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Unclaimed medications are costing Nunavut, says report on pharmacy services

A new study says Nunavut faces major problems in the way that pharmaceuticals are distributed, managed and dispensed.

Study finds some patients have never met or spoken to their pharmacist

A staffer inside the pharmacy at the Qikiqtani General Hospital in Iqaluit. A recent study found that Nunavut faces major problems in the way that pharmaceuticals are distributed, managed and dispensed. (Government of Nunavut)

Nunavut faces major problems in the way that pharmaceuticals are distributed, managed and dispensed, according to a new study 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 between health care providers and the people they serve.

In Nunavut, 85 per cent of the population are Inuit beneficiaries who receive their pharmaceuticals at no charge through federal or territorial funding. But medications are often not getting into the hands of patients.

'Some participants I had spoken to had never met their pharmacist,' says the study's author. (iStock)
"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 authors Sandra Romain, an anthropology graduate student with the University 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 compromise patients' 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 about side effects

Geographically, Nunavut is Canada's largest territory or province, yet there are only five pharmacies in the region: two in Iqaluit, two in Rankin Inlet and one in Cambridge Bay. Many people Romain spoke to said they would like to have access to a local pharmacist.

"Some participants I 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."

The study also recommends translating prescription labels into Inuit languages, something Nunavut's languages commissioner has also called for. (iStock)
In the hamlets that don't have a resident pharmacist, most people rely on health centre staff for pharmaceutical services — often nurses from outside the territory who do not speak Inuktitut. Romain said it's difficult for patients to learn about their medication when the information is not in a language they understand. 

Plans are underway to try and translate "everything from labels on prescription bottles, 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 Nunavummiut feel about the industry.

Communication barrier

"Definitely there is a communication barrier," said Donna Mulvey, a pharmacist for Nunavut's Department of Health.

'There is a shortage of pharmacists and that’s nationwide,' says Donna Mulvey, the pharmacist for Nunavut’s department of health who has been on the job for only three months. (Radio-Canada)
Mulvey said the department is working on ensuring that pharmacies print prescription labels in Inuit languages — something for which Nunavut's language commissioner recently called.

Many people in Nunavut can only communicate directly with a pharmacist by phone, and Mulvey said health centre staff have been instructed to provide access to a phone for any patient who wants to speak to a pharmacist.

"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," said Mulvey.

Mulvey, who has only been 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 that by recruiting at least one other pharmacist to 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-week supply of essential medication.

"Pain medication, antibiotics — there's a whole variety of medications — it'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."

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