Published on May 14, 2012 | Category Editorial
‘’Contrary to what we think, the value of something is not determined by its cost; it is its value that determines its cost.’’ (Étienne de Condillac)
Through precision and stiffness, numbers neutrality tends to comfort us when facing all the uncertainties we constantly have to deal with.
We determine a value for everything: the value of a last minute education for a student, the value of the work provided by a professional, the value of health and the value of quality of life for a patient… In the same range of thoughts, isn’t pharmaceutical acts compensation determined by the value we grant it? Don’t we say that we are supposed to give marks according to the goal we wish to reach through our evaluation?
I am nevertheless puzzled when I take a look at pharmaceutical acts fees. As a matter of fact, I find a little awkward that earnings from a pharmaceutical opinion or refusal is not the same for a patient covered by RAMQ than it is for a patient privately insured. Therefore the number of opinions sent for privately insured patients seems to be lesser. Is pharmaceutical opinion so useless within our way of communicating with prescribers that we get to choose patients for whom we submit it? In practice and when the patient seems at risk, it is obvious that a pharmacist will contact the physician about observations he made and adjustments he suggests. He has to do so according to his professional responsibilities, but a phone call is faster and more efficient than a fax, nonetheless it is not acknowledged as an intervention by the third-party payer. However, if a treatment is accurate but not optimal, and if there is a significant gap between both therapies, will you take some time to analyse the situation and reach the physician to make the change? If the pharmaceutical opinion does have an impact on the patient’s pharmacotherapy and the quality of the treatment provided, shouldn’t it be valued the same way for every patient?
It is about the same for the compensation given for the preparation and delivery of a prescription. If we support a monthly follow-up for patients covered by the RAMQ, why do we encourage such a wide-spreading follow-up for privately-insured patients by asking them a one time fee for several months of access to medication? It is true that reconditioning 30 or 90 pills doesn’t make a big difference, but what about follow-up or motivational interviews for compliance? Is it possible to convince a patient by only seeing him once every 3 months? What about large amounts of controlled medication lost inadvertently? Doesn’t the fee include these pharmaceutical acts that I deeply consider as being gratifying and important? Those discrepancies between insured services for patients according to their insurance seems a little confusing according to the value granted to these professional acts.
On the other hand, pharmacists keep on giving an abundance of free advice on OTC drugs. Incidentally, it is something that I really like about the job; proximity with patients and the opportunity to see them spontaneously, without appointment, according to their needs, to help them choose their therapy. Accessibility to that service makes it one of the most important in providing primary care. It is about the same when comes to sorting; pharmacists do it all the same when consulted and for free, then we reroute patients according to the emergency of their needs. However, that contribution to the healthcare system is unnoticed by other health professionals. As a matter of fact, haven’t we recently heard defamatory comments from professional organizations regarding pharmacists’ integrity along with our capacity to assess and advise a patient with his treatment?
Pharmacists are nevertheless considered by patients as the most trustworthy professionals , a study probably based on the exceptional service they received from their pharmacist… but pharmacists’ range of intervention is limited by bureaucracy and pricing of distribution rather than being helped by a real thought process on pharmacotherapy. To me, a professional and an outstanding pharmacist will be the one who puts some time and energy into making the profession evolve by designing the practice at its own image… It is also the one who values each and every patient by taking the time to assess their pharmacotherapy in the middle of a busy lab. It is a pharmacist who can proudly receive his patient’s acknowledgements when he convinced the latter to go to the emergencies on a Friday night, it is the pharmacist who picks up the phone 4 to 5 times to reach an overwhelmed physician and convince him to adjust a treatment.
What’s more, isn’t it considered to be a standard for pharmacists? Among all the things we must and wish to accomplish, will we find some time to perform new acts that are not recognised by the government yet?
The face of pharmacy is changing to take a widening room within our wobbling healthcare system. What can be done to be instrumental in valuing our role? I personally hope that among a constantly evolving profession, I will be able to fulfill myself both in a hospital and community environment. Through a practice designed for both these levels of the healthcare system, I’d like to write stories about what we deal with every day and therefore contribute to make pharmacists’ image as bright as patients see us… Because if acts performed by pharmacists are not ‘’appraised’’ yet, their value remains in the knowledge of those benefiting from it… Maybe in a few days or years from now, the value of pharmacists’ acts will become a standard in the patients’ hearts… And then maybe Ministers (and other politicians involved in the decision-making process) will give them credit and will support them through compensation before they become themselves the patrons in pharmacies and the guinea pigs of their value.
Étudiante en troisième année au Pharm.D.
Université de Montréal