Monthly Archives: October 2013

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Mobile Outreach Street Health (MOSH)

In any pharmacy practice, the diversity of the patients seen is huge. There are people with diabetes, mental illness, or cancer. People who can’t come to the store themselves and have to send family members or friends. People just coming out of the hospital. People going into nursing homes. I could go on for days about what we see in pharmacies.

I work on a busy downtown Halifax street. The population I serve is unique and extremely varied. We have a large immigrant population. We have a large elderly population due to several big apartment buildings in the area. We also have a population of people who live in shelters or on the streets.

The homeless in most cities are marginalized. The public walks past them as they beg for money without even a look. I myself have been guilty of this in the past. It wasn’t until I started working at my store that I really started to see these people. I don’t mean see with my eyes alone. I mean truly understand their plight; how they got there, and how they suffer.

Many of these people are addicted to drugs, some recreational but mostly prescription narcotics. How they got to that place was innocent enough. They may have had an injury, or a kidney stone, or a friend who was on the medication and offered to share.  Some have a problem with alcohol that has robbed them of their livelihoods and they are left to try to steal Listerine to quell their withdrawal symptoms.

Some have mental illness. Depression which leads to self medication with alcohol or drugs. Schizophrenia or bipolar disorder which lead people to run away from them in the street or tell them they are “crazy.”

Many times these patients end up in the legal system due to their addictions or mental illness because the public often doesn’t know what else to do but call the police. There are not enough resources in this town to help fix the root of these problems.

There is one group of people who are working very hard to change that: Mobile Outreach Street Health.

MOSH is a programme run through the North End Community Health Clinic and Capital Health. They have set up a group of nurses with a big van stocked with medical supplies, blood requisition sheets and HIV and Hep- C testing kits, and much more.

MOSH advocates for people who need a champion but don’t have one. I have worked with them many times. They have helped my patients get into a free dental clinic. They have paid for medications that were desperately needed but unaffordable. I have called them when concerned about a patient’s mental state and suicide risk. I have called them to ask if they have had contact with a patient I haven’t seen in a while. Each and every time I talk to MOSH, I am impressed by their programme and what they are achieving.

As a result, more homeless patients have health cards. More have access to medications and addictions counselling. More are receiving dental and wound care. More have access to clean needles and sharps containers.

As a health care professional and a proud Haligonian, I am so glad this service exists. The MOSH team saw a huge void in the healthcare system and they work every day to make sure it is filled. If we all tried to do this on some small scale in our practice daily, our patient care, and indeed our patients, can only get better.

For more information on MOSH, click on the link below.

http://www.cdha.nshealth.ca/primary-health-care/mobile-outreach-street-health-0

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Pre-Hallowe’en Writer’s Block – Catch the Flu Fever…

…Check that, maybe you’d better not.

Having good friends, family, roasted pumpkin seeds, carved works of art, and funky costumes all come together is enough incentive to kick back and relax. Waking up yesterday, I realized that life had indeed continued and we have now passed from autumn to flu season:

http://thechronicleherald.ca/novascotia/1160685-flu-shots-now-available-at-local-pharmacies

http://www.cbc.ca/news/canada/new-brunswick/pharmacists-push-to-treat-minor-health-issues-1.2074210

The two links featured above are part of this season’s awareness campaign to get folks out for flu shots at their local pharmacies. The interesting contrast between the articles is highlighting the opposite direction from where they’ve traveled to provide this service.  The first is from Nova Scotia, where legislation has only recently been passed to allow pharmacists to administer medication. Naturally, this is huge news for the province and a huge opportunity for pharmacists to expand their roles with strong support from public health. After already receiving prescribing rights (more accurately, assessing rights), pharmacists are now able to add administration to a bag of tricks that already includes minor ailments, adaptations, emergency fills, renewals, and therapeutic substitution. The second link is from New Brunswick where pharmacists have been giving flu shots for 4 years now (!?) and the program is really taking off. Unfortunately the NB bag appears to contain at least one less trick than NS. They do not have the ability to do minor ailments assessments although regulations have been drafted.

Yes, I am completely oversimplifying and exaggerating the difference. It’s been awhile since I did a sweep of the country so I find myself very curious about what is happening in other provinces. In actual fact, NB has been more progressive than most in outlining pharmacist powers, although the framework hasn’t been as rigid. For instance, there are no limits on refilling prescriptions and folks everywhere seem to have a loose translation on what is termed an ’emergency fill’. Technician regulation seems to be moving forward at a glacial pace in both provinces though a new Act has passed allowing the profession in NS.

It’s all about stakeholders and bureaucracy. Everyone has an angle but the most powerful driver is the almighty dollar. We have finite resources to spread around so any progressive movement for pharmacy MUST mean a reciprocal shuffling of those resources for someone else in the health care sector. By reallocating these dollars to fund new services, the public will certainly benefit through better access and education. The problem lies with a limited commodity like flu vaccine. The opportunity is there, but it’s so important to take maximum advantage that we almost need to drop everything until the wave is over. Funny how much we need to think as a capitalist to improve our socialist healthcare system.

Oh well, I got mine today and we delivered another 4 just to get rolling. We want this to be sustainable and after today, I really think we have a shot 😉

Happy Hallowe’en!

Nightmare before Christmas

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Pharmacy Advocacy – Pull up a Soapbox

Well don’t mind if I do 🙂

Advocacy for the pharmacy profession as a whole is like your favorite cheesecake recipe: there are many ingredients in differing amounts, but you can’t leave one out and expect it to taste right. Unfortunately It often feels like we’re trying to make this cake using only the cream cheese and hoping we can add the rest of the stuff when it’s half-cooked.

There are many segments in the pharmacy profession: community, institutional, academia, research, insurance/benefit providers, government, and consulting (to name a few) and all are required to advocate for the profession. All of these segments are impacted by reimbursement models and changes to legislation, either directly or indirectly. I strongly believe that pharmacists in all sectors want to thrive in the new environment but, as Laura’s recent post on ‘Comfort’ can attest, clinicians need time to evolve as practitioners. One day we were not prescribing, the next day the regulations passed and our whole way of practicing changed. Due to this short transition period, we find ourselves trying to convey confidence to the public while at the same time fending off doubters from other health professionals that feel we’re overstepping.

So polish up your soapbox. I’m sure you have one laying around somewhere. It doesn’t have to be large, or new, or fancy in any way. It just needs to support your weight so that you can stand above the rabble and be heard. It’s up to all of us to support our livelihoods as caregivers in a healthcare system that preys on those who lack vision. Should you have a rewarding interaction with anyone (patient, colleague, peer, another healthcare professional, etc.), share it so that others can begin recognizing their own.

With the flu-shot blitz fast approaching, we will once again be in the public eye. Get yourself ready to look the public square in the eye and show them how effective we can be with our new responsibilities. AND If they want to know a bit more about what we can do, Make sure your soapbox is in the corner…just in case 🙂

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.