Pharmacy care clinics aren’t best for patients, family physician says

On January 22, the Government of Alberta announced plans to expand private pharmacy care clinics to relieve the stress placed on family physicians. The plan intends to redistribute some of the workload off of family physicians onto pharmacists, who differ in expertise, according to Dr. Michelle Morros.

Morros is a practicing family physician as well as the family medicine residency program director at the University of Alberta. Dr. Morros said the initiative for pharmacy care clinic expansion stems from the misconception that “a patient arrives to a primary care provider with an illness or diagnosis.”

“For example, [a patient] arrives at the family doctor with a urinary tract infection. Well, that’s not true. What they arrive with is a constellation of symptoms that may be something completely different.”

In reality, Dr. Morros said landing on a diagnosis can be “very, very complicated.”

“Even with medical knowledge, we don’t always make the correct diagnosis.”

Family physicians and pharmacists have different skillsets, Dr. Morros says

While family physicians have the training to make diagnoses, “pharmacists don’t have the medical background,” Morros said.

“You don’t know what’s simple and straight-forward until you ask the questions. You’re not going to ask the questions properly if you don’t have the medical background,” Dr. Morros said.

Dr. Morros said this statement is not meant to undermine the role of a pharmacist. Rather, she explained that pharmacists bring a different area of expertise to a patient’s experience. 

“The skills of a family physician, a nurse, or a pharmacist are all equally important. But, we all have different skills.”

Due to the difference in skills, Dr. Morros said the pharmacy care clinic initiative could cause harm to the patient and the health-care system. Doctors and pharmacists would not be able to work as a cohesive team, Dr. Morros said.

“Instead of one person going to one medical home doctor, they’re gonna see a pharmacist. Then somebody else is gonna have to do another bit of the work. Then somebody else is gonna have to pick up a bit of the work.”

“If you are attached to a family doctor, you are less likely to go to the emergency department or become hospitalized,” Morros says

Additionally, Dr. Morros said that rather than improve access to primary care, the pharmacy care clinic initiative further separates practitioners, including family physicians and pharmacists, into “silos.” According to Dr. Morros, this move contrasts “what evidence has shown to be the best care for patients.”

Dr. Morros expressed further concern that this system will intensify a trend being observed in medical schools. In recent years, the number of medical students interested in pursuing family medicine as their specialty has declined. As physicians are responsible for running their own practices, medical students find the task list to be “completely overwhelming.”

“If we as a community do not start promoting this team-based care, so that the doctor doesn’t feel solely responsible for everything, we’re not attracting anybody into the profession. To be honest, I can see where they’re coming from,” Dr. Morros said.

Morros proposes medical home models for bringing health-care providers together

Dr. Morros suggested supporting proposals that bring health-care providers together, not separate them. Specifically, Dr. Morros proposed “medical home models,” which she said have already been successful in the province.

These medical home models involve physicians, nurses, and pharmacists working together in one place, so the patient has a “one-stop shop.”

“Maybe they come in and on that day, it is the pharmacist who is the right person for them to see. You don’t always need a doctor,” Dr. Morros said.  

“There’s lots of things that my nurse does better than I do. That frees up time for me to do doctor work, frees up time for the nurse to do proper nurse work, and pharmacists to the pharmacy work.”