In order to evaluate the MedsCheck program and its administration the Ministry uses the claims that are made to be paid and the numbers of people who have received the service together with the type of MedsCheck that they’ve had and also the number of pharmacies that are conducting MedsCheck. That would reveal the government cost, there was a budget for original MedsCheck program for $50 million per year, and the program has met the ministry’s expectations as far as the numbers indicate. Almost all pharmacies have conducted MedsCheck. In the first three fiscal years of the launch of the program fairly consistent number of Ontarians received the service. For example approximately $12 million, $10.5 million, and $13 million were spent on the program for the first three years, respectively. And then in the fourth year this number jumped to $25 million, so that’s clearly indicative of the growth and acceptance of the program. A Drug systems reform/ there was a significant drug system review that the Ontario government underwent/ what happened was the elimination of the professional allowances to pharmacies,44 therefore there was a loss in
revenue for the pharmacies and the pharmacists, at the same time they always had their
professional services program in which there was room for them to make revenues from there, and there was a $50 million per year budget that was underutilized, and so then it seemed to align with drug reform change, and the increase at the same time. Regarding the drug system reform, the minister announced in June 2010 that another $100 million will be added to the already in place $50 million for pharmacist’s professional services that an even higher number of spending that has been allotted for those professional services. So her team was assigned to recommend the ministry
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a list of professional services that the ministry should be looking forward to. So it’s a significant shift in the profession that the ministry is reimbursing pharmacies for the medication management services that they offer.12 MedsCheck is the first program, and in September 2010 three new
MedsCheck were added to the original one, i.e. in-home MedsCheck, MedsCheck for diabetes, and for Long-Term Care patients, to further expanding the service.
She said that according to all feedbacks from professionals MedsCheck has been a real success for the benefit of the patients34 and to benefit of the collaborative inter-professional care.68 So utilizing
a community pharmacist in this program is a very positive fact. But of course there are some certain challenges with the program as well. Most of our findings are taken back to our advisory group at pharmacy council. Pharmacy council is comprised of 12 professional pharmacists from different groups and settings that recommend the ministry in professional services. There are also physician representatives in the group as well.
One of the recommendations that the pharmacy council pointed out to the Ministry was that it’s important to standardize the original MedsCheck program in order to be able to move forward.27
And currently the Ministry is looking into this advice from the council. British Columbia, for
example, has provided its community pharmacies with standardized vendor requirements, and this has been the advice that the ministry has received for MedsCheck. Because in the original
MedsCheck program the community pharmacists were left to develop their own MedsCheck review list,6 so the government provided a template which was not necessarily used,3 and as a result there
was not a consistent product provided to the patient.37 In addition, it was not clear for the patients
that they’ve received a MedsCheck review list, and so the patients left the pharmacy without having the feeling that they have received a consultation from their pharmacist. So the patient awareness and the professional healthcare providers’ awareness should be raised with the standardized documentation of MedsCheck.53 Another critical task that should be done by the pharmacists, as she
emphasized, is to communicate the ending product of the MedsCheck review to appropriate stakeholders.S18
OCP is a regulatory body that provides guidelines to the pharmacists on developing a best possible medication history. So the job of the OCP is to provide its members with guidelines.
On the subject of double-checking of the MedsCheck reports, she mentioned that MedsCheck review list is a sort of Best Possible Medication History for the time of its conduct, and it’s not necessarily the most updated list of the medications that a patient is taking.83
Regarding the standardization of the forms and processes of MedsCheck, it’s not clear now whether the ministry is going to make it mandatory for the pharmacists to use the proposed standard forms.5 The only thing that can be said at this moment is that the ministry really emphasizes the
standardization of the documents.
Concerning the communication between MedsCheck and MedRec, she referred to the numbers that are available. The number of pre-admission MedsCheck and post-discharge MedsCheck reviews that are conducted in the community pharmacies are significantly low.64, 26 This indicates a
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hospitals have not added MedsCheck as their sources of information to be obtained for their
patients.18 She suggests that there are some patients that fill their prescriptions every three months
and therefore their community pharmacist is not aware of their medical treatments and hospital visits during that time, it’s important that community pharmacists start connectivity with their regional hospitals, and in that regard get to know when their patients are going to be admitted to those hospitals. By the same token, for those patients that prescriptions are being dispensed every month or every second week and that they are more in contact with their patients they can provide comprehensive information for those regional hospitals that are in contact with them.
One suggestion is that OCP can regulate or in their inspections can ask for the communication of the pharmacies with other care facilities in their regions,S19 such as family health teams, community
health centers. OCP has a clear role here, and not only OCP but other organizations as well. It’s a big challenge to leave it up all to the patient.
Ontario drug profile viewer is an example of a system which is to some extent working and is helpful for health professionals to figure out the medication information of a patient, and where they have their MedsCheck done. But certainly it has its limitations.72