Wednesday, March 22, 2017

“Excuse me, where is the orange juice?”


Last summer, I had the opportunity to work in a supermarket-pharmacy. Originally, I was concerned that there might be a “Supermarket-first-Pharmacy-second” mindset that would undervalue a pharmacist’s role. I thought that a dedicated pharmacy would be a more appropriate environment to practice in. However, I quickly learned that supermarket-pharmacies can be a mutually beneficial business model that allows pharmacists more opportunities to promote health and wellness.



One advantage of supermarket pharmacies is the increased foot traffic. The average adult may go grocery shopping 1-2 times a week whereas visits to a pharmacy are likely less frequent. Thus, supermarket pharmacies allow pharmacists to interact with their patients more frequently. This would facilitate easier follow-ups and long term relationship with patients.

Supermarket-pharmacies are also unique positioned for collaboration. Some supermarkets employ registered dieticians to help consumers make healthy food choices. Consequently, pharmacists who identify patients with dietary restrictions (ie: Diabetes, hypertension) may benefit from referrals to on-site dieticians. This partnership between pharmacists and dieticians can greatly improve patient outcome.

Patients are also tolerate wait times more because they can do grocery shopping while their medication is prepared. 

The only disadvantage is that there may be some role confusion. If you wander around the supermarket with a name tag, consumers may ask you where certain food items are!
Overall, supermarket pharmacies can be an interesting environment to work in. By embracing the setting, pharmacists can actually improve the pharmaceutical services they provide to the public.

Kevin

Friday, March 10, 2017

Thx Doc! TTYL!


Maple, Canada’s first 24/7 online service that allows virtual doctor’s visit, was launched in Ontario January 2017. Maple is a service that permits online consultation with registered Canadian doctors via instant messaging or video chat. This is not an entirely novel service. Akira, which also operates in Ontario, utilizes a similar model (though not 24/7). This type of service is coined “Telemedicine.” It intends to use telecommunication to provide care to patients from a distance. In countries such as U.K. and United States, massive adoption of these services has already taken place.


An encounter with Maple doctors consists of the following: describing your symptoms, talking with a doctor via instant messaging or video chat, and a wrap up. Doctors are able to write prescriptions (except for narcotics and control substances), write sick notes, and diagnose.

Maple certainly addresses some significant downfalls with our current healthcare system. A report noted “Only 31-46% of Canadians could get an appointment the same day or the next day, not including emergency department visits.” Maple claims that patients would be able to see physicians online “within minutes.” In terms of convenience, Maple may be appealing due to being accessible from anywhere:  home, vacation, or office. The advantages mentioned may be further magnified for patients living in rural/remote areas as there is a deficit of doctors areas available in these areas.

There are also several elements that prevent Maple from being widely used. Due to the nature of the interactions, a physical examination would not be possible. This can be concerning because accurate diagnosis of many medical conditions may rely on physical examinations. However, Maple has cited that up to 70% of non-emergency issues can be resolved without ever needing a hands-on physical exam. Another disadvantage is that patients are unable to pick their own doctors using Maple. This makes it difficult to establish long term relationships and to follow up on any issues. In addition, the services have to be paid for because OHIP does not currently cover these services. Lastly, there are limitations to the physician’s scope of practice. They are unable to prescribe narcotics and controlled substances, authorize a specialist referral or order lab tests, and finally consultations are not intended for emergency situations.

Maple and telemedicine are unique services. Given the technology driven age we live in, it would be exciting to see if this service will grow. Currently, the lack of public coverage significantly limits its use. Despite this, there are select groups of patients with limited access to doctors that could benefit greatly from this service.

It would be interesting to hear from patients who have firsthand experience with these types of services.

Kevin

References

CBC news. “Canadian Patients wait longest to see family doctors”. January 20, 2014.
Retrieved from
http://www.cbc.ca/news/health/canadian-patients-wait-longest-to-see-family-doctors-1.2501468  on March 9, 2017


CNW. “First 24/7 virtual doctor’s ‘office’ arrives in Canada: New services launches to connect doctors and patients in minutes.” January 30, 2017
Retrieved from
http://www.newswire.ca/news-releases/first-247-virtual-doctors-office-arrives-in-canada-new-service-launches-to-connect-doctors-and-patients-in-minutes-612141113.html on March 9, 2017


Maple. “Maple – Frequently asked questions.” 2016.
Retrieved from
https://www.getmaple.ca/faq on March 9, 2017


OTN. “What is Telemedicine.” 2017.
Retrieved from
https://otn.ca/what-is-telemedicine/ on March 9, 2017

Thursday, March 2, 2017

Hello rxBriefCase!


My name is Kevin and I am a 4th year pharmacy student at the University of Toronto. I will be joining the team for the next 5 weeks as part of my Advanced Pharmacy Practice Experience (APPE) placement. This is my final APPE rotation before heading out into the real world.

Growing up, I have always wanted to be a teacher because I enjoyed sharing knowledge and having a positive influence on others. However, my pursuit for a teaching career came to an end when I discovered that I was not too fond about spending the rest of my life in school! I shifted my focus onto pharmacy because I realized pharmacists are in an optimal position to both share knowledge (ie: counseling) and positively influence others (ie: advocate for healthy lifestyle, vaccination, etc.). I have not looked back since!

Outside of school, I am dedicated to an active lifestyle because I believe healthcare professionals should practice what they preach. In the past, I was an avid runner and was able to complete a marathon. Since retiring my running shoes, I continue to be an active member at the gym. The gym is a place where I can temporarily leave my stress behind as well as push myself at the same time.

This rotation will be significantly different from others - there will be no sick patients, no pill counting, and no MedsChecks! During my time at rxBriefCase, I will be responsible for writing an eNewsletter, an article in MedSchool For You (MSFY), and a eCME critical appraisal. I am excited to work in this new environment and look forward to meeting everybody in the coming weeks!

Kevin

Friday, January 20, 2017

Goodbye and Good Luck!


As my rotation draws to a close, I wanted to reflect on a few of my experiences at mdBriefCase. Within a span of five short weeks, I have been able to accomplish several projects, while refining my quantitative and qualitative skills.

Major highlights included the following: 

Project
Learning Outcomes
eCME Critical Appraisal on OAB
-        Provided an opportunity to analyze a participation report
-        Learned about accreditation bodies, such as CCCEP
-        Enhanced my presentation skills
eNewsletter on Sexual Health in Older Men
-        Challenged me to write succinctly and under 1300 words!
-        Collaborated with Content Development and Marketing regarding programming and promotion prior to deployment
9 Blog Posts
-        Explored a variety of topics, including vaccinations by pharmacists and tips for pharmacy students
-        Received positive feedback from colleagues
Foot Care Module on MedSchoolforYou
-        Created a module that supports health literacy amongst patients, and boosts pharmacist confidence when assessing and recommending products for different foot conditions
eCMEs
-        Completed The Diabetes Education: A Comprehensive Review, which served as excellent preparation for the CDE
-        Also finished CMEs on pain, antispasmodics and BED to increase my general therapeutic knowledge

Looking back, each activity challenged my ability to be a malleable writer, clinician and scholar.  I sincerely appreciate all of the help and kindness I have received during my time at mdBriefCase. Special thanks to Cassandra and Mike for their wealth of knowledge and support!

Warmest Regards,

Vivian


Wednesday, January 18, 2017

All in the Family

During the summer, I had the pleasure of working at a Family Health Team (FHT) in the heart of downtown Toronto. Based on my experiences there, I truly believe that the level and quality of care from a FHT cannot be paralleled to any other, more traditional healthcare model.

There are currently 184 FHTs in Ontario, which serve over 3 million people in over 200 rural and suburban communities. FHTs aim to enhance patient access to comprehensive primary care services from various healthcare providers (HCP). Each FHT has an interdisciplinary team, which typically includes physicians, pharmacists, nurses, nurse practitioners, social workers, dietitians and other allied health professionals.  


Within this ambulatory setting, patients are seen by appointment. During my practice, chronic disease management (e.g. diabetes, hypertension, COPD), warfarin dosing, treatment of short-term illnesses (e.g. UTI) and obstetrical care were most commonly encountered on a daily basis. Certain FHTs also provide specialized services, such as smoking cessation, telemedicine and substance abuse clinics. However, the availability of these services is contingent upon the population the FHT serves. 

As a pharmacy student, my role at the FHT was multifaceted and highly collaborative. In addition to providing medication reviews and patient counseling, I became a valuable drug information resource for other members of the team. I also provided extensive medication management to several complex patients, as part of the home-visit program. 

Overall, my time at the FHT was both incredibly satisfying and rewarding. The rapid turnover of patients made each day a fresh and exciting clinical challenge. Furthermore, my communication, therapeutic and leadership skills rapidly flourished within the academic environment. Looking ahead, I really hope that the FHT model will be adopted by many other jurisdictions, so that essential health care services can be readily accessible by all.

Contact your local FHT to see if you are eligible to enroll in their patient roster!


Vivian

Friday, January 13, 2017

Putting My Best Foot Forward

Week 4 of my rotation has flown by, and it’s been an exciting one at that. I have been gearing up for the deployment of “Fancy Feet: Caring for Plantar Warts, Athlete’s Foot and Fungal Toenail Infections”. This is a foot care module I have been working on for MedSchoolForYou (MSFY), one of the education platforms from mdBriefCase. This blog will give you a behind-the-scenes look at how this module was developed!

Stage 1: Picking a Topic
  • During my first week, I brainstormed a list of therapeutic topics that would be interesting to write about and appealing to readers. After perusing the MSFY website and reflecting on my experiences in community pharmacy, I identified a knowledge gap in foot care.
Stage 2: Creating an Outline
  • Using various resources (e.g. clinical databases, minor ailments guidelines), I completed preliminary research on the foot conditions I wanted to include in the module. I then created an outline to simplify the writing process.
Stage 3: Creating a Draft
  • Writing the module’s content was a multifaceted process that consisted of researching, data synthesis and organization. I also considered the depth and breadth of information, the use of patient-friendly language and the inclusion of pictures to draw interest.
Stage 4: Editing the Draft
  • I was able to get valuable feedback from Cassandra, my preceptor, and Mike, my pharmacist mentor. Following a series of amendments, the content for the MSFY was finalized.
Stage 5: Programming
  • With the help of Mila, one of our talented Content Developers, all of the content and visual elements were programmed online. She also provided me with drafts on our hidden server to test and approve.
Stage 6: Developing a Marketing Strategy
  • In order to promote the deployment of this module, Cassandra suggested that I write this blog! Furthermore, the module will be shared on mdBriefCase’s Twitter and Facebook accounts.
Stage 7: Going Live!
  • Now that the MSFY is ready to go, all that’s left to do is launch!

Overall, developing “Fancy Feet” was an insightful opportunity to learn and collaborate within the office. I hope that readers find this module to be both useful and informative!

*Update: Fancy Feet is now live! Readers can access the module here: http://www.medschoolforyou.ca/apps/programviewer/default.aspx?section=ffc&program_id=4709&subsection=pwb*


Vivian

Friday, January 6, 2017

A Case of the Cramps - Review of eCME

To mix up the blog a bit, I’ve decided to review an eCME this time around! After looking through the rxBriefCase directory, the Role of Antispasmodics in the Self-Treatment of Abdominal Cramping and Pain caught my attention.

Based on the learning objectives alone, this topic was already interesting and relevant to my practice. At the community pharmacy I work at, patients commonly ask about gastrointestinal (GI) issues and how to optimally manage them. This program provided a comprehensive overview of functional GI disorder (with a focus on IBS), and increased my confidence in recommending an antispasmodic. Due to the sensitive nature of the condition, I also appreciated the counselling suggestions found throughout the program.


After completing the session, key learning points included:
-        The pathophysiology of functional GI disorder is multifaceted, and includes genetics, psychosocial factors, visceral hypersensitivity, inflammation and changes to bacterial flora
-        Patients with “red flags” (e.g. dysphagia, weight loss >3 kg within 6 months) should be referred to a physician
-        GI diseases can severely impair quality of life, due to the unpredictable nature of symptoms and associated emotional distress
-        Therapies for functional GI disorder are not curative, but mainly target patient-specific symptoms, such as diarrhea, constipation, abdominal cramps and pain 
-        Compared to placebo, loperamide is no more effective at reducing pain, bloating or global symptoms of IBS, and may worsen nighttime abdominal pain
-        Non-prescription antispasmodic therapies (i.e. hyoscine butylbromide, dicyclomine hydrochloride) are effective and well tolerated for abdominal pain and cramps, with a low incidence of anticholinergic side effects

As practice shifts towards pharmacy-based, minor ailments programs, pharmacists are well equipped to embrace the challenges of assessing, educating and treating a number of expanded health conditions. In line with this philosophy, this CME was an excellent illustration of how pharmacist involvement can positively impact the lives of patients with chronic, GI disease.

Vivian