Pharmacy Provincial Updates

Approximately seventy pharmacists have been granted additional prescribing authorization in Alberta. The percentage of successful applicants is now approximately 90%.

The Alberta College of Pharmacists has proposed amendments to the Standard regarding ordering of laboratory tests and using laboratory data. Currently, this amendment is going through a sixty day consultation period. The amendments and recommendations will be reviewed in April, 2010. Pharmacists who orders laboratory tests must apply for a practice ID number.

Ontario Ministry of Health and Long Term Care-Drug System Reform

Since summer 2009, Ontario pharmacists have been anxiously awaiting announcements from the Ministry of Health and Long Term Care regarding proposed reforms to the drug system. Recent cuts to the overall reimbursement model have threatened to increase, and MedsCheck as the first formal reimbursement for community pharmacy professional services has not expanded within community pharmacy, or to the LTC sector. In Fall 2009, the Minister of Health, David Caplan, resigned (over an e-health scandal), and previous lobbying efforts by pharmacy were stalled. Efforts by an existing MOHLTC working group to propose a new funding model for LTC services were also stalled and then resurfaced with a new working group, pending a review of the results of the Ontario Pharmacy Costing Study. This costing study reveals valuable information about what pharmacies are funding for residents in Long Term Care in Ontario. These results were recently released and a summary and webinar can be found at: http://www.cacds.com/CACDSonRecord/ValueofPharmacy/tabid/265/Default.aspx

In the meantime, Ontario’s Community Pharmacies (OcPh), a coalition of the Ontario Pharmacists’ Association (OPA), the Canadian Association of Chain Drug Stores (CACDS) and the Independent Pharmacists of Ontario (IPO), held a series of rallies in January 2010. More than half of Ontario’s 6 000 practicing pharmacists attended, and were asked to obtain public support in case it was needed. More information at http://ontario.communitypharmacies.ca/

Auditor General’s Report on Medication Management

In 2007, the MOHLTC Auditor General’s report, based on audit of 3 nursing homes in Ontario, released a “value for money” report on medication management in LTC, available at the following link: http://www.auditor.on.ca/en/reports_en/en07/310en07.pdf

A follow up to this report is available at the following link: http://www.auditor.on.ca/en/reports_en/en09/410en09.pdf

A Standing Committee on Public Accounts responded to this report with some recommendations of potential concern to LTC pharmacy funding (link below). OPA, in participation with the LTC committee, along with CACDS, submitted a response to the Ministry. http://www.ontla.on.ca/committee-proceedings/committee-reports/files_pdf/img-Y181722-0001Eng.pdf

Released after this report (and response), but also formed in response to the Auditor General’s report, the following is the report of a Joint Task Force on Medication Management, which is generally very supportive of pharmacy services in LTC. It promotes the role of the clinical consultant pharmacist in LTC but also increases expectations of the LTC pharmacist that may not be adequately funded: https://www.ltchomes.net/ltcf2/Content/Snippets/Joint%20Task%20Force%20Report%20-%20Nov%205%20-FInal.pdf

To date, this report has been considered of great value by LTC pharmacy and LTC homes alike. Response from MOHLTC is pending.

Pharmacists and Expanded Scope of Practice

Recently introduced legislation in Ontario, The Regulated Health Professions Statute Law Amendment Act, 2009, will allow Ontario pharmacists to administer a substance by inhalation or injection; modify, adapt or extend a prescription; initiate a prescription; and perform a procedure on the tissue below the dermis. All of these pharmacist acts will be defined by supporting regulations currently being written by the Ontario College of Pharmacists. The legislation is available at the following link: http://www.ontla.on.ca/bills/bills-files/39_Parliament/Session1/b179.pdf

New Long Term Care Homes Act (Bill 140)

The Long Term Care Homes Act 2007 received Royal Assent in 2007, and when it comes into force along with accompanying part 1 and 2 regulations, will consolidate the 3 current acts that currently govern Nursing Homes and Homes for the Aged in Ontario. Part 2 Regulations have the greatest potential impact on Pharmacy’s role, and OPA and CACDS made recommendations to the draft regulations in late 2009. Details of Bill 140 can be found at: http://www.health.gov.on.ca/english/public/legislation/ltc_homes/ltc_homes.html

Funding and Defining Pharmacy Services:

The Pharmacy Association of Nova Scotia (PANS), in conjunction with the Canadian Association of Chain Drug Stores (CACDS), has been working since June 2009 on an adaptation of the Pan-Canadian Framework for Funding and Defining Pharmacy Services. The Framework proposes a new pharmacy funding model, and a transition plan to a service model in which professional services delivered by pharmacies are funded directly and sustainable. The current agreement between pharmacies in Nova Scotia and the Department of Health expires on March 31, 2010. Meetings with the Ministry of Health are expected to begin before mid-February.

Nova Scotia Continuing Care Strategy:

In May 2006, Nova Scotia Department of Health announced their “Continuing Care Strategy” with the vision “to have every Nova Scotian live well in a place they can call home”. This strategy may be viewed at http://www.gov.ns.ca/health/ccs_strategy/Continuing_Care_Strategy.pdf

Currently there are 84 licensed Long Term Care facilities (6284 beds) in Nova Scotia. The Continuing Care Strategy will see 1,320 new long term care beds in the province by 2016. Of those beds, 832 will be open no later than 2010. Across the province there are also a number of long term care facilities that are getting older. To ensure that residents continue to live in a safe environment where they can enjoy a high quality of life, the province is beginning to replace these facilities. By the end of this year, 721 beds at nine continuing care facilities will be replaced.

We have seen the design of these new facilities take on a whole new feeling that is truly like being in your own home. Residents have private rooms and bath, very comfortable and inviting common areas, kitchens on site for meal preparation, there are smaller groupings of residents under a nurse’s care, and care plans are driven by the resident as much as possible. Many existing facilities have implemented changes in resident care philosophy and design changes, where possible, to help clients feel more at home.

The changes in care philosophy and the evolving team approaches to health care of residents have certainly had a positive impact on pharmacist consultants at the homes they service. There are pilot projects ongoing in Nova Scotia related to having a physician dedicated to a facility/unit. The consultant pharmacists have been an integral part of these health care teams and have seen positive effects for the resident.

Pharmacy Requirements for Nursing Home Licensing

Nova Scotia Department of Health is in the process of revising the annual licensing requirements for nursing homes. To date the main item impacting pharmacy is that the requirement of statistical information on medication class usage is no longer required. Pharmacy is able to focus on the areas best suited to the individual facility and their residents. During the licensing process, Department of Health has been identifying consulting services offered to facilities by pharmacy. We have yet to see if/how these services will be incorporated into pharmacy service requirements of the new licensing document.