By Grant Alexander Wilson, University of Saskatchewan
Unlike many other health-care professions, pharmacists have both professional and business objectives. The majority of Canadian pharmacies are located in communities as opposed to in hospitals, selling retail products, like cosmetics and food, in addition to filling prescriptions.
Despite their dual professional and business responsibilities, Canadian research suggests pharmacy managers demonstrate high levels of professionalism and the retail setting does not compromise their ability to serve their patients.
Today, Canadian pharmacists’ professional roles are expanding and broadening to further emphasize their professional scope. Pharmacists are taking on expanded roles and are increasingly being recognized as the medication management experts of the health-care team. The comprehensive list of the expanded service offering by province and territory can be found on the Canadian Pharmacists Association’s website.
My original interest in this topic started when I was a PhD student at the University of Saskatchewan. Now, as a faculty member in the Department of Management and Marketing at the Edwards School of Business, this continues to be one of my active research areas. In a forthcoming paper in the Journal of Small Business & Entrepreneurship, my University of Saskatchewan co-authors — Jason Perepelkin and David Di Zhang — and I find that when retail pharmacies implement expanded services, they ultimately achieve both better professional and financial outcomes.
Recent regulatory changes have allowed pharmacists in Canada to expand their professional services and play a more active role as health-care providers. Depending on the province or territory in Canada, pharmacists have some prescriptive authority, can adapt prescriptions or make therapeutic substitutions, provide flu and travel vaccines and order and interpret lab results.
A pharmacy’s decision to offer expanded services depends on where the pharmacy is located, its organizational strategy and capabilities. Despite the varying degrees of legislation, 81 per cent of Canadian pharmacists have intentionally expanded their role. Both the legislation and corresponding publicly funded remuneration programs have been implemented. Moreover, 45 per cent of Canadian pharmacists plan to further expand their role as legislation changes permit.
Although pharmacists have evaluated their implementation of expanded services as successful, it remains to be seen how these new services impact patient health and the profitability — dual objectives — of retail pharmacies.
Outcomes of expanded services
Using data from 259 western Canadian retail pharmacies, we found that entrepreneurial pharmacies were the most likely to participate in the expanded services. Entrepreneurial pharmacies were those that were self-described by their owners and managers as actively innovating, willing to take some business risks and making proactive business decisions.
We also found that the implementation of expanded services was related to favourable patient health outcomes. Favourable patient health outcomes included overall quality of care, patient prescription knowledge and prescription error reduction as reported by the pharmacy owner or manager. This suggests the expansion of pharmacy services is working as intended and patients are benefiting from the new activities performed by pharmacists.
For example, the ability to get an emergency refill from a pharmacist resulted in better medication management by patients. Although this relationship was one of the study’s most noteworthy findings, it is unclear if the addition of services would also have positive impacts for patients. It will be interesting to see if the industry regulatory bodies advance the scope of practice and if these services have the same outcomes.
In addition to patient health outcomes, our research suggested that retail pharmacies financially benefited from the implementation of expanded services. Specifically, pharmacies that implemented new services reported higher levels of revenues, margins and profits over the previous year. While pharmacies’ motivation to implement expanded services is related to advancing the profession, it is evident from these findings that it supports the financial objectives too.
Expanding services and profits
Given the dual objectives of retail pharmacy, our research suggests that the implementation of expanded services can help achieve both. Faced with such opportunities, retail pharmacies should look to implement at least some of the permitted services in their province or territory, as it appears to be a win-win.
Unfortunately, because the implementation of such services is completely voluntary and an individual pharmacy decision, it creates some market confusion for patients. Therefore, which pharmacies and how many services they engage in is highly ambiguous. As the implementation is clearly effective, perhaps efforts should shift to communicating clearly which pharmacies provide which services.
Overall, the findings of our study are beneficial to patients, pharmacists, technicians, managers and owners and highlight the effectiveness of the industry’s expansion of care offerings. The results suggest the expansion of expanded services improves patient access to care and ultimately improves their health. At the same time, these new services offer new revenue streams to retail pharmacies and increase their profits. It is this combination that yields the greatest benefit overall and achieves the dual objectives of retail pharmacy.