The Tablet - Dec/Jan 2015 Issue by BC Pharmacy Association

Member Survey • White Coat Ceremony • Clinicare Pharmacists

tablet

published by the British Columbia Pharmacy Association | www.bcpharmacy.ca | Volume 23. No. 6

Genomics in Community Pharmacy How one project is taking personalized medicine to next level

DEC/JAN 2015

Regulatory Compliance Bootcamps coming to your community We have developed a new Regulatory Compliance Bootcamp that addresses regulatory compliance issues and is designed to help mitigate the risks of penalties associated with audit assessments. It also addresses privacy practices, as well as College of Pharmacists of BC regulations. This workshop is essential for pharmacists, pharmacy managers and owners. It is a hands-on event using real life situations and the errors we have seen in many different audits. There is no other playbook on this topic. We have completed three workshops in the Lower Mainland to date, successfully training almost 140 BCPhA members. Due to high demand we are bringing the bootcamp to your community in 2015.

New dates for 2015! Thursday, February 5, 2015

Prince George

Thursday, February 12, 2015 Wednesday, February 18, 2015 Thursday, February 19, 2015 Wednesday, February 25, 2015

Lower Mainland Kelowna Kamloops Nanaimo

Policy and Procedure Manuals

BCPhA eTraining

Regulatory Compliance Support

Another member benefit.

The BCPhA has developed policy and procedure manuals to support pharmacies in documenting policy and procedures that ensure operational activities are compliant with the regulatory framework governing pharmacy practice. Manuals are available for download by Pharmacy (Corporate) members.

Manuals now available online

√ √ √ √ √

Dispensary Activities Operation of a Community Pharmacy (UPDATED: August 2014) Administration of Injections Methadone Maintenance NEW! Incident Management & Reporting

www.bcpharmacy.ca/policy-procedures

• Videos • PowerPoint with voiceovers • Interactive elements • Quiz questions

Complimentary programs now online Complimentary programs now online

√ New Expanded Access to Publicly Funded Vaccines Expanded Access to Publicly Funded Vaccines √NewFrequency of Dispensing of Dispensing √Frequency Medication Review Services Action on Joints √JointJoint Action on Joints CareCare Consent or Privacy Consent? √A Health A Health Consent or Privacy Consent? Resume Guide for Pharmacists √ Resume Guide for Pharmacists www.bcpharmacy.ca/etraining

THE TABLET

DEC/JAN 2015 | VOLUME 23. NO. 6

contents Editor in Chief Angie Gaddy 604.269.2863, angie.gaddy@bcpharmacy.ca Senior Editor Elise Steeves 604.269.2866, elise.steeves@bcpharmacy.ca Advertising Sales Shannon Ward, OnTrack Media 604.639.7763, tablet@ontrackco.com The Tablet is published by the BCPhA. Views expressed herein do not necessarily reflect those of the Association. Contributed material is not guaranteed space and may be edited for brevity, clarity and content.

5 Dr. Corey Nislow

BCPhA offices: #1530-1200 West 73rd Avenue Vancouver, BC V6P 6G5 telephone: 604.261.2092 or toll-free in bc: 1.800.663.2840 fax: 604.261.2097 toll-free fax: 1.877.672.2211 e-mail: info@bcpharmacy.ca web: www.bcpharmacy.ca Pharmassist: 1.800.667.2190 For confidential counselling referral for employment or addiction related assistance

14 white coat ceremony

16 genomics

Publication agreement #40810576

On the cover: Safeway pharmacy manager Hoang Nguyen is participating in a new project on genomics in community pharmacy.

Features

Columns

Regulars

White Coat Ceremony Class of 2018

CEO’s Message Personalized medicine

Meet Dr. Corey Nislow University of British Columbia

Annual Report A year in review

DPIC Neuropathic pain

On the Cover:

President’s Message Patients embrace pharmacist injections

Member Services Make compliance your practice’s culture

Clinicare Pharmacists Culturally-appropriate terminology

Renally Speaking Off-label adventures

20 25

Genomics in Community Pharmacy A new BC study looks at how genes affect a person’s response to medication

2014 Member Survey Hearing from members

Government Relations Mobilizing patients

Products in Focus ViVAXIM

Pharmacy Practice Support Networking for success

Career Listings Find a job in pharmacy

UBC Pharmacists Clinic Helping you help your patients

Got a suggestion for an article in The Tablet? Email info@bcpharmacy.ca with your story ideas. A voice for community pharmacy

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Dec/Jan 2015

THE TABLET

SMALL TALK

In the news

President David Pavan (left) gives Minister Stephanie Cadieux her annual flu shot.

BCPhA’s past presidents attended the annual dinner in their honour.

Flu season launch

Past Presidents’ Dinner

In October, BCPhA president David Pavan joined the Ministry of Health and others at the BC legislature to officially announce the start of flu season and encourage British Columbians to get immunized. Pavan gave Minister of Children and Family Development Stephanie Cadieux her annual flu shot.

On November 21, the BCPhA hosted its annual Past Presidents’ Dinner to honour the outgoing president Don Cocar, and those who have served in previous years. Seventeen past presidents attended, along with BCPhA Board members and the CEO and directors of the Association.

BCPhA Pharmacy Awards Do you know a pharmacist who deserves to be recognized? Watch for the official call for nominations for the 2015 BCPhA Pharmacy Awards this January. The awards honour excellence in community pharmacy in British Columbia and are presented at the BCPhA annual conference May 21 to 23, 2015, in Victoria.

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Dec/Jan 2015

BCPhA welcomes new director, communications

Cocar was presented with the Past President’s Award from Marnie Mitchell on behalf of the Canadian Foundation for Pharmacy.

There are now more than 3,100 BC pharmacists authorized to administer injections.

Leung is also completing her final year in the UBC Faculty of Pharmaceutical Sciences. She has been interested in combining her research skills with her therapeutic knowledge to address clinical needs in pharmacy practice.

UBC students receive BCPhA scholarship Congratulations to Andrea Silver and Donna Leung, the recipients of the BCPhA scholarship for the 2014 winter academic session, who were recognized for their community involvement and academic strength. Silver is a fourth-year pharmacy student and BCPhA Student Ambassador, who has involved herself in many community initiatives in demonstration of her genuine passion for pharmacy practice and patient wellness.

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Angie Gaddy joined the BCPhA in October.

Angie Gaddy has joined the BCPhA as the new director of communications. Gaddy is a strategic communications professional with more than 17 years of experience, including media relations, public relations and crisis communications. Prior to this, she worked with Canadian Blood Services.

MEET DR. COREY NISLOW, UNIVERSITY OF BRITISH COLUMBIA

Meet...Dr. Corey Nislow Associate Professor, Faculty of Pharmaceutical Sciences, the University of British Columbia study of how genes affect a person’s response to medication – in pharmacy practice. Nislow’s work has gained out-of-this-world attention. This September, yeast strains developed by Nislow’s team were blasted off to the International Space Station. Once on board the ISS, astronauts will experiment with the yeast to see how microgravity affects gene expression – the process that genes use to synthesize proteins.

UBC researcher Dr. Corey Nislow sees technology in pharmacy’s DNA. As project lead for the research study “Genomics for Precision Drug Therapy in the Community Pharmacy,” Nislow believes pharmacists play a key role in providing the right drugs for the right patient at the right time. “It is time to translate the tremendous progress in genetic insight made possible by sequencing technology,” Nislow says. “We can develop safe and effective medication treatment that’s tailored to a patient’s genetic makeup. And pharmacists must play a key role in shaping the future of health care.” The study, co-funded by the BC Pharmacy Association and Genome BC and launched in October, will analyze the genetics of 200 BC patients on warfarin and determine the drug’s effectiveness for each individual patient. Nislow, along with his scientific partner and wife, Dr. Guri Giaever, runs the UBC Sequencing Centre (UBC-Seq) at the Faculty of Pharmaceutical Science. The centre is the only centre of its kind in North America that is dedicated to the application of pharmacogenomics – the

An avid runner who has completed 13 marathons, including New York City, Boston and Vancouver, Nislow received his PhD from the University of Colorado and then worked in the biotech industry for six years before running research labs at Stanford University, University of Toronto and now UBC. What do you consider your greatest achievement? Building a lab with my scientific partner Guri Giaever, which for the past 15 years, has accomplished some very good science and trained some extraordinary individuals. How would you describe your perfect day? Go for a long run in the morning, spending the day talking about experiments, and watching a great movie with Guri. What three things are on your bucket list? Fly my paraglider for 100 miles, write a book and orbit the earth. How would you explain what you do for a living to your grandma? That I am trying to figure out how the instructions for building a person or a sea urchin or a bird are carried inside of us, and equally importantly, what makes each person, sea urchin and bird unique.

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What question are you most commonly asked? Usually about someone’s ailment – then I explain that I’m not that kind of doctor. If you could do anything else for a living, what would it be? Astronaut. What motto you live by? Don’t leave anything in the tank. What phrase or words do you overuse? Enlightened self-interest. Who is your hero? Francis Crick (Co-discoverer of the structure of the DNA molecule in 1953 with James Watson). What living or deceased person would you most like to have dinner with? Francis Crick, Barak Obama and Malcolm Gladwell. What talent would you like to have? To play a musical instrument. If you were ruler of the world, what would it look like for pharmacists? They would, along with elementary school teachers and nurses be revered, wellcompensated and get free coffee anytime. What should pharmacists understand about the role of research? That research underlies everything we know about medications and patient responses, and equally importantly, every interaction they have with a patient is essential data for understanding the hardto-quantify aspects of health care: patient’s impressions, concerns, compliance, adherence and well-being.

Dec/Jan 2015

THE TABLET

GERALDINE VANCE | CEO

Community pharmacists have a real role to play in personalized medicine

The term personalized medicine is one we hear a lot and it means different things to each of us. For me, it is my Fitbit that tracks my steps every day, telling me I’ve reached my goal or I should try harder tomorrow. Personalized medicine may be the app on your iPhone that records your medications or the predictive genome test that confirms a family history for a disease like ALS or dementia. Outside of research settings or cancer facilities, what personalized medicine hasn’t meant is being able to customize prescription drug therapies for patients on medications to treat mental illness or chronic disease. The science is there, but the practical application for day-to-day use hasn’t been. Until now – or so we hope. In November 2013, the BCPhA Board of Directors took a bold move: they approved working with a research team in UBC’s Faculty of Pharmaceutical Sciences to fund and apply for matching funding from Genome BC to bring genome science into community pharmacy.

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Dec/Jan 2015

This project has the potential to define the long-term role for pharmacists in the emerging world of personalized medicine. Genome science and other technologies will change how health care will be delivered. Patient expectations on these new technologies will further drive up the demands made on providers and payers. Some ask, “Where will the money come from in a health-care system already struggling to make ends meet?”

“If it were possible to get the right medications for every patient, the trial and error way of making medication choices would be a thing of the past. ”

As with many great opportunities, it all started with an off-hand conversation between some of us at the Association and the faculty research team. At the invitation of Professor Ron Reid, we went to see the recently-installed genome sequencer and meet Dr. Corey Nislow, a genome researcher recruited to help get the pharmacogenomics program off the ground. For those who know Ron, this has been his life-long passion. For the last

couple of decades Ron has been talking about the potential to use genome science for therapeutic medication dosing. One thing led to another and during the proverbial back-of-a-napkin brainstorming session, we had the germ of an idea for a project. That project, “Genomics for Precision Drug Therapy in the Community Pharmacy,” was announced publicly on October 28.

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The answer to these major challenges comes from truly engaging pharmacists in doing what is at the core of their professional competence – being the go-to person on the health-care team for medication expertise. When you add pharmacogenomics to the already powerful expertise pharmacists have, the potential impact for patient care and system sustainability is huge.

The FDA has charted more than 150 medications whose efficacy can be impacted by a person’s genomic make-up. In some cases the medications simply will have no impact on the disease they are meant to treat. If it were possible to get the right medications for every patient, the trial and error way of making medication choices would be a thing of the past. The BCPhA’s partnership in this project is designed to see what it will take to give pharmacists in every pharmacy the tools they need to help their patients get only the medications that will work for them. Some have asked if this project is a way to take away the diagnostic and patient care role of physicians. Of course not. There is, and should be, no turf struggle here. This is about ensuring pharmacists have a real and sustainable role in the new world of personalized medicine. It’s about stretching to grasp new opportunities that will change people’s lives.

Welcome to the newest members of the BCPhA! Pharmacist (General) members: Akhtarhusen Ada, Ahoud Ali, Payman Ali-pour-saeed, Sukhdev Banwait, Bita Bateni, Robert Chan, Wui Ming Chang, Sarah, Chun, George Daoud, Trupti Dave, Ihab El Cheikh Ali, Mostafa El Hennawy, Maria Gisela Garcia, Maria Gholami, Troy Giesbrecht, Ranjeet Gill, John Grisolia, Ibrahim Guriguis, May Hammad, Carol Hansen, Jessica Joly, Joby Joseph, Sheereen Kafeel, Natalia Khasab-Hassan, Narmin Khimji, Deanna Koo, Jaspal Kumar, Amy Lam, Christopher Lewis, Hany Maawad, Melissa Machial, Shahab Majlessi, Andrew Makram, Michael Mikhail, William Millin, Injoon Moon, Emily Nevers, Onohinosen Omon-Anolu, Himeshkumar Patel, Kushalkumar Patel, Namrata Patel, Sagarbhai Patel, Judith Roschlaub, Harshil Shah, Naomi Shao, Deepak Sharma, Arvind Kumar Sidher, Gurjeet Sidhu, Richa Solanki, Nora Stamboulian, Rabia Sumar, Anna Sung, Sophie Titley, Cam Tran, Shannon Villeneuve, Valerie Weber, Regan Wetherill, Yedilken Yimam, Mohamed Zeid and Julia Zhu.

Pharmacy (Corporate) members: Lonsdale & 3rd Pharmacy, Mt. Lehman Pharmacy, Peoples Pharmacy #369, Shoppers Drug Mart #2112, and The Medicine Shoppe #163 – Surrey.

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For employment opportunities, please contact: Greg Shepherd, Director of Operations, Pharmasave Drugs (Pacific) Ltd. Direct 604.575.5738 • Toll Free 800.665.3344 ext. 738

For business development opportunities, please contact: Dave Reston, CEO, Pharmasave Drugs (Pacific) Ltd. Direct: 604.575.5730 • Toll Free 800.665.3344 ext. 730

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Dec/Jan 2015

THE TABLET

DAVID PAVAN | PRESIDENT

Patients embrace pharmacist injections

Fall is well underway, and it’s been very busy at the Association. We began the season with the UBC Faculty of Pharmacy’s White Coat Ceremony, where more than 200 students were welcomed into the profession of pharmacy. As well, we had the introduction of the BCPhA’s first Regulatory Compliance Bootcamp. These workshops for members all sold out quickly and received positive feedback. This was followed by our announcement of the partnership between the BC Pharmacy Association and Genome BC as pharmacy enters into the sphere of personalized medicine. It’s a very exciting time as 20 pharmacies and 200 patients will participate in the initial genomics study. Fall also means the flu season, which is a busy time of year for community pharmacists with injections and OTC sales. About 3,500 Canadians die from influenza complications each year – more deaths than all other vaccine-preventable diseases combined. It’s also one area where we’ve really stepped up to the challenge – and the public has embraced the accessibility of pharmacist injections. In 2009, when our scope of practice expanded in response to the H1N1 pandemic, about 30,000 British Columbians received their vaccine from a pharmacist. Fast-forward to the 2013/14 flu season, and more than 360,000 British Columbians chose their community pharmacist for their seasonal influenza immunization. This year, we expect at least 400,000 British Columbians to have their publicly-funded flu vaccines provided by BC pharmacists. With more than 3,100 pharmacists now authorized to give injections – and 92 per cent of all pharmacies in BC with at least one injection-authorized pharmacist – it’s easier than ever for patients to turn to their trusted pharmacist for this service.

THE TABLET

Dec/Jan 2015

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The BCPhA has played a huge role in the training aspect of injections, with more than 2,600 pharmacists completing our program. This year, we also launched a new injections refresher workshop that focuses on best practices around patient assessment, vaccine administration technique, management of adverse events, and vaccine clinic set-up. The program is open to all pharmacists already authorized to inject. If you haven’t given many injections in recent years, it’s a great opportunity for live practice. The next workshop is coming up in February. It’s important for everyone, however, to review your injection technique at the beginning of each flu season. This should include everything from consent collection procedures to proper needle length and gauge selection, injection site selection and landmarking technique. Publicly-funded flu vaccine can be given to seniors 65 years of age and older, pregnant women, those with chronic health conditions or compromised immune systems, and those who work or live with people who have a higher risk of complications from the flu. In addition, for the second year in a row, anyone planning to visit a loved one in a health-care facility or those who take family members to outpatient appointments will also be eligible for the publicly-funded vaccine. While there are still areas for improvement when it comes to providing injections – such as a direct distribution system through wholesaler networks, as demonstrated by a successful pilot project last year – I think pharmacists should be proud of what we have accomplished in such a short time.

CYRIL LOPEZ, CHIEF OPERATING OFFICER

Make compliance your practice’s culture not another task Pharmacies and pharmacists operate in a complex world. Physicians have limited awareness of the College of Pharmacists of British Columbia’s (CPBC) requirements or how PharmaCare and other third-party payers enforce their own rules and regulations. Payers pass the workload of program compliance onto the pharmacy all at a fixed fee that doesn’t compensate for the service being provided to their beneficiaries. Compounding this, payer rules can be at odds with CPBC practice regulations. Patients are unaware of the pharmacist's role in managing their health care and medications or the safety checks done on every dispensed prescription. In pharmacy’s highly-regulated environment, the notion of “take care of the patient’s needs first” often conflicts with “follow the payer rules to every detail irrespective of patient care” leaving the pharmacist in a difficult decision-making situation. But none of this is an excuse for not complying with the law. In such a chaotic environment, the only way to ensure you mitigate the risk of errors is to implement a robust risk prevention strategy. A compliance program is one component of this. The good news is that it doesn’t have to be onerous. Key elements of an effective compliance program Management commitment: Fostering a culture of compliance starts at the top. Management must set the tone by its actions, recognizing part of leadership is ensuring compliance.

you complete your self-assessment, be honest. You can’t manage risks unless you measure them accurately. Benchmark first then reduce errors progressively. Compliance policies and procedures: Compliance starts with awareness. Don’t rely on second-hand narratives about payers’ eligibility criteria or how to handle claims. Develop standard procedures to motivate your staff and make it easier for them to comply with the laws. Training and education: Employees play a key role in implementing a successful program because they are, in effect, responsible for carrying out the day-to-day operations of the business. Monitoring, auditing and reporting: Keep the program simple but visible even in a small practice, even if it is just for you. Compliance must evolve from a task to a culture. Discipline and incentives: Policies and procedures must have teeth. Discipline yourself. Regular evaluation of effectiveness: Evaluate how you are doing by setting goals. Improve the procedures so you are continuously improving the quality of compliance. Compliance officer: Consider appointing a compliance officer. This person must become aware of the applicable regulations and policies and be empowered to enforce compliance in the practice. A compliance officer doesn’t have to be a pharmacist, just a person who will be upto-date on bylaws and manuals and be disciplined in assisting error reduction by conducting regular self-audits.

Bottom-line: It’s very difficult to eliminate risk. You can only mitigate Resources: This means having the necessary financial and human it. Investing in a compliance program with checklist processes and a resources and ability to do the work. Your investment must match your compliance officer will reduce your risk. Your investment will bring practice size and consider all costs incurred; don’t try to save pennies. progroup_ad_v3.ai 13/11/2008 4:23:24 PM you tangible returns - your exposure could be less than the average How much should you “invest” as an “insurance premium” against a $200,000 each year you face now. potential recovery of, say, 15 per cent of your billing? In other words, if the average audit assessment is $200,000 each year, isn’t it better to invest $40,000 worth of staff time to reduce that risk? You won’t really know until you assess. C

Compliance risk assessment: Determine your risk by assessing your errors. The BCPhA has developed a regulatory compliance handbook that contains checklists to assist you in assessing error rates. When

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Dec/Jan 2015

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DRUG AND POISON INFORMATION CENTRE

Topical treatment of neuropathic pain: applying the evidence By Andrea Paterson, B.Sc. (Pharm.) and Jamie Yuen, B.Sc. (Pharm.), UBC Community Practice Residency Program Reviewed by Melanie Johnson, B.Sc. (Pharm.), PharmD, Raymond Li, B.Sc. (Pharm.), MSc., and C. Laird Birmingham, MD, MHSc., FRCP More than a million Canadians suffer from neuropathic pain (NeP).1 Can topical agents help? The International Association for the Study of Pain recently revised the definition of neuropathic pain (NeP) to be ‘‘pain caused by a lesion or disease of the somatosensory system.”2 NeP can arise from peripheral lesions or disease (trauma, diabetes, toxic exposures, infection),3-5 as well as from spinal cord and central lesions (trauma, multiple sclerosis, infarcts, tumours). Chronic NeP can markedly diminish both quality of life and daily function. Pain reduction is the main goal of treatment, but improving sleep, daily function, and quality-of-life are also important.1 First-line medications include oral amitriptyline, gabapentin and pregabalin. Duloxetine, venlafaxine, tramadol, and opioids are second- or third-line agents.1,6-9 However, chronic NeP often persists after trials of all of these medications, which can be frustrating for both the patient and the clinician.

Pain intensity is often measured using a visual-analogue scale (VAS) or numerical rating scale. A reduction in pain of >30% is considered as moderate clinical benefit, and a reduction of >50% is substantial clinical benefit.36

THE TABLET

Dec/Jan 2015

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Topical agents have the potential to deliver drugs locally without systemic toxicity.10 They are often considered for the treatment of localised NeP pain when oral therapies have failed or have been stopped due to side effects. However, there is a lack of quality evidence for topical treatments in neuropathic pain and data is often conflicting. This may be due to varying responses of different forms of NeP, the location and surface area of application, and differences in formulations used.14 The following is the evidence from randomized controlled trials (RCTs) and systematic reviews regarding topical amitriptyline, ketamine, dimethyl sulfoxide (DMSO), lidocaine, and capsaicin. Amitriptyline Results from studies of topical amitriptyline cream in strengths from 1% to 5% are inconsistent.15 Several RCTs did not show benefit with amitriptyline 5% in pluronic lecithin organogel gel,16 amitriptyline 1%17 or amitriptyline 2% cream18 versus placebo. Case reports of higher strength amitriptyline (5% and 10%) have shown dose-related efficacy but also systemic adverse effects (slower cognition and difficulty concentrating).15 Amitriptyline is often used topically in combination with ketamine for NeP. One study showed significant relief from postherpetic neuralgia (PHN) using amitriptyline 4% and ketamine 2%.19 In some case reports, pain relief was rapid, with some patients experiencing pain reduction within 20 minutes of application.15,20 Local redness was the most common adverse effect, but this may have been due to the vehicle.15

Ketamine Ketamine, a general anaesthetic agent, decreases peripheral nociceptive signalling through non-competitive blockade of N-methyl-D-aspartate receptors on peripheral nerves.21 In two short-term RCTs, neither ketamine 0.5% or 1% (with and without amitriptyline) were more effective than placebo for NeP.17,18 A RCT compared topical ketamine 5% cream (three times daily) to placebo in the treatment of painful diabetic neuropathy (PDN).22 After one month, ketamine reduced some aspects of pain but change in pain intensity was no different than with placebo.22 In patients with complex regional pain syndrome (CRPS), a double-blind, placebocontrolled crossover trial (n=20) with topical ketamine 10% reported a reduction in allodynia, but not pain intensity.21 Dimethyl sulfoxide (DMSO) DMSO increases the movement of drug through the skin in a concentration dependant manner.23 It is an ingredient in topical diclofenac solutions and may be used as a carrier in other compounded topical preparations. Skin dryness and irritation and possible systemic effects such as a garlic-like taste can occur with higher concentrations.23-25 DMSO has been used alone for NeP due to its probable modulation of afferent C-fibers26 and free-radical scavenging.25 A RCT (N=32) of CRPS patients with DMSO 50% in a fatty acid cream (to reduce skin dryness) reported pain reduction, but no difference compared to placebo.25 A 2013 Cochrane review of CRPS treatments concluded that there is very low quality evidence that topical DMSO reduces pain or improves patients’ self-ratings more than placebo.27 Lidocaine A recent Cochrane review identified 12 studies (n=508) comparing topical lidocaine vs placebo or an active control.28 The 5% medicated patch, gel and cream were used along with an 8% spray.28 Lidocaine 5% may be effective in patients with localized peripheral neuralgia, including postherpetic neuralgia, for several weeks with a low risk of adverse reactions.28 Topical lidocaine is a first-line treatment in some guidelines for localized NeP, like postherpetic neuralgia with allodynia, but it is a second-line therapy in the Canadian Pain Society Guidelines.1,7 The lidocaine 5% patch is not available in Canada, so preparations of 5%-10% must be compounded.1 Capsaicin Capsaicin works by causing local desensitization after a period of initial irritation.29 Topical capsaicin is available over-the-

counter in concentrations of 0.025% to 0.075%. Although an earlier systematic review of capsaicin in neuropathic pain found the number needed to treat (NNT) for a 50% reduction in pain to be 5.7 with capsaicin 0.075% applied three to four times per day,31 a more recent Cochrane review found that there is insufficient data to draw conclusions regarding the its efficacy for neuropathic pain.32 All studies reported local adverse skin reactions to capsaicin early in treatment, but these were reduced or disappeared after one to two weeks of treatment.31 A capsaicin 8% patch is approved in the U.S. for use in the treatment of pain associated with postherpetic neuralgia (Qutenza®, Acorda Therapeutics Inc.). The patch is applied by a physician for 30-60 minutes per treatment and may provide relief for up to three months.30 A separate Cochrane review (four studies of PHN and two of painful HIV-neuropathy) reported the patch to be better than control (0.04% capsaicin for blinding).33 The average number needed to treat (NNT) to feel “much” or “very much better” was 8.8 and 7.0, respectively, after six weeks.33 Serious adverse effects were no different between the groups, but the safety of long-term, repeated application of high-dose capsaicin is unknown. The patch is not available in Canada and future availability is uncertain. Limitations A wide variety of formulations, including creams, gels, and patches have been studied, and many are not commercially available in Canada or standardized. Extemporaneous compounding allows clinicians to individualize patient therapy, but specific formulation details are often not discussed in the literature and some concerns have been raised over the variability of extemporaneous preparations.13,34 Studies tended to be small and of short duration, and most studies have focused on specific conditions such as PHN or PDN; the extent to which results can be applied to other forms of NeP is unknown.35 Thus there is uncertainty in extrapolating study results to other preparations and conditions. Summary Except for topical lidocaine and capsaicin 8%, there is little evidence for the efficacy of compounded topical therapies for peripheral NeP. However, because oral treatment is often ineffective, a trial of a topical analgesic may be worthwhile in patients with chronic neuropathic pain; even a small decrease in pain can dramatically increase their quality of life and the risk of significant adverse effects appears low. For more information and references, visit www.dpic.org/ healthcare-professional or email info@bcpharmacy.ca.

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Dec/Jan 2015

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GOVERNMENT RELATIONS

U.S. election lesson: Pharmacists should mobilize patients by Letlotlo “Coco” Lefoka Americans voted in midterm elections in November, and President Barack Obama’s Democratic Party was trounced. Some suggest the result was a stinging rebuke of the president’s agenda, but it’s worth remembering that the incumbent president’s party usually loses midterm elections. Obama’s lagging popularity contributed to his party’s midterm defeat, having taken a significant hit during the implementation of the Affordable Care Act (Obamacare). The law represented the most sweeping overhaul of America’s health-care system since 1965. Its adoption was marred by a very toxic political debate.

A key concern for policymakers is always how potential reforms would impact the health system’s biggest users, seniors, who also happen to be the most powerful voting bloc. The fact that immediate reform is needed is well known.

Four years into Obamacare’s implementation, independent analysis mostly views the reform as having had a positive impact. Notably, more Americans have health coverage, health-care costs are rising at historically low rates, and the law’s net effect has reduced the deficit. Despite these positive impacts, however, the law remains unpopular. The Obama administration bungled its rollout, which allowed critics to pummel the president and vilify the law. Obama’s popularity has never recovered. The political price Obama has paid for pushing through the reforms shows us why health-care reform here in Canada can, at times, seem to move at a glacial pace.

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Dec/Jan 2015

Canadians view health care as a right of citizenship so reforms come with even higher political risks. Governments seeking to reform a system that is held in this regard have to tread cautiously because even the slight suggestion that reforms would come within an inch of the principle of universal accessibility would be met with strong resistance.

Health care consumes 40 cents of every tax dollar. A rapidly growing seniors’ population and rising chronic disease rates mean even more financial pressure on how the health-care system operates. The numbers don’t add up, nor are they sustainable. Only innovation and bold reform can address these cost realities. Health-care reform has not featured prominently on the BC government’s agenda lately. The priority during the recent fall legislative session was the development of a liquefied natural gas (LNG) framework. This is no surprise. After all, the BC Liberal government won its majority on the promise of a $1-trillion economic windfall from LNG

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that would fill a $100-billion prosperity fund, eliminate BC’s $60-billion debt and create as many as 100,000 jobs. The BC government’s health measures have mostly focused on managing the system and signing labour contracts. BC pharmacists have been determinedly making the case for sound reforms. They have demonstrated with immunization services their ability to efficiently deliver an important health service in a cost-effective manner. The project announced with Genome BC on October 28 should buoy the case even more about the opportunities pharmacists present for innovation in health care. But as the incremental progress on these issues here and political developments south of the border show, for pharmacists to succeed in advancing reforms, they will need to build broad-based political support. It’s not enough for the evidence and facts to be on your side. So for 2015, pharmacists must engage and mobilize their patients, particularly seniors, to build the political coalition needed to move the pharmacy reform agenda forward. To learn more or get involved with the BCPhA’s MLA Outreach Program, please email coco.lefoka@bcpharmacy.ca or phone 604.269.2868.

DEREK DESROSIERS | DIRECTOR, PHARMACY PRACTICE SUPPORT

Networking for success I recently had the opportunity to attend a couple of different student events at the Faculty of Pharmaceutical Sciences at UBC. One event in particular, the Pharmacy Speed Networking Evening, really brought home to me the tremendous quality of the students studying pharmacy at UBC. The future of the profession is in good hands. The evening presented a unique opportunity for mentors to meet and hear the perspectives of future pharmacists while allowing students to build their confidence with networking at the same time. First introduced in 2013, this event was met with great responses from students. Previous participants felt that the opportunity to meet influential, knowledgeable professionals while improving their networking skills was a productive combination. Modeled after speed networking, students rotated through 12-minute structured sessions to meet and pose questions to any of the mentors about their professional pursuits and interests in their respective fields. An informal networking session and reception followed, where the mentors stayed behind to allow the students to approach us and continue discussions started during the speed networking session. I was very impressed by the poise, professionalism and enthusiasm students showed. Many of them indicated aspirations to one day own their own pharmacy, yet they realize there are many challenges to that goal. By the end of the evening it occurred to me that many pharmacists could also benefit from learning more effective networking techniques. It would help them grow as professionals and business owners (if they own their own pharmacy). To that end, here are a few tips you may find helpful in cultivating your network of contacts.

Adelina Chalmers, founder of Presenting Good Practice, describes networking as follows: “You should consider networking as a long-term investment in your business where the key purpose is to build meaningful relationships with other businesses and professionals who will: • Send clients your way • Tell others how awesome you are • Introduce you to their contacts so their contacts’ contacts know about you • Give you “behind the scenes” information that would help you stand out to a potential client.” Your network can also keep an eye out and send you opportunities as and when they arise and give you support or ideas when you need it. Seven rules for networking success 1. Don't ask for a job... Ask for information. Networking is not a job fair; it's an opportunity to gather potentially useful information. 2. Don't take up too much of the other person's time. 3. Give the other person a chance to speak. Ask questions. 4. Ask for suggestions on how to expand your network. 5. Create a vehicle for follow-up. 6. Find ways to reciprocate. 7. Send a thank-you letter. Even a note via email can be effective. Remember, patience is a virtue – getting involved in networking is being in there for the long haul. You may not land the plum job at your first meeting but persistence will pay off eventually. References The Art of Meaningful Business Networking Guide. Cambridge, UK: Presenting Good Practice, 2014. Available:http://www.presentinggoodpractice.co.uk/free-stuff (accessed November 17, 2014). Seven Rules for Networking Success. Kettle Falls, WA: Quintessential Careers, 1996-2014. Available: http://www.quintcareers.com/networking_success.html (accessed November 17, 2014).

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UBC FACULTY OF PHARMACEUTICAL SCIENCES

White Coat Ceremony On October 9, the UBC Faculty of Pharmaceutical Sciences and the BCPhA copresented the annual White Coat Ceremony for the Class of 2018. Since 2004, the Faculty has held a ceremony each fall to welcome first year students into the professional community of pharmacy. Students are presented with a white lab

coat to symbolize the responsibilities that pharmacists have as health-care practitioners and to reflect the commitment expected as they transition into becoming professionals.

of duty to the pharmacy profession. This year, BCPhA president David Pavan spoke on behalf of the Association and participated as one of the event’s “cloakers”, a person who helps students put on their white coats.

The ceremony also features guest speakers, and the students recite a pledge of professionalism that instills pride and a sense

Congratulations and welcome to the Class of 2018!

Photos by Ivan Yastrebov, UBC Faculty of Pharmaceutical Sciences.

BCPhA president and UBC alumnus David Pavan offers words of wisdom to the profession’s future pharmacists.

First year pharmacy students listen intently to the speeches during the White Coat Ceremony.

Every first year pharmacy student receives a white lab coat to symbolize their responsibility as a health-care professional.

Students recite the Pledge of Professionalism.

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ANNUAL REPORT

A year in review The BC Pharmacy Association produced its first official Annual Report summarizing the achievements and highlights of the 2013/2014 year. Some highlights include: A voice for pharmacy A key priority for the Association is advocating for the role of pharmacists as a trusted health-care advisor. The Association expanded its MLA outreach strategy that focuses on communicating effectively to members of the BC legislature. In March we held the first-ever Pharmacy Awareness Day at the BC legislature. More than 100 MLAs, government officials and legislative staff interacted with pharmacists at the exhibit and during an evening reception. Positioning the Association as a thoughtleader in health care meant we developed

a number of submissions to government. In March, the BCPhA released a policy paper called Facing the Future Together. The paper made six recommendations focused on ways to better use pharmacists’ expertise to meet demands for access to primary care services. We also submitted statements on the 2014 budget consultations, made recommendations to the Ministry of Health to improve PharmaCare Audit Policies and Procedures, and provided a submission to Health Canada’s public consultation on drug shortage notifications. Clinical services Demand grew for the Association’s Administration of Injections Program, with more than 2,600 BC pharmacists now trained through the workshops.

A Voice for Pharmacy

Clinical Services

Pharmacy Day at the Legislature saw more than 100 people, 23 immunizations, 25 pharmacist volunteers and 12 outreach meetings

More than 360,000 flu vaccines were administered by pharmacists in the 2013/14 flu season

Near the end of the 2013/14 fiscal year, the Association finalized an agreement with a British firm, 4S Dawn, to provide pharmacies with the capacity to do point-of-care testing for patients needing international normalized ratio (INR) monitoring. Regulatory Compliance Support While work is ongoing with the Ministry of Health Audit Team and the Medical Beneficiary and Pharmaceutical Services Division (MBPSD), progress has been made with the creation of a standardized communication protocol for prescription renewals in residential care facilities and homes. To read more about the work of the Association, the full report can be viewed by visiting www.bcpharmacy.ca.

Regulatory Compliance Support 5 policy and procedure manuals are now available

Membership Growth There are now more than 3,000 Pharmacist members and 850 Pharmacy members of the BCPhA

Member Benefits

Training Opportunities

On the Horizon

The Affinity Rx Program saved more than $200,000 for members, and more than 1,800 members used the service

Seven eTraining programs are now available for members

As the 2013/14 fiscal year drew to a close, several new projects were on the horizon, including Genomics for Precision Drug Therapy in the Community Pharmacy

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GENOMICS IN COMMUNITY PHARMACY

BC pharmacists lead the way with personalized medicine by Elise Steeves

What if a patient could go to their community pharmacy and receive the right medication, at the right dose, based on their individual genetic profile? What if they didn’t have to go through the trial and error of different drugs that may or may not work for them or continuous dosage adjustments on a medication like warfarin, because their unique DNA could provide a map to the perfect drug regime? Pharmacists in British Columbia are taking part in a research project – the very first of its kind in North America – that aims to develop the protocols to do just that. Funded by the BC Pharmacy Association and Genome BC, with research led by a team at the UBC Faculty of Pharmaceutical Sciences, it could ultimately make the concept of “personalized medicine” a reality for patients and pharmacists. The project’s first phase launched this fall in 20 pharmacies across British Columbia. These pharmacies were selected to represent a wide range of rural and urban communities, and a variety of pharmacy chains, banners and independents. Beginning in January, the participating pharmacies will identify patients who have been prescribed warfarin, used widely for blood clotting disorders.

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Pharmacy manager Hoang Nguyen explains the genome project and consent process to a patient.

Dr. Corey Nislow is the lead researcher for the Genomics for Precision Drug Therapy in the Community Pharmacy project. It launched in 20 communities across BC this fall. Photo credit: UBC Public Affairs.

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GENOMICS IN COMMUNITY PHARMACY

Currently, achieving appropriate warfarin dosages requires regular testing to optimize the impact of therapy. It can take several weeks from the time the patient starts on the medication to finding the right dose. During this time health risks can be exacerbated. Patients prescribed warfarin following a heart incident may need to stay in hospital for several more days to ensure stabilization. Pharmacogenomics – the study of how genes affect a person’s response to drugs – has the potential to greatly streamline this process by determining the right dose of medication for individual patients based on their genetic profile. It’s a relatively new field that’s focused on developing safe and effective medication treatment tailored to

a patient’s genetic makeup. This project will use next-generation sequencing (NGS) to predict how each person will respond to certain drug therapies. “I see first-hand that many drugs don’t work the same way for everyone,” says Hoang Nguyen, a pharmacy manager at Vancouver’s Marpole neighbourhood Safeway Pharmacy, one of the project locations. “The knowledge we could gain about how genes affect the body’s response to medications could be used to better assess if the medication will be effective for a patient, and help pharmacists improve adherence or prevent adverse reactions. Ultimately, it means better health outcomes for our patients.

“It’s a very exciting opportunity.” Around 200 patients (approximately 10 patients per pharmacy) will be enrolled in the first phase of the project. After watching a standardized video and going over the consent process with their pharmacist, patients on warfarin will be given a saliva collection kit. Once complete, the sample will be securely sent to the UBC Sequencing Centre where the DNA will be extracted, analyzed, and a report will be generated that looks at the pharmacogenomic markers (individualspecific biological markers that may allow prediction of individual drug response). Researchers will use the data to find out if a patient could have been given an optimal dose sooner. During the project’s

About 60,000 patients in BC on warfarin

pilot pharmacies

200 patients

10% 18

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Warfarin is in the top 10% of most commonly prescribed medications

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average number of lab visits/year a patient on warfarin needs

A patient’s perspective first phase, the UBC team, led by highly-regarded researcher Dr. Corey Nislow, will also develop standard operating procedures for collecting this saliva sample, processing and sequencing. The team will also develop training and educational tools for patient awareness. “BC has an opportunity to be the first to translate the advances in next-generation genome sequencing into improved drug therapeutic outcomes,” Dr. Nislow says. The UBC Sequencing Centre that resides within the Faculty of Pharmaceutical Sciences is the only centre of its kind in North America that is dedicated to the application of pharmacogenomics in pharmacy practice. If the first phase demonstrates the feasibility of community pharmacist-based pharmacogenomic sample collection, a second phase will begin by expanding the project to more community pharmacies across the province. The proposed use of community pharmacies as the point of collection for patient genome samples is unique in Canada. This project helps position community pharmacists as the health-care providers through which genetic information can be acquired, assessed, and used to guide drug therapy decisions. “There are more than 1,200 community pharmacies across the province, which means all British Columbians could ultimately have access to this testing regardless of where they live,” says David Pavan, president of the BCPhA. “Widespread adoption of this technology will help usher in a new era of personalized medicine – targeting the right treatment to the right patient at the right time, with the potential to reduce drug therapy costs and manage health-care sustainability.” To learn more or get involved, please visit www.bcpharmacy.ca/ genome or contact genome.project@ubc.ca.

After her own experience on warfarin, Barbara Elworthy knows first-hand what a difference genomics research could have on patients like her in the future. An active Vancouver resident, who was busy with tennis, skiing and exercise, Elworthy ended up in the ER in 2011 after a lingering cough that progressed to breathing difficulty. Tests revealed both of her lungs were full of blood clots. Elworthy was immediately placed on heparin and remained in hospital for five days, so that blood tests could be done daily to continuously manage her warfarin dosage. Measuring a patient’s blood clotting time through blood tests – reported as an international normalized ratio (INR) – is a required component of warfarin therapy. “In the hospital, I had my blood taken daily and in the evening the physician would tell the nurse my INR count. Each day was different at the beginning so it took a while to figure out,” she says. “The first prescription I filled had a dose for one, two, four and five, as they didn't know how many pills I would need to take.” Once released, she continued to go to the lab for blood tests about every three days for the first month. She’s now been stable for about two and a half years, but it took almost six months to get her dosage right. “My veins are very hard to find, so between five days of having blood taken in the hospital and then again every few days when I was getting stable, I must admit I hated the entire process,” she says. “I also dislike needles.” Another problem was going into the lab in the morning so the results could be sent to her physician by the afternoon. “It seems everyone gets their blood work done in the morning,” she says. “My doctor would phone at the end of the day after all her patients left, so I waited each day to find out how many pills I should take.” Elworthy now goes to London Drugs for a monthly appointment to check her blood as part of their anticoagulation program. “I’m very lucky to have found the wonderful pharmacy team at London Drugs,” she says. “I sincerely don't think I could have stayed on warfarin without them. I book appointments ahead of time, and they work around my busy travel schedule. They are always polite, on time and treat me so well. Every time the pharmacist asks about my health, my breathing, my lungs, or any changes I might have noticed.” However, she says that if a pharmacist could collect a patient’s DNA through a spit kit and know the optimal dosage, it would be “brilliant.”

Each of the 20 pharmacies selected receive saliva collection kits (above) to collect patients' DNA.

“If they could find out what exact medication would work best for you based on one’s genetic code it would be most helpful for the patient. The period of adjustment to your individual dosage was very scary for me, as I knew nothing about this medicine before. Simple testing would have made my life a lot easier.”

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2014 MEMBER SURVEY

Hearing from members Advocate with government. That’s the top priority for the BC Pharmacy Association in the coming months and years, according to the results of this year’s member survey.

The survey, conducted by Ipsos, looked at value of the Association, the quality of services we offer and challenges and issues faced by members.

While government relations topped the charts in priorities, members also said they wanted support for PharmaCare audits. This year, the BCPhA launched a series of regulatory complaince bootcamps to help members understand key issues and laws around PharmaCare auditing.

This year, 640 members (or 18 per cent of members) completed the online survey, which ran from September 10 to October 5.

Every two years, the Association surveys our members to find out what they think of the job we’re doing.

Members hold a positive view of the Association thanks to the work being done on advocacy, support for scope of practice, timely and relevant information and value for insurance.

The biggest priorities for members in the coming years are: • Having a voice in government health care reform • Securing fair reimbursement for new pharmacy services • Advocating for expanded scope of pratice • Support for audits To view the full survey results, visit www.bcpharmacy.ca/member-surveys

Priorities for next few years (choose up to three) Having a voice in government health care policy

54%

Securing fair reimbursement for new pharmacy services

52%

Expanding the role of pharmacy in health care

42%

Providing regulatory compliance support for PharmaCare audits

33%

Promoting the profession of pharmacy

26%

Working on third-party issues

21%

Expanding member services and beneﬁts

18%

Helping pharmacists with employment and/or recruitment issues

16%

Expanding technical and other training for members

15%

Assisting with recruitment/job search Working with UBC's Faculty of Pharmaceutical Sciences to develop the next generation of pharmacists

9% 7%

2012 Top Responses Securing fair reimbursement for new pharmacy services (68%) Having a voice in government health care reform (61%) Expanding the role of pharmacy in health care (48%) Promoting the profession of pharmacy (33%)

Q15. On which three of the following areas would you like BCPhA to place the greatest priority over the next few years? Base: All respondents (n=640)

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2012

CLINICARE PHARMACISTS

Navigating culturallyappropriate terminology By Larry Leung B.Sc. (Pharm.), R.Ph., and Jason Min, B.Sc. (Pharm.), R.Ph. One of the keys to providing a higher-level of care and building rapport with your patients is to understand the impact their culture may have on health. This applies to all pharmacist-patient encounters, whether it is counseling on a new medication or conducting a comprehensive Medication Review. In our practice, providing clinical pharmacy services in aboriginal health is a large part of what we do. It’s one example of how we have used culturally-appropriate terminology to establish stronger therapeutic relationships and learned more about our patients’ traditions and culture. According to BC’s newest health authority, the First Nations Health Authority (FNHA), there are 203 different First Nations in BC, representing one of the fastest growing populations across Canada1. Using culturally-appropriate terminology when interacting with our patients can be complex. Definitions may be rooted in government law and legislation or traditional community practice. We will review some of the important facts and basic terminology related to aboriginal health that might be helpful in your practice (see box). Note that terms that may be acceptable to one community may not be acceptable to others. There is no single term that is universally acceptable to identify the first people of Canada. Many Aboriginal Peoples identify themselves with terms from their own language or community such as geographic location or name of their Nation or cultural group (e.g., Nuxalk, Heiltsuk). It is important to learn and ask your patient what is most appropriate in their Nation; this might include listening to how they introduce themselves or talking about it during encounters. The University of British Columbia (UBC) Indigenous Foundations (http://indigenousfoundations.arts.ubc.ca) is an excellent resource for more information on appropriate terminology, history, politics, identity, and culture. Since 2013, UBC has also offered a pharmacy elective course on Pharmaceutical Care in Aboriginal Health. The University of Victoria and Provincial Health Services Authority offers online courses on cultural safety and cultural competency respectively (http://web2.uvcs.uvic.ca/courses/csafety/mod1/index.htm and http://www.culturalcompetency.ca/).

Word

Definition2,3,4

Aboriginal

Refers to the first peoples living in Canada and is often the most inclusive and general term used in British Columbia. Includes First Nations, Métis, and Inuit.

First Nation

Often used to refer to Aboriginal Peoples in Canada, who are not Métis and Inuit and can refer to an individual, band, cultural group, or community. It is widely used as a term to replace the word “Indian.”

Indian

A term that should only be used to refer to the legal identity of a First Nations person with status as distinguished in the Indian Act or if it is part of a title as defined by the federal government (e.g., The Department of Indian and Northern Affairs).

“Status Indian”

Used to distinguish a person whose name appears on the Indian Register maintained by the federal government.

Métis

May have multiple meanings, but is sometimes used as a general term to refer to people of mixed ancestry (e.g., Aboriginal and European).

Reserve

A tract of land that has been set apart by the federal government for the use and benefit of an “Indian band.” Reserves originated when the British government signed treaties with First Nations to settle the land prior to Canada being formed.

Band

Local unit of administration.

Band Council

The elected local government that functions as a small municipality with specific authority. Led by a chief councilor.

Larry Leung and Jason Min are directors of Clinicare Pharmacists Inc. and lecturers at UBC. They have been working collaboratively with several First Nations across BC delivering clinical pharmacy services since 2010 and are creators of Canada’s first pharmacyspecific elective course entitled Pharmaceutical Care in Aboriginal Health at UBC. References available upon request; please contact the BCPhA Communications team.

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RENALLY-SPEAKING

Off-label adventures By David Massaro, B.Sc., B.Sc. (Pharm.), R.Ph. Reviewed by Clifford Lo, B.Sc. (Pharm.), PharmD, MHA, BCPS, Clinical Pharmacy Specialist, Fraser Health Renal Program, Administrative Fellow, BCPRA If you’ve ever completed a Medication Review or clinical workup for a renal patient, you likely realized two things: One, renal patients are often on a long list of both regular and “as-needed” medications. Two, the indication or therapeutic goal for many of their medications differs somewhat from non-renal patients. In some cases, medications are being used for off-label purposes. In addition to the BC Provincial Renal Agency’s patient information sheets, understanding the reasons why certain medications are used can help you formulate the appropriate counselling and monitoring parameters for your patients. The following are some commonly used medications for off-label indications in patients on hemodialysis: Gabapentin for Restless Legs Syndrome (RLS) This syndrome has been associated with dysfunctional dopaminergic transmission as well as iron deficiency anemia, diabetes, and venous insufficiency. Kidney failure often results in anemia. Therefore it’s no surprise that the incidence of RLS among renal patients is significantly higher than the general population. One randomized, double-blind, controlled, crossover trial did show a significant reduction in RLS symptoms with gabapentin at a dose of 300 mg given post-dialysis three times per week.1 Current practice now shows 300 mg at bedtime as the maximum daily dose for the end-stage renal dialysis population. Looking for a treatment algorithm? There are useful symptom management tools, including guidelines for managing RLS, available at www.bcrenalagency.ca. They can found in the Pharmacy & Formulary section under Symptom Management Resource. Midodrine for prevention of dialysis-induced hypotension Intradialytic hypotension (IDH, which is defined as a systolic pressure < 100 mmHg or a > 20 mmHg drop in pressure

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www.bcpharmacy.ca

accompanied by symptoms of dizziness, cramping, or blurred vision) is a complication in up to 20% of dialysis sessions.2 It often results in interruption of dialysis in order to re-establish hemodynamic stability. In more severe cases, it can lead to cardiovascular hypoperfusion complications and loss of consciousness. Midodrine forms an active metabolite which then acts as an alpha-1 agonist. The result is increased arteriolar and venous tone and an overall increase in systolic and diastolic blood pressure. Although indicated for the treatment of symptomatic orthostatic hypotension, in the setting of hemodialysis midodrine is sometimes used off-label as a preventative measure given 15 to 30 minutes prior to starting a dialysis session. The onset of action is typically within one hour and lasts through the majority of a four-hour dialysis session. As it is dialyzable, an additional dose may be required mid-dialysis run. Dosing starts at 2.5 mg orally up to a maximum of 10 mg pre-dialysis. A 2004 systematic review of midodrine used to prevent IDH showed that six out of 10 studies reported an improvement in symptoms with few adverse effects.2 What is still not answered is whether using midodrine is superior to other approaches – such as cooling the dialysate or withholding antihypertensives on the morning of dialysis sessions – to manage IDH. Quinine and/or vitamin E for leg cramps Both these medications are commonly trialed as pharmacological treatments for leg cramps during hemodialysis. A 2010 Cochrane review of 23 trials included patients of any age and location of cramping.3 Quinine alone was found to be superior to placebo and reduced cramp frequency by 28% over two weeks. Cramp intensity and days were also significantly reduced by 10% and 20% respectively. There was a 3% increased incidence of gastrointestinal adverse effects versus placebo but no significant differences in major adverse effects with daily use up to 60 days.

This review included four trials comparing quinine to vitamin E with no significant differences found in outcomes or adverse effects. The typical dose of quinine for a hemodialysis patient is 200 to 300 mg at bedtime or on hemodialysis days; however, the optimal dose, frequency, and duration for quinine or Vitamin E is not well-established. There are also risks with using both drugs. Quinine, for example, is being used less frequently due to reports of serious thrombocytopenia, Stevens-Johnson syndrome, vasculitis, and arrhythmia.4 These are only three examples of a much longer list of off-label uses of medications. Keeping this in mind can help minimize unintentional mixed messages to our patients. Please contact the BCPhA at info@bcpharmacy.ca for the list of references. David Massaro is a community-based clinical pharmacist and lecturer at UBC. He is an enthusiastic and dedicated supporter of any initiative that enables pharmacists to work at their maximum scope to provide comprehensive and impactful care to their patients.

Expression of interest â&#x20AC;&#x201C; BCPhA Board of Directors Are you interested in advancing the profession of BC pharmacy? The BC Pharmacy Association is currently seeking expressions of interest for appointed Board of Director positions for terms that begin in the 2015/2016 fiscal year (September 1, 2015). Appointed Board members serve a three-year term as do elected directors, who are elected by the membership at large. The Board is seeking individuals who are strategic, committed to the profession and bring fresh perspectives to help us fulfill our vision of advancing the professional role and economic viability of our members so they can provide enhanced patientcentered care. Community pharmacy is going through a period of rapid transition and requires strong, strategic advocacy by the Association. In keeping with the Associationâ&#x20AC;&#x2122;s Constitution and Bylaws, the Board has the authority to appoint up to five (5) members of the Board to ensure it is representative of community pharmacy in the province. The Board nominations committee is

recruiting potential candidates, who are interested in serving in the capacity of an appointed director. Prospective appointed directors must be individuals who are BCPhA members and have personal experience, strategic liaisons or other qualities which, in the opinion of the directors, are useful, desirable and important to the work of the Association. Board members may be selected because of their unique skills or insights. If you would like to be considered for an appointed position for the 2015/2016 Board, please submit a resume and letter outlining your reasons for interest. Submissions should be sent to Geraldine Vance, CEO, BC Pharmacy Association: Phone: 604.261.2092, Toll Free BC: 1.800.663.2840 Fax: 604.261.2097 info@bcpharmacy.ca

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A voice for community pharmacy

Dec/Jan 2015

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PRODUCT IN FOCUS

ViVAXIM: Dual protection against hepatitis A and typhoid fever

ViVAXIM is a combined purified VI polysaccharide typhoid and inactivated hepatitis A vaccine. It is the only vaccine available in Canada that offers protection against both hepatitis A virus infection and typhoid fever. What are hepatitis A and typhoid fever? Hepatitis A and typhoid fever are both travel-related illnesses, transmitted by contaminated food and water, and common to many developing countries. Hepatitis A is an infection of the liver. Symptoms can include jaundice and general weakness. Although rarely fatal, hepatitis A is endemic to much of the developing world, and about 25 per cent of cases require hospitalization. Typhoid fever is typically associated with travel to more rural destinations in developing countries, and is associated with itineraryspecific risk activities. It is usually associated with a sustained fever as high as 39 – 40 degrees Celsius. Symptoms can also include general weakness, stomach pains, headache and loss of appetite. The illness is frequently severe. Administration ViVAXIM is a combination vaccine that protects travellers against both hepatitis A and typhoid fever. For optimal protection it should be administered at least two weeks prior to travel to a risk area. Only one dose is required prior to departure. A single booster dose of hepatitis A vaccine, six to 36 months after the initial dose, provides approximately 20 years protection against hepatitis A disease. ViVAXIM can also be used as a hepatitis A booster after 36 months for travellers who also require protection against typhoid fever for upcoming travel. For patients not requiring hepatitis A vaccination, typhoid vaccination should be repeated every three years if needed for travel. Adverse effects Serious adverse effects are very rare. Side effects are primarily pain at the injection site, fever and/or headache. These side effects generally are limited to a few days. Drug interactions ViVAXIM is an inactivated vaccine and when administered concomitantly with other vaccines it is unlikely to interfere with immune responses. No interaction with other medication is currently known.

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Immunosuppressive treatments may interfere with the patient’s immune response to ViVAXIM. Who should not be vaccinated with ViVAXIM? • Children under 16 years of age • Anyone with a known allergy to the vaccine • Anyone ill with a high fever, serious illness, or a weakened immune system • Anyone with a bleeding disorder or taking blood-thinning medications ViVAXIM is generally not recommended for pregnant or breastfeeding women and should only be given if clearly needed based on an assessment of the risks and benefits. Patient selection The hepatitis A vaccine is recommended for a broad range of destinations outside Canada. Typhoid vaccination has recently been reviewed by the Committee to Advise on Tropical Medicine in Canada (CATMAT) to the Public Health Agency of Canada. CATMAT suggests that typhoid vaccine be used for most Canadian travellers visiting South Asia, and not used for most Canadian travellers visiting other destinations. For destinations other than South Asia, health care providers should discuss risks on an individual basis to determine the appropriateness of vaccination against typhoid fever. This discussion should include vaccine benefits and harms, as well as basic hygiene precaution. In particular, travellers who may be travelling in less ideal living conditions, those travelling for extended periods of time, and travellers visiting friends and relatives should be assessed for the appropriateness of typhoid vaccination. ViVAXIM offers the convenience of dual vaccination of hepatitis A and typhoid in one vaccine administration. Storage and stability Store at two to eight degrees Celsius; do not freeze. Submitted by Brian Stowe. Stowe is the pharmacist/owner of The Prescription Shop, Pharmacy and Travel Clinic, Carleton University, Ottawa, Ontario.

UBC PHARMACISTS CLINIC

Helping you help your patients By Barbara Gobis B.Sc.(Pharm.), ACPR, M.Sc.Phm.; Larry Leung B.Sc.(Pharm.), R.Ph.; Jason Min B.Sc.(Pharm.), R.Ph.; and Rosanne Thalakada B.Sc., B.Sc.(Pharm.), ACPR, PharmD As a pharmacist in community practice, do you see patients with complex drug therapy challenges? Do you wish you could help them more? Other health-care professionals routinely confer with colleagues when faced with difficult cases. Now you can, too, with support from the Pharmacists Clinic at the UBC Faculty of Pharmaceutical Sciences. The Pharmacists Clinic (PC) is a best-practice patient care centre where pharmacists with advanced training help you optimize the drug therapy outcomes for your patients. We provide in-depth medication management services for complex patients in respectful collaboration with community pharmacists. As the referring pharmacist, you receive a comprehensive consultation note and detailed care plans that can be implemented by you with assistance from a PC pharmacist as needed. Here’s how it works: • You (the community pharmacist): a. Identify a patient in your practice with complex drug therapy challenges. b. Tell the patient you are referring them to the PC. c. Submit a referral by phone, fax or secure email (contact details below). d. Decide how you will participate in your patient’s PC consultation (attend inperson or by phone, or confer with the PC pharmacist afterward). • The patient: a. Decides on an in-person or telephone appointment. b. Is contacted by the PC within two business days of the referral. c. Books and attends the appointment.

• The PC pharmacist: a. Completes the consultation. b. Sends a consultation note with detailed care plans to you, the family physician and specialist(s) (when necessary). c. Discusses implementation of the recommendations by you. d. Is able to provide follow-up consultation with you if requested. • You, the patient, and the patient’s physician(s) now have a plan for patient care, monitoring and follow-up with support as needed from the PC team. Patients suitable for referral have: • Complex health conditions (e.g., uncontrolled pain, reduced renal function). • Multiple drug therapies. • Sub-optimal drug therapy outcomes. • Adverse drug events, sensitivities or allergies. • A need to start or stop a drug therapy. • Difficulties taking their medications at home. • A lot of questions about medications, natural health products and supplements. • Been recently discharged from hospital. Benefits to patients: • Patients report higher satisfaction and better health outcomes when health professionals collaborate with each other in care delivery. • Any patient can be referred, regardless of their eligibility for a PharmaCare-funded Medication Review. • Initial appointments are one hour in length.

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• Patients can receive service by telephone or in-person at the PC, which ensures accessibility regardless of location or mobility issues. Benefits for you, the pharmacist: • Access to colleagues for collaboration in the care of patients with complex health-care challenges. • Professional satisfaction from your increased patient care contributions. • Existing pharmacist-patient relationships are maintained, and often enhanced. • Practical learning and skill development opportunity (each case is a workplacelearning activity for your CEU Plus Learning Record). Benefits for your pharmacy: • Existing prescription and business relationships are maintained (The PC does not offer prescription-filling services). • Increased Medication Review Service consultation and follow-up and revenue opportunities1 for eligible patients. • Service exceeds PharmaCare and College requirements for quality and documentation standards. • Increased collaboration between your pharmacy, family physicians and specialists. Contact the Pharmacists Clinic by phone at 604.827.2584, fax 604.827.2579, or visit http://clinic.pharmacy.ubc.ca/. References 1. W here applicable, the Pharmacists Clinic will submit a service claim for initial services provided by a PC pharmacist. A pharmacy will submit claims for subsequent services provided by their employee pharmacists to eligible patients.

Dec/Jan 2015

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CAREER LISTINGS

COQUITLAM

ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS?

Pharmacy assistant – full-time Specialized, high quality patient care pharmacy looking for an energized full-time pharmacy assistant. Very unique and rewarding environment with a focus on high-level patient support with exceptional customer service. Successful applicant must be able to work well in fast-paced environment and have exceptions computer skills. Organization, attention to detail, and excellent communication skills are a must. Preferred minimum of two years of experience in retail (Kroll an asset) with extensive understanding of PharmaCare coverage/insurance billing. A perfect opportunity to be challenged with continual learning opportunities and advancement. Competitive salary and benefits. Please fax resume to 1.866.246.7796.

Pharmacy members can place free Career Opportunities listings in this section and on the BCPhA website. Job postings for pharmacy technicians and assistants are also distributed by the Pharmacy Technician Society of British Columbia (PTSBC). A new enhancement to the best pharmacy job board in BC! Pharmacist members looking for new career opportunities can post their resumes for free on the Hire-aPharmacist page. To learn more, visit the Recruitment section of bcpharmacy.ca ARMSTRONG

DELTA

Pharmacist – full-time

We are independently owned pharmacy in the North Okanagan region seeking a clinically orientated pharmacist. Our modified workflow allows pharmacists to work completely separate from dispensing functions in order to focus on quality pharmacist services, clinical interventions, and follow-up with patients. We have great relationships with our patients, local physicians, and other members of the community health-care team. We are seeking a pharmacist who is willing to continue to foster and build these relationships. Experience what it's like to work with a team that will fully support you in developing new and creative ways to improve the health of our community while making full use of our growing scope of practice. We offer great hours and a competitive wage and benefit package. Please send resumes to gaarscott@gmail.com.

We are looking for full-time pharmacists for our Lower Mainland pharmacy. Experience with WinRX/Kroll and Microsoft Office (Word, Excel, etc.) are necessary. The successful applicant is required to have at least one to two years of experience working in a community pharmacy and to be injection certified. Pharmacists must also have a good working knowledge of PharmaCare and third party billing policies, knowledge of Medication Reviews, and experience with blister packing. Pharmacists must be strong communicators, clinically-oriented, and willing to further their pharmacy practice and patient-centered care. Wages start at $37/hour and increases steadily with experience. Full medical and dental benefits are provided after a trial period of three months. Please send resumes to shafik@ wescanapharmacy.com.

Pharmacy technician – full-time

Pharmacy technician or assistant – full-time

Independent pharmacy in the North Okanagan seeking pharmacy technician. Candidates must be fully registered with the College of Pharmacists of BC (CPBC). Excellent communication skills and experience with being part of a team is required. We are currently changing our workflow to have a patientfocused pharmacy experience, and we intend to fully implement the scope of practice of a pharmacy technician. To apply, please send resumes to armstrongpharmacy@telus.net.

We are looking for full-time pharmacy assistants or registered pharmacy technicians for our Lower Mainland pharmacy. Experience with WinRX and Microsoft Office (Word, Excel, etc.) are assets. Start date is immediate upon hiring. Compensation is between $12-18 depending on the applicant’s experience. Medical and dental benefits are provided after a trial period of three months. If interested, kindly send a resume and cover letter to shafik@ wescanapharmacy.com.

CHILLIWACK

FORT NELSON

Pharmacist – part-time, relief

Pharmacist – full-time

Looking for a pharmacist who can cover Fridays, Saturdays and Sundays. Must know Kroll, be comfortable and able to do injections, Med Reviews, and adaptations. Must be willing to interact with patients and have good communication skills. Please send resumes to Raj at rajs2000@hotmail.com or please call 604.807.7029.

Position available immediately. Very comprehensive compensation package and flexible 40 hour work week (no evenings, Sundays or statutory holidays). The successful applicant will be highly customer-oriented, possess exceptional communication skills and exhibit a keen willingness to work collaboratively with our local physicians and

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develop and implement clinical services. Compensation includes highly competitive wages, full benefits including MSP, extended medical and dental, both College and Association memberships, continuing education allowance, staff discount, RSP matching, relocation allowance and signing bonus as well as Northern residents allowance. Learn more at bcpharmacy.ca/jobs. Please send resumes to Duane Knott at fortnelsonida@hotmail.com, fax 250.774.2326 or please call 250.774.2323. KAMLOOPS Pharmacist – part-time Manshadi Pharmacy (477 Paul Street, Kamloops) is looking to hire a motivated pharmacist to work in a well-established independent retail pharmacy. Position is for Saturday and Sunday, 10am to 2pm. We specialize in diabetic care, compounding and home health care products. Great team that supports our pharmacists. We prefer a longterm commitment. Kamloops is a great place to be. We are close to two ski hills, Sun Peaks and Harper Mountain, and dozens of nearby lakes. Good community to raise a family with all needed amenities. Please send resumes to Missagh Manshadi, pharmacist/owner, at missagh@manshadipharmacy.com, fax 1.250.434.2527 or please call 1.250.574.0111. Pharmacy assistant – part-time Part-time experienced pharmacy assistant positon at Target Pharmacy in Kamloops. We are looking for: strong commitment to customer service, efficient, organized team player with a focus on community and patients. Applicants should have experience with the Kroll dispensing system and excellent customer service skills. We will offer a competitive wage and an employee discount. Come join an exciting pharmacy team. Please note that this position is for employment with Kleo Dimopoulos, owner of the Target Pharmacy Franchise. Please only experienced pharmacy assistants apply. Please send resumes to Kleo Dimopoulos at kleod2@hotmail.com, fax 250.374.0201 or please call 250.434.7281. KELOWNA Pharmacist – part-time London Drugs has a part-time opportunity in Kelowna. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, pharmacy operations manager, at ssangha@londondrugs.com.

CAREER LISTINGS

LANGLEY

Pharmacist – full-time, part-time

Pharmacist – full-time

Shoppers Drug Mart Valley Center, located at 107-20151 Fraser Highway, Langley, is looking to hire a staff pharmacist. Duties to perform include: prescription checking for accuracy and clinical appropriateness; outstanding counselling on OTCs; injection certified; outstanding customer service skills and communication skills. Experience is a big asset but new grads are welcome to apply. Please send resumes to associate-owner Mina Fahim at asdm2115@shoppersdrugmart.ca, apply online at www.ShoppersDrugMart.ca or fax 604.534.3874 or please call 604.534.3870.

Looking for full-time pharmacist who can work collaboratively with physicians and specialists in a pharmacy located inside a medical building. Applicants should be able to do clinical services (Med Reviews, injections) and have great communication skills. New pharmacy graduates are welcome to apply for this position. Only selected candidates will be contacted for interview. Please send resume via email to pcyrealcorp@gmail.com. Pharmacist – full-time, part-time We are looking to hire a pharmacist with experience in long-term care to join our pharmacy team. Position is available near the end of December or beginning of January. Experience with WinRx is required. Knowledge of pouch packaging machines is an asset. Only those selected for an interview will be contacted. Please send resumes to Linda Gutenberg, director of pharmacy, at lgutenberg@forewest.ca.

Pharmacist – part-time In business since 1922, Otter Co-op is a successful $200M retail operation, located minutes east of Langley. Due to our tremendous growth and expansion plans, we are accepting applications for a part-time staff pharmacist (up to 24 hours weekly). We provide an excellent pharmacy practice environment with personal growth and career development opportunities.

If you are highly motivated to provide excellent pharmacy care and customer service, please contact Hisham by email at pharmacymgr@ otter-coop.com or fax 604.856.3101. MAPLE RIDGE Pharmacy technician or assistant – full-time or part-time Unique long-term opportunity exists for a pharmacy technician or assistant, full-time or part-time within our fast-growing, full service pharmacy within a medical clinic in Maple Ridge. You will use your strong communication ability to build long-term relationships with customers, while providing superior levels of services and care. You are familiar with POS and KROLL processing systems and are seeking a long-term, mutually rewarding opportunity. Prior compounding experience is appreciated but not mandatory. We offer an excellent compensation package, consisting of very attractive salary, opportunities for growth and work/life balanced environment. Apply online at www.medlandia.com.

THE RIGHT MIX Evolution happens and we’ve been there! Pharmacy practice continues to expand in scope. Wynward is here to support that progress. In collaboration with BCPhA, Wynward recognizes the need to be responsive on emerging trends, while at the same time delivering The Right Mix on product, price, and service experience for your insurance needs. wynward.com

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CAREER LISTINGS

NANAIMO

POWELL RIVER

Pharmacist – full-time

London Drugs has a full-time opportunity in Nanaimo. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075.

Looking for a motivated and dynamic pharmacist with experience in the holistic integrative field of pharmacy and health care. Training in advance compounding, homeopathy and naturopathy an advantage. If this is you, please consider Powell River as the place for you. Please send resumes to Dirk de Villiers, director, at ms0309@store.medicineshoppe. ca or fax 604.485.5536 or please call 604.485.5530. PRINCE GEORGE Pharmacist – full-time

NEW WESTMINSTER Pharmacy manager – full-time Medicine Shoppe Pharmacy #142 is looking for a pharmacy manager to lead our dynamic team. The pharmacy is designated renal pharmacy for New Westminster and works very closely with the renal department at Royal Columbian Hospital to meet pharmaceutical needs of dialysis patients. The pharmacy is located directly across from Royal Columbian Hospital and is surrounded by medical buildings. Please see attachment at bcpharmacy.ca/job for complete details. Please send resumes to owner Nimisha Virani at nimishavirani@gmail.com or fax 604.521.9614 or please call 604.521.9313.

London Drugs has a full-time opportunity in Prince George. Join a clinical and patientfocused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, pharmacy operations manager, at ssangha@londondrugs.com or fax 604.448.1075. RICHMOND

Pharmacist – full-time

Pharmacy manager – full-time

Key responsibilities include: checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting, and collaboration with pharmacy assistant to accurately dispense prescription medications. Qualifications: Bachelor of Pharmacy, license to practice in the province seeking employment, superior interpersonal skills, strong verbal and written communication skills, commitment to providing exceptional customer service, and computer proficiency. Flexible schedule, some weekends and evenings. Please send resumes to sabeeh@globalhealthmanagement.ca.

Brand new pharmacy opening! Centric Health is the largest integrated health care company in Canada, and we are growing! Our vision is to be Canada's premier health care company with innovative solutions that focus on patients and health care professionals. We are building on the strengths of Canadian health care to promote healthy living strategies and provide patients the power of healthcare choices that will have a lasting effect on their quality of life. Centric Health is seeking driven individuals who are motivated by improving the healthcare in the community. Are you ready to make a difference in the world of health care with Centric Health? Please apply online at http:// hire.jobvite.com/j?cj=oJWzZfwX&s=BC_ Pharmacy_Association or please call 416.619.9428.

PORT ALBERNI Pharmacist – full-time Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 100 pharmacies in BC and Alberta under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging & growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! For more information on career opportunities, please contact or forward your resume in confidence to sammy_lee @owfg.com.

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Dec/Jan 2015

Pharmacy assistant – part-time Looking for part-time pharmacy assistant, Monday to Friday. Please send resumes to sheena.poonja@target.com or please call 604.234.2021. SALMON ARM Pharmacist – part-time Pharmasave in Salmon Arm is seeking a motivated, energetic and experienced pharmacist to join our team of friendly professionals. We are offering a predictable two day per week rotating schedule to the right candidate to start immediately. The desire to provide exceptional customer service and medication management counseling

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is mandatory. Our Pharmasave store is actively involved with private consultations, immunizations, compliance packaging, community seminars and prescription compounding. Please submit your resume in confidence to Troy Cook, pharmacy manager, at rx244@forewest.ca or apply online at www. pharmasavesalmonarm.com. SURREY Pharmacy technician – full-time Immediate opening for a pharmacy technician. Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist / manager, at nafisam@telus.net or fax 604.325.3276. TOFINO Pharmacist – full-time Pharmasave Tofino is a new health centre that provides a unique community pharmacy experience. We are currently recruiting for a full-time pharmacist to join our team on the west coast of British Columbia. This position is geared toward a hard-working, lifestyle orientated individual. The successful candidate must be injection trained and committed to providing exceptional pharmacy services. Essential qualities: professional, confident, reliable, positive, organized, detail orientated, and outstanding communication skills. Please send resumes to Laura at info@epicpharmacy.ca, fax 250.725.1249 or please call 250.725.4949. VANCOUVER Pharmacist – full-time We are a well-established, fast-paced independent community pharmacy currently looking for a motivated, focused and diligent full-time pharmacist to join our expanding team. We are a dynamic, clinical-based dispensary who works with multidisciplinary health care professionals to provide excellent customer service and quality patient focused care. Successful candidates must be registered and in good standing with the CPBC, possess strong and effective communication and organizational skills, and the ability to work effectively in a team environment as well as independently. Experience with adaptations, administering injections and Mediation Reviews an asset. No evenings. Position to start immediately. If interested, please send in a cover letter and your resume to vancouverpharma@gmail.com. New grads are welcome to apply. Pharmacist – part-time Part-time pharmacist position available. Experienced in retail pharmacy, exceptional communication and organization skills, familiar with Telus RxA or RxT program, and able to work productively as a member of a dynamic team. If required, willing to work at two different pharmacy locations, both in the Lower Mainland. Please, no phone calls about this job.

CAREER LISTINGS

OPPORTUNITIES ACROSS BC

Please send resumes to ymm@yyoung.com or fax 604.630.1001.

VICTORIA

Pharmacy technician – full-time

Are you looking for an opportunity with an established independent pharmacy chain that is looking to grow and expand its focus on patient care, and clinical specialization? We take patient follow-up to a whole new level. We are looking for energetic pharmacists who want to practice their full scope of clinical skills and help us bring top-notch health care to our customers. Heart Pharmacy IDA, owned by Naz Rayani, is looking for an engaged, clinically-oriented and outgoing full-time pharmacist to work at our unique community pharmacies. Please send resumes to jobs@victoriapharmacy.com.

The successful applicant must be a registered, regulated pharmacy technician with at least one year compounding experience working in a pharmacy dispensary and/or compounding lab. Must be fluent in English. Knowledge and use of Microsoft Office and excellent computer skills are a necessity. You will be dealing with all aspects of a specialized compounding lab. You must be a highly motivated team player who works well independently and with others. Very competitive compensation rate. Full benefits available after successfully completing the three month probation period. Please send resumes to michelle@macdonaldsrx.com, apply online at www. macdonaldsrx.com or please call 604.872.4200.

Pharmacist – full-time

Pharmacist – full-time or part-time

Immediate opening for a pharmacy technician. Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist / manager, at nafisam@telus.net or fax 604.325.3276.

Seeking an experienced, personable, injectioncertified pharmacist for our moderate volume, service-orientated dispensary. We offer flexible hours, a friendly work environment and the opportunity to develop your areas of interest. Competitive wage and benefits. Please apply with resume and cover letter to Maria Kwari, pharmacist/owner at mkwari@gmail.com, fax 250.388.6832 or please call 250.388.6451.

Pharmacy assistant – full-time

Pharmacist – part-time

Established independent pharmacy seeking full-time pharmacy assistant to join our team. Responsibilities include: greeting patients at prescription drop-off and pick-up; receiving and entering prescriptions; preparing and compounding medications; cashier duties and inventory maintenance; and general work place organization. Assets: good customer service skills; prior pharmacy experience or graduation from a pharmacy assistant school; general knowledge of government/private insurance; ability to operate Kroll computer software; Cantonese and/or Mandarin speaking skills desirable. We offer competitive wages with excellent training and support. If you are interested in the position, please submit your resume with email address and phone number to mjsrxmanager@gmail.com.

Cridge Pharmacy IDA is looking for an energetic, out-going, and clinically oriented pharmacist. We're a friendly, fun pharmacy and are looking for a pharmacist who wants to help us deliver a high level of care to our patients. We are a quickly growing pharmacy and are excited to find someone that will fit in well with our team. Injection authority and MMT training are a must. Ability to compound or willingness to learn is an asset. The current opening is part-time, however it will become full-time as the pharmacy grows. Please contact Jason at 250.686.7104.

Pharmacy technician – full-time

VERNON Pharmacy manager – full-time Associate-owner opportunity! The associateowner concept combines the efforts, motivation and on-site leadership skills of the associateowner with the proven marketing abilities, management expertise, financial stability, and standardized operating practices of the Shoppers Drug Mart organization. It is an arrangement based on mutual trust and respect. The associate-owner concept encourages entrepreneurial spirit within a franchise system. Our associate-owners have a strong pride of ownership, and a true commitment to patient care and the communities they serve. Want to take your pharmacy career to the next level? Go into business for yourself, not by yourself. Contact Jen Hamilton, talent acquisition specialist at jennhamilton@shoppersdrugmart. ca, or phone 604.296.4407.

LOWER MAINLAND Pharmacist – part-time London Drugs has a part-time opportunity in the Lower Mainland. Join a clinical and patient focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, pharmacy operations manager, at ssangha@londondrugs.com. ACROSS BC Pharmacist – full-time, float The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 110 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

Pharmacist – part-time London Drugs has a part-time opportunity in Victoria. Join a clinical and patient-focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, pharmacy operations manager at ssangha@londondrugs.com or fax 604.448.1075. Pharmacy technician – full-time Pharmacy technician required to work at Heart Pharmacy IDA, owned and operated by Naz Rayani. Our focus is on patientcentered practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please send resumes to jobs@ victoriapharmacy.com.

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OPPORTUNITIES OUTSIDE BC

BUSINESS OPPORTUNITIES

ALBERTA

WHAT IS IMPORTANT TO YOU IS IMPORTANT TO US. PHARMASAVE is the best choice for independent business in BC. Maintain your freedom while having access to the most comprehensive retail and professional programs in the industry and our strong national brand. We are a true cooperative, 100% memberowned and governed. Benefit from owning your own business and also share in the economic advantages of a strong group of over 500 stores. Be an owner in an organization that delivers all of its profits directly back to you, the shareholder. If you are a store owner and would like to consider opportunities with Pharmasave, or a pharmacist interested in purchasing a pharmacy, or are planning on selling your business, please give us a call. Our only priority is you and your success! Contact Dave Reston, CEO, Pharmasave Pacific, phone 604.575.5730 or 1.800.665.3344 or email dreston@ pharmasavebc.ca.

Pharmacist – full-time, float The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We are a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg. com. RANKIN INLET & CAMBRIDGE BAY, NUNAVUT Pharmacist – relief Looking for a relief pharmacist for Rankin Inlet and Cambridge Bay, Nunavut. Travel costs reimbursed. Accommodations supplied. Cambridge Bay December 29 to January 30. Rankin Inlet for four weeks, starting sometime in February. Please forward resume in confidence to Mann’s Prescription Pharmacy at manns@ superthrifty.com, phone 250.746.7168 or fax 250.746.7169.

Are you thinking of selling your pharmacy? OVERWAITEA FOOD GROUP may be interested. If you would like more information please contact via email at pharmacybuyer1@gmail. com. PEOPLES DRUG MART is an established and proven pharmacy banner that will make your pharmacy business more successful and profitable. We provide outstanding marketing support and services for a low monthly fee. Unlike other banners, Peoples Drug Mart does not charge a percentage of sales. Our belief is that the profits from your hard work should stay in your business. With Peoples, you get the best of both worlds, outstanding support and services, and the ability to maintain your profits. If you are interested in purchasing, selling or opening a new pharmacy, please contact Frank Cucca toll free 1.877.450.6006, extension 18 or 604.619.4846 or email frankc@pdmstores.com. Partnership opportunity - Vancouver Currently operating a busy pharmacy with large blister pack clientele. Would like to collaborate with other business owners and expand. We have a strong IT and construction team looking for opportunities. Please send resumes to hr@ cloudpharmacy.ca or call 1.877.331.4411.

ASSOCIATION CONTACTS Geraldine Vance Chief Executive Officer 604.269.2860 geraldine.vance@bcpharmacy.ca Cyril Lopez Chief Operating Officer 604.269.2869 cyril.lopez@bcpharmacy.ca Derek Desrosiers Director, Pharmacy Practice Support 604.269.2862 derek.desrosiers@bcpharmacy.ca Angie Gaddy Director, Communications 604.269.2863 angie.gaddy@bcpharmacy.ca Letlotlo “Coco” Lefoka Manager, Public Affairs 604.269.2868 coco.lefoka@bcpharmacy.ca Vince Lee Manager, Marketing 604.269.2867 vince.lee@bcpharmacy.ca Bryce Wong Manager, Pharmacy Practice Support 604.269.2865 bryce.wong@bcpharmacy.ca Elise Steeves Manager, Communications 604.269.2866 elise.steeves@bcpharmacy.ca Nelson Chen Coordinator, Pharmacy Practice Support 604.269.2880 nelson.chen@bcpharmacy.ca Ray Chow Database Administrator, Member & Corporate Services 604.269.2882 ray.chow@bcpharmacy.ca Maria dela Cruz Executive Assistant & Project Coordinator 604.269.2861 maria.delacruz@bcpharmacy.ca Linda Tinnion Assistant, Member Services 604.269.2864 linda.tinnion@bcpharmacy.ca Starr Rempel Administrative Assistant Member & Corporate Services 604.261.2092 starr.rempel@bcpharmacy.ca 604.261.2092, Toll-free: 1.800.663.2840 info@bcpharmacy

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You spend your life helping others. It’s now your turn to receive the right advice.

We Have the Perfect Prescription for Your Home. For 35 years Reliance has been protecting the home and automobiles of BC residents. Reliance is now a partner with the BC Pharmacy Association and has teamed up with them and Adams Insurance to offer HomeProtect Rx—a home insurance policy exclusively for members of the BCPhA. Home Protect Rx is a Comprehensive Home Insurance Policy providing Guaranteed Replacement cost coverage against loss or damage to your home and replacement cost coverage to your personal property. In addition to our exceptional policy features, as BCPhA members you will receive benefits not available to the general public: ■

■ ■

Premium Claims Service 24 hour emergency claim service; Claims advocate who works for you to ensure a quick and fair settlement Discounts up to a maximum of 70% in savings Policy Extensions, Optional Coverage, Convenient Payment Options

Fill Your Prescription Today! Contact Richard Seto or Doug Chan for your no obligation quote. TEL: 604 255 4616 TOLL FREE: 1 800 255 6789

Affinity BCPhA prescribed member discounts

BC Lions Canucks Car rental Cineplex Hotels around the world PNE and Playland Show tickets and much more!

Get your Home Protect Rx Now! Discounts and Payment Options Find out how much of a discount you are eligible for. Enjoy up to 70% in discounts. Complete the fax back form included with this issue to enter to win Canucks tickets (lower bowl, centre ice) or enter online at www.bcpharmacy.ca/home-protect-rx

2-year rate plans Unlimited Canada-wide calling Unlimited text, picture and video messaging Cash and credit back offers 250MB, 1GB, 3GB plans $55, $65, $75

Save from 10 - 45% Lower bowl tickets starting at as low as $89 A variety of tickets still available. Save even more on last minute tickets! Sign up on the last minute contact list to find out about last minute price drops. Images from: www.canucks.com

Hotels around the world

Movie tickets

On average 10 - 15% cheaper than any other booking website

15 - 30% off retail price

Affinity Rx price per ticket $8.50 ($8.92 after GST)

Regular price per ticket $11.99

HOW TO ACCESS THE DEALS Log into www.bcpharmacy.ca and go to the Member Benefits - Affinity Rx section or email vince.lee@bcpharmacy.ca