Pharmacy

The Model of "Basic" vs "Advanced" Medication Reviews is Broken

2023-11-29

In Nova Scotia pharmacy, there are two tiers of medication reviews — "basic' and "advanced"¹.

Basic medication reviews is a more cursory review of medications to ensure the patient's medication list is up-to-date, they understand what each medication is for, and any drug-therapy problems that are discovered are documented and resolved by the pharmacist.

Advanced medication reviews are a more comprehensive assessment of the patient's medication history and health status. It includes a medication reconciliation (what the patient is actually taking), but extended into a full pharmacotherapy workup and subsequent care planning for each medical condition the patient is managing.

With the introduction of pharmacy technicians into the pharmacy workforce, though, these services need to be revisited to enable higher quality pharmaceutical care in the community setting.

A proposed alternative

• Medication Reconciliation (RPT or RPh)

• Assessment & Care Planning* (RPh)

• Complex Assessment & Care Planning* (RPh)

• Chronic Disease Management (Follow-up Evaluations) (RPh)

  *Note: Basic and Advanced Care Planning Services should include a med rec as part of the service, though this component could be completed by an RPT.

Why this is better

It is often necessary to "clarify the record" in pharmacy practice. In the process of providing routine care for patients, we may determine that the patient's profile seems disordered — that there is uncertainty around the patient's actual medication-taking behaviours. A medication reconciliation in needed - and should be able to be completed by a registered technician.

It is also possible that a potential drug therapy problem is identified, and further investigation is warranted to workup the patient and create a plan for resolution if necessary. A care planning appointment is needed. A "complex" care planning activity should be included in the fee schedule to account for the difference in time, effort, and skill required to navigate patient cases involving significant poly-therapy and multiple concurrent conditions².

It is also possible that the patient will require ongoing care and monitoring following the initial care planning encounter due to the presence of uncontrolled or sub optimally managed chronic diseases. Chronic disease follow-up evaluations are needed. The number of followup assessments the patient is eligible for should be determined based on the presence of unresolved drug therapy problems, or more crudely, a set number of followups based on the conditions being managed.

This suite of services is a small, but productive step towards enabling an enhanced standard of pharmaceutical care in community pharmacies for patients who need it. This is especially important service infrastructure in the context of our current primary care crisis, where many Nova Scotias are without a family practice³.