Unclaimed medications are costing Nunavut, says report on pharmacy services

Nunavut faces major problems in the way that pharmaceuticals are distributed,managed and dispensed, according to a newstudy published in the Journal of Pharmaceutical Policy and Practice.

The study looked at how pharmacy services are delivered in a territory that grapples with problems including a shortage of pharmacists, weather-related delays, and language and cultural barriers betweenhealth care providers and the people they serve.

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In Nunavut, 85 per cent of the population are Inuitbeneficiarieswho receivetheir pharmaceuticals at no charge through federal or territorialfunding. But medications areoftennot getting into the hands of patients.

"There's an issue regarding a number of unclaimed medications that are not being picked up at the community health centres," said one of the study's authorsSandra Romain,an anthropology graduate student with theUniversity of Toronto.

She said there are many reasons why medication isn't being picked up, including"not being aware of the reasoning for the medication, difficulties trying to contact the patient,not having a current address and a patient not coming back."

Not only does that compromisepatients' well-being, unclaimed medications are also costly.

"Ultimately they're returned and destroyed, which is a huge loss," said Romain.

No one to talk to aboutside effects

Geographically,Nunavutis Canada's largest territory or province, yet there are only five pharmacies in the region:two inIqaluit, two inRankinInlet and one in Cambridge Bay.Many people Romainspoke to said they would like to have access toa local pharmacist.

"Some participantsI had spoken to had never met their pharmacist, had never spoken to their pharmacist," she said.

"They really would like to have a qualified individual residing in the community that they have discussions with about pharmacy issues, side effects, adverse drug events."

In the hamletsthat don't have a residentpharmacist, most peoplerely on health centre staff for pharmaceutical services oftennurses from outside the territory whodo notspeakInuktitut.Romain said it's difficult for patients to learn about their medication whenthe information is not in a language they understand.

Plans are underway to try and translate "everything from labels on prescriptionbottles, up to information on side effects" into Inuit languages, said Romain.

She said more study is needed to investigate why the pharmaceutical system is failing to meet patient needs in Nunavut and to find out how Nunavummiutfeel about the industry.

Communication barrier

"Definitely there is a communication barrier,"said DonnaMulvey, apharmacist forNunavut'sDepartment of Health.

Mulvey said the departmentis working on ensuring that pharmacies print prescription labels in Inuit languages something for which Nunavut's language commissioner recently called.

Many people inNunavutcan only communicate directlywith a pharmacist byphone, andMulveysaid health centre staff have been instructed to provide access to a phone forany patient who wants to speakto apharmacist.

"We're basically open to ideas and we're always looking at ways to improve our communication and our care of patients in any way that we can," saidMulvey.

Mulvey, who has onlybeen on the job for three months, recognizes the staff shortage as well.

"At the moment I'm the only pharmacist on staff with the Government of Nunavut," she said.

"There is a shortage of pharmacists and that's nationwide."

She's trying to fix thatbyrecruiting at least one other pharmacistto work in the territory.

Mulvey also said, to address weather-related delays,the territory maintains a higher inventory level than other jurisdictions in Canada, with each health centre being stocked with a two-weeksupply of essential medication.

"Pain medication, antibiotics there's a whole variety of medicationsit's very difficult to predict what the demand would be, so those are usually the ones that we're scrambling," said Mulvey.

But stockpiling medication also results in a higher volume of expired medication, which comes at a financial cost.

"We do the best that we can to get what these patients need out to them as soon as possible."