Community Pharmacists

Most patients referred to a Primary Care Clinical Pharmacist (PCCP) will already have an established relationship with one or more pharmacists in their chosen community pharmacy. The community pharmacist is part of the patient's health care team and will have the opportunity to interact with the PCCP for shared patient care.

The Role of the Primary Care Clinical Pharmacist (PCCP)

PCCPs collaborate with primary care providers and other members of the care team, including the community pharmacist, to optimize drug therapy outcomes for patients within a primary care network (PCN). Please note, dispensing medications and supporting patients covered by PharmaCare Plan B are not a part of the PCCP role.

Why is Collaborative Care Important? 

Most complex patients referred to a Primary Care Clinical Pharmacist (PCCP) will already have an established relationship with one or more pharmacists in their chosen community pharmacy. The community pharmacist, as part of the patient's health care team, can interact with the PCCP for collaborative care. Shared care enables a professional practice culture where the shared knowledge and skills of care providers contribute to improved outcomes and enhanced patient safety.¹ When pharmacists who practice in different care environments share information and collaborate on patient care, positive patient outcomes such as improved drug therapy problem resolution and decreased re-hospitalizations can occur.^2,3 The unique insights and expertise each pharmacist holds can contribute to this success.

For instance, pharmacists in community pharmacy practice have valuable knowledge about their patients’ adherence and medication trial history (including medication regimens that work best for the patient and previous medication trials >14 months prior), specialty services offered by the pharmacy (e.g., point of care testing, daily dispense and monitoring, and compounding), and medication coverage and availability (third-party insurance plans, Pharmacare, drug inventory and shortages). 

On the other hand, PCCPs may initiate and be more aware of detailed drug tapering or titration plans that are not noted on PharmaNet (e.g., opioids, corticosteroids, and antidepressants), Special Authority application processes (e.g., biologic drugs), or indications for medications which may be seen as last line or off-label but are evidence-based. PCCPs coordinate care with other members of the PCN team (e.g., family physician, nurse practitioner, or nurse).  When information is communicated between care providers, safe and effective continuity of care can occur.

How Will You Know a PCCP Has Seen a Patient?

How are PCCP Care Plans Accessed?

How Can PCCPs and Community Pharmacists Work Together?

What Does Collaborative Care Look Like in Action?

When providing collaborative care, community pharmacists and PCCPs work together to achieve the treatment goals of mutual patients. Through collaboration, a PCCP or community pharmacist may:

Recommend changes to medication regimens or blister packs

PharmaNet fill history does not tell the whole story  
Patient may not be adherent to medications (e.g., taking dose at inappropriate time or time that is hard for patient to remember)
Community pharmacist and PCCP share information  
Optimizes patient medication regimen

Request Medication Review documentation

Ensures up-to-date information (obtains most recent documentation)
Enhances clinical decision-making

Provide monitoring and share appropriate health measures

Medication adherence  
Medication side effects 
Symptom resolution 
Blood pressure, sugars 
Weight

Identify patient priorities and concerns

Out-of-pocket cost  
Medication side effects 
Symptom management
Desired treatment outcome

Act as a patient navigator

Complex patients with sub-optimally controlled conditions requiring frequent follow-up, billing concerns or time constraints in community pharmacy practice: consider communicate and transfer care from community pharmacist to PCCP, and/or shared care
Patients who are stabilized on medications or require less frequent follow up: consider transfer care from PCCP to community pharmacist
Patient’s needs may change over time

Effectively communicate patient information to make a shared decision

Utilize preferred modality of communication (e.g., fax, phone) to contact one another
Share knowledge about gaps in patient information
Involve one another in clinical decision making when appropriate (e.g., starting, stopping, adjusting, or adapting a medication or using adherence aids)

By collaborating in the care of mutual patients, optimal outcomes may be reached in a prompt fashion.

Please Note for billing purposes: 

If a community pharmacist is providing an MR-F to a patient whose original medication review was provided by a PCCP, please be sure to obtain the most recent MR-PCN documentation as per PharmaCare policies. When it has been at least 6 months since the patient’s last MR-PCN, a community pharmacist can bill an MR-S or MR-PC.

General PCN One Pager.pdf

Case Examples: Collaborative Care of Mutual Patients

1. 84-year-old male palliative patient referred to a PCCP with end stage renal failure and a recent trip to the ED due to hypotension

Medication reconciliation completed by PCCP revealed that patient was still receiving amlodipine, metoprolol and atorvastatin in his blister pack, despite all medications having been discontinued in the local EMR
PCCP liaised with Most Responsible Provider (MRP) and community pharmacy to ensure discontinuation orders were written and blister pack was adjusted accordingly
The PCCP and community pharmacist continue to work together to monitor and care for this patient

2. 65-year-old female patient referred to a PCCP for management of multiple comorbidities

Patient interview revealed the patient had been diagnosed with asthma and was experiencing chronic cough and wheezing, which she had not discussed with her MRP
The patient had been prescribed Symbicort in the past, however she was not using it due to administration issues despite her community pharmacist showing her how to use it
PCCP investigated issues regarding administration technique and recommended once daily Breo for ease of administration, applied for SA, and provided education on the importance of maintenance therapy
PCCP shared recommendations with community pharmacist and requested the patient to follow-up with the community pharmacist in one month (this is an opportunity to bill an MR-F)
Patient presented at community pharmacy one month later with no wheeze or cough; the community pharmacist faxed the PCCP and primary care provider to report this information
To provide longitudinal care, the community pharmacist and PCCP continue to work together to optimize other disease states

3. 30-year-old female patient with long-term depression, anxiety, history of suicide attempts and thoughts of harming herself and her young daughter

Referred by MRP to a PCCP regarding adjunct antidepressant therapy and query medication "wearing off" in the afternoon
PCCP liaised with community pharmacist to discuss past medication reviews and to identify potential alternative therapies for the patient
Treatment was adjusted, Special Authority approved, and the patient was able to continue without cost concerns
After 3 weeks, the patient followed up at her community pharmacy and had more energy and patience with her child
The PCCP and community pharmacist continue to work together to monitor and care for this patient

Other useful resources for community pharmacists from the Pharmacists in PCN Program

A White Paper on Team-Based Primary Health Care in British Columbia: Context and Opportunities for Pharmacists
https://pharmacistsinpcn.ubc.ca/white-paper-team-based-health-care-bc

PACT (Pharmacists Aligned in Shared Care Teams)

If you would like any further information about how you can work with a PCCP, please feel free to contact:  

Parkash Ragsdale, Primary Care Coordinator
parkash.ragsdale@ubc.ca
(604) 827-0703

References:

Gobis B, Yu A, Reardon J, Nystrom M, Grindrod K, McCarthy L. Prioritizing intraprofessional collaboration for optimal patient care: A call to action. Can Pharm J (Ott). 2018 Apr 2;151(3):170-175.
Mia E. Lussier, Haley J. Evans, Eric A. Wright, Michael R. Gionfriddo. The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis, Journal of the American Pharmacists Association. 2022 Feb; 60 (1), 2020, 153-162.
Ensing HT, Koster ES, Dubero DJ, van Dooren AA, Bouvy ML. Collaboration between hospital and community pharmacists to address drug-related problems: The HomeCoMe-program. Res Social Adm Pharm. 2019;15(3):267-278.