BC pharmacists on Thursday began diagnosing and prescribing medications for minor ailments as part of an expanded scope of practice intended to help those without a GP and reduce strain on the health care system.
The College of Pharmacists of BC said three-quarters of 4,200 community pharmacists have completed a 40-minute online training that allows them to prescribe medications for 21 minor ailments — from acne to urinary tract infections — as well as contraception. . It is a step already taken by other provinces, including Ontario and Alberta.
Previously in BC, all prescriptions had to come from a doctor or nurse practitioner. Last October, the province allowed pharmacists to administer vaccines and refill prescriptions on a temporary two-year basis, for patients whose GPs had retired or left the practice.
Now patients who don’t have a GP or can’t see their doctor in a timely manner can make an appointment online starting June 29 – in a system similar to the one set up for COVID vaccinations – or walk into a pharmacy for a prescription for any of 21 ailments.
Health Minister Adrian Dix said this week the new services would allow doctors and nurses to focus on patients with more complex needs.
The government estimates that more than 750,000 patients will use the services in the first year.
Victoria’s pharmacist Kimberley Myers at Fort Street’s Shoppers Drug Mart had yet to prescribe a drug Thursday afternoon and doubts the prompt will be immediate. “It’s not a wild ride at all,” Myers said. “We will only treat, as needed, people with pink eye or allergies – we will only deal with what comes along.”
Some of the other conditions that pharmacists may prescribe medications for include fungal infections, acid reflux, hemorrhoids, cold sores, impetigo, shingles, and vaginal yeast infections.
Myers says it’s not much different, in terms of workload, from what pharmacists already do when recommending over-the-counter drugs. He figures the most common request will come from someone running low on birth control or allergy medication, for example.
“You have access to pharmacies much faster than you would be able to go in for an emergency or possibly to see your doctor.”
Pharmacists will follow up patients with a phone call, asking them to return to the pharmacy.
A complicated case would be referred to a doctor, urgent care center, or emergency room. “It’s a collaborative approach,” Meyers said.
“We are collaborating with general practitioners and the health system. … I think it also takes a huge burden off our emergency rooms and an already overwhelmed healthcare system for common or simpler things.
It is estimated that nearly one million British Columbians do not have a GP.
Dr Joshua Greggain, president of the Victoria-based Doctors of BC, said he hoped the practice extension for pharmacists would be effective. “But we also want to make sure we continue to work with pharmacists and with the government, as this hasn’t always been the case when we do new and creative things.”
While the association recognizes that pharmacists are the experts in drugs and pharmaceuticals, it says the primary concerns for physicians are patient safety, ensuring pharmacists are accountable for their diagnoses and prescriptions, and a reporting system that in some cases it still depends on the faxes.
“We still have an isolated health system where [electronic] the information to date does not communicate with each other and so we now have a new team member,” said Greggain. Making sure information is provided to doctors and specialists, if the patient has one, is important, she said.
All drugs dispensed in BC are registered in the PharmaNet system.
“In an ideal world, we would all be able to access the same information at any time,” Greggain said. “As of June 1, 2023, there is no integrated system and so we will have to, I believe, rely on older technology that exists a lot right now, which includes faxes and e-faxes and that kind of information, until we hopes it can get to a place where that information is held centrally.
Greggain said that in terms of patient safety, everyone in the healthcare system is aware that any drug carries risks and that any of the 21 conditions could be a sign of a much more serious illness.
“Inevitably, there are going to be some challenges, some side effects or some consequences,” Greggain said.
Doctors are very concerned about pharmacists prescribing for UTIs or bladder infections without lab tests and a medical record that could determine which antibiotic will be most effective or help make an accurate diagnosis, Greggain said. Abdominal pain that presents as a urinary tract infection could also be something more serious, such as a kidney infection, an ectopic pregnancy, or bladder stones.
Faster path for patients
Suzanne Solven, chancellor of the College of Pharmacists of BC, said there will likely be more patients, most often women, who will benefit from being able to quickly access medications to treat a urinary tract infection that, if left untreated, could spread to the kidneys.
“What we’re hearing from the experiences of other provinces is actually the UTI where most patients were most anxious to see the pharmacist,” Solven said. “I appreciate the concerns of BC’s doctors, but I would say that, in fact, it’s worse if the patient doesn’t get treatment.”
Solven said pharmacists will conduct a thorough evaluation, ask the patient questions — which they also do when recommending over-the-counter medications — and ensure adequate follow-up.
Solven said most healthcare professionals can connect to PharmaNet, with some limitations, but he looks forward to “the day when we have a system that provides the complete medical record.”
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