Dr. Susan O'Dwyer:

Yes, we believe there is. We have talked a little this morning about some of the skills pharmacists have, one of them being therapeutic substitution when we are talking about serious shortage protocols. Internationally, and if we look at Canada specifically, pharmacists also do things like therapeutic initiations or adaptations. For example, if someone is diagnosed with blood pressure issues, they may then get the initial diagnosis from the GP but be brought to the community pharmacy setting to undertake the initial management. We have systems in place where we can look at blood pressure management. We have pharmacies that do 24-hour blood pressure monitoring, etc., all the time. The readout is being received that is needed to see if a medicine is working appropriately for that patient. It means it is possible to respond to the results coming back from the objective assessment and to make dose adjustments. This is necessary because certain medications will work for one person, while different medications that might work better for another person. Pharmacists have this skill set. As Ms Maher said, pharmacists are medicines experts.

When we are looking at a chronic condition, therefore, one of the key interventions in this area involves medicines. I refer to medicines management and ensuring people are using them appropriately. There are examples like the New Medicines Service in the UK. When a medication is initiated, there is a structured intervention with the pharmacist. This supports the patient to stay on the medication, because sometimes it is hard for people to start on medications when they start them, especially for things like blood pressure issues. People might not have known about their blood pressure issues and then suddenly they are on a medication. They might start to have a few side effects and wonder if they really want the medication. I refer to people in this situation being able to discuss this with their pharmacist and tease it through. There is also the aspect of ongoing management and adherence to prescriptions, because staying on a medication and taking it properly and effectively is what will keep that medicine working very effectively as an intervention, but support is required to be able to take it. Pharmacists can play a major role in this area.