MSP Mar Apr 05 Mag 126097

Communication
A Publication of the Manitoba Society of Pharmacists Inc.
Continuing Education:
Therapeutic Options
Focus on the Management of Helicobacter pylori
The Last Word:
Rx for Rover
March/April 2005
RMACY C
A
O
PH
MANITOB
ERENCE
NF
A
Vol. 30, No. 4
April 15th to
April 17th, 2005
The Winning
Combination
The Voice of Pharmacists in Manitoba
Publication Mail Agreement No. 40013710
Return Undeliverable Canadian Addresses To:
The Manitoba Society of Pharmacists
202–90 Garry St., Winnipeg, MB R3C 4H1
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THIS ISSUE
M A R C H /A P R I L 2 0 0 5
Manitoba Society of Pharmacists
Board of Directors
Brent Havelange, President
Marian Kremers, Past President
Meera Thadani, Vice-President
Nancy Remillard, Secretary Treasurer,
Finance Chair, Professional Relations Chair
Jason Pankratz, Economic Committee Chair
Denysia Wincott, Membership Chair
Jay Rich, Communication Journal Chair
Lisa Zaretzky
Laurie Kaminsky
Liaisons
Chuck Narvey, Insurance Liaison
Ron Guse, MPhA Liaison
Elmer Kuber, CPhA Liaison
Beatrice Reyes, Student Liaison
Scott Ransome, Executive Director & Editor
Jill Ell, Assistant to the Executive
Director & Editorial Assistant
Up Front
Season’s change, people change,
and sometimes, even magazines change… 4
Just as our profession is ever evolving and updating, so is the
Communication journal.
Sounding Board
Merck Frosst
5
We would like to thank you for all your efforts in communicating to your
members the process involved with the voluntary withdrawal of VIOXX®
(rofecoxib).
Feature Article
Contact Dermatitis
6
Contact dermatitis is defined as an inflammation and irritation of the skin
due to contact with allergens or an irritating substance.
Feature Article
Ralph Whitfield Receives MSP Award
of Merit
9
Ralph L. Whitfield is the 2005 winner of the Manitoba Society of
Pharmacists Award of Merit. He becomes only the fourth person to be
recognized with this special award.
Editor/Publisher
Manitoba Society of Pharmacists
90 Garry Street, Suite 202, Winnipeg, MB R3C 4H1
Telephone: (204) 956-6680 or 1-800-677-7170
[email protected]
www.msp.mb.ca
COMMUNICATION is published six times a year. The subscription
rate is $12.00 per issue, $77.04 per annum (including GST). The
inclusion of proprietary names in this publication is for reference
only. The inclusion of brand names does not imply that the brands
listed are in any way preferable to those not listed. The sources of
information are published articles in pharmaceutical and medical
journals, private communications, etc. Incorrect quotations
or interpretations are possible but not intentional. The views
expressed in COMMUNICATION do not necessarily reflect the views
of the Manitoba Society of Pharmacists Inc. The Society assumes
no responsibility for the statements and opinions advanced by
contributors in COMMUNICATION. Material from COMMUNICATION
may be copied provided that the source is acknowledged. The
deadline for submission of material for inclusion in COMMUNICATION
is the 15th of February, April, June, August, October and December.
Feature Article
Making a Difference in the
Heart-Health of Manitobans
10
The recently published INTER-HEART study, provides us with further
knowledge about the factors that predispose patients to heart attacks.
Feature Article
Beyond the Dispensary, Ryan Douglas
Leaves Work in the Dust
17
Racing his Honda CRF 450 motorcycle through a series of jumps, it’s
tough to imagine that the man beneath the helmet is a community pharmacist whose workdays seldom have physical challenges.
Q&A: Getting to Know your Manitoba Pharmacists
Morna Cook
19
ISSN 0829-6197
Printed in Canada by:
Leech Printing (204) 728-3037
Publication Mail Agreement No. 40013710
Return Undeliverable Canadian Addresses to:
Manitoba Society of Pharmacists
202–90 Garry Street
Winnipeg, MB R3C 4H1
Email: [email protected]
MANITOBA SOCIET Y
OF
PHARMACISTS
Classifieds
Pharmacists Wanted
20
The Last Word
Rx for Rover
22
There’s a new breed of patient queuing up at the pharmacy. Pets - or at
least their owners - are arriving with scripts in hand looking for an alternative to the usual channel for veterinary medicines – the vet’s office.
C O M M U N I C AT I O N
3
U P FRONT
Season’s change, people change,
and sometimes, even magazines change…
If you eagerly ripped open the plastic to browse through this special conference
edition of Communication and thought for just one moment that something
seemed a little bit different about your favorite magazine, well let me reassure
you…you are correct. Just as our profession is ever evolving and updating, so
is the Communication journal.
This month, the new look has
been introduced, and over the next few
issues, we will begin to include new
content and articles that are important
to you and your profession. A new strategy in advertising has also been established, which will allow the magazine to
generate more revenue that can then be
reinvested in the publication to allow
for its continued growth. Of course,
all of your favorites will still be here:
Sounding Board, Therapeutic Options,
Local Features, Getting to Know Your
Manitoba Pharmacists, The Last Word,
and the Editorial (I’m assuming on this
one…).
Communication Journal and the
MSP have long been the “Voice of
JAY RICH
Communication Chair
Pharmacists in Manitoba”, and just as
winter will surely become spring (no
promises on a summer, though), we
will continue our quest to be the voice
you trust.
So welcome to the first issue of
the new look Communication Journal.
Tell us what you think by sending us
an e-mail at [email protected], drop us
a line at 956-6681, or hey, you could
even send in a letter to the Sounding
Board…
Congratulations to MSP
Executive Director, Scott
Ransome and his wife Caroline,
on the birth of their first child.
Shane Scott Ransome was born
on Sunday, Feb. 20th at
12:11 pm. He weighed in at
9lbs, 4ozs and was just over 21
inches long. Mother and baby
are doing fine.
www.superthrifty.com
Requires a
FULL TIME PHARMACIST
at the following Manitoba locations
Virden and The Pas
Career opportunity for experienced pharmacist
or new grads. Good communication and
human relations skills are an asset.
• Quality Rural Lifestyle
• No Evenings, Sundays, or Holidays
• Technician Support
• Health Benefit Package
• Salary Negotiable
• Profit Sharing Available
• Future Ownership Opportunity
Contact Tom Busch at: Phone (204) 727-8451
Fax (204) 727-3471
or [email protected]
All replies kept confidential
4
C O M M U N I C AT I O N
MARCH /APRIL 2005
S O U N D I N G B OA R D
The Sounding Board is here for members to speak up and speak out on issues that are of interest to pharmacy. The Sounding Board is not
intended to be an expression of the opinions of the Manitoba Society of Pharmacists, but rather is meant to be a forum for opinions and
thoughts. We encourage you, our members, to write in with your opinions on the topical issues of the day.
January 27, 2005
Dear Mr. Ransome,
We would like to thank you for all
your efforts in communicating to your
members the process involved with
the voluntary withdrawal of VIOXX®
(rofecoxib). This product withdrawal
has been a tremendous undertaking
for Merck Frosst and your efforts are
greatly appreciated.
We are pleased to report that we have
started to provide reimbursement to
pharmacies that provided us with their
log sheets and copies of receipts, in
addition to the returned product. While
we are trying to process these returns
as quickly as possible, there have been
some unanticipated delays caused by
a combination of factors, including
additional time and resources required
to build and validate a comprehensive database to record and monitor
returns and the requirement to followup on a larger than anticipated number
of incomplete pharmacy log sheets.
As you may recall, we shared with
you a letter sent to third party payers dated October 8, 2004. In that letter, we indicated that it was our goal
to issue payments to all concerned
third-party payers, such as private and
public insurers, within 60 days of the
end of the withdrawal period (January
31, 2005). The purpose of this letter is
to inform you that the target date for
issuing payments to third-party payers has been revised to April 30, 2005.
Of course, pharmacists and pharmacies will receive reimbursement in
advance of this date and will continue to receive reimbursement as their
returns are processed. However, with
third party payers, we need to complete all the returns from pharmacists
before their reimbursement can be calculated. Addressing these issues will
help ensure that refund amounts are
accurate and that as much information as possible regarding the refund
is provided.
Once again, thank you for your patience
and understanding. Should you have
questions, please contact Tracey
Maconachie at 204-475-4036.
Yours sincerely,
Gregg Szabo
Executive Director, Corporate Affairs
VIOXX®, Registered trademark of Merck & Co., Inc.
Used under license.
Excellent Plans, Exclusive to You
The CPBA is dedicated exclusively to providing quality insurance and benefits programs to
meet the needs of pharmacists. All CPBA plans are designed for you, your store and staff,
and your personal and business properties. Your provincial CPBA Insurance Advisor will
ensure you receive quality products and personal service to meet your specific needs.
• Malpractice Insurance
• Internet Malpractice Insurance
• Store Insurance
• Homeowner Insurance
• Life & AD&D Insurance
• Disability Insurance
• Health & Dental Insurance
• Critical Illness Insurance
MANITOBA SOCIET Y
OF
PHARMACISTS
www.cpba.ca
Your Manitoba CPBA Insurance Advisors
Property & Casualty Insurance
Individual & Group Benefits
Bill Benham
Phone: (204) 988-5002
Email: [email protected]
Ed Bodnarchuk
Phone: (204) 988-1517
Email: [email protected]
C O M M U N I C AT I O N
5
F E ATURE ARTICLE
Contact Dermatitis
What is contact dermatitis? Contact dermatitis is defined as an inflammation and
irritation of the skin due to contact with allergens or an irritating substance.
Allergic contact dermatitis is caused by a T-cell-mediated hypersensitivity to
environmental allergens, either natural or synthetic. The body can respond within
a few hours or days following exposure.
Factors influencing the reaction can
include the health of the skin, humidity and duration of contact. Common
allergens include perfumes, cosmetics,
jewelry (nickel), hair dyes, lanolin, poison ivy/oak/sumac, topical medications
(local anesthetics, neomycin).1 Figure 1
shows a case of contact dermatitis that
was attributed to the application of a
perfumed body lotion.
Figure 1 Allergic contact dermatitis
Nonallergic contact dermatitis is
usually caused by exposure to harsh or
highly concentrated acid, base or soap.
It can occur on the first direct contact
(within minutes) or after repeated exposure (over several hours). The severity of
the reaction is includes the condition of
the skin, concentration of the chemical
and duration of contact. Nonallergic
dermatitis usually occurs on the hands,
face, neck, axilla, and trunk of the body.
Symptoms: Contact dermatitis is
characterized by skin changes which can
appear quickly or over a few hours to 48
hours after exposure depending upon
the type of irritating substance or allergen. Skin changes consist of erythema,
local edema and blisters depending on
the degree of sensitivity to the offending
agent. The blisters may weep in severe
cases. Patients complain of intense itch-
6
C O M M U N I C AT I O N
MEERA B. THADANI
M.Sc.(Pharm.)
Figure 2 Systemic symptoms that must
be referred to the physician. The eyes
and lips are swollen. The patient experienced difficulty swallowing.
ing. These signs and symptoms usually
last 10 to 14 days. Re-exposure to the
cause will trigger a relapse.1
Pharmacists are frequently the first
person the patient seeks for help in
determining the cause and suggesting treatment. The glossary provided
reviews the terminology used in describing the lesion (Table 1).2,3
suggested. Involvement of large areas of
the body or swelling near the eyes and
lips indicate systemic symptoms and
must be referred (Figure 2).
Treatment or referral?
The distinguishing feature between
nonallergic and allergic dermatitis is
that the skin reacts very quickly after
exposure in the case of nonallergic dermatitis.3 Therefore, treatment depends
upon the patient’s history and pharmacists should ask the following questions:
• When did the problem start?
• Where is it located?
• What are the signs and symptoms?
• Have you had this condition before?
• Do you have a history of allergies?
• Have you used anything (prescription, nonprescription, herbal product) to treat this? If so, what have
you used?
• What is your occupation?
• Have you been exposed to a new
product or activity? For example,
have you changed your laundry
soap, cosmetics, domestic cleaning
agents or gardening, hiking, painting, woodworking?
Patch testing is a diagnostic aid for
allergic contact dermatitis and it must
be performed after the dermatitis has
resolved. If the lesions are localized and
small, nonprescription treatment can be
Treatment
Non-pharmacologic
treatment
to relieve the symptoms in mild cases
includes:
• Identifying the irritant or allergen
and preventing further contact with
the substance.
• Relieving symptoms by using cool,
wet compresses.
• Protecting injured skin and advising
patients not to scratch the area.
Pharmacological treatment includes:
• Cleansers – non-medicated soap
free cleansers such as Cetaphil or
Spectro Derm should be recommended. Colloidal oatmeal soaks
contain starch that dilutes the
offending agent and helps to soothe
the affected areas.
• Astringents – for example, Burrow’s
solution (aluminum diacetate
0.35% and benzethonium chloride
0.035%) serve to coagulate offending allergenic proteins present at
the site. The solution is applied as
a wet dressing for 15 to 30 minutes
several times a day for up to seven
days. If improvement is not seen
then the patient should be referred
to a physician.
MARCH /APRIL 2005
• Antipruritics – topical antihistamines may be useful but should not
be applied to excoriated skin. Oral
antihistamines can be considered
and the pharmacist can discuss
the choice between the first and
second-generation nonprescription
medications with the patient.
• Topical hydrocortisone 0.5%
- decreases inflammation and
itching. It is available as a cream,
ointment or lotion and should be
applied thinly to the affected area
two to three times a day for up to
seven days. It is contraindicated if
the skin is infected.
• Lubricants – for example nonmedicated hypoallergenic bases such
as Glaxal or Dermabase provide an
occlusive layer to the skin and serve
as emollients and moisturizers
especially in chronic dermatitis.
The pharmacist should suggest a
follow-up call or visit. Advise the patient
that physician referral is required if:
• the dermatitis has not improved in
7 days,
• there is an indication that the
lesions are infected, or
• there is systemic involvement.
MANITOBA SOCIET Y
OF
PHARMACISTS
Table 1
Glossary of terms used in Describing skin conditions 3
Bulla
a thin-walled blister of the skin or mucous membranes greater than 1 cm
in diameter containing clear, serous fluid.
Crust
solidified, hard outer layer formed by the drying of a bodily fluid, common
in skin conditions such as eczema, impetigo, seborrhea, and favus
(chronic ringworm) and during the healing of burns and lesions; a scab.
Excoriation
an injury to the surface of the skin or other part of the body caused by
trauma, such as scratching, abrasion, chemical or thermal burns.
Fissure
a crack-like lesion of the skin that extends into the dermis
Lichenification
thickening and hardening of the skin, often resulting from the irritation
caused by repeated scratching of a itchy lesion.
Papule
a small, solid, raised skin lesion less than 1 cm in diameter, such as the
lesions of lichen planus and nonpustular acne
Primary lesion
a sore or wound that develops at the point of inoculation of the disease.
Scale
small, thin flake of keratinized epithelium.
Secondary
lesion
second in importance or in incidence; a lesion that results from external
forces acting upon the primary lesion.
Vesicle
small bladder or blister, such as a small, thin-walled, raised skin lesion
containing clear fluid.
References:
1. Venes, D., Taber’s Cyclopedic Medical dictionary,
19th edition, F. A. Davis Company, Philadelphia
2001.
2. Pray, S., Non-prescription Product Therapeutics,
Lippencott Williams & Wilkins, Philadelphia,
1999.
3. Mosby’s Medical Encyclopedia on CD-ROM,
Mosby Publications, 1997.
4. Repchinsky, C., Compendium of Self-Care
Products, Canadian Pharmacists Association,
Ottawa, 2003.
5. Digital images by M. Thadani, January 2005. Skills
Laboratory 46.210.
C O M M U N I C AT I O N
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F EATURE ARTICLE
Ralph Whitfield Receives
MSP Award of Merit
Ralph L. Whitfield is the 2005 winner of the Manitoba
Society of Pharmacists Award of Merit. He becomes only the
fourth person to be recognized with this special award.
In his sixty-second year of working in pharmacy, Ralph
still puts in ten hour days running Whitfield Drugs in Souris.
With the assistance of three staff pharmacists, a pharmacy
technician, and his wife Averill, Ralph manages a 4,200 square
foot store. It’s the only drugstore in the town of 2,000 and also
serves approximately 9,000 people in the surrounding district.
Ralph greets customers by name or nick-name and is serving
fourth and fifth generation families. Averill says that friendly,
customer service, beyond the expected is his trademark.
Within the profession, Ralph is recognized as an evangelist for pharmacy.
Grant Schiltroth, a pharmacist in Reston, MB says, “Ralph
has helped to unite pharmacists in this corner of Manitoba.
He’s been an inspiration to me in running a retail business and
has shown that a pharmacist can be an advocate for patients
rather than leaving them with the government bureaucracy.”
Ralph opened for business in 1956. Along with his wife
Averill, he raised four children, all with successful careers
including a family physician, a public health manager, an
agronomist banker and a pharmacist. He has been a community builder, promoter and supporter, earning the Bowl of
Hygeia in 1979. He remains the owner/manager of the Souris
Medical Centre adjacent to the drugstore.
After half a century as a practicing pharmacist, Ralph figures he’ll sell the pharmacy, probably within a year, and then
dedicate more time to his ranching interests. He has 700 head
of Simmental cattle, a breed (especially when tattooed “RLW”)
that produces meat which is low in fat and cholesterol.
Pharmacy has changed drastically since Ralph bought his
store from J.G. Hatch in 1956. Third party insurance and the
higher profile of the pharmacist as a counselor to physician
and to patient have broadened the work of the person in the
dispensary. At the core, however, Ralph is sure that it is ethical
issues that continue to drive the profession.
When questioned, he sees cross-border pharmacy posing
a challenge to the idea that the pharmacist should know and
counsel the patient. “I have reservations about international
pharmacy,” he explains. “I worry about scripts from doctors
who have not seen the patient, and I worry about shortages
in the supply of some drugs. These shortages did not occur
before international pharmacy existed.”
Ralph has set ethical standards for the profession, say
colleagues. Retired pharmacist Lawrence Hargreaves from
Neepawa explains, “He has always been ethical in his standards. He represents the values of society.”
Away from the dispensary, Ralph enjoys listening to classical music. In the past, he has coached baseball and hockey.
MANITOBA SOCIET Y
OF
PHARMACISTS
One of his former protégés
was Andy Murray, the coach
of the L.A. Kings. Off the
ice, as well, he has been a
leader in Souris, serving as
alderman for eight years.
Working to advance the
profession of pharmacy as
a member of the MSP Board
of Directors, President of
MSP for the 1999-2000 term
and before that as Chairman
of the MSP Economics Committee, Ralph has been a leader for
each of his communities, says Dr. Les Knight, a physician who
retired in 1999 after 54 years of practice in Souris. Ralph has set
a standard for others to follow.
ANNUAL GENERAL MEETING
April 16th, 2005
Victoria Inn, Winnipeg
Members who wish to receive an advance copy of the Annual Report,
please contact the MSP office at 956-6681/1-800-677-7170
prior to April 8th and a copy will be mailed to you.
Manitoba Society of Pharmacists Inc.
ANNUAL GENERAL MEETING AGENDA
Saturday, April 16, 2005
Victoria Inn, 1808 Wellington Ave., Winnipeg
Chair – Brent Havelange
Minutes of the Annual General Meeting, April 17, 2004
Business Arising
President’s Address . . . . . . . . . . . . . . B. Havelange
Auditor’s Report
Finance Report . . . . . . . . . . . . . . . . N. Remillard
Executive Director’s Report . . . . . . . . . . S. Ransome
MSP Committees
7.1 Communications Journal Committee . . . . . . J. Rich
7.2 Membership Committee . . . . . . . . . . D. Wincott
7.3 Economics Committee . . . . . . . . . . . J. Pankratz
7.4 Professional Relations Committee . . . . N. Remillard
8. Liaison Reports
8.1 Insurance Liaison (CPBA) . . . . . . . . . . C. Narvey
8.2 Canadian Pharmacists Association Liaison . . E. Kuber
8.3 Student Liaison . . . . . . . . . . . . . . . B. Reyes
9. New Business
10. Closing Resolution
1.
2.
3.
4.
5.
6.
7.
C O M M U N I C AT I O N
9
F E ATURE ARTICLE
Making a Difference in the
Heart-Health of Manitobans
The recently published INTER-HEART study, provides us
with further knowledge about the factors that predispose patients to heart attacks.1 It had been previously
suggested that known risk factors account for only about
50% of the risk for an MI; the INTER-HEART data suggest
that 90% of the risk can be accounted for by 9 main risk
factors. The 9 main risk factors are as follows:
1. Cholesterol ApoB/ApoI (Ratio Good:Bad )
2. Smoking
3. Abdominal Obesity
4. Hypertension
5. Diabetes
6. Stress
7. Regular Exercise (4 hour/week)
8. Regular Fruit and Vegetable Intake
9. Alcohol Intake ( > 3x/week modest protective effect)
The INTER-Heart study has made it clear that cardiovascular disease is largely preventable. Since 2003 the CRIMP
program (Cardiovascular Risk Intervention by Manitoba
Pharmacists) has provided pharmacists with the tools to
intervene in the management of patients at high risk for
cardiovascular events. The therapeutic interventions facilitated by the CRIMP program deal directly with the treatment or management of 5 of the 9 major risk factors.
2004 In Review
Pharmacist Training
The CRIMP program kicked off the year with a training workshop conducted on January 10, 2004. Twenty three
pharmacists attended the full day workshop which include
presentations from Susan Lessard-Friesen (Assistant
Registrar, MPhA), Dr. Bill Semchuk, Dr. Mark Friesen, Dr. Jeff
Taylor, Shawn Bugden (PrISM), Joyce Marozas and Michelle
Deschamps. The workshop presentations included:
• High Risk Population and Cardiac Rehabilitation:
Pharmacological Means of Lowering Risk
• Can (We Make) People Change
• The PIRR Study – Pharmacists Intervention in Risk
Reduction
In addition to these educational talks, the functional
details of the CRIMP program were discussed, including
interactive case sessions in identifying, enrolling and fol-
10
C O M M U N I C AT I O N
lowing-up with patients. All of the pharmacists received a
resource binder that included an outline of the program,
contact information for resource clinicians, patient education tools, review articles and the latest guidelines. The
resource binder also housed guidance on how to best identify, recruit and follow-up patients in the program, and contained copies of the enrolment forms, patient information
sheets and physician referral forms.
Participation and Enrolment
A total of 18 pharmacy sites agreed to participate in the
CRIMP program. A total of 113 patients were recruited from
January 10th to December 31st, 2004. The pre-specified
recruitment goal for the CRIMP participants was 8 patients
per site. A number of sites were unable to achieve this goal
but 33% of pharmacy sites exceeded the target of 8 patients
per site. The average age of the patients recruited was 62
years old and 53% were men. The age and sex distribution of
the CRIMP participants is provided in Figure 1.
Risk Identification
In the 113 patients enrolled in the program, pharmacists identified 204 risk factors for primary or secondary cardiac events. Figure 2 provides a breakdown of the identified
risks. By far the most commonly identified risk factor was
diabetes. Considering that sixteen new diabetics are diagnosed per day in Manitoba (the national average is 11 new
diagnosis per day), and there will be an estimated 70,000
diabetics in the province by 2005 we are encouraged that
CRIMP pharmacists are identifying these high risk patients
so regularily.2 Diabetes and previous angina were the most
commonly identified risk factors because they are most
readily apparent through a medication review. The presence of oral hypoglycaemic agents, insulin or nitrates would
highlight the patient’s diagnosis of diabetes or angina.
Figure 1: Demographics of CRIMP
Participants
35
30
25
20
# of
Participants 15
10
5
0
males
females
<50
50-59 60-69 70-79 80-89
Age (years)
MARCH /APRIL 2005
Figure 2: Identified Risk Factors
6%
4%
Figure 3: Therapeutic Interventions
9%
Diabetes plus ≥ 1 Risk Factor
12%
Previous Angina
41%
2%
ASA
28%
11%
Weight Reduction
Revascularization
Lipid Lowering Therapy
Previous Acute MI
12%
Peripheral Vascular Disease
Glucose Control
16%
17%
Cerebrovascular Disease
24%
Anti-hypertensive Therapy
Smoking Cessation
17%
Intervention
After completing a review of the patient’s risk factors,
the CRIMP pharmacists were asked to decide which, if any,
of a number of therapeutic interventions were appropriate
for their patient. A total of 172 therapeutic interventions
were made by the CRIMP pharmacists. Figure 3 provides
details on which interventions were most commonly proposed to the patients and/or their physician.
Underutilization of ASA in high risk populations has
been recorded in a number of studies. In the ALLHAT trial,
a large randomized control trial of patients with hypertension and a minimum of one other cardiac risk factor, the
baseline ASA use was only 36%.3 Considering this agent’s
documented underuse in high risk populations, it is not
surprising initiation of ASA was the most commonly recommended therapeutic intervention by the CRIMP pharmacists. Initiation of an ACE-inhibitor, promotion of weight
reduction and initiation of lipid lowering therapy were also
common interventions. Initiation of a smoking cessation
program was the least common intervention recommended
by CRIMP pharmacists. Smoking is an important risk factor for cardiovascular disease and pharmacy access to
over-thecounter smoking cessation products represent an
important opportunity for change. Smoking can be a very
difficult behaviour to change but more could be done to
help pharmacists take a proactive approach in dealing with
this important health concern.
Follow-up and Therapeutic Changes
A total of 121 follow-ups were conducted on the 113
enrolled patients in the program. This is slightly over 1⁄2
the number of follow-ups that should have occurred over
the course of the study indicating that lack of follow-up
was a substantial problem in the 2004 program year. The
lack of complete follow-up suggests there are some barriers
that may inhibit pharmacists in completing this process.
Analysis of therapeutic change was limited to patients that
had at least 1 follow-up contact.
There were a total of 99 therapeutic changes that were
captured in the follow-up correspondence. Fifty-five of
the therapeutic changes were related to the pharmacists’
interventions. Thus, 47% of the CRIMP pharmacists’ interventions resulted in a documented therapeutic change (55
therapeutic changes from 118 therapeutic interventions).
MANITOBA SOCIET Y
ACE Inhibitor
OF
PHARMACISTS
CRIMP in Context
When the CRIMP program was created, it was thought
that one of the major barriers to the provision of this
degree of patient care was the lack of financial incentive.
As such, the CRIMP program was designed with monetary
compensation (for both enrollment up and follow-up).
However, the lack of follow-up indicates that other factors
may be adversely affecting patient intervention initiatives.
In a study by Weinberg et al. they identified 3 major barriers
that affected their ability to implement a community-based
pharmacist intervention program.4 The first was changes in
pharmacy ownership or authority structure. The investigators found that changes in the management of a pharmacy
that occur over time affected their ability to maintain active
intervention programs. The second was concerns over
patient confidentiality. The rules around patient confidentiality are not well understood and as such, physicians and
pharmacists are not always comfortable with requesting
or providing information that is outside of their normal
activities. The final was pharmacist behaviour. Investigators
found that many pharmacists did not adhere to the program
protocols. They tried different strategies to improve pharmacist compliance including more close investigator supervision, comparing pharmacist adherence to colleagues and
finally, financial incentive. It is not clear if any of the factors
identified by Weinberg et al. affected the CRIMP program;
however, it is evident that many factors will have to be taken
into account to determine the best way to improve followup if the CRIMP program is continued.
Patients with diabetes were the most common risk
group identified in the CRIMP program. A recently published Saskatchewan database review analysed the pharmacological management of 12,106 diabetics.5 They looked
at the proportion of the patients being appropriately managed with anti-platelet, statin and ACE Inhibitor therapy.
Considering the high rates of vascular morbidity and mortality experienced by diabetic patients it would be expected
that the use of these agents would be common. The authors
found that 25% of the study population were on anti-platelet therapy, 20% were on a statin and 49% were on an ACE
Inhibitor. A sub-group analysis of diabetics with known
cardiovascular disease showed 37% on an anti-platelet, 29%
on a statin and 60% on an ACE Inhibitor. This represents
an improvement in utilization, but when you consider that
all patients with diabetes and known CAD should be on all
C O M M U N I C AT I O N
11
these agents (unless they have a contraindication) the rates
are still dismally low. The CRIMP program represents one
small effort to try and bridge the gap to address cardiovascular risk in patients with diabetes.
Other provinces have also had success with programs
like CRIMP. The Study of Cardiovascular Risk Intervention
by Pharmacists (SCRIP) published in 2002 in the Archives
of Internal Medicine provide us with an indication of the
impact pharmacist can have on the health of our clients.6
Tsuyuki et al. theorized that treatment gaps between the
known benefits of cholesterol lowering therapy and the
proper application of these therapies in high-risk patients
could be narrowed through pharmacist intervention. This
study took advantage of pharmacists’ ready accessibility
and their knowledge of disease states and drug therapy to
collaborate with patients and physicians to improve cardiovascular care. Patients in the study who “received” the
pharmacist intervention were more likely to have their
cholesterol checked, more likely to receive a prescription
for cholesterol lowering therapy and more likely to have an
increase in their dose of cholesterol lowering medication.
The follow-up to the SCRIP study, the SCRIP-plus went on to
determine that pharmacists’ intervention could significantly impact the cholesterol management of patients.7 They
found patients who were subject to pharmacist intervention
had significantly lower LDL cholesterol 6 months later.
Knowing that there is substantial underutilization of
life-preserving therapeutic agents in high-risk cardiovascular patients and knowing that pharmacists can make a significant difference in the utilization highlights the need for
programs like CRIMP. The HOPE trial showed that you need
to treat as few as 26 people with ramipril to prevent one heart
attack, stroke or cardiovascular death.8 The Antithrombotic
Trialists’ Collaboration found, through meta-analysis that
you have to treat as few as 40 patients with ASA to prevent
one heart attack, stroke or cardiovascular death.9 In the past
year alone the CRIMP pharmacists identified 113 high-risk
cardiovascular patients and made 172 therapeutic interventions on their behalf. Having an impact on reducing
important cardiac events is well within the capacity of pharmacists practicing in a community setting and it is through
programs such as CRIMP that pharmacists have been given
the tools to make this capacity a reality.
Acknowledgements
On behalf of the pharmacists participating in the
CRIMP program and the Prescription Information Services
of Manitoba we would like to thank Sanofi-Aventis for their
support of this worthwhile program and hope that we will
have an opportunity to continue this important initiative.
Authors
Kyle MacNair and Shawn Bugden, Prescription
Information Services of Manitoba (PrISM)
For more information about CRIMP please contact PrISM
Phone: 204-231-4688
Fax: 204-231-5964
E-mail: [email protected]
www.prisminfo.org
References
1. Yusuf, S., Hawken, S., Ounpuu, S., et al. Effect of potentially modifiable
risk factors associated with myocardial infarction in 52 countries (the
INTERHEART study): case-control study. Lancet 2004; 364: 937-52.
2. Manitoba & Nunavut Home Page. Canadian Diabetes Association. http://
www.diabetes.ca/Section_Regional/manitoba_index.asp Accessed October
1, 2004.
3. Major Outcomes in High-Risk Hypertensive Patients Randomized to
Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs
Diuretic: The Antihypertensive and Lipid Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT). JAMA 2002; 233(23): 2981-2997.
4. Weinberger M, Marrero D, Brewer N, et al. Issues in conduction randomized controlled trials of health services research interventions in nonacademic practice settings: the case of retail pharmacies. Health Serv Res
2002; 37(4): 1067-1077.
5. Brown L, Johnson J, Majumdar S, et al. Evidence of suboptimal management of cardiovascular risk in patients with type 2 diabetes mellitus and
symptomatic atherosclerosis. CMAJ 2004; 171(10): 1189-1192.
6. Tsuyuki R, Johnson J, Teo K, et al. A randomized Trial of the Effect of
Community Pharmacist Intervention on Cholesterol Risk Management:
The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP).
Arch Intern Med 2002; 162: 1149-1155.
7. Tsuyuki R, Olson K, Dubyk A et al. Pharmacist Intervention on Cholesterol
Levels in Patients at High Risk of Cardiovascular Events: The Second
Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP-plus).
American Journal of Medicine 2004; 116: 130-133.
8. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of
an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular
events in high-risk patients. NEJM 2000; 342(3): 145-153.
9. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of
randomised trials of antiplatelet therapy for prevention of dealth, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.
12
C O M M U N I C AT I O N
MARCH /APRIL 2005
vision products service tools
service
strengthening the
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The very foundation of our success has been built upon providing
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efficiently we serve you, the more effectively you can serve your
Copyright © 2005, Apotex Inc. All rights reserved.
patients. And isn’t that what it’s all about?
www.apotex.ca
MANITOBA SOCIET Y
OF
PHARMACISTS
C O M M U N I C AT I O N
13
14
C O M M U N I C AT I O N
MARCH /APRIL 2005
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MANITOBA SOCIET Y
OF
PHARMACISTS
C O M M U N I C AT I O N
15
A
ERENCE
NF
MANITOB
ARMACY C
H
O
P
The Winning Combination
Conference Schedule
April 15th to April 17th, 2005
Victoria Inn, Winnipeg, Manitoba
Thursday, April 14
TBA
CSHP-MB Annual General Meeting (Niakwa Country Club)
Friday, April 15
1:00pm – 7:00pm
1:30pm – 2:00pm
2:00pm – 3:00pm
3:00pm – 3:15pm
3:15pm – 5:00pm
5:00pm – 7:30pm
Saturday, April 16
7:45am – 7:00pm
7:45am – 8:15am
8:15am – 10:00am
10:00am – 10:15am
10:15am – 12:00pm
12:00pm – 1:00pm
12:00pm – 1:00pm
1:00pm – 3:15pm
3:15pm – 3:30pm
3:30pm – 4:30pm
6:00pm – 7:00pm
6:00pm – 7:00pm
7:00pm – 11:00pm
Sunday, April 17
9:00am – 1:30pm
9:00am – 12:00pm
10:00am – 10:15am
10:15am – 12:00pm
12:00pm – 1:30pm
1:30pm – 3:00pm
3:00pm – 3:15pm
3:15pm – 4:30pm
16
C O M M U N I C AT I O N
Registration Desk
Opening Remarks – Tim Sale
Session A – Diabetes: Discovering Our Options
Break
Session B – PrISM - Beyond the Newsletter/Diabetes - Beyond Glucose
Exhibitors Hosted Wine & Cheese
Presentation by the Faculty of Pharmacy
Merck Frosst Young Leaders Awards Presentation
Registration Desk
Continental Breakfast
MSP Annual General Meeting
Break
MPhA Annual General Meeting
Exhibitors Venue Open
Exhibitors Hosted Buffet Lunch
Issues Forum
1. Open Discussion 2. MILE Program 3. Jurisprudence
Break
Session C – Option 1 – Eating Disorders
Option 2 – Short & Snappies
Exhibitors Venue Open
Exhibitor/Conference Chair Reception
Awards Banquet & Silent Auction
Guest Speaker – Bob Irving
Registration Desk
Session D – Option 1 – Blood Glucose Monitors Workshop
Option 2 – Internet 101
Break
Session E – Living with Diabetes
1. A Patient’s Perspective 2. Insulin Therapy - Who, Why, What, and How
3. Diabetes and Depression
Manitoba Pharmaceutical Association Luncheon
Session F – Option 1 – A Teamwork Approach to Diabetes
Option 2 – C-difficile Disease
Break
Session G – Learning to be a Better Preceptor
MARCH /APRIL 2005
F E AT U R E A RT I C L E
Beyond the Dispensary, Ryan Douglas
Leaves Work in the Dust
Racing his Honda CRF 450 motorcycle through a series of jumps, it’s tough to
imagine that the man beneath the helmet is a community pharmacist whose
workdays seldom have physical challenges. Perhaps that’s why Ryan Douglas,
34, has become a champion racer in motocross, a sport that requires the deft
maneuvering of ballroom dancing and the toughness of prizefighting.
Ryan, 34, has been in practice for
11 years. Today, in Morden, a town of
6,000 a half hour drive north of the U.S.
border, he plays a sort of Clark Kent
role, dispensing during his shifts at the
town’s Pharmasave and spending his
time off tuning and polishing his red,
black and silver bike.
The appearance of the sport – small
bikes swirling through the peaks and
valleys of specially prepared tracks – is
more violent in appearance than in fact,
Ryan says.
“In motocross racing, there is little
risk of injury,” he explains. “The courses
are designed for safety and we have
ambulances on hand.” Despite the jar-
MANITOBA SOCIET Y
OF
PHARMACISTS
ANDREW ALLENTUCK
ring the body takes on the tough tracks,
Ryan says that his worst injury was a
torn knee ligament.
Crowds come to watch motocross
events. In a visible and fast-growing
sport, Ryan has become a town hero.
Supported and sponsored by Sig Pfahl,
for whom he has worked at Pharmasave,
he is recognized for both his work and
his sport. “I put the
Pharmasave name
on the bike. I do it
because Ryan is a
good guy more than
for commercial gain.”
The rewards for
bouncing
through
the tracks are trophies like the Plus 30
Award and the 250
Junior Championship,
both awarded by the
Manitoba Motocross
Association in the
summer of 2004.
When he takes time
off from racing, Ryan
seeks other physical
challenges, especially
hockey. Golf and curling, he says, will wait
until he’s much older.
Ryan is a guy who
likes his sports to be
physical. Cruising on
a huge Honda Gold
Wing, a bike designed to look like the
marriage of a motorcycle with a stretch
limo, is not appealing. The core of the
motocross sport is action and that, Ryan
says, is what drives him to work out
twice a week in 90 minute sessions of
full body cardio routines, pumping up
his arms and legs, and toughening his
back.
The sport has an addictive appeal,
says Corey Friesen, also 34, a graphic
designer who lives near Steinbach and
who, like Ryan, is a motocross racer.
“The riding is great and what goes with
it, the community of racers is like a big
family. We’re motoheads – it is a closer
union than one can get out of any fraternal association.”
At home, with his wife Michelle
and his two lapdogs, Casey and Baxter,
Ryan is part of the growing community.
With a new medical clinic, a new hospital and an established personal care
home, Morden has ample professional
opportunities and, he says, a homey
atmosphere that would be hard to find
in a city.
After hours, at the track or tinkering with the bike, Ryan is the guy who is
waiting for what he calls “the adrenalin
rush” of competition.
“The thrill is in achieving your
goal,” says Donna Johnson, a former
Manitoba Motocross Association official. “The racers fly though the air as
they navigate the course. More than
just a race, it’s about achieving things
for yourself. Ryan has achieved a lot
for himself, proving that he’s one of the
best and one of the smartest riders on
our circuit.”
A seasoned racer with almost four
years of experience, Ryan usually finishes in the top five in races with up to 40
bikes. Then, after washing dust and mud
off the bike and showering, he’s ready to
go back to being the mild-mannered
pharmacist. In a motivational sense, it
remains an open question whether it’s
the pharmacist that supports the race or
the race that supports the pharmacist.
C O M M U N I C AT I O N
17
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18
C O M M U N I C AT I O N
MARCH /APRIL 2005
Q & A : GETTI NG TO
K N O W YOUR MANITOBA
P H A RMACISTS
Name:
Morna Cook
Place/Year of Graduation: University of
Manitoba, 1969
Years in Practice: 35
Currently Working: Grand Medicine Health
Services
Accomplishments in pharmacy: First
woman President of the Manitoba Society
of Pharmacists, 1983-1985. First woman
President of the Canadian Foundation
for Pharmacy 1990-1991. First woman
President of the Association of Canadian
Community Pharmacists 1984-1985.
Manitoba Pharmacist of the Year 1984.
Canadian Pharmaceutical Assoc. Meritorious Service Award 1992. Editorial
Review Board Member Pharmacy Practice magazine 1995 to present, especially for diabetes related practice issues. Robins Bowl of Hygeia winner
1997. Award of Merit- April 2000, Manitoba Society of Pharmacists. Honorary
life member of the Manitoba Pharmaceutical Assoc. 2001. Member of the
Professional Development Committee, Manitoba Pharmaceutical Assoc.
2004-2006. Honorary Chair of the Annual Manitoba Pharmacy Conference,
2004-2005.
Family: Husband Jim, cat Smokie, 28 nieces and nephews, 32 great nieces
and nephews, 2 great-great nephews.
Hobbies: Baking, and reading. Also have become “A Dreaded Crafter”! Using
anything with natural products such as birch bark (pictures, bowls, cups)
vines, pinecones, and grasses. Also make teddy bears for the Christmas
Cheer Board.
Community activities: Nominated in 1992 and again in 2005 for the YMYWCA Women of Distinction Award. Represent the pharmacy sector on
Manitoba Blue Cross and Uni Blu Inc. Boards of Directors 1999 to present.
First woman President of the Osteoporosis Society of Canada, MB Branch.
Chief Pharmacist, Manitoba Marathon, 1988 to 1995. Chief Pharmacist,
Western Canada Summer Games 1990. Co-Chair Pharmacy Services,
Pan-Am Games 1999. Fundraising volunteer for the Epilepsy Assoc. of
Manitoba Out of the Shadows Run, 2003-2005. Pharmacist Advisor to
Western Canada Summer Games in Selkirk, 2003. Advisor and volunteer at
Canada Summer Games in Brandon, 1997. Member and active volunteer
with Manitoba Runners Assoc. 2002 to present. President of the Canadian
Diabetes Assoc. MB Division, 2000-2002. Served as Acting Regional Chair
at CDA, 2002-2003. Elected Regional Chair of the CDA for the 2003-2006
term. Co-Chair third party fundraising Run in the Park events for Team
Diabetes 2003-2005. Volunteer representative for CDA to the Alliance for
the Prevention of Chronic Disease in Manitoba from 2001 to present.
(Currently Treasurer on the Executive). Awarded the BD Volunteer Service
Award at the CDA/CSEM Professional Conference in 2004.
Favorite thing about Manitoba: Fall- wonderful long days, great colors, no
bugs.
Most relaxing vacation choice: Our cottage at Sandy Hook on Lake
Winnipeg.
Pet peeves: People who endlessly complain about things (the state of the
profession, leadership, pharmacy’s public image) but never roll up their
sleeves and do something about it!
Are you looking to work in a patient focused care setting?
Do you want to work for a company which provides a
strong team environment?
Are you looking for a company that can provide you
room to expand your skills and future opportunities?
Do you want to feel secure and work for a company
that will provide you an outstanding benefits package
as well as bonus potential for your skills?
Our Benefits Package allows you to earn over
$100 000 in compensation and benefits.
Our Bonus Plan allows you to receive potential yearly
Bonuses as a Staff Pharmacist.
Our Prescription Sharing Plan allows you to enjoy
potential yearly Profits as a Staff Pharmacist.
In addition, we believe in reimbursement for cognitive
services and as such have developed positions in
many practicing specialties including:
• Long Term Care Clinical Pharmacists
• Asthma Certified Pharmacists
• Certified Diabetes Educating Pharmacists
• Men’s and Women’s Health Specialty Pharmacists
If you are a pharmacist who is licensed to practice in
the province of Manitoba, and looking to provide patient
focused care within a strong team environment, then
this opportunity may be for you.
Together, the Safeway family is one of the largest
employers of retail pharmacists in North America, and
in Canada operates pharmacies in British Columbia,
Alberta, Saskatchewan, Manitoba, and Ontario.
We currently have full time employment opportunities
for both staff and manager positions in various rural
Manitoba locations.
What could you do without forever: mosquitoes, definitely.
If this is an opportunity of interest to you, please
send a cover letter and resume by e-mail or fax to the
address below. New grads are welcome to apply.
What couldn’t you do without for even a day: The incredible support and
love of my best friend, my business partner, and my partner-in-life; Jim.
Farzin Rawji, B.Sc. Pharm
Favorite fictional character and why: “The Littlest Engine”: “I think I can, I
think I can, I think I can….” What a great attitude to life!
What you love about pharmacy: Because pharmacy is so connected to the
real world, its one constant is CHANGE! I can’t imagine being bored with
my job because even after 35 years in practice, there is something new to
learn or overcome almost every day. I love meeting the people too; just like
snowflakes- everyone unique and interesting in their own way.
Do you know someone who is making a difference in the pharmacy
community? We would like to highlight them in this article!
Please contact the MSP office at (204) 956-6681 or [email protected].
MANITOBA SOCIET Y
OF
PHARMACISTS
Pharmacy Recruiting Coordinator
Canada Safeway Ltd.
14360 Yellowhead Trail, Edmonton, AB T5L 3C5
Voice Pager: (800) 749-4974 Fax: (780) 439-4227
Email: [email protected]
C O M M U N I C AT I O N
19
C L ASSIFIEDS
FEBRUARY 2005 WINNIPEG: Part-time pharmacist wanted for
2 days a week (Mon, Tues - 9-5) plus covering other pharmacist
vacation time. Join a team of 7 pharmacists. Competitive wages.
We are not an internet pharmacy. If interested call Grand Medicine
Health Services - 885-0768
PHARMACIST OPPORTUNITY: Looking for a change? Generous
salary, no evenings, no Sundays or holidays, friendly staff. Call Keith
at (204) 367-2517; evenings (204) 367-8635, fax (204) 367-2984.
FULL TIME PHARMACIST REQUIRED for Rock Lake Pharmacy,
Crystal City, MB. No evenings or holidays, closed for lunch. Close
to a wide range of recreational activities. Housing available
for successful applicant. Competitive salary offered with the
opportunity for partnership into business if desired. For more
information contact: Wayne Currah at work (204) 867-2071 or
home (204) 867-3978.
FULL TIME PHARMACISTS WANTED: Super Thrifty requires full
time pharmacists at the following Manitoba Locations: Virden
and The Pas. Career opportunity for experienced pharmacist or
new grads. Good communication and human relations skills are
an asset. Quality rural lifestyle, no evenings, Sundays, or holidays,
technician Support, salary negotiable, profit sharing available,
health benefit package, future ownership opportunity. Contact
Tom Busch at: Phone (204) 727-8451, fax (204) 727-3471 or
[email protected] All replies kept confidential.
FULL-TIME PHARMACIST needed for busy but well-organized
community pharmacy in Northern Manitoba. We’re looking for
someone who works well as part of a team and genuinely cares
about people. Call Mike (204) 778-8391 Shoppers Drug Mart,
Thompson, MB
PHARMACIST WANTED: Full/Part-time with flexible hours
at a newly opened pharmacy in the north end of Winnipeg.
No weekends and no evenings. Please forward resume to
[email protected] or by Fax 204-339-8023.
PHARMACIST WANTED: Pharmacy has immediate opening for
licensed pharmacist. We require excellent pharmaceutical care and
communication skills. We offer competitive rates and a very flexible
schedule, unique arrangement. For more information contact Tony at
(204) 582-3287.
Pharmacy is the most important part of our business at Shoppers Drug Mart®/
Pharmaprix®, and we want you to be a part of it. As Canada’s leading pharmacy,
we have tremendous career opportunities. We offer competitive salaries and
benefits and, if you have an entrepreneurial spirit, the chance to become a
Pharmacist Owner. You will also have access to rewarding professional practice
opportunities, career development and leading-edge technology. Achieve your
full potential while providing top patient care.
We are currently looking for Licensed Pharmacists for:
• Thompson, Manitoba
• Prince Rupert, BC
• Thunder Bay, Ontario
• Dawson Creek, BC
• Calgary, Alberta
• Kitimat, BC
• Edmonton, Alberta
• Kelowna, BC
Shoppers Drug Mart has opportunities available across Canada!
E-mail to receive a current listing of opportunities in other provinces!
For the experience of a lifetime, please contact in strict confidence:
Samantha Beaudry, Recruitment Coordinator
Phone: (306) 586-8582
E-mail: [email protected]
20
C O M M U N I C AT I O N
Looking for Locums in Winnipeg.
Please contact Manny Morry at 896-4577.
www.drugstorepharmacy.ca
Opportunities available for licensed pharmacists…
• Full-time Pharmacists in Brandon, The Pas, Winnipeg,
Swan River
• Full-time area relief positions based in Winnipeg
Please contact:
Mark Kupser, Regional Pharmacy Recruitment Manager
– Western Canada
The Real Canadian Superstore #1577
5858 Signal Centre SW
Calgary, AB T3H 3P8
Phone: 403-249-5290
Cell: 403-249-4758
Fax: 403-461-7121
e-mail: [email protected]
The MILE Line: An Update
(Medication Information Line for the Elderly)
The Medication Information Line for the Elderly (MILE) was relocated to
the University Centre Pharmacy by Vice-President (Administration) Debbie
McCallum in July of 2005. A room was specially designed to accommodate
a comfortable office that could also serve as a private counseling area for
patients wishing to discuss their medications.
The strength of the MILE Line has been in the people and technology being
utilized to provide current drug information. The service uses an electronic
province-wide data base for patient files, and an online reference library for
medical information that allows the pharmacist on the phone to call up a
patient profile and assess their medication issues.
The staff includes pharmacist consultant Sunita Persaud, B.Sc.(Pharm.) who
fields questions on the phone and meets with patients who can either drop
into the office or make an appointment to see the pharmacist. The Outreach
Program for MILE is handled by Meera Thadani, M.Sc.(Pharm.) who
meets with community groups, hospital staff, students in other faculties and
provides continuing education to other health professionals.
While the first few months were spent becoming familiar with the technology
and database, MILE now handles calls for patients as young as three months
to older adults in their nineties. The current location is more accessible to the
University population as well as the public and patients are encouraged to
come to the office to discuss their medications in person.
The nature of the questions handled by MILE varies widely. Patients seek
information for prescription and non-prescription medications, herbal
products, and nutrition, interactions between drugs and natural products as
well as investigational drugs. The University Centre Pharmacy also benefits
from MILE because it provides an added resource to the services currently
being provided.
MILE is unique as a community based pharmacy consult service. It serves as
a model for the profession in that medication information can be handled as
part of day to day practice by any pharmacist. Current plans are to expand the
scope and potential for MILE as a service, outreach, teaching and research
opportunity for the benefit of all Manitobans.
The staff acknowledges the support MILE has received from the office of
the Vice-President (Administration). A special thank you is extended to Dr.
David M. Collins, Dean, Faculty of Pharmacy, for writing and managing the
program for the data base.
For a more detailed report please attend the presentation at the Annual
General Conference or visit us at:
University Centre Pharmacy
Room 111 University Centre
66 Chancellor Circle
University of Manitoba
Winnipeg, R3T 2N2
9.30am to 2.30pm Monday to Thursday
Tel: (204) 474-6493
Fax: (204) 474-7572
e-mail: [email protected]
MARCH /APRIL 2005
Retired? or Bored?
Pharmacist required Saturdays Only!
10am til 5pm
Will pay for yearly license fee plus
competitive hourly rate of pay!
All you do is work Saturday and
relieve my Pharmacists Vacation
Call Jim @ 837-7882 Ext # 7
LOOKING FOR A PHARMACIST TO
RELOCATE TO THE TOWN OF ROBLIN,
MANITOBA.
A town considered to be the jewel of the Parkland.
Roblin is located on the Manitoba-Saskatchewan border
and brags about the great fishing at Lake of the Prairie;
water skiing; golfing and other amenities for a good life.
Pharmasave has a staff of 12 young personable
employees who work hard and play hard.
Competitive salary with a signing bonus
and moving allowance. For more information, please call
1-204-937-6505 and ask for Darren or Vera.
Problems – or more appropriately – personal problems.
We all experience them, and work them out most of the time.
Some problems might involve
• Marital issues
• Financial issues
• Family issues
• Chemical use (including alcohol)
• Emotional/psychological/physical issues
• Gambling
Because we are all unique as individuals, we respond
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O M M U N I C AT I O N
21
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T H E LAST WORD
Rx for Rover
vomit the drug. However, once dosages
and administration are adjusted, the animal patient – the owner, if you like - can be
There’s a new breed of patient queuing
a good customer. “Pets with degenerative
ANDREW ALLENTUCK
up at the pharmacy. Pets - or at least
diseases or in old age require drug maintetheir owners - are arriving with scripts
nance just like people,” he explains.
in hand looking for an alternative to the
Pet pharmacy is an expanding business. A variety of international sources for animal drugs can be
usual channel for veterinary medicines – the vet’s office.
found on the Web at sites like www.talktothevet.com. Dispensing
via cyberspace may add to drug interaction issues.
In a story published during the yawning days between
Christmas and New Year’s Day, Canadian Press revealed that a
British Columbia has dealt with what can be called the
Quebec City pharmacy is dispensing such things as Prozac for
crossover problem of drugs for animals. In its July/August 2004
puppies to customers who say that they can save an average of
bulletin, the College of Pharmacists of British Columbia recommends that pharmacists set up a separate patient record for
30% of what vets charge for the same preparations.
each animal using the patient’s Personal Health Number (PHN).
Pharmacies can dispense drugs for animals, notes Ron
In Manitoba, there is no similar provision, for DPIN numbers
Guse, Registrar of the Manitoba Pharmaceutical Association.
While filling prescriptions for dogs and cats is a marginal busiare assigned by government for human patients. Veterinarians
ness for most pharmacies, Tache Pharmacy in St. Boniface does
do not have immediate access to provincial drug databases for
a surprising amount of it. Among the drugs it sells for animals
human patients. Sharing drugs with one’s animals can give rise
are Amlodipine for blood pressure, Fluoxetine for depression,
to unusual interaction problems.
the antibiotic Itraconazole, and steroids like Dexamethasone.
In a lawsuit filed in 2002, Novartis Animal Health US Inc.
charged that some online retailers of animal drugs have moved
“Some of the products are put into capsules and some are made
drugs out of their proper channels, leaving veterinarians out of
into specialty gels for such things as application to the inner ears
the prescription chain. The drugs sold out of the usual chanof cats,” says Scott Groen, a pharmacist at Tache and a member
nel do not have poison control numbers, do not have phone
of the Professional Compounding Centers of America. He notes
numbers for Novartis and lack FDA disclosures. Innovative drug
that the dispensary has prepared prescriptions for rats, ferrets,
retailing may increase competition, but as the Novartis litigahorses, snakes, birds, several pigs and one chinchilla.
tion reveals, it can also add to safety issues.
Preparing drugs for critters can be a challenge, Groen says.
Dr. Keith Campbell, president of the Canadian Veterinary
Mixing a drug with catnip for a feline patient is intuitive. Other
Medical Association, says that vets have used pharmacies for
patients are more challenging. “For a preparation for a ferret, we
years for special drugs for animals. “Certain drugs are just not
tried several flavours including liver, beef, chicken and strawberry before we hit on what he would eat, which turned out to
convenient for me to keep in stock,” he explains. Dr. Campbell,
be banana,” he recalls. Flavours tend to be patient-specific, he
who practices in Winnipeg, says that when he writes scripts
adds. Some drug administration calls for imagination. How do
for animals, he assumes that drugs will be of good quality. It is
not different than dispensing from bulk bottles, he says. “What
you get a snake to take its medicine? Suggests Groen, “you can
counts is the integrity of the product as maintained by the
put a capsule into a mouse and then let the snake consume the
dispenser and the maintenance of the prescriber-patient relamouse.” Frozen mice are available at some pet supply stores.
tionship, he adds. The larger issue is the maintenance of that
Groen takes the quirky business of dispensing for animals
relationship, for if ethical pharmaceuticals are bought outside
very seriously. “We don’t dispense without a prescription from
of the prescriber – patient relationship, then accountability has
a veterinarian,” he explains. “For dogs and cats, we may dispense antibiotics like Enrofloxacin, which is somewhat like
been bypassed.”
Ciprofloxacin but with a different molecular form. We don’t
Accountability resides in part with animals’ owners, Dr.
prepare a lot of drugs for animals that are part of the food chain
Campbell adds. He worries that owners may give their own
medications to their animals or take what has been prescribed
or whose products, like milk, are ingested by people.”
for animals. He cautions against the practice. “Dosages may
Counseling patients is a special art when it comes to animals, Groen says.
differ by species, some drugs that people commonly take such
“I find that pet owners tend to listen better when their pet
as ibuprofen are very toxic to cats, some drugs that people take
is sick than when they do when they, themselves, are ill. For a
more than once a day are needed by dogs only once a day and
lot of people, pets are family members. I understand their ownby cats just once every three days. Thus, he says, the source of
ers’ concerns.”
drugs is less the issue than the proper administration of those
The amount of dispensing for animals varies geographidrugs. He adds that that the Canadian Veterinary Medical
cally. Rural pharmacies dispense for farm animals, as one
Association is reviewing the issues involved in compounding
would expect. Dan Wasko, owner and pharmacist of Killarney
of drugs for use in animals. Pharmacists can be part of the
Pharmacy says that he dispenses insulin preparations for dogs
veterinary dispensing process, but they should ensure that
and cats with dosages adjusted for the weight of the patient.
owners know that what’s good for Rover is not necessarily good
“The trick is to get the animal to accept the drug,” Wasko
for his keeper. And that what helps an owner may do harm to
says. “Dogs will chew a pill that is very bitter, then gag and
the pup.
22
C O M M U N I C AT I O N
MARCH /APRIL 2005
You come first. We’re not kidding.
From your name on the storefront to full-service programs to responsive daily support,
Procurity Pharmacy Services Inc. and its banner programs are built around you.
You hold the greatest value when it comes to your customers, your business, and ours.
YOUR CUSTOMERS COUNT ON YOU MOST
Our banner philosophies and marketing strategies are built entirely around
your promise to your customers and your inherent value in their community.
Introducing:
CounterWise Drug Mart • We Share Great Values
Promoting your wisdom, knowledge and excellent value, variety and quality
of products you provide for customer convenience and peace of mind.
CounterCare Pharmacy • Prepared to Make the Difference
Promoting your strong focus on health, well-being, and your proactive approach:
one that includes resources, products, advice and support to make your
customers’ visits more informative and helpful.
YOU CAN COUNT ON US
YOUR BUSINESS. YOUR FUTURE.
For all business supports and strategies required to establish
and grow your practice. Leading-edge technology, a seamless
distribution network, full advertising and merchandising.
All with one-to-one, personal service at every turn.
Randy Gray, Director of Sales
Profits and Equity
You own your own business, and part of ours. Procurity
Pharmacy Services Inc. is 100% owned and operated by
member pharmacists and shares all profits and equity.
We are accountable to you - that means no disappointments.
YOUR CALL.
(204) 631-3509
[email protected]
Please visit: www.procurity.ca
FORMERLY
Manitoba Pharmacy Conference 2005
The Winning Combination
Sponsors
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