SPECIAL SUPPLEMENT. A New Way Forward: Exploring a New Pharmacist Practice Model. JOSHUA TORRANCE University of Alberta

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1 SPECIAL SUPPLEMENT In 2013, the Blueprint for Pharmacy National Coordinating Office launched the second annual Blueprint Live: Blueprint for Pharmacy Prize for Student Leadership in Practice Change, a pharmacy student essay competition. This special supplement to the December 2013 issue of Blueprint in Motion is a collection of the Blueprint Live entries from the three finalists. BLUEPRINT LIVE A New Way Forward: Exploring a New Pharmacist Practice Model 1 st JOSHUA TORRANCE University of Alberta Introduction Health care has a special spot in the hearts of Canadians. A 2005 poll found that 85% of Canadians believed that eliminating public health care would result in a fundamental change to the nature of Canada, putting it ahead of abandoning English and French as Canada s two official languages and eliminating peace keeping operations. 1 This importance is solidified when one examines the cost of the Canadian health care system: over $200 billion annually; the three biggest expenditures of health care being hospitals, drugs, and physicians, at 29.1%, 15.9%, and 14.2% respectively. 2 As the population of Canada ages, we will see continued use of health care resources, largely driven by an increased prevalence of chronic disease. Chronic disease rates in Canada are growing 14% per year and already impact three out of five Canadians over the age of Given these growing trends, it is expected that health care expenditures will continue to increase unless changes are made. The Federal and provincial governments continue to look for ways to tackle the growing health care budget, particularly with the three largest expenditures. Recent changes to the profession of pharmacy have been largely driven by these factors; for example, generic drug cost reductions to reduce costs to public health plans. Other changes have been implemented to address the other two major health expenditures: physician and hospital expenses. The rapid expansion of the scope of practice for pharmacists across the country has positioned pharmacists to play a larger role in primary care (Figure 1). These changes ideally will help address the concerns of increasing chronic disease and health care costs by two means: improving access to primary care and reducing use of higher cost health care resources, such as physician and hospital services. 4 January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 1

2 Figure 1: Summary of Pharmacist s Expanded Scope of Practice Activities across Canada. Adapted and modified from the Canadian Pharmacist Association, June ,6 3 Implemented in jurisdiction P Pending legislation, regulation or policy 6 Not implemented Pharmacist Scope of Practice BC AB SK MB ON QC NB NS PEI NL NWT YT NU Provide emergency prescription P Renew/extend prescriptions , Change drug dosage/formulation P 3 3 7, Make a therapeutic substitution , Minor ailments prescribing P 7 P Initiate prescription drug therapy P Order and interpret lab tests P P 3 7,8 3 P Administer a drug by injection P 3 5 P 7,9 3 P 6 P AB: pharmacists in Alberta who have additional prescribing authority can prescribe a prescribe a Schedule I drug (prescription-only) for the treatment of minor ailments 2. SK & NS: only as part of minor ailments prescribing 3. MB: as per Continued Care Prescriptions policy 4. ON: prescribe specified drug products for the purpose of smoking cessation 5. ON: administration of influenza vaccination to patients five years of age and older. Administration of all other injections and inhalations for demonstration and educational purposes 6. QC: Currently only through of administrative agreements between pharmacist & physician regulatory authorities and QC government 7. QC: Act 41 will independently permit these activities as of September 3, QC: when authorized by a physician by means of a collective prescription (i.e., collaborative agreement) 9. QC: for demonstration purposes only 10. NB: prescribing constitutes as adapting, emergency prescribing or within a collaborative practice; independent prescribing or as part of minor ailments prescribing is impending While the aforementioned changes enable a broader scope of practice for pharmacists and allow them to address many problems within the health care system, they have been frequently criticized for not providing sufficient financial support to support pharmacy practice, particularly following the significant reductions in generic rebates in many provinces. 7,8 These concerns range from a complete absence of public funding to concerns over inadequate reimbursement for the time and work involved. 6,9-12 Even Alberta, arguably the forerunner in scope of practice and funding of pharmacy services through the Pharmacy Practice Framework (Table 1), has seen significant concerns over whether these changes will be able to support pharmacy practice. 13 These concerns in Alberta were raised quickly after the Pharmacy Practice Framework was announced by the Government of Alberta, but there has been little work into testing how to incorporate these changes into pharmacy practice. Current statistics released by the Alberta College of Pharmacists and the Alberta Pharmacist Association shows that, in general, uptake of these services has been slow (Figure 2 and Figure 3). Figure 3 shows that, while pharmacy service delivery has increased for billed services since implementation, most pharmacies are delivering less than two billed services per day. As a student finishing my final year at the University of Alberta, these are services I have been trained to deliver since I started the program. I believe these services to be the future of pharmacy and I have a vested interest in seeing how new models can be incorporated into a sustainable practice. Thus, I spent the summer with two classmates designing a practice and payment model to test the sustainability of the Alberta Pharmacy Practice Framework. Table 1: Reimbursement fees for Alberta Pharmacists under the Pharmacy Practice Framework 10 PHARMACY SERVICE BILLABLE FEE Assessment for a Prescription Renewal $20.00 Assessment for an Adaptation of a Prescription Assessment for the Administration of a Product by Injection Assessment for Prescribing at Initial Access or to Manage On-going Therapy $20.00 $20.00 $20.00 Assessment for Prescribing in an Emergency $20.00 Assessment for Refusal to Fill a Prescription $20.00 Assessment for a Trial Prescription $ Comprehensive Annual Care Plan (CACP) without APA $ CACP with APA $ Follow-Up CACP Assessment without APA $20.00 Follow-Up CACP Assessment with APA $25.00 Standard Medication Management Assessment (SMMA) without APA $60.00 SMMA with APA $75.00 Follow-Up SMMA without APA $20.00 Follow-Up SMMA with APA $ Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

3 Figure 2: Cumulative totals billed for various services under the Alberta Pharmacy Services Framework since July 1, ,000, ,000 10,000 1, Renew Rx Adapt Emergency Injection APA CACP/SMMA Follow-Up Figure 3: Average number of billings per day per pharmacy for various services under the Alberta Pharmacy Services Framework Renew Rx Adapt Emergency Injection APA CACP/SMMA Follow-Up January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 3

4 THE MODEL The focus of this project was two-fold: to explore the financial and logistical considerations of the Pharmacy Practice Framework. The ultimate purpose of the project financially was to achieve net profits that would sustain a pharmacist at their equivalent hourly wage. Due to limitations at the practice site, this project was operated under a limited fee-for-service model, with payment occurring only for the completion of CACPs, SMMAs, and the follow-ups for each. A person who completed one of these services was compensated with a percentage of the total billable fee for said service. The logistics focused on were: recruitment of patients, completion of services, patient documentation, and appropriate notifications to both the family physician and patient. We all found that patient recruitment was best done in person at the pharmacy, whether patients were dropping off a prescription or picking one up. The actual interaction was left to the discretion of the student, with the knowledge that certain information had to be collected for the completion of a Best Possible Medication History (BPMH) and for pharmacy documentation (e.g. patient height, weight, medical conditions, and allergies). The final documentation note and the BPMH were completed using documentation forms I developed on Microsoft Word and were modified by the three of us as we became more comfortable with the process. All documentation was done electronically; all required paper documentation, such as patient consent, was scanned and kept on file. Physicians were notified of our completion of these services and any recommendations via fax and patients received a copy at a future pharmacy visit. While this model was developed independently of the Blueprint of Pharmacy, it embodies many of the messages contained therein. It addresses some of the current issues noted in The Blueprint for Pharmacy: Our Way Forward report, as well as supports the need for work done in other areas. The following will examine the various aspects and details of our model in the context of the Blueprint of Pharmacy. pharmacy human resources The appropriate use of human resources was one of the earliest problems that had to be addressed when the model was being developed. The pharmacy is typically staffed with multiple assistants and a pharmacist who is located in the dispensary and primarily responsible for dispensing tasks. Given this dispensing model, we felt the assistants would best be used in the preliminary identification and recruitment of patients, as they have the most direct patient interaction at entry and pick-up, and the pharmacist is largely occupied with dispensing activities. They were provided with aids and trained to recognize key medications that would identify qualifying conditions and risk factors (Figure 4). Potential patients were verified by a pharmacist or pharmacy student and then flagged in the dispensing software. Flagged patients were approached at prescription drop-off or pickup and offered care plan services by a staff member. Ultimately, this system worked well; it added minimal work to the assistant staff and did not add significantly to the workload of the pharmacist. It also allowed us students to focus more on the delivery of services and documentation as needed. Figure 4: Patient eligibility criteria for a CACP or SMMA Group A (Chronic Diseases) Hypertensive disease Diabetes mellitus Chronic obstructive pulmonary disease Asthma Heart failure Ischemic heart disease Mental health disorder Group B (Risk Factors) Tobacco Obesity Addictions CACP Eligibility Two conditions from Group A OR One condition from Group A and one risk factor form Group B SMMA Eligibility One condition from Group A AND Three schedule 1 medications/ insulin 4 Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

5 GOING FORWARD I felt this model had a good opportunity to contribute on a greater scale to pharmacy practice and, with the owner, I successfully registered the pharmacy to participate in the Vascular Risk Reduction Community Pharmacy Initiative. This study will examine effectiveness of community pharmacists in identifying and initiating interventions for patients at high risk of cardiovascular events and the subsequent reduction in estimated risks for cardiovascular event. Recent legislation in Alberta has also resulted in the creation of the profession of registered pharmacy technicians. This profession is able to supervise and complete all technical aspects of dispensing. With adjustments in workflow it would be possible to free up pharmacist time to deliver these clinical service alongside their dispensing roles. This is something the pharmacy is interested in pursuing and it may generate alternative methods to deliver these clinical services in the future. EDUCATION AND CONTINUING PROFESSIONAL DEVELOPMENT While this was not an area directly considered in the project, I do feel it has relevance. Pharmacist students are generally not given the same level of experiential training as other students, such as medical or nursing students. This can lead to them being stuck more in an observer role and potentially even viewed as a burden. 19 This project is a potential model in which students can gain more experiential training and ensures that they are providing some level of benefit to the site. It provided all three of us an excellent opportunity to explore or strengths in weaknesses in patient care under the supervision of a pharmacist as needed. As will be shown, we were also able to provide a significant financial benefit to the pharmacy. GOING FORWARD We realized that we would be unable to continue this project in the long term due to school schedules. This prompted us to design the program in a way that closely matches the patient care process as taught by the University of Alberta. Doing so has allowed us to easily train and allow other students to benefit from these services. This is something to consider for both pharmacies and the Faculty, as the easier the transition is from school-to-pharmacy, the more beneficial it is for students and pharmacies. INFORMATION AND COMMUNICATION TECHNOLOGY The delivery of clinical services in a community pharmacy is a fairly recent development and there was a clear acknowledgement that the current state of available technology was lacking. This included our own resources and tools and that of the entire health care system. Our own limitations became incredibly apparent when we started to document. The process was extremely time-consuming and we had no way to effectively use the dispensing software to communicate with other staff members. While we did optimize our documentation form, there were still numerous areas where we were duplicating our efforts unnecessarily, such as in the constructions of a BPMH. Despite these limitations, I feel we were able to make the process as efficient as we could and have a positive impact on patient care. One clear example was making full use of medical conditions and vital statistics on the patient profile. Completing this information in the level of detail we did allows the current technology to run automatic checks for issues such as condition-drug interactions and dosage adjustments due to weight, body surface area, or creatinine clearance. This is something that will provide an important double check for the pharmacist while dispensing medications. The limitations of the Electronic Health Record (EHR), Netcare, were also quite apparent. While it did provide invaluable information such as laboratory information, we found that information such as medications may be missing and documentation by other health care professionals was often minimal or absent. Even basic information, such as a diagnosis, may be entirely absent on a patient profile. This is something I hope will be improved countrywide as I feel it could have a significant impact on not only pharmacy services, but all levels of health care delivery. January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 5

6 GOING FORWARD The need for specialized software to accommodate both dispensing and clinical services is apparent. The integration of these functions would greatly reduce the duplication of work we had to do, such as adding medical conditions to both the patient documentation and patient profile and typing up a completed BPMH when the information is already available on the patient profile. It would also improve the communication between clinical and dispensing staff, allowing one to benefit directly from the other. This is something I hope to work on in the coming months, as the demand for such tools will only increase as more pharmacists deliver these services. Improvements to Netcare are another important area that would greatly improve patient care services. The biggest improvement would be to allow better communication between health care professionals. The current systems of faxing notifications and care plans to physicians could be improved with changes to the EHR to allow more interdisciplinary communication. Additionally, it could greatly reduce the duplication of efforts between health professionals. It is unlikely we were the first people to take full histories as we did, and having access to prior documentation notes would reduce workload on numerous professionals. Fortunately this is an area that has been acknowledged nationally, and organizations such as Canadian Health Infoway are working to address many of these concerns. FINANCIAL VIABILITY AND SUSTAINABILITY This was perhaps the most important question I sought to address, as I feel it is one of the key factors that will determine uptake of these services by pharmacists. Table 2 shows the services delivered by the pharmacy and the financial breakdown of these services. Only period 5 and 6 were assessed for hourly income, as subsequent analysis was confounded by the reset of the billing year on July 1, Many care plans done after this date were ones that had been recently completed and required significantly less effort than that of a new patient. Period 5 shows an estimated hourly income of $68.87 and period 6 an estimated hourly income of $ I attribute this difference to our increased familiarity with the system and improvements in our technology and methods. While this is by no means a complete analysis of the financial viability of the Pharmacy Practice Framework, I feel the results have some merit. From an hourly wage stand point we achieved the goal of matching a pharmacist wage. One major consideration that would need to be taken into account would be the issue of pharmacy overhead costs. At these current rates there would still be at least $20 per hour that could be given back to the pharmacy as a fee for pharmacy resources and patients. While this does not likely replace income lost for generic price reductions, it is still an extra source of income for the pharmacy. Another important consideration is if this wage is attainable in a standard length pharmacist shift. We found that effective recruitment and completion of services coincided with busy periods in the dispensary, as this was when foot traffic was greatest. If one focuses on the completion of services during these periods, and completes documentation at slower times, it was quite possible to complete four to six care plans in one eight hour shift. There are several other factors to still consider, but I believe this preliminary analysis should encourage pharmacies to explore increased investment into pharmacist-delivered services. Table 2: Summary of services completed, gross income, and estimated hourly income PERIOD TOTAL HOURS WORKED COMPLETED SERVICES CACP SMMA FOLLOW-UP CARE PLAN TOTALS GROSS INCOME HOURLY INCOME Period 5 (Apr 21-May 18) $9, $68.87 Period 6 (May 19-Jun 15) $12, $79.08 Period 7 (Jun 16-Jul 13) $21, Period 8 (July 14-Aug 10) $9, TOTAL $51, Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

7 GOING FORWARD Our model was not capitalizing on potential revenue in multiple areas. Simply having a pharmacist on staff with Additional Prescribing Authorization (APA) would have increased total income by 25% (Table 3), and increased hourly income to $86.09 and $98.85/hour respectively. This is a major issue for the profession in Alberta. APA has been available since mid-2008, but only 220 of the province s 4431 pharmacists Table 3: Estimated gross income and hourly income had services been performed with APA PERIOD INCOME HOURLY INCOME Period 5 (Apr 21-May 18) $11, $86.09 Period 6 (May 19-Jun 15) $15, $98.85 Period 7 (Jun 16-Jul 13) $26, Period 8 (July 14-Aug 10) $12, TOTAL $64, have obtained this authorization. 18 This is a very simple method to make these services more profitable, and is something I would deem a necessary requirement. We also had many lost opportunities for follow-up due to patients not be identified by the dispensing staff. This is an area I feel could generate a significant and stable income source for the pharmacy if implemented properly. Another issue was the limited number of services we were reimbursed for: CACPs, SMMAs, and follow-ups. There are numerous other services for which pharmacists can be reimbursed that we did not promote and actively recruit for. Using data collected before we initiated our project, this pharmacy completes about 2.2 other pharmacy framework services per day compared to the provincial average of 1.3 services per day per pharmacy However, I feel this is still well below what the pharmacy could complete. For example, there are still a significant amount of unnecessary refill and change requests that are sent to physicians that could be safely managed by the pharmacy. LEGISLATION, REGULATION AND LIABILITY The legislation enacted by the Government of Alberta was critical in developing this project. While I feel it is a very important step forward for the profession, I do believe there is still work to be done with the current system. The biggest concern was that the current qualifying criterion does not always reflect the complexity of the patient. Qualifying patients could have as few as two medications or twenty; they could simply be a smoker with mild COPD or have five additional conditions. While on average the system works out, issues arose when multiple people are working on one patient. One approach we considered was focusing on the qualifying conditions on the initial consult and using followups to cover the other conditions. However, this made it difficult to fairly reimburse all involved staff. Two people may do equivalent amounts of work, but the one who did the initial consult made significantly more money. We addressed these concerns on a case-by-case basis, but I feel the entire issue highlights potential risks with the current system. Patients who benefit the most of these services may not ideal candidates from a financial perspective, and they risk being overlooked for easier to manage patients. I also found that there were several conditions oddly absent from qualification, such as atrial fibrillation and chronic kidney disease. Such conditions may carry significant risks for patients or significantly impact pharmacological treatment, but there is no financial incentive to target these patients. This again highlights how those who may benefit the most from these services may be passed over. GOING FORWARD I believe the current legislation would benefit from at least one more level of complexity on the system. Looking to other billing systems, I feel the physician model may have some appropriate ideas. Two methods they have used to address the issue of complexity are using multiple different billing codes to more accurately reflect the services provided or using modifiers that provide an additional fee for patient care that may take longer than average. 20 Both options have potential and could address the noted problems. January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 7

8 PUTTING IT ALL TOGETHER This experience was an incredible opportunity to take a patient care model and business idea and see first-hand the difficulties and successes that would arise. I feel I have a far better understanding of our current health care system in Alberta, and truly appreciate the work that is being done by organizations such the Alberta College of Pharmacists and the Alberta Pharmacists Association. I also better understand the need for the Blueprint for Pharmacy and am far more appreciative for the work it does and the goals it promotes. I have learned that the problems I have faced in this project are similar problems seen across Canada for the profession, and that we are making progress on the issues. More and more provinces are developing an expanded scope of practice, and new payment models are close behind. While the Alberta model is not perfect, I do believe it has the potential to succeed. I think what I have shown with my classmates is a good first step in the examination of the Pharmacy Service Framework. It is my hope that pharmacists in Alberta will take the risks we did and see that pharmacists have the potential and the ability to offer direct patient care services beyond dispensing. Studies like the Vascular Risk Reduction will only further these goals, as we show that these services not only have a financial benefit, but a measurable benefit on patient health and outcomes. I truly believe the vision outlined by the Blueprint for Pharmacy will have a significant impact in addressing the concerns of the Canadian health care system, whether they are concerns for patient health and safety or over rising health care expenditures. With continued support from pharmacists, patients, and governments, I believe the road map laid out by the Blueprint for Pharmacy is attainable and we will continue to make advancements. I look forward to my future career as a pharmacist and hope that I will be able to continue to contribute to the future of the profession, and I hope that others will do so as well. n Acknowledgments Special thanks to my classmates Sakina Adamjee and Melissa Chung for all their help in making this project possible, Joey Ton for his help in the early stages of the project, and to Murtaza Hassanali and the staff at Shoppers Drug Mart #371 for their continued support to this project. References 1. Soroka SN. A report to the Health Council of Canada: Canadian perception of the health care system. [Online] Feb [cited 2013 Aug 14]. Available from: PublicPerceptions.pdf. 2. Canadian Institute for Health Information. National health expenditure trends, 1975 to [Online] [cited 2013 Aug 14]. Available from: 3. Elmslie K. Against the growing burden of disease., Centre for Chronic Disease Prevention; Canadian Institute for Health Information. Health Care Cost Drivers: The Facts. [Online] [cited 2013 Aug 14]. Available from: secure.cihi.ca/free_products/health_care_cost_drivers_the_facts_ en.pdf. 5. Canadian Pharmacists Association. Summary of pharmacists expanded scope of practice activities across Canada. [Online]. June 2013 [cited 2013 Aug 14]. Available from: macists.ca/cpha-ca/assets/file/pharmacy-in-canada/expanded- ScopeChart.pdf. 6. Association Québécoise Des Pharmaciens Propriêtaires. The new services authorized in Bill 41. [Online] [cited 2013 Aug 14]. Available from: 7. Shaskin I. Changes to the Alberta pharmacy compensation model: what you need to know. [Online] Feb [cited 2013 Aug 27]. Available from: 8. Lynas K. Ontario pharmacists embrace new Medscheck opportunities, but funding concerns remain. Canadian Pharmacists Journal Jan; 144(1): p Government of British Columbia. PharmaCare policy manual: section 8.9. [Online] mar [cited 2013 Aug 14]. Available from: Government of Alberta. Compensation plan for pharmacy services May 1. Ministerial Order 23/ Pharmacists Association of Saskatchewan. Updated PAS It On (52) Special Edition Prescriptive Authority: Minor Aliments. [Online] Jan [cited 2013 Aug 14]. Available from: Leduc C. Quebec government reveals which pharmacy services it will pay for [News Article].; Aug 2013 [cited 2013 Aug 19]. Available from: news/government/quebec-government-reveals-which-pharmacyservices-it-will-pay-for I Care About My Pharmacist. Patient Care First: Over 24,000 Albertans Show Their Support for Local Pharmacies [Press Release] [cited 2013 Aug 19]. Available from: Alberta Pharmacists Association. Pharmacy Service Framework in Numbers. RxPress. 2012; 12(3): p Alberta Pharmacists Association. Pharmacy Service Framework in Numbers. RxPress. 2012; 12(4): p Alberta Pharmacists Association. Pharmacy Service Framework in Numbers. RxPress. 2013; 13(2): p Alberta Pharmacists Association. Pharmacy Service Framework in Numbers. RxPress. 2013; 13(1): p Alberta College of Pharmacists Annual Report Annual Report. 19. Hall K, Musing E, Miller DA, Tisdale JE. Experiential training for pharmacy students: time for a new approach. Canadian Journal of Hospital Pharmacy Jul; 65(4): p Alberta Health & Wellness. Family Medicine Billing Quick List. [Online]. May 2011 [cited 2013 Aug 19]. Available from: albertahealthservices.ca/hp/if-hp-cfm-billing-codes-quick-list.pdf. 8 Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

9 SPECIAL SUPPLEMENT BLUEPRINT LIVE The Ideal Pharmacy Practitioner David Mancini University of Waterloo 1 st 2 nd I was honored to have the opportunity to complete my second year placement at the Children s Hospital of Eastern Ontario (CHEO) in Ottawa. In addition to allowing me to implement many of the 3 rd Blueprint principles, this experience was also instrumental in forming my personal vision of how pharmacy should be practiced within the Canadian healthcare system. Collaborating with the Pediatric Palliative Care Team: Under the supervision of my mentor, I provided pharmacy support to the pediatric palliative care team. I participated in morning rounds by visiting patients and their families alongside the palliative care physicians, nurses and social workers. During this time, I strived to understand the conditions and medication therapies of each patient. Each day, prior to morning rounds, I would view the patients information and lab results in the hospital computer system to update myself on any changes to their condition. This aligns with the Blueprint principle of accessing relevant patient care information in health records. 1 I would then attend morning rounds and would report to my mentor afterwards with information regarding each patient s condition and therapy regimen. At this time, we would discuss the patient s condition and medication therapies. From this, we would identify medication use issues 1 and determine how we could more thoroughly manage the patient s conditions to improve their quality of life. The recommendation would then be presented to the palliative care team. As an example, one patient under our care was suffering from severe uncontrollable seizures that were caused by the advanced stages of a fatal neurodegenerative disorder called: Neuronal Ceroid Lipofuscinosis. The seizures were insufficiently managed despite aggressive anticonvulsant and benzodiazepine therapy. Following consultation with the palliative care team and the patient s family, it was then decided to add high-dose melatonin to the medication regimen. 2 This resulted in only a slight reduction in the frequency and severity of the seizures. Following further collaboration with my mentor, we then made the recommendation to add high-dose choral hydrate to the regimen to further improve seizure control. 3 A pharmacist operating within the palliative care team is a prime example of managing drug therapy in collaboration with patients, caregivers and other healthcare providers. 1 Also, pharmacists working in this capacity are utilizing the entirety of their education and practicing to the full extent of their knowledge and skills. 1 January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 9

10 The need for pediatric pharmacists operating within advanced care teams will increase considering that in the Ottawa area alone, there will be seventy thousand more children in twenty years time than there are today. 4 My intention upon graduation is to practice in a pediatric setting and use my knowledge and skills to further the profession and improve the health of our future youth. Conducting Research: As well, during this placement, I conducted an original research study and completed the corresponding research paper, which is currently submitted for publication. It had been reported that many children were experiencing taste or odour disturbances following intravenous (IV) flushing with the current brand of prefilled normal saline (NS) syringes that are being used at CHEO. The disturbances have been attributed to the leaching of non-toxic volatile substances into the saline from the plastic of the syringe. These disturbances can be particularly problematic for children that are already experiencing sensory dysfunction due to chemotherapy or radiation treatments. 5 Therefore, in collaboration with my mentor, I conducted a study to compare the occurrence of taste and odor disturbances in pediatric patients receiving IV saline flushes from commercially available prefilled syringes and patients receiving IV saline flushes from fresh syringes that were prepared daily in the CHEO pharmacy. From this study, it was determined that 72% of patients that received NS flushing from the prefilled syringes experienced taste or odour disturbances whereas only 4% experienced disturbances from the fresh saline (p <0.001). 5 Perhaps an alternative to the currently used prefilled NS syringes may improve the IV flushing experience for children at CHEO. This demonstrates my ability to lead the development of and participate in quality improvement initiatives 1 within CHEO by conducting research in order to enhance the quality of care provided to the children. Research participation is an ideal way for a practitioner to remain on the forefront of new information and to contribute to the advancement of pharmacy knowledge. Research involvement is particularly important in pediatric pharmacy since the majority of drugs that are prescribed to children have not actually been tested in a pediatric population. 6 Therefore, there remains a knowledge gap to be explored by future scientists. Pharmaceutical Pictograms: Also, the CHEO pharmacy department is involved with research into the creation and implementation of pharmaceutical pictograms. A pictogram is a graphical representation of an instruction. A pharmaceutical pictogram is used to communicate medication instructions to patients that have low literacy or have no common language. During my time at CHEO, I created a pictogram storyboard (Fig. 1) and a pictogram calendar (Fig. 2) for a child s complicated medication regimen. In this situation, the child s mother was illiterate, and she would be administering all of the child s medications upon discharge. Following the creation of the pictograms, I educated the mother on the proper use of the calendar and storyboard. This is an example of how I was able to lead the development of and participate in medication safety initiatives 1 within CHEO by providing information about the optimal use of medications 1 in a unique way to ensure the safe administration of medication to the child. Research into pictograms to communicate medication instructions is necessary in our health care system considering the fact that the about 20% (6.3 million people) of the Canadian population communicates in a language other than English or French. 9 Furthermore, about 20% of the Canadian adult population is considered to have a low level of literacy. 10 Therefore, as a pharmacist, it is beneficial to be comfortable with alternative mechanisms for communicating medication information to patients. Figure 1: A Sample Pictogram Storyboard for a Medication 7 Reprinted from the International Pharmaceutical Federation (FIP) Website 7 10 Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

11 Figure 2: A Sample Pictogram Calendar that Combines All Medications 8 Reprinted from the International Pharmaceutical Federation (FIP) Website 8 Dose Validation at the Roger s House: As well, during this placement I provided pharmacy support to the Roger s House by conducting dose validation. The Roger s House is a pediatric hospice that accommodates a maximum of eight children. The services provided include: respite care, acute end-of-life care, and pain and symptom management. My duties involved reviewing the patient s medication profiles on a daily basis to ensure that the doses were within the published pediatric reference ranges and that each medication was appropriate for the indication it was being used for. I would then consult with the physician and the pharmacist to discuss and resolve any discrepancies. Afterwards, I would document the relevant information in the patient s health record. 1 Performing dose validation was another way that I was able to participate in medication safety and quality improvement initiatives 1 at CHEO. It has been estimated that the average inpatient is subject to at least one medication error per day. 11 Therefore, performing daily dose validation is important for reducing medication dosage errors and ensuring that each patient is consistently receiving a therapeutic dose of their medications. Creating a Crosswalk Document: In collaboration with my mentor and several other pharmacist reviewers, I created a crosswalk document. A pharmaceutical crosswalk is a table that demonstrates equivalent standards in more than one pharmacy organization. This crosswalk demonstrates the similarity of the Basel Consensus statements to Accreditation Canada s Medication Management Standards and the Canadian Society of Hospital Pharmacists Goals and Objectives for Pharmacy Practice in Hospitals document. The Basel Consensus statements are a series of 75 statements that were developed at the Global Conference on the Future of Hospital Pharmacy in Basel, Switzerland by a group of hospital Table 1: Excerpt from the Crosswalk Document FIP Basel Statements Hospital pharmacists should be allowed to access the full patient record. CSHP Objectives In 75% of hospitals and related healthcare settings, pharmacists will be able to electronically access pertinent patient information and communicate across settings of care to ensure continuity of pharmaceutical care for patients with complex and high-risk medication regimens Rating: 3 (sufficient similarity to Basel statement 12) Accreditation Canada Medication Management Standards The organization provides staff with and service providers with timely access to the client s medication profile and essential client information 14 Rating: 2 (some similarity to Basel statement 12) January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 11

12 pharmacists representing 98 nations. The statements are a collective reflection of the vision of hospital pharmacy practice across the world. The similarity of the Basel Statements to the standards and objectives of the other organizations were rated by pharmacist reviewers on a scale of one to three (1 = no similarity; 3 = sufficient similarity). The development of this crosswalk is an example of conducting practice research. 1 This is because this document will allow us to identify the differences between the goals and objectives of Canadian Pharmacy organizations and the ideal standards of pharmacy practice the Basel statements. Furthermore, this document will allow us to identify barriers that are preventing the successful implementation of these statements into practice. Therefore, the creation of this document is also promoting best practices in patient care. 1 The Ideal Pharmacy Practitioner: In summary, implementing these Blueprint principles at CHEO has ignited in me, a true passion for the pharmacy profession. Earlier, I mentioned that this experience shaped my vision of the pharmacist s role within our healthcare system. So what is my vision of the ideal pharmacy practitioner? In my vision, a pharmacist utilizes all of their education to enhance the patient s health. A pharmacist contributes to the growing body of knowledge by participating in research initiatives. A pharmacist advocates for their profession by being involved in professional organizations and promoting practice change to improve patient care. Finally, a pharmacist is motivated and dedicated to lifelong learning and professional development. Ultimately, the health of our patients depends on this. n Acknowledgments I would like to thank my mentor Dr. Regis Vaillancourt for his support and guidance throughout this placement and for providing me with these learning opportunities. In my opinion, he is a true advocate for the profession. References 1. Task Force on a Blueprint for Pharmacy. Blueprint for pharmacy: the vision for pharmacy. Ottawa (ON): Canadian Pharmacists Association; Bhavsar B, Farooq MU, Bhatt A. The Therapeutic Potential of Melatonin in Neurological Disorders. Recent Pat Endocr Metab Immune Drug Discov. 2009; 3: Vaillancourt R, Collins M, Vadeboncoeur C, Jacob P, Graham N, Foster D, Splinter W. Successful Treatment of a Seizure Disorder with Chronic High-Dose chloral hydrate: a pediatric case report. J Palliat Care. 2010; 26(4): CHEOnext: Strategic Plan. Children s Hospital of Eastern Ontario (CHEO) Website. Accessed August 12/ Mancini D, Vaillancourt R, Pouliot A, Lin A, Sharpe D. A Randomized Single Blinded Study Comparing Taste and Odour Disturbances in Pediatric Patients Undergoing IV Flush with Normal Saline Administered By Prefilled Syringe and Freshly Prepared Syringe. In Review/ Currently Submitted for publication Boots I, Sukhai RN, Klein RH, Holl RA, Wit JM, Cohen AF, Burggraaf J. Stimulation programs for pediatric drug research do children really benefit? Eur J Pediatr. 2007; 166: Pictogram Software/A Storyboard of a Medication. International Pharmaceutical Federation (FIP) Website. fip/pictograms/storyboard1.png. Accessed August 12/ Pictogram Software/A Pictogram Calendar that Combines All Medicines. International Pharmaceutical Federation (FIP) Website Statistics Canada. Canadian Demographics at a Glance [Catalogue no XIE] Ottawa (ON): Minister of Industry: Indicators of Well-being: Learning Adult Literacy. Human Resources and Skills Development Canada Website. Accessed August 12/ Radley DC, Wasserman MR, Olsho LEW, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013; 00: FIP Global Conference on the Future of Hospital Pharmacy: Final Basel Statements. International Pharmaceutical Federation (FIP) Website. Statements.pdf. Accessed August 13/ CSHP 2015 Crosswalk. Canadian Society of Hospital Pharmacists Website. Accessed August 13/ Accreditation Canada. Qmentum Program: Medication Management Standards: For Surveys Starting After January 1/2014. Ottawa (ON): Accreditation Canada; Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

13 SPECIAL SUPPLEMENT 1 st 2 nd BLUEPRINT LIVE Le PharmaBlogue et le Plan Santé 3 rd François-Xavier Houde Université de Montréal Submission en français (see page 16 for the English translated version) Bonjour, Je m appelle François-Xavier Houde, je suis étudiant en pharmacie en 3ème année à l Université de Montréal et je vous présente ma candidature pour le prix du leadeurship en matière de changement de pratique. Cette année, j ai eu la chance de travailler au sein d une compagnie pharmaceutique québécoise nommée Pharmapar sur deux projets web en particulier : le PharmaBlogue et le Plan Santé. Suite à mon implication dans le développement de ces deux plateformes, je crois fermement être digne du prix aux étudiants remis par le Plan directeur pour la pharmacie. Je suis fier, en tant que futur pharmacien, d avoir pu participer l évolution de deux sites web pour pharmaciens. La place qu on m a donnée auprès de ces projets a dépassé toutes mes attentes. Elle m a notamment permis de rejoindre cinq priorités fixées par le Plan directeur pour la pharmacie. December 13 Blueprint 2013, Volume in Motion 4, Issue Special 9 Supplement Blueprint in Motion January Special 2014, Supplement Volume 5, Issue 131

14 1 Accroître les possibilités de formation continue pour les pharmaciens et techniciens en pharmacie dans la prestation de soins axés sur le patient et des services élargis. Le PharmaBlogue est un blogue professionnel n existant que depuis un peu plus d un an, se positionnant comme la première plateforme sur la santé multidisciplinaire au Québec. Il se veut être l endroit où les différents professionnels de la santé peuvent partager leur expertise et discuter de différentes pathologies. On réalise qu il s avère pertinent de colliger toutes ces opinions d experts sur la même plateforme lorsqu on est conscient de la variation des regards entre les disciplines sur certains problèmes de santé. En participant à différentes discussions au sujet du développement du PharmaBlogue, j ai contribué à définir son identité et à trouver comment en faire un outil pertinent pour les professionnels de la santé. J ai également effectué une campagne de sollicitation auprès des professionnels de la santé du Québec pour les inviter à contribuer au PharmaBlogue. J ai aussi outillé l équipe du PharmaBlogue en leur proposant différentes pistes de rédaction pour les futurs collaborateurs, autant sur des maladies chroniques que sur des questions d économie de la santé. Mon esprit d étudiant en pharmacie a permis à l équipe d approfondir sa réflexion sur certains sujets et de faire la lumière sur d autres, comme l histoire des différentes professions de la santé par exemple. Grâce aux expertises des autres professionnels de la santé, le PharmaBlogue constitue un outil de formation continue pour les pharmaciens. Il permet en effet aux pharmaciens de mieux connaître les différents professionnels de la santé ainsi que leurs champs de pratique respectifs, ce qui est essentiel à l établissement d un système de santé bien orchestré. Le PharmaBlogue compte plus de 60 contributeurs, dont des pharmaciens, des nutritionnistes, des massothérapeutes, des kinésiologues et même des assistants techniques en pharmacie. Vous trouverez la liste complète des contributeurs ici. 2 Faciliter l intégration de la prescription électronique et de systèmes d information sur les médicaments dans les pharmacies communautaires et hospitalières. À plusieurs reprises durant l été, j ai été appelé à travailler avec Tractr, l agence web responsable de développer le Plan Santé, une plateforme de prise de rendez-vous et de valorisation des services en pharmacie destinée aux pharmacies communautaires. J ai ainsi pu apporter à l équipe de Tractr mon point de vue et mes connaissances sur les préoccupations d une équipe de laboratoire en pharmacie communautaire. Cela a permis à Tractr de personnaliser et d adapter la plateforme aux besoins de la pratique de la pharmacie en officine. Le développement du Plan Santé découle de la promulgation de la Loi 41 au Québec, laquelle permet notamment aux pharmaciens de prescrire, de prolonger et d ajuster des ordonnances sans validation préalable du médecin. Le lancement du Plan Santé est prévu pour le 1 er octobre. La Loi 41 a pour but d augmenter l accessibilité à certains services de santé dans un contexte où les urgences sont engorgées et où certains patients font face à des risques d arrêt temporaire dans le traitement de leur maladie chronique. Les bénéfices de ces nouveaux droits sont conditionnels à leur mise en application. C est la mission que le Plan Santé se donne. Le PharmaBlogue et le Plan Santé sont deux plateformes web. Elles exploitent les technologies de l information et de la communication pour favoriser une meilleure organisation et prestation des soins. En d autres termes, ils constituent des outils d e-santé. En contribuant au développement de ces deux plateformes, mises principalement sur pied pour les pharmaciens, je m implique dans l intégration de nouvelles technologies dans les pharmacies. L implantation d un tel outil hautement personnalisé en pharmacie communautaire constitue un pas de plus vers la prescription électronique et l usage des systèmes d informations sur les médicaments en pharmacie. Qui sait, peut-être qu un jour ces deux outils seront agencés avec le Plan Santé? Les possibilités d optimisation des outils électroniques en pharmacie sont multiples! 3 Entreprendre une campagne nationale de relations publiques sur la valeur des services en pharmacie. Comme mentionné ci-haut, le Plan Santé constitue non seulement un outil de prise de rendez-vous, mais également un outil de valorisation des services en pharmacie. Le site permettra notamment aux pharmaciens n offrant pas de rendez-vous d avoir une visibilité sur la plateforme et d afficher les services à valeur ajoutée qu ils offrent. Au cours de mon emploi chez Pharmapar, j ai décrit et documenté les services disponibles en pharmacie communautaire au Québec afin que l équipe du Plan Santé comprenne le quotidien d un pharmacien et puisse bien mettre ses services en valeur sur la plateforme. De plus, j ai synthétisé, vulgarisé et documenté les règlements encadrant les nouveaux actes en pharmacie (Loi 41). 14 January Blueprint 2014, Volume in Motion 5, Issue Special 1 SupplementD Blueprint in Motion december Special 2013, Supplement Volume 4, Issue 149

15 J ai également écrit trois textes sur le PharmaBlogue, dont deux qui valorisaient et décrivaient les droits de pratique élargis des pharmaciens. Le premier met en évidence la pertinence de l élargissement des droits de pratique des pharmaciens, tandis que le deuxième explique de façon succincte ce que les pharmaciens pourront concrètement faire selon les nouveaux règlements de la Loi 41. J ai aussi écrit un article au sujet de la reconnaissance du titre de spécialiste en pharmacothérapie avancée pour les pharmaciens détenteurs d une maîtrise. Le potentiel du Plan Santé à titre d outil de valorisation des services en pharmacie est immense. De plus, le potentiel de visibilité de mes articles est enviable considérant le fait que le PharmaBlogue possède déjà plus de 1500 abonnés à son Infolettre quotidienne. Pour ces deux raisons, j estime avoir entrepris au meilleur de mes moyens une campagne de relation publique sur la valeur des services en pharmacie. 4 Faciliter l adoption des modèles d affaires des pharmacies communautaires qui intègrent de nouveaux services de soins aux patients. Changer le paradigme des modèles d affaire en pharmacie demande des outils de support à l organisation des consultations avec le pharmacien. Il faut un outil s ajustant au débit de la pharmacie, facile d utilisation, permettant un service rapide et capable d établir des statistiques sur la performance des pharmacies à des fins d amélioration de processus. Le Plan Santé peut offrir ces possibilités. En discutant avec Pharmapar et Tractr sur l optimisation du chevauchement entre la distribution et les consultations en pharmacie, j ai aidé à faire du Plan Santé un outil non seulement personnalisé, mais également polyvalent. Nous voulions qu il puisse favoriser le changement du modèle d affaire pour la plus grande quantité de pharmacies. Je suis convaincu que mon passage chez Pharmapar permettra au Plan Santé d être un outil technologique encore plus appréciable pour les pharmaciens qui désirent intégrer de nouveaux services pharmaceutiques dans leur modèle d affaire. 5 Soutenir les changements législatifs et règlementaires visant à élargir le champ de pratique des pharmaciens et techniciens en pharmacie. Les changements législatifs permettent aux pharmacies de changer leur modèle d affaire. La relation de causalité est directe. Cela signifie que de faciliter l implantation d un nouveau modèle d affaire, c est également supporter un changement législatif. Au travers de mes interventions sur le plan Plan Santé, j estime avoir sensibilisé les responsables à l impact du déploiement de leur plateforme de prise de rendez-vous. Le Plan Santé, ainsi que je leur ai dit, permettra aux pharmaciens de négocier plus habilement avec le gouvernement pour d autres droits de pratique et pour des meilleures conditions de travail. Cela sera possible grâce à l obtention de statistiques pour les pharmaciens sur les rendez-vous. Ces données pourront être utilisées afin de quantifier le nombre de patients servis par jour ou encore les types de services les plus sollicités. Enfin, à l aide de mes articles sur la Loi 41 et sur la spécialisation en pharmacothérapie avancée, j ai contribué d une autre manière à supporter les changements législatifs en pharmacie. En conclusion, je suis heureux d avoir pris l initiative d offrir mes services à une compagnie pharmaceutique innovatrice québécoise. Je suis fier d avoir fait preuve de leadership dans mes implications auprès du PharmaBlogue et du Plan Santé. Ces deux projets auraient difficilement pu être développés par un pharmacien en pratique, faute de temps et d argent, deux ressources dont les compagnies pharmaceutiques disposent davantage. Je suis convaincu que mes actions contribuent à changer concrètement la pratique de la pharmacie au Canada. n December 15 Blueprint 2013, Volume in Motion 4, Issue Special 9 Supplement Blueprint in Motion January Special 2014, Supplement Volume 5, Issue 151

16 SPECIAL SUPPLEMENT 1 st 2 nd BLUEPRINT LIVE PharmaBlogue and the Plan Santé 3 rd François-Xavier Houde Université de Montréal Hello, My name is François-Xavier Houde and I am a third-year student in the pharmacy program at Université de Montréal. I am presenting my candidacy for the leadership award in practice change. This year, I had the good fortune to work for a Quebec pharmaceutical company, Pharmapar, for two web projects: PharmaBlogue and the Plan Santé. After being involved in developing these two platforms, I believe I should be considered for the student award from the Blueprint for Pharmacy. As a future pharmacist, I am proud to have participated in the evolution of two websites for pharmacists. My role on these projects exceeded my expectations. It allowed me to pursue five priorities set by the Blueprint for Pharmacy. 16 Blueprint in Motion Special SupplementD december 2013, Volume 4, Issue 9

17 1 Enhance professional development opportunities for pharmacists and pharmacy technicians in providing patient-centred care and expanded services. PharmaBlogue is a professional blog that has been published for a little over a year and positioned as the leading multidisciplinary health platform in Quebec. It is a place where health care professionals can share their expertise and discuss diseases and pathologies. We realized that it would be of value to gather all of these expert opinions on a single platform, given the variety of perspectives on certain health problems between disciplines. By participating in discussions about the development of PharmaBlogue, I helped develop its identity and determined how to make it a valuable tool for health care professionals. I also conducted a campaign with Quebec health care professionals to invite them to contribute to PharmaBlogue. I equipped the PharmaBlogue team with ideas for topics for future contributors, from chronic disease to health economics issues. My approach as a student in pharmacy helped the team further its reflection on certain subjects and get to the bottom of others, such as the history of different health care professions. Thanks to the expertise of other health care professionals, PharmaBlogue is a professional development resource for pharmacists. It allows pharmacists to find out more about different health care professionals and their fields, which is essential to developing a well-organized health care system. PharmaBlogue has over 60 contributors, including pharmacists, nutritionists, massage therapists, kinesiologists and even pharmacy technical assistants. A complete list of contributors can be found here. 2 Facilitate integration of e-prescribing and drug information systems into community and hospital pharmacies. On a number of occasions over the summer, I was asked to work with Tractr, the web agency that developed the Plan Santé, an appointment scheduling and service promotion platform for community pharmacies. I shared my point of view and knowledge about the concerns of a laboratory team in a community pharmacy with the Tractr team. This allowed Tractr to customize and adapt the platform to the needs of retail pharmacies. The Plan Santé was developed in response to the enactment of Bill 41 in Quebec, which allows pharmacists to prescribe, extend and adjust prescriptions without checking with a physician. The launch of the Plan Santé is planned for October 1. The goal of Bill 41 is to increase access to certain health care services in a context where emergency rooms are overflowing and where some patients face the risk of a temporary interruption in the treatment of their chronic illness. We will reap the benefits of these new rights only if they are applied. This is the Plan Santé s mission. PharmaBlogue and the Plan Santé are web platforms. They exploit information and communication technologies to promote better organization and delivery of health care. In other words, they are e-health tools. In helping develop these two platforms, created mainly for pharmacists, I took part in integrating new technologies to pharmacies. Implementing such a highly customized tool in community pharmacies is one more step toward electronic prescriptions and the use of drug information systems. Who knows: maybe one day these tools will be combined with the Plan Santé. There are many possibilities for optimizing electronic tools in pharmacies. 3 Undertake a national public relations campaign about the value of pharmacy services. As mentioned earlier, the Plan Santé is not just an appointment scheduling tool; it is also a tool for promoting services in pharmacies. The site will allow pharmacists who do not offer appointments to have visibility on the platform and list the value-added services they offer. As part of my job with Pharmapar, I described and documented the services available in community pharmacies in Quebec so that the Plan Santé team would understand a pharmacist s work day and be able to promote services on the platform. I also summarized, popularized and documented regulations governing new pharmaceutical acts (Bill 41). I also wrote three texts for PharmaBlogue, two of them promoting and describing the expanded practice rights of pharmacists. The first demonstrates the importance of expanding pharmacists powers, while the second succinctly explains what pharmacists can do under the new regulations of Bill 41. I also wrote an article about recognizing the title of advanced pharmacotherapy specialist for pharmacists with a master s degree. The Plan Santé has tremendous potential as a tool for promoting services in pharmacies. Furthermore, my articles could well receive broad visibility since PharmaBlogue already has over 1500 subscribers to its daily newsletter. This is why I believe I was effective in conducting a public relations campaign about the value of services in pharmacies. 4 Facilitate the adoption of community pharmacy business models that incorporate new patient care services. Changing the business model paradigm in pharmacies requires tools to support organizing consultations with the pharmacist. The tool needs to adjust to the pace at the pharmacy, be easy to use, allow for fast service and gather statistics January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 17

18 on pharmacy performance, with a view to process improvements. The Plan Santé offers these possibilities. In discussing optimizing the overlap between distribution and consultations in pharmacies with Pharmapar and Tractr, I helped make the Plan Santé a customized, versatile tool. We wanted it to be able to foster a change in the business model for as many pharmacies as possible. I believe that my time at Pharmapar will make the Plan Santé a technology tool that is even more valued by pharmacists who want to integrate new pharmaceutical services to their business model. 5 Support legislative and regulatory changes to expand the scope of practice for pharmacists and pharmacy technicians. Legislative changes allow pharmacies to change their business model. There is a direct causal relationship between the two. This means that facilitating the implementation of a new business model also supports legislative change. Through my efforts on the Plan Santé, I believe I made those responsible aware of the impact of deploying their appointment scheduling platform. As I pointed out to them, the Plan Santé will allow pharmacists to better negotiate with government for other practice rights and better working conditions, using statistics about appointments with pharmacists. This data can be used to quantify the number of patients served daily and the services most in demand. Finally, with my articles on Bill 41 and on the specialization in advanced pharmacotherapy, I further contributed to supporting legislative changes in pharmacies. I am pleased that I took the initiative to offer my services to an innovative Quebec pharmaceutical company. I am proud of having shown leadership through my involvement with PharmaBlogue and the Plan Santé. These two projects would have been difficult for a practicing pharmacist to complete, for lack of time and money, two resources that pharmaceutical companies have more of. I am confident that my efforts will help make a concrete change in the practice of pharmacy in Canada. n 18 Blueprint in Motion Special Supplement January 2014, Volume 5, Issue 1

19 contact information FOR MORE INFORMATION ON THE BLUEPRINT FOR PHARMACY CONTACT: Blueprint for Pharmacy National Coordinating Office Canadian Pharmacists Association 1785 Alta Vista Drive Ottawa, Ontario K1G 3Y6 Secretariat for the Blueprint for Pharmacy National Coordinating Office January 2014, Volume 5, Issue 1 Blueprint in Motion Special Supplement 19

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