Between Dusk and Dawn—Who Ya Gonna Call?

The BC NurseLine Pharmacist Service

Barbara Gobis Ogle, BSc(Pharm), MScPhm and Elaine Chong, BSc(Pharm), PharmD, BCPS

Reprinted from "Medications" issue of Visions Journal, 2007, 4 (2), pp. 30-31

It’s shortly after midnight. As you were getting ready for bed earlier, you noticed a rash on your arm. You start to worry. You’ve recently started taking a new medication that your doctor prescribed. Is it the new medication? Could this be a side effect? Does the new medication interact with any of your other medications? And, most importantly, who can you speak with at this time of day to get some much-needed peace of mind?

Access point—NurseLine

In a perfect world, health care professionals would be readily available to everyone at all times. However, the reality is that our demand for health services may far exceed the system’s capacity to deliver. But it’s clear that we need more ways to ensure that health care professionals are more accessible to those in need, no matter where they live or what time of day it is.

The BC NurseLine (BCNL) is using technology and creative thinking to increase access to nurses, dietitians and pharmacists for BC residents. The BCNL is a toll-free, 24-hour-a-day, seven-day-a-week, 365-day-a-year provincial telehealth service. Every British Columbian can reach a registered nurse or pharmacist for confidential health advice, free of charge. This line provides interpretation services for people who speak different languages, helping them to access the information they need. There is also a separate line that accommodates people who are hearing impaired.

While nurses are on standby around the clock, pharmacists are only available between 5 p.m. and 9 a.m. During the day, callers are referred to a pharmacist in their home community. At night, after a nurse has assessed any symptoms the caller may have, callers with medication questions are transferred to the BCNL Pharmacist Service (BCNL-PS). A caller from Castlegar could be connected to a pharmacist located in Vancouver or in Langley.

Pharmacist Service—helping with adverse reactions

The Pharmacist Service is provided through a network of specially trained pharmacists who work in pharmacies located around the province. This service not only provides people with after-hours access to pharmacists, but it also ensures that your pharmacist stays where he or she is needed—in your community.

Of the more than 40,000 callers who have received medication advice since the launch of the BCNL-PS in 2003, the majority were seeking general information or advice regarding home treatment and non-urgent care. Over two-thirds of callers are female, mostly between the ages of 18 and 50. Although most callers are adults seeking medication advice for themselves, approximately one-quarter are parents calling on behalf of their children.

Adverse reactions are a common topic of discussion between callers and pharmacists. In fact, in one internal study1 we found that one in every 10 calls to the BCNL-PS involves a potential or actual adverse reaction, usually concerning a prescription medication. Not surprisingly, people who are taking multiple medications for chronic health conditions may be at higher risk for adverse reactions.1 Medications that affect the central nervous system—including those usually taken for mental health or addictions treatment—account for approximately 25% of all adverse reaction calls.1

The possibilities of “virtual” technology networks

At this point in time, BCNL-PS is unlike any other health line in the world. Instead of putting health care professionals in a call centre, which is the common staffing model, the Pharmacist Service “virtual” network connects pharmacists, wherever they are in the province, by technology. This approach widens the possibilities for medication-related services such as monitoring for safety and effectiveness, support for chronic diseases, and medication “coaching.”

Networks of health care providers are well suited to provide scheduled follow-up services (by appointment), via outbound calls to clients, using the same health professional for all calls to a particular client. These same professionals can also provide a combination of face-to-face care and telephone-based care (depending on where the clients are located). The technology network concept is flexible enough to overcome geographical and time barriers, and clients can be directly connected to ongoing services with minimal inconvenience. This means that coaching and follow-up monitoring that involve a relationship between the client and the health professional can be easily accomplished.

Follow-up service trial in BC

Just such an enhanced service has recently completed pilot testing in BC. Pharmacists within the network are now helping certain BC health authorities provide support and coaching by telephone to people who want to be more actively involved in their medication care.

One of these people is a woman who suffers from depression and chronic pain. Despite the fact that she was a health care professional herself, she had spiralled downward to become very isolated and low functioning. Using strategies tailored to help her manage her specific situation, her pharmacist coached her through the process of breaking down her health goals into smaller action plans. She and her pharmacist worked together to make taking her medications easier. The pharmacist supported her to complete bite-sized action plans—putting her meds in a dosette† and tying the timing to a regular event such as brushing her teeth, for example—in progressive steps.

With this extra support, the woman’s health has improved dramatically, and she has regained her confidence to be in control of her own health. In the past, only one-time caller support was provided. This expanded service, however, allows the client and pharmacist to develop an ongoing relationship and to work together at all stages of a client’s recovery.

No ‘one-size-fits-all’

Given the range of challenges that people with chronic health conditions have, a one-size-fits-all approach doesn’t work for all people. On some days, an individual may be fine and have no need to contact a health care professional. One night, however, this person may need to call the BCNL-PS for medication advice. Other people may need additional self-management support or coaching to deal with their medications.

The key is to find the help that works—that provides the right information, to the right person, at the right time. The BC NurseLine is the place to start.

Summary of medication advice categories requested by callers1

28.4%—interactions between medicatio s

8.5%—adherence to medication directions as prescribed

15.7%—clarifying the dose of a medication

6.5%—other

15.3%—medication use while pregnant or breastfeeding

1.6%—identification of a medication

12.5%—specific recommendation regarding a medication

0.7%—storage

10.4%—adverse reactions

0.4%—availability of a medication

 

 
About the author

Barbara is Vice-President of Clinical Services, and Elaine is the Clinical Services Specialist at Network Healthcare, a health services company formed in 2002. Network Healthcare manages virtual health care networks, and specializes in integrating innovative services into primary care practices. The Pharmacist Network, a service delivery arm of Network Healthcare, uses pharmacists to provide the BC NurseLine Pharmacist Service.

Footnotes:
  1. Ogle, B.G. & Chong, E. (2007). Internal analysis of BC NurseLine Pharmacist Service from June 2003–July 2007. Internal report, BC NurseLine.

 

 

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