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.