Part 3: Consumption – The 21st Century Villain

This is Part 3 in a series that we have elected to focus on the pharmaceutical industry as it pertains to describing the pharmaceutical industry, the supply of drugs and the development of some intelligent measures focused on providing Canadians a healthcare system that is one of the best in the world.    Care has been taken to make certain the information shared is accurate, the opinions are those of the author and do not reflect the opinions, or the philosophies of staff or management.    The series is provided to inform and stimulate discussion among concerned Canadians.     Access to healthcare for all Canadians is a philosophy that people in other parts of the globe have identified as characteristically Canadian not so different than those other Canadian attributes such as our game is hockey;  the maple leaf and our reputation for being “those nice, polite people living in the frozen north”

EnviRx: Alberta Program

There are statistics being maintained that report as late as 2010, Albertan’s through some 650 participating pharmacies in Alberta have brought in for disposal 55 metric tonnes of drug products.  That includes prescription medications and non-prescription medications such as over the counter cough and cold products, pain medications and the like.   You have to admit that 55 metric tonnes is a large number and although we don’t have a dollar value to attach to this, that too must be an even larger number.   There is no doubt that in this writer’s opinion, the real “holy grail” to solving some of our healthcare budgetary problems is buried in those 55 metric tonnes and unfortunately are being burned up in the incinerator rather than analyzed and reported to those who are trying to find funding for our healthcare demands.   The money is right there!  Wasted, year after year, in increasing quantities!  Why do we continue to waste more and more drug product?   It’s not because Albertan’s are doing anything different than any other provincial populace, but since no one is paying attention to the consumption variable in this complex formula no efforts are being made to tackle this growing problem.   Remember that when those drugs are disposed and incinerated, those are both tax dollars and consumer dollars that have been spent and will not be recovered.   Don’t blame consumers for being environmentally responsible and doing just as pharmacists have been urging.  That is to bring their dead, unused medications into one of those 650 pharmacies for proper disposal, keeping them out of our environment.   Just like so many things, this is the symptom, the real problem – the disease in this case, is the consumption rate that continues to increase, what with all the incentives to purchase, the various retailer incentive points, air miles and the like.

Yes I said it and I’m going to burn because of it, but someone has to say it.  We can’t dance around the issue.  We can’t pretend to protect “free enterprise” and a “competitive marketplace” while at the same time stripping our drug budgets bare, right down to the bone.  Governments and insurance companies are going to come after pharmacies again this year and again next year, just like they have every year since I’ve been in this business.   Each year they put someone in place to “negotiate” with pharmacy representatives, but it’s not a negotiation, it’s a one sided, heavy handed, power play where pharmacy loses.   A process that employs a government representative who despises pharmacists and sees no value in their participation in the healthcare of Albertans.   A person who has no clear plan for pharmacist’s participation in healthcare, no vision for healthcare in Alberta and no strategy for moving healthcare forward.  So instead, we continue to stagnate, stripped of revenues,  given empty promises,  forced to seek other methods of  bringing revenues into the pharmacy – you know what I mean – the fast food items, groceries, snow shovels, barbeques, electronics, computers, tires and all manner of products unrelated to what pharmacists really do.

As a result of this new business model, Corporate Pharmacy comes out of this smelling like roses.   They offer consumers everything they need and a little more, at prices that often appear to unbeatable which of course has the side effect that people often buy more than what their immediate needs demand and once you’ve got the product, well for some reason it just doesn’t seem to last any longer than before, so you’re back in the “all under one roof” retailer for that something.   And the cycle continues, which is one thing if it is snack food and toilet paper, but quite another if it is prescription medications.  Remember what I just described a minute or two ago – 55 tonnes of dead drugs in ONE year. Well, that consumption and waste has to be paid for by someone and that someone is you – the consumer – the patient.  And you will, sooner or later, which is what really bothers many knowledgeable people in the industry.  Of course, in this situation, where is the pharmacist? Depending on the environment, he or she is either an employee within a corporate structure which puts revenues via number of transactions first and foremost; or she or he is in an independent pharmacy environment as an employee or a business owner, where income is tied in not so much on transactions but on the quality of interaction with the patient and the outcomes of those interactions.   After thirty-two years of experience in this profession I will tell you that the profession of pharmacy (which includes it’s members, it’s professional institutions such as the Alberta College of Pharmacists, and teaching institutions) has shown a greater influence on the independent pharmacy and its pharmacists than it has on the corporate environment.

And before I am criticized by the pharmacist working in the corporate environment I will further clarify that I have met some exceptional pharmacists working within corporate pharmacy, who fight every day to maintain the priority of their professional duties and responsibilities over the number of transactions head office continues to push on them.  I have the greatest respect for those pharmacists because they have continued a fight to change corporate thinking and to retain or in some cases, regain professional autonomy within that environment.   This takes a certain kind of courage that is not all that common, but to those pharmacists, I salute you!

Pharmacy as a professional practice should be self-sufficient and self-sustaining with respect to its revenues based solely on prescription medication sales and those directly related health products and services. This is what we are trained for!  This is what we do best.  This is how we will provide the greatest impact on the healthcare of Albertans.  This would seem logical don’t you think?  You don’t see your physician or dentist having to sell barbecues, computers, big screen TV’s, produce and cuts of beef to sustain their practice?   So why the pharmacist?  It’s a question that I have struggled with for more than thirty years practicing in community pharmacy.

To add insult to injury this training of pharmacists is with your tax dollars, in case you were wondering.  Yes, you understand correctly; Albertan’s are still paying for the bulk of the five year education of 130 pharmacists each year in this province.  What’s the cost per student?   Good question and not likely a small sum.  By the way – that education cost will be increasing very quickly as the education program moves to a six year PharmD program.   What’s the logic in this?  Well, it is in response to the fact that a growing number of jurisdictions in the United States and now Canada are doing the same.  In fact, in the U.S. the PharmD has been the entry level education and degree level for pharmacists in many states for more than ten years.  So this is not a new initiative but I’m asking you to look at with a more critical eye, now that you are better informed about the profession and the industry.

Getting back to the logic of the PharmD in Alberta – the amount of knowledge that is being transferred to pharmacy students in the course of their studies as well as the need for an expanded clinical experience component (a hands on ; in the field; practical if you will – experiential training for students) as pharmacists are placed into more clinical roles where therapeutic decision making is their focus as well as drug therapy monitoring and management of this therapy.  In some environments the physician will make the diagnosis and the decision to treat with drug therapy.  The pharmacist then quickly steps in to choose the best drug therapy, set up monitoring parameters, treatment outcomes and then prescribes the appropriate drug therapy for the patient.  The therapy is then followed by the pharmacist, with reports going to the physician and changes to the therapy are done as a result of a discussion between pharmacist, physician and patient.   This model has proven itself over and over to be very effective, efficient and the satisfaction level from the patient much better because they are playing a role, not to mention that the treatment outcomes are consistently much, much better.  You have to like those kinds of results!

That treatment scenario however does not yet exist in Alberta so the addition of the PharmD in this pharmacist’s opinion is a bit premature.   Although we have made some major strides in the role of the pharmacist as a primary healthcare provider, there are still many aspects of our role that must change as well as the way our own profession recognizes its many practising members.  Unfortunately, that discourse although very important has to wait for maybe another article.   Let’s get back to the discussion on drug consumption because that is where I am still headed.

Until pharmacists can be given the authority to make the important drug utilization decisions, we will continue to be dictated to by everyone else including the drug plans, the third party plan adjudicators and government bureaucrats.   None of those mentioned have a vested interest in the care and the health outcomes of each and every man, woman or child living in this province.   Don’t misunderstand, economics, budgets, how much we spend on healthcare is important make no mistake about this.  But there are ways to balance budgets, keep healthcare costs within reason – in particular, drug therapy – that is not at the sacrifice of good patient care.  Universal healthcare as it stands in Canada can work if the healthcare professionals are allowed the control of patient care that they must have to be effective.  And in particular, there is adequate demonstration that your pharmacist is a key to this solution; is a solution and not a problem; is NOT a cost to the payers, but an asset that must be used intelligently, thoughtfully, within the context of a community based team of healthcare professionals who are focused on improving the health of their community as well as participating in the acute care of those affected by illness, trauma or tragedies.

Thank you for reading this three part article.  The hope is that it generates some intelligent discussion among us; that it will pose some questions that some will feel compelled to find answers to and maybe create some small controversies in the process.  Most importantly, it has you thinking, and questioning.   Now you need to act, so this democracy we call Canada, can continue to improve and become the leader in everything we do, including the healthcare of its people.

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