Jeremy Sasser - September 2, 2020
Have you ever wondered what it's like to be a pharmacy technician in Canada? We've got you covered. Don’t miss this information packed episode that provides insights into pharmacy practices outside of the US.
In this episode, Jeremy and Jessica have a discussion with our neighbors from the North. Dr. Alam Hallan, Director of Pharmacy and Lead Pharmacy Technician, Lori Hayden, from Guelph General Hospital in Guelph, Ontario discussing pharmacy trends in Canada. Pharmacists and technicians alike taking on more roles and responsibilities. Similar to states regulating pharmacy practice in the US, pharmacy regulations can vary greatly from province to province. With some national standards to be a pharmacy technician, we discuss what it takes to practice in Canada as a whole, as well as specific provincial requirements in Ontario. With a single payer national healthcare system, these subject matter experts compare and contrast the benefits and struggles of both the US and Canadian healthcare systems with regard to remuneration for services as scope of practice expands.
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Jeremy Sasser: Pharmacy Podcast Nation, Jeremy Sasser here, host of the On-Script Podcast, and I'm super excited to announce that the National Healthcareer Association, along with other leading pharmacy industry organizations, have formed the Coalition for the Advancement of Pharmacy Technician Practice. With the help and support of our industry partners, the coalition's singular mission is to advocate for the expansion of technician scope of practice through working with state boards of pharmacy to adopt rules that allow for this expansion. The coalition's most immediate efforts focus on increasing state's authorization to permit appropriately trained pharmacy technicians to administer immunizations. The coalition continues to add supporters and encourages pharmacy stakeholders to consider becoming a partner of this meaningful initiative. For more information about the coalition or how to become a sponsor of its efforts, please visit www.nhanow.com and click on the banner at the top of the page, or view the show notes in episode 12 for a direct link. Thank you. And now we hope you enjoy this episode of On-Script, powered by NHA.
Speaker 2: You're listening to the Pharmacy Podcast Network. Since 2009, the Pharmacy Podcast Network has led the podcasting space for the pharmacy industry. This network of pharmacists and pharmacy technicians leads the podcasting charts with more than 2 million downloads, 40 different stations and new episodes every week. The Pharmacy Podcast Network is the number one podcast for the pharmacy professional. Subscribe now on Apple Podcasts, Spotify, Castbox and all your favorite podcast players. Join the Pharmacy Podcast Nation today.
Speaker 3: This is On-Script hosted by Jeremy Sasser, a podcast publication partnership between the Pharmacy Podcast Network and National Healthcareer Association. Our podcast is dedicated to providing the pharmacy technician workforce with news, real life stories and discussions that can impact personal and professional growth. Here's certified pharmacy technician and National Healthcareer Association content strategist, your host, Jeremy Sasser. Let's get On-Script with NHA.
Jeremy Sasser: Pharmacy Podcast Nation, it's Jeremy Sasser coming at you with the On-Script podcast, the only podcast on the Pharmacy Podcast Network dedicated to the pharmacy technician workforce. Joined today by the gracious, knowledgeable, intelligent, awesome Jessica Langley.
Jessica Langely-Loep: In case you didn't know on our last podcast, he said he was going to have to come up with a few more adjectives to describe me. So I challenged him. I will gladly take them. So thank you, Jeremy, and I'm happy to be here today for a really great topic. I'm super excited.
Jeremy Sasser: Indeed, indeed. So part of what we're trying to do here with the podcast is provide as many different perspectives on pharmacy practice, particularly as it pertains to pharmacy technicians, multiple settings, multiple geographical locations. So we're really excited today that our guests are practicing pharmacy in Canada. So we're going to talk to them a little bit about the differences in practicing in the US and in Canada. So joining us today is Alam Hallan, a PharmD. He's the Director of Pharmacy for Guelph General Hospital in Guelph, Ontario. Also joining us is Lori Hayden, who is the Lead Technician at Guelph General Hospital in Guelph, Ontario. Thank you guys so much for joining us.
Lori Hayden: Our pleasure.
Dr. Alam Hallan: Thanks for having us, Jeremy.
Jeremy Sasser: So can you maybe start off by talking a little bit about pharmacy practice in Ontario? How is direct patient care services viewed when offered by pharmacists? And then, as far as pharmacy technician practice goes, just paint us the general landscape.
Dr. Alam Hallan: So Jeremy, in Ontario, as with other provinces across Canada and states across USA, there's a lot of push for pharmacists to take on more and more clinical role. As part of this role, pharmacists in Alberta have been doing a lot more extensive prescribing, but the pharmacists in Ontario also got some exposure to that. Things like smoking cessation prescribing, ability to adapt prescription, do some emergency refills, administer vaccinations, including two vaccines for five years or older individuals. So a lot has been happening on that end. There's a lot of focus on the pharmacist taking on more of the medication management role, the clinical aspects of it, and further pushing on that role, there's new regulations that are being proposed this year which will further expand the role of the pharmacist to give more vaccinations to individuals who are as young as two years.
Dr. Alam Hallan: There's also an expansion on the renewing of prescriptions when patients are running out of refills up to a year. So they're expanding on that as well. The other expansion that we've seen in the pharmacist role is the increase in the ability to give substances inject or inhalation. Before it was only to demonstrate to the patient or for patient education, but that's being expanded as well. The final two changes, which are the big changes that are happening this year, one is the performing of point of care test for chronic conditions. That is with the Ministry of Health, as it requires some changes to the specific Collection Centralizing Act, which is the act that regulates the labs. So that's the one big change that's happening. The other one is prescribing of drugs for certain minor ailments. So in contrast to Alberta that has opened it up broadly to basically all Schedule 1 medications, in Ontario, we are going to start off with certain minor ailments.
Dr. Alam Hallan: There's a list of 19 conditions that are being proposed as a starting point. So all of this great things are happening in the world of pharmacy with a focus on the pharmacists taking on more and more patient care. We know the benefits are there when we have more pharmacists engage with the patients, spend more time with them, focus more on the clinical issues. We know we make a huge difference to their outcome. But the key thing that I want to focus on is, with this transition of the role, none of this can happen if we don't have an expansion on the technician scope as well. So pharmacists expansion of a role can only happen when there's a equivalent expansion of the technician role that can take on more and more of these technical side of responsibilities in the pharmacy to free up the pharmacist to spend more time with the patient.
Jeremy Sasser: Yeah, of course. Just for clarification, you had mentioned schedule one drugs. I assume that refers to medications that require a prescription.
Dr. Alam Hallan: That's correct.
Jeremy Sasser: Just wanted to clarify that because in the US, Schedule 1 drugs are basically illegal drugs, and Schedule 1 was set by our DEA.
Dr. Alam Hallan: Yeah. Sorry.
Jeremy Sasser: So for anybody who is listening, I just wanted to be clear about that.
Dr. Alam Hallan: No, I was referring to those drugs, Jeremy.
Jeremy Sasser: So how is pharmacy technician practice, though, regulated? I mean, is it as general as just under the delegatory control of the pharmacist in charge or are there specific statutes that say, "This is what technicians can't do or can do?"
Lori Hayden: So from a technician point of view, I can tell you how I landed where I am with accredited education program being a requirement, the practical evaluation program, the Pharmacy Examining Board of Canada for the PBC exam and the Ontario College of Pharmacist jurisprudence exam are all requirements that then designate you as a regulated pharmacy technician.
Jessica Langely-Loep: Awesome. So it is a little bit different than what we have seen here in the US which I know, I've been in on multiple sessions when the debate is still happening here in the United States around some sort of standardized education training and certification or assessment requirement. We oftentimes look to you all in Canada and what you guys have set in place, because you have done that in a sense by mandating that the accreditation come with the education, that you actually have a practical component that must be completed along with that national exam. Lori, tell me a little bit, I know Dr. Hallan talked about all of this role expansion with the pharmacist, how is that changing your particular role? He mentioned, we know and we're fighting for the same thing here, that if we want pharmacists to have provider status and be able to provide more patient care services, the technician's scope or role has to be elevated as well. How are you all achieving that in Canada right now?
Lori Hayden: Well, to paint the picture of our current regulated pharmacy technician working in hospital in Ontario, specifically at Guelph General, we have technicians doing everything from inventory management to purchasing and Omnicell administration. So really detecting those transactions that need follow up on the nursing end. We have everyone certified for best possible medication history, technicians going up and interviewing patients that have come in for hospital admission to review the meds that they are on at home. So I've really seen, over the last 15 years, a true elevation in the pharmacy technician role with folks really just getting excited about what is to come.
Jeremy Sasser: That's excellent. I have to imagine probably one of the biggest, or at least one of the most visible differences between health care in the US versus Canada, is the insurance companies and the pharmacy benefit managers that are so prevalent here in the US. So not only are pharmacists pushing for provider status, just in terms of being able to provide services, but a big component of that is to be able to provide services and get reimbursed for those services. So even if a state here gives provider status to a pharmacist, it's still up to that entity to be able to contract with a payer that will reimburse the pharmacist for those services. Until that happens on a national level here, there won't be any federal reimbursement from Medicare, Medicaid, TRICARE, et cetera. That is obvious. That's not a hurdle you guys have to deal with, right?
Dr. Alam Hallan: Well, we do have that hurdle, but at the same time there is a silver lining as well. In 2008, around the time when the Medtech program was introduced, the government pays for medication consultations with patients who are on three or more chronic medications. The program has since been... They're trying to pull back on the program, but at the same time, it's there. The government does pay for some of these increased scope of practice. The pharmacists get compensated for giving flu shots. The pharmacists do get compensated for finding out pharmaceutical problems when they're dispensing medication. There's billing codes associated with that. And on the private side, there's some innovative drug plans that are actually recognizing this as well, and have started to do two things. They've started to compensate for some of these pharmacy services.
Dr. Alam Hallan: On the other side, what they're doing is they're rating pharmacies as per some standards, looking at the compliance rate for the patients of a particular pharmacy and some of the variables and basing on that, they're giving them a star reading, which impacts how much dispensing fee the pharmacies get paid. So that's still in the infancy, but these things have started to set in motion. So there are some places that we're winning, but of course we're still fighting for proper compensation to further enhance the scope. But yes, we are heading in the right direction in Ontario.
Jeremy Sasser: Well, and I imagine that the reimbursement based on star rating, the dispense fee is determined upfront as opposed to retroactively, correct?
Dr. Alam Hallan: Well, what the plate... Yeah. So the plan checks what they pay and the pharmacies set their own dispensing fee, but what they get reimbursed, as you know, there's always a difference.
Jeremy Sasser: Because another big issue here, I'm sure you've heard, is direct and indirect remuneration, which is essentially a clawback of funds much later, sometimes up to a couple of quarters later when they review the data. So it becomes something that it's hard to predict and also can be quite devastating to a pharmacy's revenue. So that's interesting. So Lori, let me ask you, what was the appeal for you to get into pharmacy? How did you get into it? How is the pharmacy technician profession viewed in Canada?
Lori Hayden: So the pharmacy technician profession is viewed, I think, from the perspective of the possibility of participating in such a broad scope of practice and the variety of responsibilities that a regulated pharmacy technician can participate in. So like I was mentioning before, we do have the role of an Omnicell system administrator. So they're doing everything from nursing orientation to midwife orientation. This is getting the frontline users ready to work with those automated dispensing cabinets. So we have those folks that are going up and interviewing the patients for that best possible medication history. That's where we're really seeing the interest, is when we're able to... So for me, I come from retail and really getting a chance to interact with the patient once again and really get to the heart of what matters in pharmacy is getting back to the patient.
Jeremy Sasser: That's great. I have to imagine that is a program that you are rolling out to multiple areas, multiple care areas of the hospital.
Lori Hayden: So we try to focus our best possible medication history to patients coming through an emerg. So in the ER department, that's really our first line of defense. So if we can get to the patients early on, then that is ideal. But also on units such as medicine and surgery, these are the areas where we try to focus.
Jeremy Sasser: I see, and correct me if I'm wrong, you are also responsible for implementing Lean practices into the pharmacy operations.
Lori Hayden: That's right. So I do have my yellow belt and I'm currently going through for my green Lean belt. So really working on those internal processes to do with narcotic management. With the opioid crisis that we're currently living in, this is the time and the time is now. So we're really working to nail down those processes internally and then incorporate our internal narcotic working group, and once we have a good handle on things, we're going to be bringing that out to a more broad view, to more of a hospital-wide inter-disciplinary team, including HR, human resources, and employee services. So really just bringing everybody to the table that we can all try to make a difference.
Jessica Langely-Loep: That sound awesome. I love to hear about the expansion that you're experiencing in even non-traditional ways. And I say non-traditional because the role of technicians really hasn't gone that way. We do see some in independent pharmacies to where a pharmacy technician will work their way up to be a manager or sometimes even an owner, and those are really great stories, but we want more of that. Can you tell me a little bit just about your journey on how you recognized when opportunities were there for you in terms of taking that next step into a different role and elevating your career for yourself and how technicians can, who are wanting to expand right, and wanting to do more in the industry, what they can do, what they should be looking for to be successful at that?
Lori Hayden: Sure. So like I said, I started off in retail and that was always in the background for me during high school, so more of a part time basis, and then went to college specializing in rec and leisure in gerontology. So I took a bit of a vacation from pharmacy, but it was always still in the background for me. So I did work with the seniors for about two years and after that, deciding that pharmacy was still sticking around there and really wanting to go back in and give myself that challenge that pharmacy provided. So recognizing the opportunity to, at that point in time, Ontario had a certification process for pharmacy technicians and I [inaudible 00:20:04] the certification process successfully. After that, continued on with retail and really getting a chance to say, challenging yourself to do more. At that point, I decided to apply at the local hospital, Guelph General, and was successful and really got... It's really like night and day with retail compared to hospital.
Lori Hayden: So really taking on all of those new responsibilities and it really is a whole new world. So was quite eager to take on that new challenge. And then of course, as Alam was mentioning, the regulation came into place and we in Ontario, the Ontario College of Pharmacists started regulating in 2010 and there's approximately 3000 regulated technicians in Ontario currently.
Jessica Langely-Loep: Awesome. So I'd like to ask, as we start to wrap this up a little bit here, is knowing that Canada or specifically some of the specific states within Canada, like Alberta and Ontario-
Jessica Langely-Loep: Knowing that you all are a couple of steps ahead in terms of the regulatory and the advancement of scope of practice, what little piece of advice for those of us who are here in the United States that are advocating for this to happen across our borders and looking to support the advancement of technicians, what are some recommendations or things that you might tell us to help us be more successful here or continue our march forward?
Dr. Alam Hallan: Jessica, just to add my two cents, I'm going to reflect back on the time that I went to a hospital in Philadelphia. So I walked into the pharmacy. So they were using top-notch equipment. We were there to look at equipment for our facility. I was at Brantford General Hospital at that time, which is again, a small community hospital. Lack of funds. We're trying to get this fancy equipment from, I believe it was Swisslog. So we walked into this facility. They had the top of the line equipment and they were sending medications from the pharmacy to the floors. So the machines were spitting out these medications and I saw this pharmacist sitting with a whole bunch of medications next to him and he's going through each one of them. I was trying to... I was a fairly new grad at that time. I think it was two years in my practice, and I was really shocked to see that the pharmacist was going through each medication, spending time to make sure that the right medication is in the right pouch. And there's tons of technicians around.
Dr. Alam Hallan: As I was trying to understand the philosophy of what's happening, I asked him, I said, "Why are you doing that? You have technicians over here." And he said, "Listen, this is my license and this is how I'm going to make sure that no one is able to raise a finger at my license that I'd made this mistake." That moment stayed with me. So what I would say for that is for the pharmacist to move forward, it's a give and take relationship, right? It's a teamwork environment that we're working in. So we each have our role. We each have our responsibility and we all have our role to play to ensure patient safety.
Dr. Alam Hallan: So in order for us to do that, we need to look at that as a team-based environment, pharmacy technicians and pharmacists working together to accomplish the end goal. Because what that gentleman, that pharmacist, was there trying to do was getting the med safety to the patient. But there's other ways of doing that. There's this collaborative ways that we can do, collaborating with our pharmacy technicians, taking advantage of their scope, getting a better understanding of their role. And not even the technicians, even the nursing staff. So it's a collaborative environment that we work in. So the hospitals in Ontario, we've done a fabulous job of doing that, facing that demarcation in that role, understanding that together we are able to make the system safer.
Dr. Alam Hallan: The community had its challenges, but there's, like you said, Jessica, there's some independents that are taking massive advantage of this opportunity to make it happen. But the same principles apply, right? Pharmacists need to be on board as well, and the technicians need to be on board as well as to help each other make a push for these expansion of scope for the betterment of not just the pharmacist or the technician, but the pharmacy profession as a whole.
Jessica Langely-Loep: Yeah. And great insights there on, maybe it's those pharmacists that have been working in this environment for so long, they're stuck within their own borders, right? How do we knock down those walls to get them to see the bigger picture and to think differently about the individuals around them? What an amazing job that you guys have done up there. One day we'll hopefully get there as well. Lori, any comments on your side?
Lori Hayden: I would say from my perspective, from a technician point of view, I would say never turn down an opportunity. There's been many that have been presented to me and I think just continuing to challenge yourself and see the opportunities to really drive home the difference you can make with the patient and in your community. Never turn down an opportunity.
Jeremy Sasser: That's fantastic.
Dr. Alam Hallan: I can vouch for that. Lori never turns down an opportunity. Every time we have something new to try out, she's always ready, be it working with the pharmacy staff, the patients, or the nursing staff. The other thing that I just want to briefly touch upon is the role of the laws and the regulations. They're there as enablers. But at the end of the day, we as professionals, we have a responsibility to push the boundaries, work to scope, not just within our scope, but push on those boundaries to not only take advantage of the laws and regulations that we currently have, but also push on them to further extend them as we move forward as our professions transition, as we look on to taking more and more responsibility for our patients.
Jeremy Sasser: Yeah, absolutely. I mean, the true mark of a professional is to, as you said, practice at the very top of their license and use their professional judgment. Part of that, too, is having the delegatory authority to give tasks to their pharmacy technicians that they work with side-by-side every day and they know what their skill set is. They know what their training is. They know what their capabilities are and a pharmacist can trust their technicians to do certain tasks, then that should be within their professional judgment. So, well, we really appreciate the time, guys. Really appreciate the insights into what is going on north of our border. To our listeners, don't forget, we love to get your emails. Our email is firstname.lastname@example.org. Let us know what you would like to see happen where you're practicing.
Jeremy Sasser: What expansion in terms of scope of practice are you seeing, would you like to see, what makes sense? We'd love to hear from you. As always, we encourage anybody listening to subscribe. You can subscribe through Apple podcasts for On-Script powered by NHA, or you can visit our blog at www.nhanow.com/learning-leading. All of our podcast episodes are up there. Lori, Alam, thank you again so much. Really appreciate your time.
Speaker 3: Thanks for listening to On-Script, where we cast a spotlight on pharmacy technicians, the services they provide, and to the patients they serve. So for all the spatula warriors, TPN ninjas, and lieges of levigation, this podcast is for you. Subscribe at Apple Podcasts, Spotify, or go to pharmacypodcast.com.