BRINGING CANCER CARE TO THE COMMUNITY

BY ROSALIND STEFANAC
Ottawa, Ontario:
Pharmacy concept:
A collaborative group of pharmacists with an expertise in oncology who provide cancer care, education and medication monitoring to patients receiving take-home oral cancer drugs in the Ottawa area.

Background:
After spending 10 years in in-patient medical oncology at the Ottawa Hospital, and continually seeing patients re-admitted due to medication side-effects, Jason Wentzell and his colleagues determined there was need for a pharmacy that could support patients in their cancer care in the community. Extend Pharmacy opened in November 2019 and is conveniently located only 2 kms from Ottawa’s largest cancer centre. It’s the first independent cancer care community pharmacy of its kind in Canada.

Were you nervous about leaving a permanent hospital job for a new venture?

This whole concept was researched as part of a Masters in Health Management project and in doing so, we really felt that this type of model would serve our patients well in the community. We decided to take the leap into the real world. It wasn’t an easy decision and we definitely weighed the pros and cons. Ultimately, we saw it as an opportunity to expand oncology practice to an ambulatory setting.

“We’re located in a medical building with other healthcare providers and a lab. Once we found this space to lease, we worked with a designer to completely renovate it to be a calm, quiet and inviting space for our patients.”

How do patients find you?
Most of our business comes through referrals. Patients are either referred by their healthcare providers, family members or they refer themselves. We see patients on a scheduled, consultation basis. An initial consult is about one hour and patients can bring family and friends with them. Follow-ups are typically half an hour and can happen in person or by phone. Then we are available to answer patients’ questions for as long as they are on treatment. We aren’t charging for these consults but the prescriptions they’re filling at our pharmacy are for high-cost, take-home cancer drugs. We are reinvesting the markup on these drugs to pay for operation costs and staffing. We don’t dispense medications for any other chronic conditions.

Are former physician colleagues referring patients?

Yes. There were some early adopters and now others are starting to refer patients too.

It’s early days still, but how are things going so far?

So far things are going pretty well and we’ve gotten lots of moral support from the local board of trade and city counsellors. In January 2020, we were presented with a plaque from the City of Ottawa for being Ottawa’s first cancer community pharmacy. We haven’t done any external advertising as of yet, but our patients have been excellent advocates for us and we are sharing our successes on social media as a way to raise awareness.

Any challenges so far?
Basically just raising awareness that this model exists for people going through cancer treatment. Plus, we are a small dispensary in a very busy oncology space dealing with the medication acquisition challenges (of accessing these specialty drugs for community distribution). Most hospitals have their own representatives to help patients get medication reimbursement, so part of what we are still learning is where do we fit and how can we help patients get the best care.

Why do patients need this kind of service?

One thing we’ve learned even in this short time is that patients really appreciate being able to go through their medications with us and understand what they should be watching for when it comes to side effects. It’s been very rewarding being able to help patients reduce harmful side-effects that prevent hospital re-admissions. Every patient receives our extended cancer care service, which includes medication teaching and patient empowerment (teaching them how to manage side effects and when to seek medical help). Our goal is to help patients achieve their best possible outcomes.

Plus, we have a strong belief in the pharmacist’s role in stewardship of these high-risk, often publicly funded medications. Of course, we’re not underselling the important work of oncologists, but we do think there is more information needed at the community level.

Tell us about your team.

Our core team consists of two full-time and four part-time pharmacists, with a combined 45 years of diverse oncology and hematology experience. Two of us are board-certified oncology pharmacists. For patients to be able to access pharmacists in the community who have an underlying oncology expertise is pretty great, as this is an area of healthcare that changes so rapidly.

How do you stay on top of the newest treatment options?
We are still heavily involved in research, exploring performance indicators in ambulatory oncology and collecting data on side effect management. I also work with the University of Waterloo as an adjunct clinical assistant professor for their PharmD program and help facilitate clinical rotations for fourth-year pharmacy students in the Ottawa area. We had our first pharmacy students start here at Extend Pharmacy in March.

How is the pharmacy designed?

We’re located in a medical building with other healthcare providers and a lab. Once we found this space to lease, we worked with a designer to completely renovate it to be a calm, quiet and inviting space for our patients. The space is 1,200 square feet, and has a family presentation room, multiple counselling rooms and a dispensary. We have no plans for a frontshop area at this point.

So no one is doing anything like this in Canada?

Of course there is cancer care, and it varies across provinces, but a concept like this, with oncology pharmacist specialists using a referral and consultation model, doesn’t exist anywhere in Canada to my knowledge. The need is there for this service and we’d love to work with national groups to help generate a role for oncology ambulatory pharmacists across the board.

Considering your vulnerable patient base, how has COVID-19 affected your daily operations?

Our daily operations have indeed changed to both reflect our patients’ needs and help follow public health-recommended safety practices. Many of our patients are immunocompromised and are very cognizant of the potential risks associated with being in close physical proximity to others, so we’ve transitioned to using telephone and teleconferencing to support them and their families during cancer treatment. As pharmacists, we are proud to continue our operations as an essential health service, especially as we recognize the increased anxiety our patients are feeling due to precautionary adjustments in local oncology care delivery, and in-person support initiatives.

What’s your advice for other would-be pharmacy entrepreneurs?
Do your research in the areas you’re interested in and identify your niche. Then surround yourself with amazing, passionate colleagues who share your vision.

EXTEND PHARMACY
www.extendpharmacy.com

Suite 324, 1929 Russell Rd 3rd Floor, Ottawa, ON K1G 4G3
(613) 260-7890
Ottawa, Ontario, Canada

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