When more gets you most: These doctors say full integration of pharmacists into family health teams brings great advantages

A pilot project with family medicine groups in Québec has found that increasing the hours of pharmacists who are integrated into the healthcare team can yield benefits for doctors, other healthcare providers in the practice and for patients. “There are so many advantages to having one in the team,” said Dr. Philippe Melanson, who leads a family medicine group in Saint-Donat, about a 90-minute drive northwest of Montreal. “(Pharmacists) are the most autonomous and versatile professionals in their practice.” In Québec, a growing number of pharmacists work as part of family medicine groups, thanks in large part to the health ministry’s professional support program which provides funding that allows clinics to hire a pharmacist for between five to 34 hours a week, depending on the clinic’s classification. Dr. Melanson’s clinic and four other family medicine groups took part in a pilot project last year that looked at increasing pharmacists’ weekly hours within a family medicine group. Anne Maheu, pharmacist and coordinator of the Québec Network of Pharmacists Groupe de médecine de famille, said having a pharmacist work in a clinic for less than a day-and-a-half per week is “not optimal—the pharmacist is not available enough to significantly free up family doctors.” One way to fund additional hours for pharmacists in a family medicine group is to dip into funding that would normally be allocated to other professionals, said Maheu, noting that this would be done at the discretion of the family medicine group manager. Read: 5 tips for demystifying the role of team-based primary care pharmacists Clinics can also avail of provisions under the province’s primary care access point rules, which could provide funding of $20 per patient. Dr. Melanson’s family medicine group took this route to free up a budget of $40,000, enough to hire two part-time pharmacists for four sites. Over in Rivière-du-Loup, the Groupe de médecine de famille Lafontaine also took advantage of these provisions by registering a cohort of 1,000 patients. Dr. Valérie-Anne Gagnon, the group’s medical manager, said the funding from this source partially covers the hours of one pharmacist who works at the clinic 37 hours a week. To bridge the funding gap, the clinic currently uses money allocated for a nurse or social worker. "Pending the hiring of our second social worker, we have temporarily assigned these hours to our pharmacist," said Dr. Gagnon. The nature and extent of pharmacists’ roles within family medicine groups depend on how much time they spend in the practice, as well as on what is defined within their service agreement. “Our involvement in (family medicine groups) is still recent and our skills remain unknown,” noted Léa Prince-Duthel, pharmacist at Groupe de médecine de famille du Sud-Ouest, in Verdun. “The service agreement details what we can do or not do, defines the target clientele that can be referred to us, clarifies our ways of working, our methods of communication, et cetera.” Dr. Gagnon said it’s important for family medicine groups to remember to "to learn to work together" and to review service agreements to adapt to new realities or new needs. In her clinic, she organizes “clinical afternoons” where team members can each talk about their roles. Read: Pharmacists in Quebec: lack of staff and poor distribution according to OPQ Dr. Melanson said the integration of pharmacists into family medicine groups is still very much a work in progress. "It's still new, not all doctors are systematically thinking about it yet,” he said. “Adjustments (need) to be made to know what to delegate to which professional.” His family medicine group, for example, decided that diabetic patients should be placed in the care of nurses because “they have more training” while pharmacists would look after hypertensive patients, whose blood pressure can be managed remotely. Prince-Duthel said it’s a good idea for pharmacists to include “advanced practice in partnership” in their service agreements. "It takes time to write, but once it's done, the agreement allows us to initiate or modify drug therapy, without a prescription or consultation request from doctors," Prince-Duthel explained. The advanced practice in partnership agreement details the target clientele or pathologies. Prince-Duthel can, for example, intervene with “all registered patients whose diagnosis is recorded in the file. By comparison, at the family medicine group led by Dr. Gagnon, the agreement specifies a list of pathologies. Read: Physician and pharmacist team up to offer hair loss solutions The service agreement between family medicine groups and pharmacists must also specify the methods of referral and communication between professionals. At the very least, the pharmacist must have a telephone with voicemail, an email address with the clinic or establishment and access to the electronic medical record (EMR) of the family medicine group. Pharmacists must also have access or own an office or clinic where they can see patients in a confidential setting. Ideally, said Maheu, pharmacists’ calendars are shared with the rest of the team so that secretaries, doctors and other members of the family medicine group can book pharmacy appointments. "It legitimizes the pharmacist, and his role, if we can make an appointment with him,” she said. This article has been translated and adapted from its original French and first appeared on our sister site Profession Santé. Read: Can we afford to be picky when it comes to solving the orphan patient problem?

When more gets you most: These doctors say full integration of pharmacists into family health teams brings great advantages

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