pharmasaveabby.com. Pharmacist - part-time Garden Park Pharmacy is a long-established, friendly community pharmacy seeking a pharmacy manager, pharmacist and pharmacy assistants to join our company. Abbotsford is about a 45-minute drive from Vancouver. We offer competitive wages. No Sunday, Saturday, statutory holidays or evenings. All experience levels and new graduates are welcome. Please send resume to alanchoi5588@yahoo.com, fax 604.746.2825 or call 604.859.3300. BURNABY

Drug shortages

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Nov/Dec 2016

bcpharmacy.ca

Pharmacist - part-time Looking to hire a permanent part-time pharmacist for an independent pharmacy in Burnaby. Potential to lead to a full-time position. Hours of operation are Mon-Fri 10-6. Knowledge of WinRx is preferred. Must be able to quickly and accurately dispense medications, provide medication reviews and adequately assess for interactions. Applicant must be a licensed pharmacist in good standing with the College of Pharmacists of BC. Wages will be competitive and based on experience. Please send resume to rahim_2002@yahoo.com.


CAMPBELL RIVER Pharmacist - full-time Peoples Drug Mart is looking for a full-time pharmacist to complement our excellent pharmacy team. We are located on the main floor of a medical building with a dental practice and medical office upstairs. The medical office has five full-time doctors in the office so we have a busy dispensary. We do a lot of blister packaging and some methadone prescriptions. If you are injection certified that would be an asset. Our store is open Monday to Saturday, 9am-6pm, Sundays and holidays, 10am5pm. Campbell River is located about an hour and a half drive north of Nanaimo. It is the fourth largest city on the Island. We have a brand new hospital that will open this fall. Also, BC Hydro is currently building a new dam in the area. Please send resume to Victor Choo, Owner at vchoo@shaw.ca, online at peoplesdrugmart.com, fax 250.287.2473 or call 250.204.0234. Pharmacist - part-time, relief London Drugs has a part-time opportunity in Campbell River. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Nelson Costa, Pharmacy Operations Manager at ncosta@londondrugs.com, fax 604.448.1075 or call 604.272.7113. COURTENAY Pharmacist - part-time, relief London Drugs has a part-time opportunity in Courtenay. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Nelson Costa, Pharmacy Operations Manager at ncosta@londondrugs.com, fax 604.448.1075 or call 604.272.7113. CRANBROOK Pharmacist - full-time Cranbrook Peoples Pharmacy is the outpatient pharmacy for the East Kootenay Regional Hospital in Cranbrook, BC. Our pharmacy specializes in long-term care, BC renal program, mental health, addiction services, immunization, sterile compounding, pain and wound care and hormone consulting. Please send resume to peoplespharmacy@telus.net, fax 250.420.4135 or call 250.420.4133. See attachment at bcpharmacy.ca/jobs.

of three months. If interested, please send resume and cover letter to careers@wescanapharmacy.com.

LANGLEY

Pharmacist - part-time

We are looking for a part-time, permanent pharmacist for Saturday and Sunday from 10am-2pm. Please send resume and cover letter to ms0361@store.medicineshoppe.ca or fax 604.510.3141.

A growing independent new pharmacy specializing in patient-centered care. We do dispense methadone but are not your typical methadone pharmacy. Known for our outstandingly efficient operations and loyal patient population, we have created a great environment to work and thrive. Seeking a pharmacist who is highly motivated, with a strong work ethic, strong customer service skills, good communication & leadership skills, ability to work as a member of a dynamic & energetic team, and most importantly willingness to actively participate in patients’ health-care outcomes. Position is a permanent part-time leading to full-time. We offer stability, competitive pay structure and a great benefits package. We pride ourselves on our dedication to our employees and interest in longterm relationships. Please send resume to careers@ wescanapharmacy.com. FORT MCMURRAY Pharmacist - part-time Two permanent part-time positions available. Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! Please send resume to Denise Nilsen, Regional Manager, Pharmacy Operations at denise_nilsen @owfg.com. See attachment at bcpharmacy.ca/jobs. GRAND FORKS Pharmacist - full-time Join a well-established, progressive, communitybased independent pharmacy. Our pharmacy staff are encouraged to spend time with patients and go beyond the pharmacy counter to actively participate in their patients' health-care outcomes using their professional training. Our pharmacy is currently involved in many patient care initiatives including weight loss and metabolic management using the Ideal Protein protocol, advanced health screening using HealthTab, medication reviews and travel health. We offer a newly renovated pharmacy with two consultation rooms, an exciting work environment, competitive wages and benefits, as well as payment of professional dues and continuing education. Please send resume to ps298lake@gmail. com, fax 250.442.3523 or call 250.442.3515. KAMLOOPS

DELTA

Pharmacist - full-time, part-time

Pharmacist - full-time

Manshadi Pharmacy is looking to hire a fulltime and part-time (up to 30 hrs/week or more) motivated pharmacist to work in a well-established, independent retail pharmacy. Experience working in a busy pharmacy is a requirement. We specialize in diabetic care, compounding and home health care products. Great team that supports our pharmacist. We prefer a long-term commitment. Kamloops is a great place to be. We are close to two ski hills, Sun Peaks and Harper Mountain, and dozens of nearby lakes. Good community to raise a family with all needed amenities. New grads are welcome to apply. Please send resume to Missagh Manshadi, pharmacist/owner at missagh@manshadipharmacy. com, online at manshadipharmacy.com, fax 250.434.2527 or call 250.574.0111.

We are looking for full-time pharmacists for our Lower Mainland pharmacies. Experience with WinRX/Kroll and Microsoft Office (Word, Excel, etc.) are necessary. The successful applicant is required to have at least one year of experience working in a community pharmacy and to be injection certified. Pharmacists must also have a good working knowledge of PharmaCare and third party billing policies, medication reviews, and experience with blister packing. Pharmacists must be strong communicators, clinically oriented, and willing to further their pharmacy practice and patientcentered care. Wages start at $37/hour. Full medical and dental benefits are provided after a trial period

Pharmacist - part-time

Pharmacist - part-time We are looking for a part-time pharmacist (14-30 hours per week) in Langley. Pharmacist must know how to use Kroll system and be able to do injections and clinical services. Please send resume to pharmacycareltd@gmail.com. MAPLE RIDGE Pharmacist - full-time, part-time, relief We are looking for a full-time/part-time pharmacist for a small, independent compounding pharmacy in the Lower Mainland. Experience with WinRx preferred but will train right candidate. Must be injection certified, authorized to dispense Methadone, good knowledge of PharmaCare and third party billing, clinically oriented, enjoy doing medication reviews, strong verbal and written communication as well as organizational skills, able to perform in a fast-paced environment, must be flexible and a team player, and be business minded with a patient-focused attitude. This is an ideal position for someone looking to further their knowledge of pharmacy and grow with a company. Above average compensation and benefits. Please send resume to alouettepharmacy@gmail.com. NANAIMO Pharmacist - part-time CareRx is looking for a part-time pharmacist to help us in our busy LTC pharmacy in Nanaimo on a regular basis. Required qualifications: Licensed to practice as a pharmacist in BC, superior interpersonal skills, strong verbal and written English communication skills, commitment to providing exceptional customer service and computer proficiency. Desired qualifications: Exposure to Kroll computer software, efficient time management abilities, effective organization and planning skills and experience with clinical services to long-term care facilities. Please send resume to kevin.liew@ carerx.ca or online at carerx.ca. NEW WESTMINISTER Pharmacist - full-time Key responsibilities include: checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting and collaboration with pharmacy assistant to accurately dispense prescription medications. Qualifications: Bachelor of Pharmacy, license to practice in the province seeking employment, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency. A flexible schedule with some weekends and evenings. Please send resume to sabeeh@ globalhealthmanagement.ca. NORTH VANCOUVER Pharmacist - full-time, part-time We require a part-time or full-time pharmacist for busy, independent North Vancouver pharmacy. If you are looking for a great work environment with a strong clinical role coupled with dispensing, interdisciplinary collaborative focus, competitive pay and consistent enjoyable work, please send resume to nvpharmacy1@gmail.com.

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PARKSVILLE Pharmacist - full-time Overwaitea Food Group, one of Western Canada's leading food and consumer-goods retailer, operates more than 110 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! We have an opening for a pharmacist position at our store in Parksville. Please send resume to Sammy Lee, B.Sc. (Pharm), R.Ph., Regional Manager, Pharmacy Operations at sammy_lee@owfg.com. PORT HARDY Pharmacist - full-time Demonstrate strong sales ability, leadership, energy, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care. Consult with patients to maximize Rx and OTC sales, provide professional advice and applicable dialogue with patients on prescription and OTC products to provide excellent customer service. Be aware of any in-store events and support these events within the store. Supervise pharmacy technicians. Ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed. Implement proper pricing and receiving procedures to minimize shrinkage. Maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resume to DBilson@rexall.ca. PORT MCNEILL Pharmacist - full-time Looking for a pharmacist to work with a great team in a newly renovated, spacious pharmacy and dispensary. Please send resume to Ron Downey, owner at rwdowney@telus.net. POWELL RIVER Pharmacist - full-time Overwaitea Food Group, one of Western Canada's leading food and consumer-goods retailer, operates more than 118 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! We have a permanent pharmacist position available at our Powell River store located at 7100 Alberni St. Please send resume to pharmacyemployment@owfg.com. PRINCE GEORGE Pharmacist - part-time Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! Part-time, permanent (32-40 hrs/wk) pharmacist position available at 555 Central

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Street in Prince George. Starting rate is $47.20. Please send resume to Livia Chan, Regional Manager, Pharmacy Operations at livia_chan @owfg.com. Pharmacist - part-time Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailers, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging and growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! This permanent part-time position would include holiday relief coverage as well as clinical work in the Prince George region. Please send resume to Livia Chan, Regional Manager, Pharmacy Operations at livia_chan @owfg.com. Pharmacist - part-time Looking for a part-time pharmacist (up to 40 hrs) to cover a maternity leave position for six to 12 months. Please send resume to Livia Chan, Regional Manager, Pharmacy Operations at PharmacyEmployment@ owfg.com. PRINCE RUPERT Pharmacist - full-time Duties and responsibilities: Checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting, participation in SDM programs including cognitive/ enhanced services as these programs may evolve over time and as required by the business, collaboration with pharmacy assistant to accurately dispense prescription medications. Desired skills and experience: Bachelor of pharmacy, license to practice in the province seeking employment, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency. Flexible hours including some evenings and weekends. Store hours: Monday through Sunday 8am-10pm. Please send resume to Larry Chow, Associate/Owner at asdm2256@shoppersdrugmart. ca or call 250.624.9656. RICHMOND Pharmacist - part-time We are looking for a part-time bilingual pharmacist for our Centric Health Pharmacy location in Richmond, BC. Please send resumes to Vittoria, Manager Talent at careers@centrichealth.ca, fax 416.619.9428 or please call 416.619.9428. SALMON ARM Pharmacist - part-time Part-time staff pharmacist needed for three days per week in a busy pharmacy in downtown Salmon Arm. No evenings or Sunday shifts. Focus on pharmacy services and injection services are required. Previous compounding experience is preferred. Only those selected for an interview will be contacted. Please send resume and cover letter to Todd Gehring, Pharmacy Operations Coordinator at tgehring@ forewest.ca or call 604.315.3273. SURREY Pharmacy manager - full-time Demonstrate strong sales ability, leadership, energy, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care. Consult with patients to maximize Rx and OTC sales, provide professional advice and applicable dialogue with patients on prescription

bcpharmacy.ca

and OTC products to provide excellent customer service. Be aware of any in-store events and support these events within the store. Supervise pharmacy technicians. Ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed. Implement proper pricing and receiving procedures to minimize shrinkage. Maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resume to DBilson@rexall.ca. Pharmacist - full-time Key responsibilities include: Checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting, and collaboration with pharmacy assistant to accurately dispense prescription medications Qualifications: Bachelor of Pharmacy, license to practice in the province seeking employment, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, computer proficiency. A flexible schedule with some weekends and evenings. Please send resume to sabeeh@ globalhealthmanagement.ca. Pharmacist - full-time As a growing company, NAZ’s Pharmacy is looking for a pharmacist to join our group. We are a group of independent, community-based pharmacies that provide patient-centered practices. Our pharmacists require the following individual qualifications: highly motivated with a strong work ethic, strong customer service skills, good communication and leadership skills, ability to work proactively as a member of a dynamic and energetic team, willingness to actively participate in patients’ health-care outcomes, and various managed care initiatives. We offer stability, a competitive wage, and a benefits package. We pride ourselves on our dedication to our employees and interest in long term relationships. Please send resume to hr@nazpharmacy.com or fax 604.608.3230. Pharmacist - full-time We are looking for a pharmacist to join our growing company. We are an independent, communitybased pharmacy providing patient-centered care. We require a pharmacist with the following qualifications: highly motivated and with a strong work ethic, strong customer service skills, good communication and leadership skills, ability to work proactively as a member of a dynamic and energetic team, willingness to actively participate in patients’ health-care outcomes, and various managed care initiatives. We offer stability, a competitive wage, and a benefits package. We pride ourselves on our dedication to our employees and interest in long term relationships. Please send resumes to hr@ nazwellness.com or fax 604.608.3230. Pharmacist - part-time Part-time pharmacist position with new independent Pharmacy in Surrey - 2 to 3 shifts a week. Need to be able to work independently. Must be proficient in both Kroll as well as Pharmaclik. Preference given to pharmacists that are injection certified, have completed the methadone training, and are able to conduct professional services such as medication reviews, adaptations and refusal to fills. New grads are welcome - great learning opportunity! Position to start immediately. Please send resume to vivacarerx@gmail.com or fax 778.293.2274. VANCOUVER Pharmacist - full-time Save-On-Foods is in search of a motivated and enthusiastic pharmacy intern to join our team. If you are a pharmacy student seeking to obtain


essential experience in retail pharmacy, come join us, advance your knowledge and gain leverage that you can use in your future career. We have a position available for you in our Vancouver location. With over 118 pharmacies in over 50 communities across BC and Alberta, and growing into Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality, patientcentered care. We offer an attractive compensation package and our extensive benefits package is one of the industry’s finest. Please send resume to pharmacyemployment@owfg.com. Pharmacist - full-time Macdonald's Prescriptions at the Fairmont Medical Building has a full-time maternity leave coverage position available immediately. Successful candidate must have excellent communication skills and will be exposed to a pharmacist's full scope of practice. You must have the ability to work effectively in a team environment as well as independently. Experience with compounding and billing to special programs would be very useful. Fluency in a second language would be an asset. We are open Monday-Friday 8:30am-6pm and Saturdays 9am-4pm and we are closed on Sundays and stat holidays. We offer a very competitive salary, benefits and a pension plan. If you are interested in joining an established pharmacy and to continue to develop your skills, please send resume to jeff@macdonaldsrx.com or call 604.872.4200. Pharmacist - full-time Macdonald's Prescriptions Renal Pharmacy is looking for an immediate, full-time pharmacist who is enthusiastic and energetic who wants to use their full scope of practice. We are a licensed renal dispensing community pharmacy. You must have the ability to work effectively in a team environment as well as independently and have great communication skills. Fluency in a second language would be an asset. We are open Monday to Friday 9am-6pm and Saturdays 9am-4pm. We are closed Sundays and stat holidays. We offer a very competitive salary, benefits and a pension plan. If you are interested in joining an established pharmacy and continue to develop your skills, please send resume to michelle@macdonaldsrx.com or call 604.872.4200. Pharmacist - part-time There is an opening for a part-time staff pharmacist in a pharmacy located in Vancouver. Hourly wages are based on experience. New grads are welcome to apply. At least one to two days per week to start and depending on performance this could become full-time. Compensation is negotiable. Qualifications: Bachelor of Science in Pharmacy, impeccable communication skills, high attention to detail, ability to communicate with team members effectively, excellent inter-personal skills; our team is crucial to our success. Please send resume to Jack, owner at jackthepharmacist@yahoo.ca or call 604.753.9116. VICTORIA Pharmacy manager - full-time Full-time pharmacy operations manager. Requirements: Pharmacist license in good standing, three years of retail, hospital or long-term care pharmacy experience, three years of management or supervisory experience, effective written and verbal communication skills, excellent interpersonal and customer service skills, excellent organizational and multi-tasking skills, ability to delegate responsibility, team player and leadership skills. Please send resume to Farishta.ahmad@loblaw.ca. 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. Heart Pharmacy IDA owned by Naz Rayani is looking for an engaged, clinically oriented and outgoing full-time pharmacist to work at our unique community pharmacies. Please send resume to jobs@victoriapharmacy.com. Pharmacist - full-time Attractive opportunity for a pharmacist in Victoria. Excellent wages, health benefits, great hours, in a community pharmacy. Please forward resume to victoriamedicaljobs@gmail.com.

OPPORTUNITIES ACROSS BC Pharmacist - part-time Advance your pharmacy career with the Overwaitea Food Group, a Canadian-owned company that operates under multiple banners: Save-On-Foods, Coopers Foods, Overwaitea Foods, PriceSmart Foods, and Urban Fare. With over 115 pharmacies in over 50 communities across BC and Alberta, and growing into Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality, patient-centered care. We offer an attractive compensation package and our extensive benefits package is one of the industries finest. We have positions available in Kitimat & Creston, Parksville, Prince George, Quesnel, Grand Forks, Fernie, Fort Nelson, Prince Rupert & Campbell River. Floater pharmacist positions are also available. New grads are welcome to apply. Please send resume to pharmacyemployment@owfg.com.

applicable dialogue with patients on prescription and OTC products to provide excellent customer service. Be aware of any in-store events and support these events within the store. Supervise pharmacy technicians. Ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed. Implement proper pricing and receiving procedures to minimize shrinkage. Maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resume to DBilson@rexall.ca.

OPPORTUNITIES OUTSIDE BC ALBERTA Pharmacist - full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We are a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health-related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Please send resume to pharmacyemployment@owfg.com. MANITOBA Pharmacist - full-time

LOWER MAINLAND Pharmacist - part-time London Drugs has a part-time opportunity in the Lower Mainland. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resume to Nelson Costa, Pharmacy Operations Manager, BC at ncosta@londondrugs.com, fax 604.448.1075 or call 604.272.7113. OKANAGAN Pharmacist - relief Advance your pharmacy career with the Overwaitea Food Group, a Canadian-owned company that operates under multiple banners: Save-On-Foods, Coopers Foods, Overwaitea Foods, PriceSmart Foods, and Urban Fare. With over 118 pharmacies in over 50 communities across BC and Alberta, and growing into Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality, patient-centered care. We offer an attractive compensation package and our extensive benefits package is one of the industry’s finest. We have a relief pharmacist position available for the Okanagan region. New graduates are welcome to apply. Please send resume to pharmacyemployment@owfg.com. VANCOUVER ISLAND Pharmacist - full-time Demonstrate strong sales ability, leadership, energy, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care. Consult with patients to maximize Rx and OTC sales. Provide professional advice and

Advance your pharmacy career with Save-OnFoods. With over 100+ pharmacies in over 50+ communities across BC and Alberta, and growing in Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality patient-centered care. Our pharmacy team members are made up of hardworking people who thrive in a demanding and changing environment and are deeply committed to their patients. We offer: Friendly, professional and supportive work environments; flexibility, stability and great compensation packages; opportunities to develop your leadership skills, expand your scope of practice and advance your career. Pharmacist positions available in: Winnipeg, Manitoba. For more information on career opportunities, please send resume to Livia Chan, Regional Manager, Pharmacy Operations at livia_chan@owfg.com. SASKATCHEWAN Pharmacist - full-time Advance your pharmacy career with Save-OnFoods. With over 100+ pharmacies in over 50+ communities across BC and Alberta, and growing in Saskatchewan and Manitoba, our pharmacy team members share a passion for healthy living and quality patient-centered care. Our pharmacy team members are made up of hardworking people who thrive in a demanding and changing environment and are deeply committed to their patients. We offer: Friendly, professional and supportive work environments; flexibility, stability and great compensation packages; opportunities to develop your leadership skills, expand your scope of practice and advance your career. Pharmacist positions available in: Regina & Yorkton. For more information on career opportunities, please send resume to Livia Chan, Regional Manager, Pharmacy Operations at livia_chan@owfg.com.

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MAPLE RIDGE - Pharmacy assistant - part-time Please send resume to alouettepharmacy@gmail. com or fax 604.467.3714.

PHARMACY TECHNICIANS AND ASSISTANTS

MAPLE RIDGE - Pharmacy assistant - part-time Please send resume to gwong2108@yahoo.ca.

For the full listings of pharmacy technician and assistant positions visit the Pharmacy Technician Society of BC website at ptsbc.ca

MASSET - Pharmacy technician - full-time - Please send resume to Alan Williamson, Owner at ps214@shaw.ca.

ACROSS BC - Pharmacy technician - full-time Please send resume to jason.tran@costco.com or call 604.444.9347.

MCBRIDE - Pharmacy technician - full-time - Please send resume to Regan Ready, Pharmacist/Pharmacy Operations Manager at regan@teamrx.net.

ABBOTSFORD - Pharmacy technician - full-time Please send resume to cmhjobs@outlook.com or fax 604.856.7178.

MIDWAY - Pharmacy technician - part-time - Please send resume to Cris Bennett, Pharmacy manager/ owner at boundarypharmacy@gmail.com, fax 250.449.2867 or call 250.449.2866.

BARRIERE - Pharmacy technician - full-time - Please send resume to Regan Ready, Pharmacist/Pharmacy Operations Manager at regan@teamrx.net. BURNABY - Pharmacy technician - full-time - Please send resume to Farishta.Ahmad@loblaw.ca. BURNABY - Pharmacy assistant - full-time - Please send resume to pharmacyemployment@owfg.com. BURNABY - Pharmacy assistant - part-time - Please send apply online at www.safewaypharmacy.jobs. CAMPBELL RIVER - Pharmacy technician - full-time - Please send resume to Farishta.Ahmad@loblaw.ca. CLEARWATER - Pharmacy technician - full-time, part-time - Please send resume to ps231@telus.net, fax 250.674.0056 or call 250.674.0059.

MILL BAY - Pharmacy technician - full-time - Please send resume to rxmanagerps221@gmail.com. NANAIMO - Pharmacy technician - full-time, parttime. Please send resume to Kevin Cox, Pharmacist/ manager at phr01525@loblaw.ca, fax 250.390.5732 or call 250.390.5730. NEW AIYANSH - Pharmacy technician - full-time Please send resume to Alan Williamson, Owner at ps214@shaw.ca or call 604.926.5331. NEW WESTMINSTER - Pharmacy technician - fulltime - Please send resume to pdm128@pdmstores. com or call 778.928.1067. PORT COQUITLAM - Pharmacy assistant - part-time - Please send resume to jobrx@pharmasavepoco.com.

COURTENAY - Pharmacy technician - full-time Please send resume to Farishta.Ahmad@loblaw.ca.

SICAMOUS - Pharmacy technician - full-time - Please send resume to Regan Ready, Pharmacist/Pharmacy Operations Manager at regan@teamrx.net.

COURTENAY - Pharmacy assistant - part-time Please apply online at sobeyscareers.ca.

SURREY - Pharmacy assistant - part-time – Please apply online at www.safewaypharmacy.jobs.

CRANBROOK - Pharmacy technician - full-time Please send resume to peoplespharmacy@telus.net, fax 250.420.4135 or call 250.420.4133.

VALEMOUNT - Pharmacy technician - full-time Please send resume to Regan Ready, Pharmacist/Pharmacy Operations Manager at regan@teamrx.net.

CRANBROOK - Pharmacy assistant - part-time Please apply online at www.safewaypharmacy.jobs. DEASE LAKE - Pharmacy technician - full-time Please send resume to Alan Williamson, Owner at ps214@shaw.ca.

VANCOUVER - Pharmacy technician - full-time Please send resume to ms285@pharmacybc.com.

DELTA - Pharmacy technician - full-time - Please send resume to careers@wescanapharmacy.com.

VANCOUVER - Pharmacy technician - full-time Please send resume to brooke@bixa.ca.

DUNCAN - Pharmacy assistant - part-time - Please apply online at sobeyscareers.ca.

VANCOUVER - Pharmacy technician - full-time Please send resume to Farishta.ahmad@loblaw.ca.

DUNCAN - Pharmacy assistant - part-time – Please apply online at sobeyscareers.ca.

VANCOUVER - Pharmacy technician - full-time - Please send resume to hr@yyoung.com or fax 604.630.1001.

GOLD RIVER - Pharmacy technician - part-time Please send resume to Colleen, Owner at collhogg@ hotmail.com, fax 250.285.3375 or call 250.285.2275. GRAND PRAIRIE, AB - Pharmacy assistant - part-time - Please send resume to pharmacyemployment@owfg.com.

VANCOUVER - Pharmacy technician - full-time Please send resume to hr@nazwellness.com or fax 604.608.3230. VANCOUVER - Pharmacy assistant - full-time, parttime - Please send resume to pharmavancouver@outlook.com.

HUDSON HOPE - Pharmacy technician - full-time - Please send resume to Alan Williamson, Owner at ps214@shaw.ca. KAMLOOPS - Pharmacy technician - full-time, parttime - Please send resume to Missagh Manshadi, Owner/Pharmacist at missagh@manshadipharmacy. com, online at manshadipharmacy.com, fax 250.434.2527 or call 250.574.0111.

VANCOUVER - Pharmacy assistant - full-time Please send resume to Robin, Owner at robin@ robinspharmacy.ca or call 604.876.3784. VANCOUVER - Pharmacy assistant - part-time Please send resume to albertopharmacy@gmail.com. VANCOUVER - Pharmacy assistant - part-time Please send resume to christyhe_@hotmail.com.

LADNER - Pharmacy assistant - part-time - Please send resume to ps246rx@dccnet.com.

VANCOUVER - Pharmacy assistant - part-time Please apply online at www.safewaypharmacy.jobs.

LANGLEY - Pharmacy technician - full-time - Please send resume to hr@nazpharmacy.com or fax 604.608.3230.

VICTORIA - Pharmacy technician - full-time - Please send resume to jobs@victoriapharmacy.com. VICTORIA - Pharmacy assistant - full-time - Please send resume to Dr. John Forster-Coull, Owner at wecompound@telus.net, online at wecompound.com, fax 250.388.5191 or call 250.388.5181.

LOGAN LAKE - Pharmacy technician - full-time Please send resume to Regan Ready, Pharmacy Operations Manager at regan@teamrx.net. LOWER MAINLAND - Pharmacy technician - full-time - Please send resume to Nelson Costa, Pharmacy Operations Manager at ncosta@londondrugs.com, fax 604.448.1075 or call 604.272.7113.

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BUSINESS OPPORTUNITIES Are you thinking of selling your pharmacy? Overwaitea Food Group may be interested. If you would like more information please contact pharmacybuyer1@gmail.com. Forewest Holdings partners with local pharmacists and currently owns 34 Pharmasave locations. We have been partnering with local pharmacists for more than 30 years. We are currently looking for opportunities to acquire more community pharmacies in BC and Alberta. Please contact us if you are ready to sell all or part of your store. Forewest is also always looking for pharmacists who would like to become part owners of a pharmacy. Under the Forewest program you become a shareholder of your store and receive your full prorata share of its income in addition to your normal salary. We have several ownership opportunities available at this time. Please contact Don Fraser, CEO and President, at dfraser@forewest.ca or please call 604.788.9315. Peoples Drug Mart is an established and proven pharmacy banner that will make your pharmacy business more successful and profitable. We provide outstanding marketing support and services for a low monthly fee. Unlike other banners, Peoples Drug Mart does not charge a percentage of sales. Our belief is that the profits from your hard work should stay in your business. With Peoples, you get the best of both worlds, outstanding support and services, and the ability to maintain your profits. If you are interested in purchasing, selling or opening a new pharmacy, please contact Frank Cucca toll free 1.877.450.6006, ext. 18 or 604.619.4846 or email frankc@pdmstores.com. BURNABY - business partner opportunity We are looking for an enthusiastic and experienced pharmacist to become a business partner in this new pharmacy. The candidate must be energetic, friendly, patient focused, capable of enhancing operational efficiency and business value. Minimum of four years' working as a pharmacist is essential. Experience as a pharmacy manager is preferred. Please email your resume and cover letter to masmajlesi@gmail.com. LANGLEY - pharmacy for sale Buy a busy compounding pharmacy. Good neighbourhood clinics. Lots of senior clientele. No methadone. Pharmacy has been in business for over 15 years. Asking $1,499,000 for the whole business. Excellent opportunity for new entrepreneurs or existing pharmacy owner. Email with your phone number and some background about yourself for more details. Please send resumes to jackthepharmacist@yahoo.ca or please call 604.753.9116. TOFINO – partnership/sale Tofino Pharmacy is seeking a partnership for gradual, or immediate outright purchase. Very busy 7000sq ft store, with extremely profitable frontstore. Best location in Tofino, long renewable lease with reasonable rent. Call George at 250.725.8605 or email pdm134@gmail.com UCLUELET – pharmacy for sale Independent pharmacy in Ucluelet, B.C. Owner retiring. Well-established business with growth opportunity for young, entrepreneurial pharmacist(s). Flexibility with purchase agreement and hours worked. Please email hport@ukeecable.net or call 250.726.4342. VANCOUVER – pharmacy for sale Pharmacy for sale. The pharmacy is adjacent to a Medical clinic. For more information contact pharmacy1601@gmail.com.


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