February 2013 Drugstore Canada 1514 CanadianHealthcareNetwork.ca

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Not only does she call me every two weeks, but whenever I’m at the pharmacy she’ll ask me how

things are going. And I can phone her any-time,” says Lazaruk of Sonal Ejner, phar-macy manager and certified respiratory educator at Crowfoot Calgary Co-op in Calgary, Alberta. “Two years ago I went to a smoking cessation clinic, and the people there were really good, but they didn’t do this kind of follow-up. This personal touch really helps.”

Karl Valois echoes those comments when asked about his pharmacist, Ryan Keller, pharmacy manager at Calgary Co-op’s Rocky Ridge location. His doctor re-ferred him to Keller, a certified diabetes educator, to start insulin therapy. After two face-to-face appointments, “we’re in touch now from week to week,” says Valois. “He’ll email or text me, or I’ll email him. I also do groceries at the Co-op twice a week and go to see him. Sometimes we talk for just a few seconds, and that’s all I need. He’s great.”

Both Lazaruk and Valois enthuse not only about the time saved by being able to talk with their pharmacist in this way, but also the time gained to manage their health. “I can breathe a lot easier now and I’m us-ing less medication,” says Lazaruk, who has COPD. “Sonal has definitely changed my perception of what pharmacists can do. But she also leaves the final decisions com-pletely up to me. That’s important. In this day and age, people have to look after their own health.”

Valois agrees. Despite losing 50 pounds in the first year after diagnosis, his blood-glucose readings “were beyond the scope of most meters,” he says. While insulin thera-py has performed a “miracle” to bring those

numbers down, he knows the last few steps to reach the normal range are up to him. Valois likens Keller’s support to that of a “game plan” to follow and adjust as required. “I’d say this is definitely a novel approach for pharmacists. We can all hope that more will do it.”

Time on your side At Calgary Co-operative Association Ltd., optimal patient care is simply a matter of time. Literally. The chain of 24 co-opera-tively owned supermarkets with pharma-cies is taking concrete steps to ensure phar-macists have the time to counsel patients on all prescriptions and, more recently, to deliver expanded services.

“With the pressures of generic pricing, we’re seeing other pharmacies with one pharmacist and three techs or assistants on duty to cut costs. That will never happen here,” says Trent Lane, pharmacy director. “Our policy provides guaranteed overlap and time for breaks. A new pharmacy al-ways starts with three pharmacists and a four-hour overlap between one and five. When we reach a certain volume we’ll add an assistant, and then as volume grows we’ll maintain a one-to-one ratio between phar-macists and assistants or technicians.”

At the Crowfoot location, which dis-penses more than 300 scripts a day, four pharmacists and four assistants are typically on duty during the afternoon peak period, says Ejner. The pharmacists use this time to conduct previously booked appointments for injections, medication reviews and care plans (the latter for those with chronic con-ditions). With Alberta’s implementation of the Pharmacy Services Framework in July 2012, all of these services are billable.

At CAlgAry Co-op’s phArmACies, the goAl optimal patient healthCare drives the business

putting the patient

firstby Karen Welds

Top, L-R: Sonal Ejner, Carol Lazaruk (patient), Nadine Hammoud, Judy Roberts.Bottom, L-R: Carol Lazaruk; Sonal Ejner and Carol.

StoryCover

Carol Lazaruk is breathing much easier these days,

and it's not just because she hasn't smoked a

cigarette for six months. It's also because she knows

she can count on her pharmacist for support.

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CoverStory

“Pharmacist overlap is absolutely essential for services,” says Ejner, adding that head office can also provide an additional floater pharmacist during clinic days (see sidebar, page 18). Booking ap-pointments during set blocks of time is also important. “We tried to squeeze them in during the rest of the day but it was too disruptive to workflow. We can make exceptions for those who can’t make it between two and four in the afternoon, but for the most part people are making the effort, the same as they would for a doctor’s appoint-ment. Public response has been great.”

Customers also have no problem taking their prescriptions to the front checkout for payment, since there are no registers at the dispensary. “This is a huge benefit,” says Keller at the Rocky Ridge Co-op. A cash-free dispensary not only saves time because “you’re not ringing in diapers and bread,” but it also makes for a much more professional environment. Indeed, it’s company policy that the phar-macist is “always the last point of contact with the patient for all prescriptions, including refills. That time is for a final check with the patient, not to ring in purchases,” says Keller.

Both Keller and Ejner estimate that a third of their time now goes to clinical services. For Ejner, that includes two days a month to conduct spirometry clinics (one day to test, one day to review results) that rotate through all 24 locations. When not in appointments, they use scheduled overlap to follow up with patients by phone or, in Keller’s case, by email or text as well.

“I’m helping to fill a gap in health care for sure, particularly in terms of the follow-up education,” says Ejner. While the transition to clinical services can be a challenge in time management, adds Keller, it’s a relative pleasure compared to previous jobs, when it would “just be me and four techs, filling 300 prescriptions a day. I could never go back to that.”

sTrong home baseTo prepare for the transition to professional pharmacy services, Cal-gary Co-op grew its head-office contingent from a department of one in 2006 to four personnel today: a director, two operations man-agers and a pharmacy professional services manager. From this base,

the company has been able to improve store-level efficiencies and implement services (see sidebar, page 18) during a time of intense economic upheaval due to drug plan reform, and without having to reduce hours of opening or compromise its commitment to phar-macist scheduling. In fact, “our bottom line keeps getting stronger,” says Lane.

The company also increased investments in training and com-munications. Pharmacists can apply for tuition for certification pro-grams; as well, the company posts opportunities for specialty train-ing. For example, this year it is sending four pharmacists to the travel medicine certification program in Maastricht, the Netherlands.

Nadine Abou-Kheir is one of those four pharmacists, and the op-portunity meets her personal goal to complete an advanced-training program every year. It began in 2010, when the pharmacy manager at the West Springs location became a certified diabetes educator (CDE). The following year she became an injecting pharmacist, and in 2012 she obtained additional prescribing authority. She now dedicates half her day to expanded services, most of it appointment-based. “This is primary care in action,” she says, adding that one of her staff pharmacists is training to become a CDE and the other is an asthma educator and injecting pharmacist, thanks to the support of head office.

On the communications front, head office hosts monthly meet-ings or conference calls between pharmacy managers, and quarterly gatherings of staff pharmacists, assistants and technicians “to talk about any issues they may have,” says Lane. The annual pharmacy conference includes an open discussion forum, and annual perfor-mance reviews dedicate time to personal objectives. While not all pharmacists are ready for advanced training, a positive momentum is building, says Lane.

“We are trying to shape staff ’s thinking so that they see expanded services as the way of the future,” notes Ejner. “We need to keep in mind that regulated technicians will be playing a major role in the technical side of dispensing. While the right drug for the right patient is still very valuable, and you’ll always need pharmacist coun-selling for that, we are encouraging staff to do more. As well, the

CALgARy CO-OP AT A gLANCE

Background One of the largest retail cooperatives

in North America, with more than 440,000 members and

operating 24 supermarkets with pharmacies, as well as

gas bars, car washes, liquor stores, travel offices and

home healthcare centres. Established in 1956; the first

pharmacy opened in 1965.

pharmacy staff 106 pharmacists, 76 assistants,

3 regulated technicians.

pharmacy hours of opening 9 am to 9 pm on

weekdays; 9 am to 6 pm on Saturdays;

10 am to 6:00 pm on Sundays.

Website www.calgarycoop.com

Top, L-R: Sonal Ejner, Judy Roberts, Nadine Hammoud.Bottom, L-R: Trent Lane; Ryan Keller.

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CoverStory

more we can do now, the more suggestions will come forward to streamline the process.”

This one-on-one approach to communi-cations and change management also ulti-mately builds patient demand. Public accep-tance “doesn’t happen through advertising or store posters,” explains Lane. “Until some-thing actually applies to a person, it doesn’t really sink in. Therefore we focus on one-on-one communication between the pharmacist and the patient to communicate the value of a particular service to a particular patient. This not only needs the right work environ-ment, where pharmacists aren’t too busy or stressed, it also needs pharmacists who be-lieve in the value of the service, whether or not they personally provide it.”

“We truly work as a team,” agrees Abou-Kheir. “For example, if a staff pharmacist sees a person with diabetes who is strug-gling, they promote my expertise and book an appointment on my behalf. This happens all the time. We cover each other during ap-pointments, or when I’m out of the phar-macy to give a presentation. We’re working harder and smarter, together.”

Their efforts are paying off. Since the company began tracking government-funded professional services in 2012, rev-

enue has doubled month after month. “In the last two months, we have increased our revenue generated by professional ser-vice fees by between 120% and 165% each month,” says Lane.

mosT precious commodiTyWhen all is said and done, Calgary Co-op operates on the premise that time is its own reward. When you make time for professional services, then pharmacist commitment, consumer support and fi-nancial growth will follow.

Equally important, fulfillment on the job leads to fulfillment outside the job. Turnover is low among the pharmacy staff, with an av-erage tenure of 10 years. “Our entire corpo-rate structure from the CEO down focuses on quality of life, on having a life outside of work,” says Lane. “When I was a pharmacist elsewhere, I remember that all I could do at the end of the day was collapse on the couch. That’s no way to live. Our goal is to give pharmacists the tools and the work environ-ment not only to do their job, but also to enjoy their job—and have enough energy at the end of the day to enjoy their lives outside the job. Happy employees are loyal, produc-tive employees.”

✔ Diabetes health One of the five certified

diabetes educators and a local chef co-host

an education session and cooking class up

to eight times a year at the locations with

community kitchens.

✔ heart health Three months a year, more

than 1,000 customers book appointments

for cardiac assessments using CardioVision

equipment administered by technicians

from Healthwave Diagnostechs. Pharmacists

then review the results with participants.

Customers pay $15 to help cover costs.

✔ injections In addition to flu shot

clinics, some of Calgary Co-op’s injecting

pharmacists regularly administer

testosterone, B12, travel vaccines, gardasil,

Humira and Zostavax.

✔ Central compounding A specialty

compounding centre prepares unique

meds, including veterinary products, for all

locations within 24 to 48 hours.

✔ Central adherence packing Using

PacMed pouches, Calgary Co-op provides

24-hour turnaround on compliance packs for

all locations.

✔ gluten awareness The company’s latest

program, launching in May, includes training

pharmacists to conduct gluten-intolerance

tests and counsel patients on results.

Current signage already identifies more than

600 gluten-free foods stocked throughout

the supermarkets.

✔ spirometry tests In partnership

with Peak Pulmonary Consulting labs,

the company’s two certified respiratory

educators conduct a mobile spirometry

clinic at all locations once a year. The

pharmacists conduct the test on day

one; two to four weeks later, they return

to review the results and develop care

plans. Fuelled by doctor referrals, there is

currently a waiting list.

Calgary Co-op leverages its

pharmacists with advanced training by

offering mobile clinics throughout the

chain. It seeks out medical devices and

outside partners to engage patients,

and uses centralized services to reduce

costs and improve efficiencies, says

Judy Roberts, pharmacy professional

services manager. “Head-office support

is focused on providing the resources,

work conditions and environment

for pharmacists to pursue their

passions. We seek innovative ways

for our patients to get benefit from

the knowledge and services that our

pharmacists offer.”

groWing slate of serviCes

here’s a summary of its services:

Karen Welds is a journalist and editor With tWo decades of experience in the pharmacy industry, including eight years as editor of pharmacy post (precursor to DRUgSTORE CANADA).