My fondness of words often gets me into trouble when expressing my thoughts in these pages or in person. Every few drafts, my editor Laura needs to snap me back into reality by stating how a reference, or in some cases, complete tangents make very little sense. Re-writing paragraphs is part of the routine now, but I swear it’s so clear in my mind as I type.

A new year is upon us, and another fresh start. I found many parts of 2017 challenging. Many people close to me were dealing with personal strife and it seemed to pile on. Losses of family members, relationship breakdowns, catastrophic injuries and prolonged recoveries all made multiple appearances during the year. My hope is that 2018 will hold more good fortune. The pharmacy profession has been the one constant through my adult life, so I tend to reflect on that first to regain my footing when I’m starting to wobble.

It happens to be mid-year review season for our company’s employees and I’m beginning to have some productive conversations with my management team. For the sake of simplicity, my message for 2018 consists of two points and they will always be front of mind when making decisions for our dispensaries:

1. Patient-focused care vs distribution-focused care.
2. Own the therapy, not the physical prescription.

For the first one, it’s more of a reinforcement of the discourse we’ve been having for as long as I remember. The difference to me is that we have much better measures and overall evidence to the health benefits of adherence strategies and care plans. These have been part of pharmacy practice for a long time, and pharmacists from all over have wanted to have productive conversations with their patients. I can personally attest to the pressures of filling prescriptions on time; sometimes those interactions are shortened, and that extra open-ended question remains unasked. Removing barriers to clinical care is essential to the next evolution of pharmacy practice.

For the second, Wikipedia is always handy for a quick definition:

Therapy (often abbreviated tx, Tx, or T_x) is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is usually synonymous with treatment (also abbreviated tx or T_x). The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means “curing” or “healing”.^[1]

A *prescription* is a health-care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient.^[1] The term often refers to a health care provider’s written authorization for a patient to purchase a prescription drug from a pharmacist.

Unless the pharmacist is the prescriber, and owning the administrative side of a prescription as well, I am also reinforcing that pharmacists can own the therapy more than ever before. The crux of the matter is defining the clinical (treatment) versus the technical (program) portions of that therapy. We do this every day in practice. For example, how many times has a family member or mutual friend asked for an opinion on a new sample they started taking, or a drug regimen that their doctor is considering? Each of us have a process whereby we collect info about allergies and medical conditions, other medications, relevant blood test results, etc. and arrive at a recommendation. We may agree with the drug, the dosage, the frequency, and the necessary monitoring plan or we may need more information to properly assess. Then we’re done. We stand by our response. At that stage, there is no written or virtual piece of paper. There is no suggestion of how many the physician wants dispensed at one time. There is no discussion about different brands or changes in the shape of tablets. Only an assessment of whether it’s appropriate or not, and how to get the most out of the regimen. Idealistically, we could envision a day where that same approach could apply to a busy dispensary. Some have already begun defining that clinical/technical separation by investing in layout changes, new automation, and role adjustments, including regulated technicians. Lab values are being requested in some provinces already and the availability of this information is becoming more accessible. Demonstration projects are being developed to take advantage of a pharmacist’s expanded scope.

These two tenets are closely intertwined. By staying patient-focused, and having dispensary teams adhering to a patient-first philosophy, it becomes much easier to own the therapy because the relationships are that much deeper, the conversations broader, and the interventions that much more meaningful.

There is a lot of good work ahead, and complexities to overcome along the way. Hopefully by keeping the messaging simple, those barriers in the distance won’t seem so difficult after all.

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.