By Will Shum, Charles Au, and Anthony Tung

Picture this: David arrives early at his family doctor’s office. Today, however, he’s not here to see his doctor. He has an appointment to review his medications with a primary care pharmacist.

Juggling a list of 15 medications, his inhalers, and his bag of vitamins and herbal supplements, he isn’t sure what to expect. Over the years, his medication regimen has become increasingly complex, and he’s unsure why he’s taking some of them. 

The pharmacist introduces herself to David, and over the next hour she talks to him about how he uses his medications and his personal health goals. With David’s personal preferences in mind, she reviews each medication, assesses how they align with his health goals, and develops a care plan that works for him. David learns that one of his medications could be causing low blood sugar and some of his supplements might not be necessary.

The pharmacist suggests some medication changes that should help reduce this side effect, while also improving his heart health and lowering his medication costs. David is on board, and they end the appointment with a plan for the pharmacist to discuss these suggestions with his family doctor.

A week later, David speaks with his family doctor, who has spoken with the pharmacist and reviewed her recommendations. With his doctor’s support, David decides to go ahead with the medication changes. He also arranges a follow-up appointment with the pharmacist to review how the medication changes are working.

David isn’t a real person, but this common narrative represents people who are taking many medications or are struggling with chronic conditions such as diabetes, high blood pressure, or heart conditions.

Pharmacists are being integrated into primary care networks: alliances of primary care service providers (family doctors, nurse practitioners, nurses, and allied health providers) within communities throughout BC. There are currently 48 primary care pharmacists that meet one-on-one with patients to provide fulsome medication reviews, education, and care plans. They don’t dispense medications, but they communicate closely with community pharmacists and other members of a person’s primary care team to coordinate high-quality care. This is particularly valuable for people with complex medical conditions or vulnerabilities.

People value pharmacist-led medication reviews, and primary care providers recognize their pivotal role in supporting comprehensive patient care, creating more opportunities in the health system to provide care to underserved areas and vulnerable populations.

“I referred one of my complex chronic pain patients with polypharmacy to our pharmacist and she provided an in-depth review of this patient’s medications and medical history,” says Dr. Conrad Rusnak, physician coordinator of Vancouver Coastal Health’s Home Visits to Vancouver’s Elders program (polypharmacy is the simultaneous use of multiple drugs by a single patient, for one or more conditions). “She left me clear recommendations and followed up to ensure we were on the right track. It has given me more confidence in supporting these challenging clinical situations.”

As we add primary care pharmacists to help patients, our pharmacists’ relationships with primary care providers and the communities they serve are of paramount importance. We strive to support family doctors and nurse practitioners working within the overburdened primary care system by strengthening their capacity to care for patients with complex medical needs. Since health care needs vary across the province, we continue to collaborate with community partners to ensure that pharmacists work effectively with their primary care teams.

As we celebrate Pharmacy Appreciation Month in March, we invite anyone with questions or concerns about their medications to ask their pharmacist. For those individuals who have challenging questions involving multiple medications or medical conditions, we invite them to ask their family doctor or nurse practitioner for a referral to their primary care pharmacist.

Will Shum is a primary care pharmacist working with the Richmond Primary Care Network. Charles Au is a primary care pharmacist with the Surrey-North Delta Primary Care Network and the clinical pharmacist educator for primary care in British Columbia. Anthony Tung is the coordinator for pharmacists working in primary care networks within Vancouver Coastal Health.