Issue: BCMJ, Vol. 52,
January, February ,
page(s) 37 Pulsimeter
Lloyd Oppel, MD, MHSc, FCFP(Em)
Prescription drug users in Ontario recently got some good news. New technology is being deployed to increase ease of access, decrease travel, and improve patient safety—all without the pharmacist present.
The machines at the heart of the story are designed as stand-alone kiosks, much like bank machines. Manufactured by a Canadian company, PCA Services Inc., the units are stocked with medications appropriate for the practice or locale at which they are placed, and will read the computer-generated prescription obtained from a physician.
A pharmacist at a remote site is online to approve the release of the medication after payment is made to the machine. The manufacturer has had kiosks located in a number of Ontario hospitals but plans to deploy hundreds more over the next few months in high-traffic areas such as shopping malls.
The machines have the potential to link with the patient’s EMR and PharmaNet (after ensuring the patient’s identity and obtaining consent) to check for allergies and potential drug interactions.
In the last year pharmacist associations across Canada have made great efforts to expand their scope of practice. Frequently representing themselves, despite the existence of the medical specialty of pharmacology, as the health profession most knowledgable about drugs, they lobbied provincial governments for the right to initiate new prescriptions, diagnose disease, and treat minor emergencies—all for an additional fee.
In BC, the changes in pharmacists’ scope were more modest, but included things like amending and extending prescriptions, and implementing fees for simply notifying (and therefore making liable) a physician of the changes.
A common theme invoked by pharmacists in defence of their aspirations to undertake medical care is that of patient convenience. Why go to the doctor when the pharmacist can diagnose, treat, and dispense? It’s easy to forget that historically doctors did dispense, but this was given over to pharmacists largely because of concerns over conflict of interest.
None of this appears to concern the pharmacy associations seeking expanded scope, but it does highlight one of the potential advantages of stand-alone dispensing machines. For example, there is nothing to stop a government agency from purchasing and deploying machines close to medical offices. Stocked with generics, and offering no incentive to physicians to dispense, the machines could even be within the premises of a group practice.
The physician might receive a flat management fee for simply providing space, power, and the occasional dusting; but the stocking and maintenance of the unit could be completely managed at arm’s length by the provincial drug agency. The machines might even print out an instruction sheet for patients on how to take their medication. The option to videoconference with an online government pharmacist could be offered.
Such an arrangement offers a number of advantages: less travel time for patients, less cost to fill a prescription, the potential for after-hours use, and—if the manufacturer’s claims are true—fewer dispensing errors.
Could drug-dispensing machines be the way of the future? The answer may soon be at hand. PCA Services Inc. is set to deploy thousands of the machines throughout the UK in the next 2 months.
—Lloyd Oppel, MD
Chair, Council on Health Promotion