B.C. pharmacists began diagnosing and prescribing medication for minor ailments on Thursday under an expanded scope of practice intended to help those without family doctors and reduce pressure on the health system.
The College of Pharmacists of B.C. said three-quarters of the 4,200 pharmacists who work in communities 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’s a step already taken by other provinces, including Ontario and Alberta.
Previously in B.C., all prescriptions needed to come from a physician or nurse practitioner. Last October, the province allowed pharmacists to administer vaccines and renew prescriptions on a temporary two-year basis, for patients whose family doctors had retired or left their practices.
Now patients who don’t have a family doctor or can’t see their health practitioner in a timely way can make an online appointment as of June 29 — in a system similar to that set up for COVID vaccinations — or walk into a pharmacy for a prescription for any one of 21 ailments.
Health Minister Adrian Dix said this week the new services will free up physicians and nurse practitioners to focus on patients with more complex needs.
The government estimates more than 750,000 patients will use the services in the first year.
Victoria pharmacist Kimberley Myers at Shoppers Drug Mart on Fort Street had yet to prescribe a medication on Thursday afternoon and doubts the demand will be immediate. “It’s not a mad dash by any means,” said Myers. “We’ll just be treating, as needed, people with pink eye or allergies — we’ll just deal with it as it comes.”
Some of the other conditions pharmacists can prescribe medications for include fungal infections, acid reflux, hemorrhoids, cold sores, impetigo, shingles and vaginal yeast infections.
Myers maintains that it isn’t that much different, in terms of workload, from what pharmacists already do in recommending over-the-counter medicines. She imagines the most common request will be from someone running out of birth control or allergy medication, for example.
“You have access to pharmacies a lot faster than you’d be able to get into the emergency or possibly in to see your doctor.”
Pharmacists will follow up with patients with a phone call, asking them to return to the pharmacy.
‘Collaborative approach’
A complicated case would be referred to a doctor, urgent care centre or emergency department. “It’s a collaborative approach,” said Meyers.
“We’re working together with primary care physicians and the health care system. … I think it also just takes a big weight off of our emergency rooms and an already kind of overwhelmed health-care system for things that are common or more simple.”
It’s estimated that close to one million British Columbians do not have a family doctor.
Victoria-based Dr. Joshua Greggain, president of the Doctors of B.C., said he’s hopeful the expanded scope of practice for pharmacists will be effective. “But we also want to be sure that we continue to work with the pharmacists and with the government, as that hasn’t always been the case when we do novel and creative things.”
While the association recognizes pharmacists are the experts in medications and pharmaceuticals, it says the main concerns for physicians are patient safety, ensuring pharmacists are accountable for their diagnosis and prescriptions, and a communication system that in some cases is still reliant on fax machines.
“We still have a siloed health-care system where [electronic] information to date doesn’t talk to each other and so now we have a new team member,” said Greggain. Making sure that information is provided to physicians and specialists, if the patient has one, is important, he said.
All medications dispensed in B.C. are recorded in the PharmaNet system.
“In an ideal world, we will all be able to access the same information at any given time,” said Greggain. “As of June 1, 2023, there is not an 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 sort of information, until we can hopefully get to a place where that information is held centrally.”
Greggain said in terms of patient safety, everyone in the health-care system is aware that any medication comes with risks and any of the 21 conditions could be a sign of a much more serious illness.
“Inevitably, there’s going to be some challenges, some side-effects or some consequences,” said Greggain.
Physicians are most apprehensive about pharmacists prescribing for urinary tract infections or bladder infections without lab testing and a medical history record that might determine which antibiotic will be most effective or help make an accurate diagnosis, said Greggain. Abdominal pain that presents as a urinary tract infection could also be something more serious, such as a kidney infection, ectopic pregnancy or bladder stones.
Quicker path for patients
Suzanne Solven, registrar for the College of Pharmacists of B.C., said there will likely be more patients — most often women — who will benefit from being able to quickly access medication to treat a urinary tract infection that, if left untreated, could spread to the kidneys.
“What we’re hearing from the experiences of the other provinces is actually UTI is the one where most patients were most anxious to see the pharmacist,” said Solven. “I appreciate the concerns from the Doctors of B.C., but I would say, actually, it’s worse if the patient doesn’t get treatment.”
Solven said pharmacists will conduct a full assessment, ask the patient questions — which they do even when recommending over-the-counter medications — and ensure proper follow-up.
Solven said most health-care providers can connect to PharmaNet, with some limitations, but she looks forward to “the day we have one system that provides the complete medical record.”
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