YOU A YOUR PHARMACIST
A Relationship That Matters
PRESENTED BY THE CANADIAN ASSOCIATION OF CHAIN DRUG STORES
You and your pharmacist:
A relationship that matters
BY CAMILLA CORNELL
In conjunction with the Canadian Association of Chain Drug Stores
A RECENT CANADA HEALTH MONITOR SURVEY ASKED PEOPLE WHO had been diagnosed with a serious chronic condition how involved their pharmacist was in advising them on medications and health-care equipment. Four out of 10 respondents-who suffered from a range of ailments like high blood pressure, arthritis, rheumatism, heart trouble, asthma, lung disease, diabetes and cancer-said their pharmacist was "very involved." The same number said they would welcome an even more involved pharmacist.
That still means that six out of 10 people, however, are not taking full advantage of a highly trained and very accessible health-care professional. With at least one year of university training and an additional three to four years of specialized study, pharmacists have a detailed knowl-
Four in 10 with selected chronic conditions report pharmacist “very involved”
Pharmacist very involved in advising you.
0% 20% 40% 60% 80% 100%
% of respondents with selected chronic conditions
Source: Canada Health Monitor
edge of the effect of drugs on the human body and the clinical use of drugs for disease prevention. What is more, they are as close as the neighborhood drugstore and you do not have to make an appointment to see them.
Even if you are generally healthy, it pays to develop a relationship with your pharmacist. The 378 pharmacists who responded to a 1996 Pharmacy Practice magazine survey reported catching an average of 67 drug-related errors per week, ranging from patients who did not take their medication properly to patients actually taking the wrong drug. And a more recent analysis of hospital data by two Canadian researchers found that adverse drug reactions to properly
administered drugs (including allergic reactions, side effects and drug interactions) may kill 10,000 Canadians a year.
A pharmacist who knows if you suffer from allergies and is aware of your health conditions can work with you if you are having problems with a particular medication, or provide a last line of defense against potentially lethal adverse drug reactions. As well, he or she can help you learn how to cope with chronic conditions that may, at first, seem overwhelming. With the restructuring of health services across Canada, it is too easy to fall between the cracks. But developing a relationship with your pharmacist can help; it truly is a relationship that matters.
compliance is probably
one of the
THE HIGH PRICE OF NON-COMPLIANCE
Have you ever started a course of antibiotics and then stopped halfway through because you already felt better? Or perhaps you swallowed a pill with dinner and then glanced at the bottle only to find that you should have taken it on an empty stomach? Have you missed a dose or two half-way through? If any of these scenarios ring a bell, you have been guilty of what health-care professionals call "non-compliance"; basically you have not followed the directions for taking your medication.
You are not alone. A 1996 study by Pharmacy Practice researchers found non-compliance was the most commonly reported drug-related problem for pharmacists, who dealt with the issue on average 17.5 times a week. But non-compliance is by no means a trivial matter. Failing to take medication as prescribed renders it less effective, enabling diseases or health conditions to gain a foothold once again. In the case of antibiotics, it can lead to the development of "super-bugs" and hard-to-defeat infections.
Indeed, the cost to the health-care system of drugs being taken or prescribed inappropriately is conservatively estimated at $7 to $9 billion a year, according to the University of Toronto's Centre for Health Promotion. Even more chilling, an estimated 12,000 deaths a year can be attributed to patients failing to follow through on a course of medication or taking it incorrectly. "Non-compliance is probably one of the biggest challenges any pharmacist faces," says Todd Read, a pharmacist with Canada Safeway in Calgary. "It's tough for a medication to work if you're not taking it."
Most people, of course, do not set out to be non-compliant. An elderly patient may be confused and have trouble keeping track of a number of different medications to be taken at different times. Others stop taking medicine once they are feeling a bit better, or give it up because of unpleasant side effects.
Read tries to ensure his patients comply with their doctors' orders by initially stressing just how important it is to take medication as prescribed. "You tell patients what it does and what are the implications of not taking it," he says. "You can't assume they've discussed all that with their doctors." Read also tries to come up with a schedule for taking the drug that fits into the patients' daily routines to help them remember. "I find it helpful to give them a specific time to take the medication rather than just saying, 'Take
this three times a day'" he explains.
Neither does Read let his patients off the hook when they come in for a refill. Before he hands over the medicine, he asks: "Does this look familiar?" His point: to force people to actually look at the medication and acknowledge that it is the right one. Then, instead of asking whether they are taking it three times a day, he asks: "How are you taking it?" That way, he says, "they have to think about it and dredge from their memory,
'Well I'm taking it at this time, this time and this time.' In probably 10 to 15 per cent of the prescriptions we refill I make some sort of change to the regimen to make it easier for patients to remember."
Other initiatives underway at pharmacies across the country include followup phone calls to patients who have missed picking up a refill and so-called trial prescription programs that monitor medication use more closely. Most pharmacists also sell a range of devices intended to make it easier for patients to follow a medication plan. Says Read: "We can't be there to babysit people, but we do everything we possibly can to make sure they're following some sort of regimen."
Over the counter countenance: Feel free to talk to your pharmacist about any health issues.
PRESCRIPTIONS ON TRIAL
Trial prescription programs are an increasingly popular way to try to ensure that people are getting the maximum benefit from their drug therapy and to cut down on drug wastage. The pharmacist dispenses a seven to 10-day supply of medication rather than the more common 30-day to three-month supply. When the trial prescription is nearly finished, the pharmacist calls the patient to find out whether he or she is experiencing side effects and whether the drug therapy is working as it should. If all is well, the pharmacist dispenses the remainder of the medication.
That call-back has a dual purpose, according to Fred Smith, president of London, Ont. consulting firm Solutions in Health Inc. First, he says, many people go off their medication in the first week or so. "Cardiovascular medications are a good example," he explains. "A patient may go to the doctor feeling fine. But the doctor tells them they have a problem with cholesterol or high blood pressure and they get put on some form of medication." Due to the side effects, they may well feel worse, at least for the first little while. Their response: "They may just stick that medication up in the medicine cabinet and forget about it," says Smith." That's why we have nursing homes full of people who have stroked out."
But Smith says that if patients bite the bullet, those side effects will often improve or even disappear. “The call-back on a trial prescription program is really an encouragement to get people to stay on the medication, to tell them, these lethargic feelings will go away, just stick with it," he says. Alternatively, says Ruth Mallon, managed
care coordinator for the Ontario Pharmacists Association, the pharmacist may recommend you talk to your doctor and try to find a medication that agrees with you better. "Sometimes it's just a matter of switching one beta-blocker for another that works better," she says. At the very least, if you choose not to continue with the therapy, at least you are not wasting 93 days worth.
Currently four provinces in Canada have trial prescription programs for provincial drug plan beneficiaries; British Columbia, Saskatchewan, Quebec and Nova Scotia. Several other provinces have launched programs on a more limited basis. The result-better patient care, reduced drug wastage and monetary savings. For example:
■ In Saskatchewan, the 2,169 trial prescriptions filled for 1996 resulted in savings of $38,000. Although pharmacists received an additional reimbursement fee for the extra work required to monitor the trial prescriptions, every dollar spent generated $2.58 in savings. Fully 1,140 patients chose not to fill the remaining portion of their prescription, cutting down on the amount of unused drugs.
■ In British Columbia, 5,982 trial prescriptions were filled for 1996, of which 2,141 were never completed at an estimated savings of $22,000.
■ In Quebec, 4,764 trial prescriptions were filled, and about 33 per cent of patients chose not to fill the remainder of the prescriptions.
FOLLOW-UP PROGRAMS CAN HELP
At the Brampton Pharma Plus where Anna Posca works, a computer program identifies patients who have not come in for refills of necessary medication. "We call those people every week," says Posca. "And the first thing we ask, is: 'Are you still on the medication?"' Sometimes Posca gets an answer that sends shivers up her spine: "People will say, ‘they cost so much money, I quit taking them, or ‘I was feeling better so I stopped taking my medicine,"' she says.
Her response is to point out that their health is very important and the doctor would not have prescribed medication unless it was necessary. "All kinds of problems can arise from patients not taking their medication correctly," says Posca. "If people don't take blood pressure medication, for example, their blood pressure can skyrocket and they could end up having a heart attack or a stroke." For people who simply cannot afford to pick up their medications at that time she suggests putting the purchase on credit card, or a charge account set up for patients. Most people do come in and fill the prescription after a call from Posca, and she admits that gives her a feeling of great satisfaction. Her advice: "Take medication exactly as your doctor prescribes it and don't stop until it's finished. If you're having bothersome side effects, call your physician or talk to a pharmacist. Don't just stop taking it."
Since 1961, Zellers has been committed to operating in-store pharmacies. Today, with more than 37 years of pharmacy service under its belt, Zellers continues to search out new ways to prove its commitment to excellence in the profession.
“There are numerous reasons for customers to come into a Zellers store-and pharmacy is a value-added reason,” says Bob Seibel, Director of Pharmacy. “As part of our corporate philosophy, our pharmacists are committed to giving the best possible patient counselling available at a value-added price.”
Zellers currently has 230 pharmacies in Canada, of which 169 are owned corporately and the remaining 61 are licensed to individual pharmacists. The acquisition of Kmart has resulted in strong growth over the past year, and plans for further growth are in the works-in addition to the conversion of Kmart pharmacies, 10 new pharmacies are scheduled to open before year-end, for a grand total of 240 Zellers pharmacies across Canada.
“GOOD HEALTH" THRIVES FOR ZELLERS
The cornerstone of a Zellers’ pharmacy is the Good Health program. This program, launched in 1996, promotes healthy living through in-store clinic days, which can be either national or store-specific to address local products or health issues.
A Zellers pharmacy conducts a Good Health Clinic Day at least once every four weeks. The event addresses one of a number of topics, including: allergies, asthma, cholesterol, diabetes and heart health, and, new for 1998, a clinic focusing on checking the contents of your medicine cabinet. This latest clinic
allows customers to bring in medications to discuss possible drug interactions and side effects, as well as check expiry dates.
Registered nurses from the Victoria Order of Nurses help manage the clinics and work with pharmacists to counsel
TRAINING FOR PHARMACISTS
As part of its operational upgrade, Zellers pharmacy revamped its training program for pharmacists to include programs in computer processes, marketing, business and customer service. This ensures the consistency of care and augmented patient services at ail of its locations.
patients, answer questions and conduct clinical testing where appropriate. Patient education material, summarizing key points made during the clinic’s discussions, are distributed to attendees.
Pharmacists are particularly pleased to have the opportunity to improve patient outcomes in the long term, thanks to their patients’ attendance on a clinic day.
Along with regularly scheduled clinic days, the Good Health program is accessible to customers every day of the year through in-store stand alone units-Good Health Centres—displaying an arrangement of information brochures on 24 disease states, including ulcer, heartburn, high blood pressure, smoking cessation, angina, menopause, breast cancer, rheumatoid arthritis, diabetes and prostate cancer. Videos are also available for patients to borrow free of charge. Other program components include a Healthy Living Guide for Seniors, which is a practical passport-style booklet full of health and medication guidelines; it also features a section for recording medications and health concerns. The First Aid Safety Guide is also available for all patients—it’s a unique flip-card booklet that attaches with a magnet to the fridge for
quick and ready reference on a wide range of emergency situations. Both guides are distributed free of charge.
The Good Health Centres are strategically located near the dispensary so pharmacists can use these tools to assist in their counselling of patients.
EYES ON THE HORIZON
In light of the economic realities of health care today, Zellers pharmacy puts patients first. In Ontario, for example, Zellers waives the government’s $2 co-payment levied on provincial drug benefit plan recipients. There are self-service blood pressure machines in all stores, and Zellers pharmacy also offers free delivery from all locations.
A key to Zellers’ continued success in pharmacy is its cohesiveness as a corporate entity that’s backed by senior management. It already ranks among the top 10 pharmacy banners in Canada, and its aggressive expansion plans will make Zellers pharmacy more convenient than ever for consumers to visit.
ADVERSE DRUG REACTIONS CAN BE LETHAL
Prescription drugs have proven their benefit to society again and again. Before Banting and Best's discovery of insulin, all children with juvenile-onset diabetes lapsed into coma and died. And new medicines to treat coronary heart disease have saved an estimated 600,000 lives, according to the Pharmaceutical Manufacturers' Association of Canada.
But medications are not without their risks. After conducting an analysis of hospital data, University of Toronto researchers, Bruce Pomeranz and Jason Lazarou estimated that adverse reactions to properly administered drugs kill an average of 106,000 people annually in the U.S. (and, extrapolating from that, more than 10,000 in Canada), making them the fourth leading cause of
Antacids like Dioval®, Gelusil® and Maalox® and acid-suppressives like Zantac® and Losec®
Antifungals like Nizoral® and the antibiotic erythromycin
Ibuprofen, contained in Advil® and Motrin®
ASA, contained in Aspirin®
Ulcer drug cimetidine (ie. Tagamet®)
Protease inhibitors used to treat AIDS such as ritonavir (Noravir®)
Antacids (ie.Dioval®, Gelusi® and Maalox®) or dairy products
Iron supplements (ferrous gluconate or sufate, and also some multivitamins with iron)
Note: In some eases physicians deliberately prescribe the two together, where the benefits outweigh the risks.
The antibiotic tetracycline
Terfenadine, an antihistamine contained in Seldane®
or astemizole contained in Hismanal®
Warfarin, a blood thinner contained in Coumadin®
Diazepam(Valium®) and some other tranquilizers
The antibiotic ciprofloxacin (Cipro®, used for urinary tract infections)
You run the risk of reducing absorption of the antibiotic by up to 90 per cent.
Your body may be unable to break down the antihistamines, potentially causing irregular heartbeat and heart palpitation.
Boosts the bloodthinning effect, leading to increased risk of bleeding. **
The cimetidine may reduce the metabolism of the warfarin, lengthening the time it takes for blood to clot and perhaps causing hemorrhaging.
The effect of the diazepam could be dramatically increased, making you extremely drowsy.
Absorption of the antifungal will be reduced, potentially rendering it less effective.
Absorption and effectiveness of the antibiotic can be reduced.
death, after heart disease, cancer and stroke.
Pomeranz and Lazarou's figures take in allergic reactions to drugs, side effects and drug interactions, which result from mixing together two medications that may well be helpful on their own. To ensure you are not one of the statistics, advises Todd Read, a pharmacist with Canada Safeway in Calgary, ask your pharmacist if your new medication has any common side effects-perhaps nausea, upset stomach, dizziness, headaches or drowsiness. And make sure you know the signs of potentially dangerous side effects for the medication you are taking. As a rule of thumb, if you are getting chest pains or leg pains, having difficulty breathing, faintness, rapidly beating heart or excessive nausea, vomiting
Ten to 30 per cent of elderly patients are admitted to hospital because of medication toxicity.
or diarrhea, call your doctor Immediately.
As for drug interactions, according to Dr. Robyn Tamblyn, professor of epidemiology at McGill University in Montreal, scientists have documented fully 33,000ranging from impeded absorption of one of the drugs, prolonging illness or negating treatment, to increasing the toxicity of the medications to a potentially lethal level. And if there is one group particularly at risk, according to Statistics Canada, it is seniors. Why? Because they are the heaviest users of prescription drugs. A recent report by StatsCan’s Health Statistics Division indicated that, in the two days prior to the study, a full 10 per cent of Canadians aged 65 to 74 and 13 per cent of those aged 75 or older had taken five or more drugs. The report estimated that 10 to 30 per cent of elderly patients are admitted to hospital because of medication toxicity.
And it is not only prescription drugs which interact with other prescription drugs. Interactions can occur with over-thecounter drugs, herbal products and even foods. With so many possible complications, what can you do to ensure you are not the victim of a dangerous drug interaction? First, advises Bill Cornish, a pharmacist with Sunnybrook Health Science Centre's Drug Information Service, keep your doctor and your pharmacist abreast of any changes in your health. Let them know what other medications you are taking and whether you have allergies or medical conditions. As well, it is important to build a relationship with your pharmacist. Most pharmacies use sophisticated computer systems to track your medication history, allowing them to pinpoint potential drug interactions immediately. But the information often is not shared between drugstores (except sometimes within chains), so if you are frequenting several different pharmacies, a potential interaction may go undetected.
Finally, if you have a health condition
like diabetes, epilepsy, asthma or high blood pressure for which you are taking medication, or you are allergic to a specific type of medication, wear a medical I.D. bracelet or necklace. You might also write up a medication record if you regularly take a number of different drugs. Include the name, dosage and any special instructions for taking each
SOME FOOD AND DRUGS DON’T MIX
Few people would think about grapefruit juice as a potentially lethal substance. Yet, taken with certain medications, it can lead to irregular heartbeat or serious kidney problems. Similarly, milk-so useful for building strong bones and teeth-can reduce absorption of the antibiotic tetracycline. "There are some foods and drugs that just don't mix," says Carole McKiee, director of pharmacy services for Medical Pharmacies Ltd.
Sometimes McKiee explains, the wrong food can simply interfere with a drug's effectiveness, as in the case of the tetracycline/milk combination. "The tetracycline binds with the calcium, changing its form and making it more difficult for the body to absorb the antibiotic," she says.
But the more dangerous situations occur when a food interacts with a medication to boost its potency beyond what is safe. Grapefruit juice, for example, contains flavonoids which can push the power of some heart medications into toxic territory. It can also prevent your body from metabolizing antihistamines like Hismanal®, causing irregular heartbeat. Other examples of food-drug combinations that may give you more than you bargained for are:
Antidepressants like phenelzine, sufate or the Parkinson's medication selegiline
Alendronate sodium (Fosamax® an osteoperosis drug)
Levodopa and cabidopa (Sinement®) used to treat Parkinson's Disease
The blood-thinner warfarin (Coumadin®)
Foods containing tyramine, including cheeses, sour cream and home-made yogurt, liver, smoked or pickled fish, salami, bologna or pepperoni, brewer's yeast, anchovies, avocados, soy sauce and chocolate, as well as beverages like red wine, liquors and beer.
Any food, beverage or medication Fosamax® must be taken with water only, first thing in the morning, at least 30 minutes before anything goes into your mouth. You have to remain sitting or standing (don't lie down).
A high-protein diet, including plenty of meats, cheese and beans, for example.
Green tea and other foods rich in Vitamin K (broccoli, spinach and other green leafy veggies).
It can cause a rapid rise in blood pressure potentially leading to a stroke.
Absorption of the drug will be impaired. It may also cause irritation of the esophagus or ulceration of pharynx with difficulty or pain upon swallowing, new or worsening heartburn.
The anti-coagulant effect of the element of protein may compete with the levodopa, reducing absorption.
The anti-coagulant effect of the drug may be decreased, potentially leading to a stroke.
medication, as well as the name and phone number of the doctor who prescribed it. Keep a copy in your wallet or purse and at home. What you should never do, is simply go off your medication for fear of an interaction. "Certainly the benefits of drugs are tremendous," says Lazarou," and they outweigh the risks in most cases."
OUT WITH THE OLD...
Last summer, seven teens from St. Thomas, Ont. landed themselves in hospital from an overdose of prescription pills, beer and vodka. One was unconscious when he was brought in and another went missing for a day and a half before he was finally found, still disoriented and wandering in a nearby ravine. Such pill parties are common, teens told a reporter after the incident, fueled by raids on the family medicine cabinet.
Toxic Avenger: Big V Pharmacies were instrumental in disposing of tons of unused drugs.
Most people have one or two bottles in the medicine cabinet with expiry dates that are months, if not years, overdue. What you may not realize is the cost to both people and the environment of those vials of unused medicine. According to Dr. Michael McGuigan, medical director of Toronto's Poison Control, about one child (up to age 18) a week turns up at the city's Hospital for Sick Children due to accidental poisoning. "If you've got old medications lying around, you've set the scenario," he says. "You've got the child, who's curious and looking around. You've got a potential source of toxin available. And a lot of the young ones can’t tell the difference between medications and candy."
What is more, points out Ian Brown, a pharmacist with Shoppers Drug Mart in Etobicoke, having unused medication around increases the risk that even adults will take the wrong drug, potentially causing a dangerous drug reaction. "People wake up in the middle of the night; they're groggy, and they grab the wrong thing," he points out. "We always say, if you're not using something anymore, it's best to discard it."
Taking expired drugs can be risky as well. Although it is uncommon, expired prescrip-
tion drugs have actually caused seizures and even death. For the most part though, says pharmacist Fred Smith, president of Solutions in Health Inc., both prescription and non-prescription drugs simply become less potent as they age. So if you are taking an expired prescription for antibiotics, for example, “it's like not finishing out a full treatment course; you may contribute to the problem of antibioticresistant bugs and you could end up with a super-infection which is very difficult to clear up."
Stewart suggests tossing drugs that have passed their expiry date or that you no longer use, as well as those which are crumbling, have developed an odor, or
simply do not look right. Do not drop them in the garbage, though, or flush them down the sink or toilet. Drugs are regarded as hazardous waste products, points out Dennis Lam, supervisor of Household Flazardous Waste for Toronto. "If residents don't dispose of medication properly, it can attract animals, who will eat it and potentially get very ill."
Most cities have a place where residents can drop off unused medication; last year, Toronto alone disposed of 4,450 kgs. In Alberta, which has been operating a drug round-up since 1985, fully 230 tons have been collected; equivalent to the weight of more than 60 grown elephants. In
1996, 27.6 tons were turned in, compared to 19.2 tons in
1997. The most common: antibiotics, pain killers and heart medications.
Smith, who also ran a medicine cabinet clean-up program at Big V pharmacies in Southwestern Ontario, actually tried to put a price on the amount of unused medication he collected and came up with an average of $10,000 worth of medications a month from each of the chain's stores. "If there are about 6,500 stores in Canada, that's about $780 million worth of drugs a year that people are throwing away," he says. "And that’s just the people that actually bring their drugs in. There are others who never do."
In order to dispose of unused medications legally, they must be treated as toxic waste, points out Smith. "We used to send 45-gallon drums of solid dosage drugs away for destruction," he explains. "The company we hired trucked it to a plant where they made a sludge out of it and then buried it in the ground in drums." If you can't make it to your local disposal site, most pharmacies will accept and dispose of unwanted drug products year-round.
JUST A SPOONFUL OF SUGAR...
Telling an adult they need to follow through on a course of medication is one thing. But how do you get a reluctant squirming child to take the medicine he or she needs to get better? According to John Tse, a pharmacist with London Drugs in Richmond, B.C., most pharmacists have a bag of tricks up their sleeves that can help any parent cope. Here are some of his suggestions to help the medicine go down.
Disguise it: Crush up a tablet or pour a medicinal syrup on ice cream, or mix it with applesauce and other foods. That said, make sure whatever you are mixing it with is not going to interfere with its therapeutic effect. For example, some medicine should not be taken with milk and other dairy products, or should be taken on an empty stomach.
Use a Dispensing Device: There are a range of products available to make giving children their medicine a little easier. A sampling would include: "alligator spoons" which allow you to pour the proper dose of medicine into a hollow handle, then just tip it to let the medicine flow onto the spoon; a syringe-type dispenser that enables you to squirt medicine into a child's mouth; and the latest, a baby bottle, with a built-in medicine dispenser.
Give them a choice: When children feel in control of what goes into their mouths, they are more likely to comply. Try asking: "Do you want the Tylenol liquid or the chewable tablets?"
DISEASE STATE MANAGEMENT
If you have just been diagnosed with a chronic health condition like asthma, diabetes or high blood pressure you are probably feeling somewhat overwhelmed. Suddenly you need to become an expert on a disease you likely knew next to nothing about just yesterday. There is, however, an information source that is easily accessible, wellinformed and eager to help: namely, your neighborhood pharmacist.
Zellers pharmacist Jane Penney, of Cobourg, Ont., says conveying the information patients need without overloading them is a difficult balancing act. "I try to give them enough facts about their condition
Jane Penney, Medicine Woman: This Zellers pharmacist devises tailored action plans to help patients manage specific health conditions.
to get them interested, and then I refer them to a place where they can get even more information," she says. "If I can get them to say, 'You're kidding, I didn't know that,' I know I've got them."
Penney sometimes writes out patient action plans for asthma sufferers for example, so that they know what to do when faced with a particular scenario. The plans help remedy some peoples' inclination to ignore the disease. "Parents are sometimes horrified to find out that their child has asthma," Penney explains, "They figure if they don't give the child the medication then the child won't have the condition; so they wait until the child is blue in the face to start them on their inhalers. We have more and better treatments for asthmatics now than we ever did, and yet we have more asthmatics dying."
Penney also encourages her patients to start thinking about potential "triggers" for their condition. Some migraine sufferers find red wine brings on the debilitating headaches, while for others it might be dairy products. And asthmatics may react to grasses, mould or pets. "If they're aware of what makes their disease state worse, they can be ready to respond," she says.
Many pharmacy chains offer special clinic days where patients can come to find out more about high blood pressure, asthma, diabetes, migraines, caring for infants, among other topics. People may have their blood pressure or cholesterol levels checked, or their blood glucose levels monitored. Often separate consultation rooms are set aside so patients can discuss their concerns in private.
BACK IN THE DRIVER S SEAT
When Jerry Young's doctor told him he was a "borderline diabetic” eight years ago, he thought nothing of it. "I had no real illnesses; my vision was the same. The doctor gave me some pills to take twice a day and I figured, that'll do the trick," he says. An admitted "fast food freak," Young continued to feast on the high-fat food he loved and eschewed exercise. At six feet tall, he weighed in at a
Screen Test: Pharmacist Ken Burns (right) shows a borderline diabetic his glucose levels via an in-store computer.
hefty 360 pounds and his blood sugar was consistently high.
It was not until Young started to get severe cramping in his legs after walking that he began to realize that the lifestyle he led was taking a toll on his health. Last October, he agreed to participate in a study run by Ken
ASK YOUR PHARMACIST...
■ Why am I taking this medication?
■ How should I take it? (i.e. before or after a meal; in the morning or at night, etc.)
■ Should I avoid certain foods or alcohol while taking the product?
■ Is there any possibility the medication will react with another drug product I'm taking? (either prescription, over-thecounter or herbal).
■ Is it safe to drive a vehicle or operate hazardous machinery while taking this medication?
■ Are there any possible side effects? If so, what are they, and how will I
know if the side effects are dangerous?
■ How will I know if this medication is working?
■ Are there any alternatives to this medication? If so, what are the pros and cons?
■ Do you have patient information available on my medical condition?
Burns, a pharmacist with Errington IDA in Chelmsford, Ont. "The genesis for the study was that we'd get people coming into the pharmacy to buy testing strips and we'd ask what their blood sugar level was. They'd say 14 [which is very high]." When asked what they were doing to bring their glucose levels back under control, though, they'd reply: "Nothing."
Burns figured that if those people could see a graph of their glucose levels and knew exactly what they meant in terms of an
increased risk of heart attack, blindness, kidney failure and circulation problems potentially leading to amputation, they might be more apt to change their tune. Young, for example, had to monitor his glucose levels at random intervals over a month. Then he turned that data over to Burns, who fed it into a software program that spit out charts showing the highs and lows in his blood sugar according to time of day-what his maximum reading was, how many times he was over the optimum blood
sugar level and how many times he was under.
What they showed was that Young-whose blood sugar levels averaged about 12 but fluctuated considerably-was unlikely to reach age 60 without major complications unless he changed his ways. "I guess seeing it on paper helped,” says Young. "I couldn't ignore it any longer. And I guess I came to realize that a pill wasn't going to take it away. I had to do it."
Burns also pointed out to Young that the pills he was taking for his diabetes were not going to do any good unless he took them previous to eating; something he had not known. Young asked his doctor to make an appointment with a diabetes education team, including a dietitian who would be able to give him useful advice on which foods to eat and which to avoid. "I never went on a diet," he says, "I just began to pay attention to the foods I was eating and how they affected my body." As well, he began a regimen of regular walking after work.
Nine months later, Young's blood sugar level averages five or six, which is normal even for a non-diabetic, and there are no major fluctuations.
He has dropped almost 100 pounds, and Burns proudly refers to him as "my diabetes poster boy."
Young says, he has every intention of keeping to his good habits. Says Young: "I have five years to work until I'm eligible for a pension and I'm thinking, I want to see that pension. I want to enjoy the life my wife and I can have later on."
Tiny Matthew McMurrer went into respiratory distress when he was born, and continued to have breathing problems even as a baby. At just five months old, he was diagnosed with asthma after several incidents in
which he turned blue, forcing his frantic parents-Catherine and Rob McMurrer of New Lawrencetown,
N.S.-to rush him into emergency.
was getting regular doses from asthma inhalers meant to aid his breathing, the McMurrer family endured a series of frightening asthma attacks in the years that followed. It got so bad that Matthew did not want to go outside for fear of having an attack. The McMurrers got a break, however, when they moved to their new home in the Porters Lake area two years ago and began to frequent the nearby Lawtons Drugs. On one such visit to fill a prescription for Matthew, pharmacist Kim Sweet picked up on the fact that the child had been
Sweet Relief: Pharmacist Kim Sweet coaches a young patient on how to control asthma attacks.
STORE MEDICINE SAFELY
Shoppers Drug Mart pharmacist Ian Stewart says drugs may deteriorate even faster than their expiry dates if they're not stored and handled properly. A common example is Aspirin® which is very sensitive to moisture and can break down into two types of acidacetic and salicylic—which cause upset stomach. Here are Stewart's tips for keeping medications safe and effective:
■ Keep medicine in a cool dark place. The traditional medicine cabinet actually contributes to drug-aging because of the moisture and heat in your bathroom. Instead choose a locked cabinet, preferably in your bedroom.
■ Never leave medicine in the car glove compartment since it may well be sensitive to heat and light.
■ Store medications in the original container so that the instructions are visible and you are not apt to mix up your prescriptions. As well, says Stewart. "If you’re travelling, it’s a good idea to have the labelled container at border crossings.”
going through far more Ventolin® (an emergency inhaler which opens up the air passages during an asthma attack) than Beclovent® (a second inhaler meant to be used on a regular basis to prevent asthma attacks). Sweet pointed out that the situation should be reversed. "Ventolin® is only meant for use during an asthma attack," she says.
When used regularly it can cause irritability, hyperactivity, sleeplessness and even heart palpitations. Beclovent® on the other hand, should be jk used two to four times a day and although the
patient does not feel any immediate effects, it quietly keeps asthma under control.
Catherine was amazed; she did not remember the doctor telling them that. "Kim gave us a video and cassettes and pamphlets on asthma," 'M she says. "She didn't even charge us for them, although you're supposed to rent the videos." As well, Sweet provided the McMurrers with an asthma management plan detailing exactly how and when to use the inhalers. Instead of using the Ventolin® "every time Matthew wheezed," as they had been doing, Sweet suggested the McMurrers use the Beclovent® four times daily until his symptoms were under control and then cut back slowly to twice a day within a few months time. "We made it to that goal within a month," says Catherine. Now the McMurrers notice that Matthew is far calmer and healthier. "He hasn't had an attack in months," says Catherine gratefully. "If it wasn't for Kim, we would still be doing what we were doing, and that's dangerous."
As for Sweet, she admits it is very rewarding to have been able to intervene in such an immediate way. "We caught it before Matthew started school, so he's not going to have to carry puffers everywhere he goes. It's nice to see the whole family a little more relaxed," she says.
TECHNOLOGY: SHARING YOUR PERSONAL HEALTH INFORMATION COULD SAVE YOUR LIFE
Donna Pipa, until recently a pharmacist with Children's Hospital in Calgary, regularly adjusted her small patients' medications according to information gleaned from their medical charts, consultations with their doctors, lab reports and their medical and nursing plans.
In fact, Pipa admits she would not have been able to do her job half as well if she did not have access to such data. The lab reports, for example, tell her if levels of the antibiotic Gentamicin are too high—potentially damaging auditory or kidney functions-or too low-in which case it is not going to work its healing magic. As well, she can tell if the child is at risk of an allergic or adverse drug reaction from his medical history and she might be able to adjust the timing of his medication to allow him to get a good night's sleep or
be less drowsy in the day.
This is all information that is not available to community pharmacists. And, with patients being released much sooner from hospitals across the country, many are beginning to wonder if it would not help to have it. "Pharmacists typically would be able to figure out with reasonable certainty what condition a patient has from the drug profile on their computer screen," says Bob Nakagawa, director of Pharmacare, British Columbia's provincial drug program. "But they can't know definitively because many drugs have more than one use. For instance they could be getting a beta-blocker for a heart condition or for a migraine headache." A patient with a migraine, he points out, is going to be counseled quite differently than one with a heart condition.
Nakagawa would like to see community pharmacists given access to a kind of "electronic chart" on patients, with diagnostic information and other pertinent data. That kind of detailed information, however, is still a dream. Two provinces—British Columbia and Manitoba-have taken the first step by implementing on-line linkages from each of their pharmacies to a central computer system which stores patient information. What that means is that wherever you are, your pharmacist has access to your medication history. Alberta, Ontario and Saskatchewan are in varying stages of implementing similar systems.
As well, British Columbia has launched a pilot project in a number of emergency departments giving doctors and nurses access to the same information. What that means is that doctors can pull up a patient's medication profile and other pertinent information, including adverse reactions and allergies to certain drugs. "When you come
into an emergency room, you may or may not be able to provide that information directly," says Nakagawa. "You may have just been in a car accident and you may be unconscious. And especially elderly patients may not remember the long list of drugs they're receiving with all those complicated names."
When the "bugs are worked out" of this new system, it may be rolled out to emergency departments across the province. "The key thing is to make sure that the information is confidential and is not available to people who do not need to know," says Nakagawa.
Fie points out, however, that information only flows one way right now, and that is into the hospital. Debbie Saltmarche, pharmacy systems manager for Wal-Mart and director of the CACDS's fledgling pharmacy systems committee, would like to see a two-way sharing of information. "We already have sharing of information in the hospital setting; I would like to see that extended into community pharmacy so that we have one standard of care no matter whether the patient is in hospital or at home."
Like Nakagawa, she thinks it would be particularly valuable for pharmacists to have diagnostic information. "You may well ask, why wouldn't the pharmacist simply ask the patient why he's being treated," she says. "But in some cases, the patient may be confused and uncertain as to what the diagnosis really is, especially if he or she has had a number of tests." As well, a pharmacist may not want to question her patient in front of the rest of the pharmacy about what is making them ill. "The pharmacy has been identified as a key point of contact with the patient," says Saltmarche. "If the pharmacist knows the diagnosis she’s able to give a lot more pertinent information." ■