Virtual solutions, pharmacists enhance clinical care for First Nations

While government and private health plans often include coverage for prescription medications, there is virtually no funding for comprehensive clinical care by pharmacists.

Seeing the lack of these services in many isolated, First Nations communities in Canada, The North West Company (NWC) decided to step in and make a positive, progressive difference.

Several healthcare banners of NWC joined forces in 2021, endeavouring to improve health literacy and diabetes care for Indigenous individuals, starting with the community of Cross Lake, Manitoba.

Kevin McDonald, director of North West Telepharmacy Solutions (NTS), said: “As many Canadians with chronic conditions are on multiple medications, it is the knowledge of pharmacists that is going to really make the difference to the healthcare system and for patients. Pharmacists are able to optimize pharmaceutical care, and for people in remote communities, this is a service that is clearly needed.”

The venture involves a virtual pharmacist with the NTS banner partnered with NWC community pharmacy retailer North Mart Pharmacy. Together, they’re proving medication management reviews and remote follow-ups for the diabetic patient community of Cross Lake, Manitoba.

Cross Lake is a Cree First Nation reservation with a population of approximately 8,000. As of today, studies suggest eight out of every 10 individuals in First Nations communities will develop diabetes in their lifetime.

Patients who have an appointment with their family doctor in Cross Lake are identified by nurses in the clinic about a week beforehand. They are offered the chance to speak with the virtual pharmacist from NTS about their medications before visiting the doctor.

By the time the patient goes to see the doctor, the pharmacist has already made suggestions for improving therapy.

“There is a huge opportunity to stop medications that may no longer be necessary,” says Glenys Vanstone lead virtual pharmacist with NTS for this initiative. “A medication that may have been the right choice when the patient is 50 may be causing side effects and problems when they are 65. This process is called de-prescribing.”

Furthermore, an encounter provides an opportunity to inquire about smoking cessation and stress management. Many interventions have involved smoking cessation counselling, smoking cessation medication starts, and follow up.

Once the medication review is completed and a document is sent to the clinic office and pharmacy, the community pharmacist may follow up on any outstanding recommendations, including addressing smoking cessation support, blood pressure monitors and glucose monitoring.

In several cases the community pharmacist has offered alternative solutions or recommendations to drug-related problems identified by the medication review.

The community pharmacy has found the medication review program to be over all positive for their clients.

So far, the feedback from clientele has been very positive. Some comments include:

• “I’m really glad you called me. I didn’t know what my medications were for. Now I feel okay to take my medications.”
• “I really like the questions you ask; you are right on – really awesome pharmacy we have here in Cross Lake.”
• “No one has every talked to me like this about my health before.”

Amdocs (a banner of NWC that provides physician care to remote communities) medical director, Dr. David Folk, said “There is so much need for comprehensive healthcare services in the northern communities. The opportunities of a collaborative care model with pharmacists and physicians is tremendous for the care of patients. It is wonderful to finally have the technologies and acceptance to run this virtual care program in Manitoba – and hopefully into northwestern Ontario soon.”

For its part, NWC is collecting results regarding patient satisfaction and quality of life, medical team satisfaction, community pharmacy satisfaction and the overall benefit of the medication review program.