For most Canadians, the role of a pharmacist resides at a large retail drug store where their primary job is to convert prescriptions into correct dosages of drugs separated in appropriate containers after a 15~30-minute wait. Or perhaps it involves busy professionals moving swiftly behind the counter with bottles and paper in their hands rushing to serve the next customer.

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For most Canadians, the responsibilities of past and modern pharmacists can largely be summed up to involve dispensing and filling drugs, which is often demeaned to the term “Pill Counting”. And this is not entirely wrong —

Current market economics, especially in Canada, favours a dispensing model of pharmacy practice because it is more profitable on a unit effort basis than other pharmacy services.

In fact, the overwhelming majority of a typical pharmacy’s revenue is from drug dispensing when excluding front of store sales.

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Unsurprisingly, this introduces opportunities to improve the current model of pharmacy care for Canadians on a per dollar basis. Medication adherence and adverse drug reaction rates indicate that much more can be done to improve the health outcomes of Canadians. It’s even more absurd when you realize pharmacists spend most of their professional degree learning about pharmacodynamics and pharmacotherapy — significantly more than typical doctors — and yet they only spend 7% of their practice providing pharmacy services and much of the rest on dispensing and administrative tasks.

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So, what can a pharmacist actually do other than count pills?

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Pharmacist Scope of Practice in Canada

In Canada, pharmacists are trained to provide the following services:

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• Prescribing Authority — In certain provinces, pharmacists can not only adapt/manage existing prescriptions but also initiate new prescriptions (i.e. directly provide drugs for ailments like strep throat and pink eye)
• Injection Authority — In most provinces, pharmacists are qualified to administer vaccines and any other drug via injection (i.e. flu shots, travel vaccines, etc.)
• Health Coaching — Pharmacist intervention and counseling for specific chronic illnesses such as cardiovascular disease, hypertension, high cholesterol, etc.
• Medication Therapy Management — Pharmacists can review your current medication regime and provide more detailed instructions as well as note potential adverse effects (i.e. for when there’s a new caregiver, when they’re getting drug prescriptions from many different practitioners, etc.)
• Smoking Cessation — One-on-one service to help patients quit smoking by providing necessary materials and counseling (i.e. Nicotine Replacement Therapy patches/gum)
• Pharmaceutical Opinion — Enhance patient health outcomes through suggesting changes in prescription and consumption methods (i.e. dietary restrictions and exceptions, prescription adaptation/de-prescribing, etc.)

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and much more as seen in the table below:

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As most Canadians are not aware of these services, it’s evident that current market economics are not aligned with delivering value for patients even though pharmacists are very much capable to do so.

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Outlook of Pharmacy Practice

Several movements in technology, regulations, and market needs have already been transforming pharmacy practice. Some recent and upcoming technology advances include:

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• Pharmacy Automation: As automated dispensing cabinets become more commonplace (thanks to companies like Pyxis from BD and Omnicell), it’s expected that a large portion of traditional tasks like filling and counting will be automated and replaced.
• Online pharmacies: Companies like Pillpack in the US are leading the way in moving the pharmacy storefront online with their delivery options. Though a low-compromise effective telepharmacy solution has yet to be seen, some pharmacy owners are recognizing the possibility of having remote pharmacy warehouses for dispensing only in the future.
• Digital pillboxes: Automated smart pillboxes are now full-suite solutions in medication management and capable of enhancing medication adherence outcomes by tracking compliance on a per dose level (i.e. Spencer and Pillo).
• Pharmacogenomics: Personalized medicine advances such as pharmacogenomics allows more effective drug therapy outcomes by using genes to predict someone’s response to medication and reduce adverse effects.

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These advances in technology are pushing pharmacy practice to shift from a dispensing model to a decoupled service/analytics model with increased personalization, quality, access, and convenience.

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On the other hand, some regulatory and market trends include:

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• Telepharmacy Designation — British Columbia is leading the country in establishing new regulatory and incentive structures to help pharmacy practice transition to a digital model
• Aging Population — Currently, 1-in-6 Canadians are 65 years of age or older. By 2030, we expect the ratio to grow to 1-in-4. With the average senior taking 7 different drug classes over a year, Canadian pharmacies must prepare to serve the older population with much more accessible and convenient care.
• Telemedicine — Companies like Maple and Dialogue are transforming the way we visit a family doctor by bringing the traditional consultation online. There still seems to be a gap after the telemedicine process that could be filled by online solutions that offer not only medication delivery, but online pharmacy consultation and services.
• Remote Patient Monitoring — Devices from companies like Dexcom and Propellor Health are transforming the way pharmacists collect real-time real-world biometrics of their patients without lengthy pharmacy or at-home visits.

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These forces add to the advances in technology to incentivize a more personalized and digital approach to pharmacy practice that could more optimally utilize a pharmacist’s skills.

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In short…

Pharmacists today in Canada are heavily underutilized resources that could provide a significant amount of value for patients to improve health outcomes. Thankfully, many technological advances and regulatory changes are pushing the market to adopt a more service-oriented digital model that will help increase personalization, convenience, access, and efficiency to pharmacy care.

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The next time you need to get a prescription filled, go online and search for new pharmacy solutions and you’ll be surprised by what you’ll find.

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