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A Pharmacist-Nurse Practitioner Collaborative Care Model in Action
A first of its kind in Canada, the Pharmacist Walk-in Clinic+ (PWIC+) launched in February 2022, by Sobeys and Lawtons Drugs and Nova Scotia Health. Through partnership, the Nova Scotia Health Innovation Hub and Sobeys and Lawtons Drugs launched test-and-try walk-in clinics to explore a collaborative care model to provide Nova Scotians greater access to timely and appropriate health care closer to home. The model elevates the clinical scope of both pharmacists and nurse practitioners, and pairs them in a clinical setting to offer comprehensive care and a quality patient experience.
A Need for Healthcare Innovation
Like the rest of Canada, Nova Scotia is amidst a health worker shortage. There is significant demand for health services in Nova Scotia communities and about 10% of Nova Scotians are currently unattached, meaning they do not have a primary care provider. Lack of timely and appropriate access to health care has resulted in a depleted focus on disease prevention and comprehensive disease management for patients with complex needs. Emergency departments are treating patients seeking non urgent care and hospitals have been forced to close emergency departments because of staff shortages.
There is an immediate need to deploy new and innovative healthcare models to increase capacity, particularly in rural areas of Nova Scotia. The scarcity of available resources has necessitated the coupling of unconventional pairings (teams) of healthcare professionals to build models of high-quality care to suit community and patient needs.
An Opportunity for Community Pharmacists to Play a Larger Role
Throughout Nova Scotia, there are more than 300 community pharmacies and more than 1,000 certified pharmacists. Historically, community pharmacies have not been well integrated into the broader Nova Scotia Health system, in that they do not have access to the same tools, technologies, or workflows used by most providers which are designed to navigate patients into Nova Scotia Health programs and services. However, from a clinical care perspective, community pharmacists are well positioned to play a larger role in providing high quality, collaborative care in communities.
Partnering with Sobeys and Lawtons Drugs to Increase Access to care Closer to Home
The Nova Scotia Health Innovation Hub and Sobeys and Lawtons Drugs partnership is based on mutual goals and objectives to be more present in rural communities, provide comprehensive patient care, and elevate the scope of community pharmacists. Both were keen to test and try a new care delivery model and explore new technologies.
The partnership aimed to pair a pharmacist and nurse practitioner to amplify the impact of both practitioners to offer comprehensive care, a quality patient experience and meet a community need by:
- Activating community pharmacists to play a larger role in the health system, increasing capacity amid healthcare worker burnout and shortages to meet the elevated demand for health services.
- Empowering community pharmacies and employers to create an optimized environment where pharmacists can apply their full range of training, knowledge, and skills every day.
- Relieving strain on emergency departments by providing attached and unattached patients whose care needs could be better met in another healthcare setting with more appropriate options for timely access to care.
In February 2022, Nova Scotia Health and Sobeys and Lawtons Drugs announced the first two PWIC+ locations, increasing access to primary care in Nova Scotia with a model of collaborative care for walk-in clinics led by a pharmacist and nurse practitioner.
Three PWIC+ sites in three communities have launched with plans to extend to four more sites before June 2023. The success of this partnership will act as a catalyst to drive and inspire innovation in community pharmacy and provide Nova Scotians with increased access to care close to home.
We knew from the experience of our first pharmacist-led walk-in clinic in New Glasgow that this kind of innovative healthcare delivery model could work. Now, there is also a successful partnership with Nova Scotia Health with additional clinics in Nova Scotia. By pairing a nurse practitioner with the pharmacist in the clinical setting we can provide trusted, appropriate, and timely access to care. And, we have the data to show it is diverting unnecessary visits to emergency departments, adding capacity to our province’s healthcare system, and most importantly, helping people get the healthcare they need.
~ Vivek Sood, EVP, Related Businesses for Sobeys Inc.
How the Pharmacist Walk-in Clinic+ is Positively Impacting Nova Scotian Communities
The PWICs+, through the innovative collaborative care model, have been successful in positively influencing key focus areas for Nova Scotia Health:
Increasing access to care and improving patient flow:
Nova Scotia Health and Sobeys and Lawtons Drugs' innovative health care model demonstrates community impact by improved timely and appropriate access to health care for attached and unattached patients.
- More than 90% of clinic patients strongly agreed the PWIC+ has made it easier to get care closer to home in a timely manner.
- More than 85% of clinic patients are unattached, meaning they are without a primary care provider.
Relieving strain on emergency departments:
The clinics have also reduced emergency department visits for non-urgent care.
- More than 65% of patients served indicated they would have gone to a local emergency department had the clinic not been available.
Meeting the unmet demand for chronic disease management:
An overwhelming number of patients are presenting at PWICs+ with chronic diseases.
- More than 70% of clinic patients report having at least one chronic disease
- More than 75% of the care pathway for the top chronic disease states seen by PWIC+ practitioners can be managed by a pharmacist; 100% can be managed in collaboration with a nurse practitioner
Improving workflow efficiencies & patient experience with tools and support:
Through this test-and-try, Nova Scotia Health and Sobeys and Lawtons Drugs are working to have community pharmacies play a larger role in the provincial health care system, through better technology integrations and optimized workflows between providers ultimately resulting in better patient care.
- 94% of patients felt their overall experience accessing the clinic, including appointment scheduling and interaction with the healthcare provider(s) was very good
- 10 community pharmacists and pharmacy assistants have been trained on the Nova Scotia Health Electronic Medical Record (EMR).
This exciting innovative collaborative care model and partnership has already made a difference in the lives of many Nova Scotians by increasing access to timely and appropriate care closer to home. There is so much potential, and we are continuously evaluating and finding ways to do better. This initiative has already yielded a policy recommendation around funding for pharmacist-delivered health services which will improve access to care throughout the province.
~ Dr. Gail Tomblin Murphy, Vice President, Research, Innovation and Discovery and Chief Nurse Executive at Nova Scotia Health
PWIC+ : A Commitment to Action
The Nova Scotia Health Innovation Hub is committed to improving access to high-quality care for Nova Scotians. Through test-and-try projects like the Sobeys and Lawtons Drugs partnership, we can explore ideas and solutions that have never been done before in our province.