海角社区官网

Three former Shoppers franchise owners, all pharmacists, told the Star聽they faced corporate pressure to meet quotas for MedsCheck reviews, compromising their ability to use professional judgment as to whether patients needed the service.

One of the pharmacists said they were 鈥渆xpected鈥� to perform between 80 and 100 MedsCheck reviews per week during COVID-19, whereas prior to the pandemic they were 鈥渁pplauded鈥� if they performed 25 a week.

They also said they were told to hire additional pharmacists to 鈥渃old call鈥� patients for the reviews.

鈥淚 really felt disgusting as a health-care professional because it was no longer a health-care service, and I鈥檓 now a salesperson trying to convince someone that they need this medication review and I don鈥檛 feel that it was necessarily beneficial,鈥� the pharmacist said.聽

Another said the company was telling pharmacists 鈥測ou still have to do these things, even if in your professional judgment you don鈥檛 want to.鈥� This pharmacist said they gave up their Shoppers franchise 鈥渙ut of disgust.鈥�

(The Star granted the pharmacists anonymity because their comments could result in retribution from Shoppers and harm future employment opportunities.)

Doctors add that the millions of dollars in Ontario Drug Benefit funds spent on the program could聽be better used in other areas where patient need is higher. Ontario鈥檚 MedsCheck program pays pharmacists up to $75 for each annual review.

Internal government figures obtained through a freedom-of-information request by the Star show that between Jan. 1, 2023, and March 13, 2024, Shoppers Drug Mart pharmacies billed the Ontario health ministry $61.9 million for just over 1.2 million MedsCheck reviews.聽

That means Shoppers,聽which is owned by Loblaw, was responsible for performing, and billing for, roughly 60 per cent of the medication reviews done in Ontario during that period, despite Shoppers pharmacies only making up about 13 per cent of the pharmacies in the province. (The company initially objected to the聽province鈥檚 decision to provide the data to the Star, forcing the request to mediation at the Information and Privacy Commissioner of Ontario.)

鈥淭he numbers raise some serious questions regarding how meds checks are initiated and being conducted,鈥� said Aly Haji, a health regulatory lawyer at the 海角社区官网firm RxLaw. 鈥淕iven that the intention of the MedsCheck program is to conduct a thorough medication review that takes 20 to 30 minutes, if meds checks are being conducted at this rate, this data brings into serious question whether the intention of the program is being achieved.鈥�

Asked about the high number of reviews, Loblaw鈥檚 public relations department聽told the Star MedsChecks 鈥渁re more necessary than ever for Canadians,鈥� citing a rise in chronic and pre-chronic conditions, particularly among patients without primary care providers. The company noted that the data obtained by the Star 鈥渞epresent fewer than five medication reviews per day per location across the province鈥� over the 14-month period.

鈥淐ompared to other pharmacies, we provide more medication reviews because of our鈥痚stablished infrastructure, which includes鈥痩arger stores,鈥痗entral prescription-filling capabilities that allow pharmacists more time for professional services,鈥痬ore pharmacists per location and higher weekly operating hours,鈥� Loblaw said, noting that 78 per cent of its Ontario stores operate for more than 84 hours per week. 鈥淪imply put, there is an important need for this service, and we are delivering.鈥�

Optimum rewards misused

Controversy around the MedsCheck program began to grow early last year following media reports聽that Shoppers Drug Mart pressured pharmacists to meet quotas for the reviews, as well as targets for vaccinations and diagnoses of minor ailments.

A photo posted to聽social media platform Reddit at the time showed a memo titled 鈥淏onus Optimum Points Chart,鈥� which was posted at one franchise where pharmacists were offered 20,000 Optimum points (the equivalent of $20) if聽they conducted more than 16 MedsCheck reviews in an eight-hour shift, while students were offered the same if they conducted more than eight checks in a four-hour shift.聽

The company told the Star that this was 鈥渁bsolutely unacceptable,鈥� and said it took 鈥渋mmediate action鈥� when it was made aware of the issue.

However, one patient who spoke to the Star said that even as controversy swirled around the MedsCheck program, she was pressured by staff at one Shoppers Drug Mart pharmacy to have a review she neither wanted nor needed.

海角社区官网resident聽Alanna Kong, 24, said聽she was picking up her medications from a Shoppers location near the intersection of Bay and Bloor streets in early 2024聽when she was asked by a pharmacist if she wanted a medication check.

鈥淚 just said no because my doctor had never said anything about me needing this sort of thing and they had never said anything about potential harmful interactions,鈥� said Kong, who was taking three medications at the time. 鈥淚t felt a little bit pushy and it just felt like it was some sort of sales pitch to be honest.鈥�

She also got a phone call at home from someone she presumed was a staff member at the pharmacy 鈥渁nd they just kind of gave me the same song and dance, essentially.鈥�

鈥淚t just didn鈥檛 feel completely necessary and the way it was presented to me it didn鈥檛 feel right,鈥� Kong recalled.聽

Poonam Prajapati, owner of the Bay and Bloor Shoppers, said she was sorry that Kong聽had a negative experience at the store and that the review was offered as a 鈥渧alue-added service.鈥澛�

鈥淚鈥檝e seen firsthand the benefits to our patients and many times patients do not realize the impact until after having the consultation with the pharmacist,鈥澛燩rajapati said.

Loblaw said it regrets聽鈥渁ny negative interactions with patients,鈥� but said it has heard from 鈥渃ountless鈥� patients and health-care providers who聽鈥渧alue and appreciate not only this service, but the end-to-end care their local Shoppers pharmacy provides.鈥�

Kerry Bowman, a bioethicist at the University of Toronto, said he has worked with seniors who felt they had meds checks 鈥減ushed on them.鈥澛�

鈥淭hese types of things can be very confusing, especially when they鈥檙e not initiated by patients,鈥� he said. 鈥淯nder laws of Ontario, consent has to be three things: it has to be capable, it has to be informed, and it has to be voluntary. So any element of coercion is not acceptable. No is no.鈥�

Pharmacists 鈥榩ressured鈥�

One of the former Shoppers franchisees who spoke to the Star said they were told by district managers that any patient on three or more medications was to automatically receive a medication review, and any diabetic patient, even if they were on just one diabetic medication, was also to receive a review and a minimum of four followups a year.

The pharmacist said Shoppers 鈥渁bused鈥� the MedsCheck program, and that it was 鈥渄isgusting because at the end of the day, it鈥檚 taxpayers鈥� money.鈥�

Another former Shoppers franchisee said they didn鈥檛 think it was acceptable for anyone other than a pharmacist to be talking to a pharmacist about the appropriate delivery of a professional service. This pharmacist added that they were pressured to minimize support staff hours, which means pharmacists could become rushed in their work and 鈥渕ay miss the critical piece of information that鈥檚 required to protect the patient from harm.鈥澛�

When asked about the allegations from the former Shoppers franchisees, Loblaw told the Star that the decision to deliver a professional service聽鈥渕ust always be made by the pharmacist and we adhere to that principle.鈥�

鈥淧harmacy as a profession has evolved rapidly in recent years and some have embraced the change more than others.聽We have worked hard to ensure the teams have the support they need to continue to deliver quality, professional care, and as part of these efforts we are doubling down on quality and patient safety,鈥澛爐he company said, adding that it has established a 鈥渜uality services framework鈥� for pharmacists and a 鈥減atient care and quality committee鈥澛爐hat includes 鈥渞enowned鈥� health-care leaders,聽鈥渞eaffirming our commitment to excellence in health care.鈥�

Jennifer Lake, an assistant professor at the University of Toronto鈥檚 Leslie Dan Faculty of Pharmacy, points out that fee-for-service procedures can incentivize health-care providers to focus on simpler cases as the reviews can be performed more quickly.

鈥淚t means more complex patients who may need the service may not receive it,鈥� she said. 鈥淭he same problem likely exists with MedsCheck. The program could be improved by changing the patient criteria to those at higher risk of medication harms, such as those with more medications.鈥�

Ontario 鈥榠mproving鈥� program

When asked what it was doing to ensure the MedsCheck program rules are being followed, the Ontario health ministry said it was 鈥渋mproving鈥� the program 鈥渢o support health outcomes鈥� and 鈥渞educe unnecessary service duplication and administrative red tape, while continuing to protect patient choice.鈥� It added that it has consulted with sector partners on how to improve the program and has posted regulations for public feedback.

鈥淲e will have more to share about changes to the MedsCheck program in the coming months,鈥� the ministry said.聽

Pharmacists the Star spoke to say there is nothing inherently wrong with performing medication checks. If they are done properly the reviews can be a valuable service and can catch patients taking their medications incorrectly, they said, preventing unintended side effects and hospital visits.聽

However, there is little research in Ontario about whether the MedsCheck program as currently implemented results in better patient outcomes.

The Star asked the health ministry if it had any data showing that MedsCheck reviews keep patients out of hospital or prevent harmful drug interactions. The ministry provided none, saying the Star would have to make a freedom-of-information request to obtain any information it had.聽

One study published five years ago found that older adults who were discharged from hospital and received medication reviews when they had their prescriptions filled had a within 30 days.

In 2023, the World Health Organization deemed medication safety as and pointed to medication reviews as a key area of action.

鈥淚t helps build relationships, it helps build trust, and it also allows us to try to educate the patient in more depth about the medication they鈥檙e taking,鈥� said Kathleen Leach, a pharmacist and owner of independent Sutherland Pharmacy in Hamilton, Ont.聽

Leach said she has performed about 30 MedsCheck reviews a year since the provincial program began in 2007 and has found 鈥渉undreds鈥� of cases where patients had problems with their medications. This, she said, helped prevent visits to the hospital or family doctor and improved patients鈥� quality of life.聽

But, she said, in any kind of quota system 鈥測ou鈥檙e going to choose the low-hanging fruit.鈥�

鈥淚f you figure that three meds is going to take 20 minutes, how much do you think a proper review of 15 meds is going to take?鈥�

Meds checks not useful, doctors say

Several family doctors interviewed for this story said that while MedsCheck reviews may benefit some patients, particularly those recently discharged from hospital and who are on several medications,聽on the whole they are not particularly useful.聽

Dr. Allan Grill, a family doctor and lead physician at the Markham Family Health Team, said he doesn鈥檛 find the checks helpful for his practice because most of the MedsCheck reports he receives 鈥� which can be as long as seven pages 鈥� indicate no concerns.

鈥淪ometimes I鈥檒l have days where I get 10 of these in my inbox and I鈥檝e got to open each one and take a look,鈥� he said. 鈥淓ven though it might only take 10 seconds to sign off, I鈥檓 spending time on things that haven鈥檛 benefited the patient really at all in my opinion, at a time where family physicians are already spending an average of 19 hours a week on administrative duties.鈥�

Grill added he believes there are other places where the tens of millions of dollars spent on the MedsCheck program could be put to better use in Ontario鈥檚 publicly funded health-care system, where resources are limited. These include investing in more access to team-based primary care, increasing staff at emergency departments to prevent closures and funding expensive new cancer drugs, he said.

Markham family physician Shivani Sritharan said she received 52 meds checks in February 2024 alone.聽

鈥淚 also had a patient who declined a med check but yet I still got a fax a day later that a med check was done,鈥� Sritharan said.

鈥淚n theory, the med checks are a good program with good intentions,鈥� she said, 鈥渂ut I think private corporations are finding loopholes for it to be taken advantage of.鈥�