Embed Size (px)
Citation preview
Pharmacy Services Supported by a Provincial Drug Information System
Grace Paterson and Naomi Mensink, Medical InformaticsMay 11, 2011, Halifax, NS
CAHSPR Annual Conference 2011: “Renewing Federalism, Improving Healthcare: Can This Marriage be Saved?”
We Acknowledge…
■ Funding from the Canadian Association of Chain Drug Stores (CACDS)
■ The achievements of the PEI pharmacy community and the challenges they faced in implementing and using the PEI-DIS● Also see Infoway commissioned pan-Canadian study, National
Impacts of Generation 2 Drug Information Systems Technical Report of September 2010
■ Collaborative feedback from Erin MacKenzie, Executive Director, PEI Pharmacists Association; Kelly Drummond, Pharmaceutical Information Program Coordinator, PEI Department of Health and Wellness; and Canadian Pharmacists Association
Outline■ Ethnographic Research Study
■ Nature of the Prince Edward Island (PEI) Drug Information System (DIS)
■ Findings● Perspectives of pharmacists on services provided● Taxonomy of Pharmacy Services
■ Conclusions
The Purpose of the Research
“The purpose of this study was to assess the impact of Prince Edward Island’s (PEI) Drug Information System (DIS) on the dispensing process and to study the value of pharmacy services (VPS). The results are intended to inform further planning, decision making and quality improvement.” (Report to sponsors)
Research Objectives
■ To create an inventory of pharmacy services
■ To demonstrate impact of PEI DIS system post-implementation.
PEI as a Living LaboratoryPopulation 141,550 in 2009
Ethnographic Methods
■ Semi-structured interviews■ In situ workplace observation■ Workplace conversation■ Two one-week periods in 2010■ Immersion in pharmacies■ 23 of 43 community pharmacies visited
● Rural and urban● Chain, banner and independent stores
Ethnographic Methods, detail
■ Devoted a half day to visit each pharmacy and kept a field journal with notations that included ● the results of the interview with the lead
pharmacist – these notes were checked with the pharmacist for clarity and accuracy of meaning
● timed observations of dispensing● observations of the provision of pharmacy services● results of in situ conversations with pharmacists
and other staff in the pharmacy ● insights into the work culture of a community
pharmacy
Nature of the PEI Drug Information System
■ In planning for 10 years● Collaboration among pharmacists through PEI
Pharmacists Association, government (provincial and Canada Health Infoway), and software developers.
■ Major characteristics ● Shared patient prescription profiles among all
pharmacies● Linked to a knowledge base that would flag
safety issues● Owned and operated by government through
contract with a private software company● Back-end provincial infrastructure displayed
through in-store vendor systems
PEI Drug Information System (DIS) Impact
■ Completely implemented in 2008■ Normalized in day-to-day use by time of this
study■ Most pharmacy staff had moved beyond
reacting to the provincial system and were finding the best ways to use it for provision of services. A few were still not comfortable, and were reluctant to embrace it: they were still working through their learning curve. Many had suggestions for improvement.
Technology AdoptionDrug Utilization Review (DUR)
■ History of store systems that handled DUR efficiently and thoroughly
■ Additional layer of DIS■ Some aspects that were still problematic
● Duplicate or Unimportant Alerts● Incorrect or Missing Information ● Rigidity to rules that varied among multiple payers● Human-Computer Interface
■ Loss of efficiency
Taxonomy of Pharmacy ServicesFour Major Groupings
Medications Management
Professional Pharmacist
Clinical Services
Managerial Services
Medications Management■ Dispensing and quality review
● Although the interview question asked for valuable services beyond dispensing, most pharmacists indicated that the most valuable service they provided was dispensing.
■ Advising on medications being dispensed■ Compounding of special medications■ Services for special populations
● Elderly and infirm ● Travelers to and from PEI● Persons requiring end-of-life care at home ● Persons with addictions● Persons with mental illnesses/dementia● Persons with chronic conditions
Professional Pharmacist
■ Medications expert■ Continued care prescribing■ Collaborative practice■ Counseling and advising patients on prescription
medications OTCs● Counseling on OTCs● Availability of pharmacists for counseling● Counseling as a teaching/learning experience● Counseling on general health issues
■ Counseling patients on the basis of medications/profile reviews
■ Checking on patient progress
Clinical Services
■ Answering general queries by patients/customers ■ Providing health screening ■ Providing health education (individual and group)■ Providing primary care
● Monitoring of patient’s condition related to medications use
● Immunization (travel or public health)● First aid● Services of a pharmacy nurse● Referrals
■ Providing home health and professional healthcare products expertise
■ Providing or supporting lab and related assessment services
■ Veterinary health
Managerial Services
■ Data stewardship of information in the PEI-DIS■ Organizing range of services, work-flow and
physical layout ● Overall management of services for expanded practice● Management of inventory● Design and management of layout and space ● Redesign of pharmacy practice
■ Collaborating with other providers for provision of services
■ Providing general health education for the public■ Training and managing technicians and assistants■ Providing friendly, caring services■ Providing for continuity of pharmacy professional
services
Conclusions
■ Valuable lessons can be learned through ethnographic study methods: (holistic, captures unscripted messages, contextualized)
■ Pharmacy work continues to evolve with changes in health services delivery in Canada
■ The critical elements were the nature of the need, work and relationships. The technology was a tool to support what was already important work done by trusted professionals.
