Research Profile - Q&A: An Evolving Role
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Dr. Ingrid Sketris
With 16,000 drugs on the market in Canada and more patients taking multiple medications for longer periods of time, the pharmacist's role is changing.
CIHR-funded researcher Dr. Ingrid Sketris is one of Canada's leading thinkers on the evolving role of the pharmacist. She was Chair of Health Services Research at Dalhousie University for 10 years, focusing on pharmaceutical policy and drug utilization. She has also been a leader of the Dalhousie College of Pharmacy's Initiative on Medication Management, Policy Analysis, Research & Training (IMPART). Dr. Sketris shares her perspective here.
Question: What is your sense of the pharmacist's changing role in health care – and what is driving that change?
Answer: There are a number of things driving it. One is that pharmacists are increasingly well trained. I've been teaching and doing pharmacy-related research at Dalhousie for 31 years. In the beginning we had much focus on the basic biomedical sciences and how drugs work. While pharmacists still have that strong training, they also get more education on clinical aspects of drugs to determine which one is likely to work best for which patient. We've also focused on improving their communication skills to help them work more effectively with patients to develop individualized care plans for better outcomes from drug therapies.
By the numbers: where pharmacists rank in the health-care workforce*
- Nurses: 348,499
- Physicians: 68,101
- Pharmacists: 30, 553 (excluding Quebec and Nunavut); 31, 384 according to the National Association of Pharmacy Regulatory Authorities
- Medical Laboratory Technologists: 19,238
- Physiotherapists: 17, 312 (excluding the Northwest Territories and Nunavut)
- Occupational Therapists: 13, 122
* Source: Canadian Institute of Health Information health-care workforce reports for 2009 – the most recent data available.
Q: What brought about that shift?
A: Again, it's a number of things. There are over 16,000 drugs on the Canadian market and pharmacists have to know about all of them. The pharmacist can screen to ensure that the potential for drug interactions is minimized, to reduce adverse events and to make sure the patient is not inadvertently receiving multiple drugs for the same thing. Also, today chronic disease is more prevalent. Decades ago, drugs were often used to treat acute illnesses – you had an infection and you were on your drug for a week or two. Now we have a number of different chronic diseases, such as diabetes or hypertension, and people are on drugs for those conditions for very long periods of time. So it's important that someone on your care team monitors which drugs you're on and which ones are the best ones for you. Are the drugs having the intended therapeutic outcomes? Are you having any avoidable side effects?
Q: Has the shortage of family doctors created a need for someone to fill the breach?
A: Absolutely. There are a number of Canadians – some studies put it at 4 million1 – who don't have family doctors. They often need their medications reviewed and renewed. The pharmacist can play a role by renewing prescriptions. However, regulations vary across provinces. Here in Nova Scotia, the pharmacist can renew a prescription if they've had a professional relationship with the patient for a period of time and if their disease is stable. Many provinces allow pharmacists to adapt prescriptions. For example, a doctor might write a prescription for a patient in tablet form but if the patient is having difficulty swallowing the tablet the pharmacist can change it to a liquid form, without having to call the doctor to get permission for the change.
Q: In some provinces, pharmacists can initiate prescriptions and can give vaccines for influenza. So there is recognition from provincial governments that pharmacists can play a greater role, isn't there?
A: Currently, there are three provinces – New Brunswick, Alberta and British Columbia – that permit pharmacists to prescribe and administer vaccines. That's particularly useful in the flu season when working people find it hard to take time off. A pharmacy is a convenient place for a vaccination. Although there is legislation for pharmacists to prescribe vaccines in Nova Scotia, they cannot yet administer them.
Q: Are pharmacists embracing these challenges?
A: As in any new practice, there are early adopters and then the others follow. In Nova Scotia, pharmacists do medication reviews for seniors paid for by the government if the senior meets a number of conditions. The pharmacist sits down with a patient to review all their medications and determine if some need to be stopped or new ones started and then provides this information to their physician. A study showed that 30% of Nova Scotia pharmacies had done at least one medication review. So, it's not everybody yet, but it's coming.
Q: Is there acceptance within the medical community of pharmacists being more involved in the provision of health care? Are physicians warming up to this?
A: Health care has become very complex. There are so many facets of disease prevention and management that it's imperative to involve those with specialized expertise – physicians, nurses, pharmacists, physiotherapists, dietitians or others – who can contribute to patient care. Crucial issues are collaboration, coordination and effective communication. According to recent literature from the United Kingdom, general practitioners are often still the quarterbacks, but there has to be good communication among the team members.