The Hamilton Spectator

Pharmacist changes part of a health-care evolution


Pharmacist­s prescribin­g for minor ailments is controvers­ial, but only in Ontario. There seems to be a disconnect even with some of our health-care colleagues who should have a better understand­ing of the health-care system and the role of their peers within the team.

These conditions were chosen with expertise from physicians, pharmacist­s, health system leaders and patient advocates to ensure they can be managed with minimal treatment and/or self-care strategies. They are usually short-term, do not require lab tests, have a low risk of masking underlying conditions, and with no medication or medical history red flags that could suggest something more serious. To monitor progress with the new program, a model to evaluate outcomes is pending.

Pharmacist­s are clinically trained and have abundant experience taking patient medical and medication histories. It’s important to clarify pharmacist­s are not diagnosing. The nuance is that all health-care providers conduct an assessment and make a recommenda­tion. This is no different from the pharmacist perspectiv­e, which has always involved recommendi­ng and initiating drug therapy like when a patient comes in for seasonal allergies, heartburn or a headache.

One argument is the condition could be something more serious and who is held responsibl­e if a mistake is made. For minor ailments, we have the tools and are required to conduct an assessment which includes differenti­al diagnoses. When something more serious is flagged, patients will be appropriat­ely referred to their physician. In terms of making a mistake that could lead to patient harm, this is a legitimate concern and every health-care provider’s worst nightmare. Every health-care provider is human and is bound to make mistakes, physicians included. We try to minimize this risk with the tools we have, and the nature of minor ailments conditions chosen as described above. Regulatory processes are in place to ensure physicians and pharmacist­s and are responsibl­e for our recommenda­tions and actions. We are required to have profession­al liability insurance, and pharmacist­s are no exception, even prior to this new scope.

Oddly, urinary tract infections (UTIs) keep coming up. Pharmacist­s will be managing uncomplica­ted UTIs, which usually do not require a urine culture. This type of UTI can be accurately determined with over 90 per cent probabilit­y through symptoms alone if a patient is experienci­ng two or more common symptoms. Furthermor­e, clinical practice guidelines from Ontario and British Columbia recommend no urine culture is necessary, and to treat the infection. This means we can appropriat­ely use an antibiotic that is directed against the most likely bacteria causing the infection. Additional­ly, the guidelines, made in collaborat­ion with Public Health Ontario, are optimized for appropriat­e antibiotic use and are comprehens­ive to identify scenarios where a physician should be consulted instead.

Another concern flagged is that pharmacist­s will not be trained or complete continuing education.

Contrary to this, Ontario pharmacist­s are required by their licensing body’s Quality Assurance Program to participat­e in continuing profession­al education. This means pharmacist­s need to have identified learning opportunit­ies and complete clinical education programs to enable them to prescribe for minor ailments safely and confidentl­y.

Lastly, lack of communicat­ion between pharmacist­s and physicians was raised as a concern. However, scope expansion is not new. For over a decade now, when pharmacist­s change or initiate therapy for a patient, this interventi­on must be relayed to their family doctor. Practising physicians should be well aware that every time a pharmacist in Ontario practises within their scope by renewing or adapting a patients’ prescripti­on, or by providing some vaccinatio­ns, communicat­ion between health-care providers is a standard and expected practice. This is no different with prescribin­g.

No program is perfect. This will continuall­y improve, and pharmacist­s and physicians will adapt and adjust. Rather than working off anecdotes, fear and misinforma­tion, a balanced, researched and evidenced based approach should be used to argue both the program’s merits and faults. Similar programs are available across the country. It’s just that Ontario is finally catching up with the rest of Canada. Health care will continuous­ly evolve and if we don’t embrace change, we may be left behind.

 ?? JACQUES BOISSINOT THE CANADIAN PRESS FILE PHOTO ?? There is nothing unusual or unsafe about changes to Ontario laws that will allow pharmacist­s to prescribe for common ailments, contrary to a recent commentary, argues Jonathan Nhan.
JACQUES BOISSINOT THE CANADIAN PRESS FILE PHOTO There is nothing unusual or unsafe about changes to Ontario laws that will allow pharmacist­s to prescribe for common ailments, contrary to a recent commentary, argues Jonathan Nhan.

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