Spotlight on Collaboration

Rashna Batliwalla is an Ottawa community pharmacist about to work much more closely with a very important part of the community: its family practice physicians.

"My responsibilities will be as a non-dispensing pharmacist at the Riverside Family Health Network," explains Batliwalla. "The eight family doctors there will be able to refer particular problem patients to me and I can identify drug-related problems."

While such arrangements exist only sporadically in Canada, Batliwalla is among seven Ontario pharmacists embarking part-time in the next several weeks on an initial year-long trial called IMPACT - Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics.

"It's a demonstration project to see if this will provide better outcomes for patients," says Batliwalla, who also anticipates educating colleagues and patients in such areas as the use of medical devices.

Anchored by clinicians and researchers at the University of Ottawa, McMaster University and the University of Toronto, IMPACT will continue in stages after the initial year until reporting its findings in mid-2006. The effort is supported by the Ontario Primary Health Care Transition Fund.

"This is a time when we realize that for pharmacists to be more effective, they should be better integrated in family practice," explains Lisa Dolovich, the IMPACT principal investigator at McMaster University in Hamilton. "We want to see how this integration improves health care processes and health care outcomes. How can we best facilitate this integration?"

Dr. Lisa Moore, one of the family physicians in Ottawa, says the project is no abstract query (I wonder if they meant theory?) but a response to ongoing practical difficulties that she and her colleagues across the country are facing.

"One of the greatest challenges of a family physician is managing our patient's medications,' she remarks, also citing making the choice of medication, keeping abreast of other drugs and alternative therapies the patient is using among the other challenges.

"Typical clinical practice in the family physician's office is not well-suited to being able to manage these issues," she continues. "Information systems are poor and current drug interaction programs are generally poor and not user friendly. Office visits are generally short - 10 to 15 minutes - and not conductive to dealing with these issues."

While harried family physicians are hard-pressed to stay current with the abundance of new medications coming on-stream, community pharmacists are themselves often chained to a hectic dispensing role that doesn't always allow sufficient consultation time with patients.

By employing pharmacists in non-dispensing, consultative roles, and teaming them with senior mentors to do it, IMPACT will bring to its communities what usually only exists in hospital settings.

"I look at the teams in hospitals and then I go to the community and there's no one," observes Barbara Farrell, an IMPACT co-principal investigator and Ottawa scientist who has experience as both a hospital and community pharmacist.

"We're trying to look at the process of integration," she adds. "What we would hope to see ideally at the end of the project is a really synergistic type of practice. There would be a lot of bi-directional communication between the pharmacist and physician."

The University of Ottawa colleague who shares her role as principle investigator in IMPACT is a family physician equally persuaded of the need for stronger collaboration.

"My interest is in strengthening primary health care," says Dr. Keven Pottie. "This project has come a little from my personal experience working in more rural environments and working more closely with the pharmacist."

"What I've come to feel very strongly is that the pharmacists bring not just skills and knowledge but attitudes that are very different from those of doctors. A family physician has a lot of responsibilities in complex care, deals with a lot of medications, does counseling and prevention. The difference is that the pharmacist brings an expertise and a focus on things like the cost of drugs, on their effectiveness, on the interaction problems."

Having worked in developing countries where populations are younger and medications are more scarce, Dr. Pottie has been particularly struck by the contrast with an aging population here using up to 15 medications or more.

"It's a very complex field and it would be so valuable to have someone working with us in a synergistic way and not just another specialist giving us advice, something we have a lot of now," he comments.

IMPACT has been designed to collate experiences from different kids of communities, with one site in downtown Ottawa, another in suburban Ottawa, another in the smaller city of Burlington and others in Stratford, Mt. Forest, Toronto and Beamsville.

Practices with about eight to ten physicians were sought and, happily, the program was actually oversubscribed with physician interest.

That in itself was perhaps a sign of things to come.

"There is a lot more awareness of this need within the pharmacy profession," observes Farrell. "Gradually, I think more physicians are doing to be willing to adopt this approach."

- This article was originally published in May, 2004, as part of A Special Information Supplement to The Globe and Mail.