Netcare contains a wealth of information that can assist pharmacists when they assess patients, including medication history, immunization history, laboratory values, diagnostic imaging, and medical reports. Checking Netcare is a cornerstone of the patient assessment, care plan, and follow-up processes.
The ACP Vital to Chat, Check, and Chart tool card provides clarity and advice on accessing Netcare as a part of a patient assessment.
When patients require medication, ACP’s expectation is that pharmacists will review Netcare data as part of their assessment of the patient to help determine a medication’s appropriateness and safety. This review is especially important with drugs that can cause harm and are associated with substance use disorder.
The TPP Alberta program at the College of Physicians and Surgeons of Alberta (CPSA) recently brought a situation to the attention of ACP. A physician had called TPP Alberta after they routinely checked a patient’s Netcare profile and noticed numerous different pharmacies had dispensed the same medication to the same patient before the previous quantity of medication was to have been completed. These dispensing events involved multiple prescribers. Over the course of a 39-day period, 210 tablets of various strengths of Vyvanse® were dispensed to the patient on seven separate occasions from seven different pharmacies from prescriptions written by six different prescribers.
During this same 39-day period, it was noted that the patient was dispensed 58 Dexedrine® 15mg capsules prescribed by two additional prescribers at two additional pharmacies.
While neither lisdexamfetamine nor dextroamphetamine are monitored by TPP Alberta, they both have the potential for diversion and inappropriate use by individuals for reasons other than which they were prescribed.
Pharmacists who identify patients who are at risk of substance use disorder should collaborate with the prescriber and other health care professionals involved in the care of the patient to determine the best course of action.
In the case above, at least 19 different health professionals had the opportunity to review this individual’s Netcare profile and identify the poly-prescriber, poly-pharmacy issue and the possible drug-related problems associated with the patient’s apparent overuse of the medication.
More information on the non-medical use of stimulants and the associated harms can be found on the Canadian Centre on Substance Use and Addiction webpage.