The changing the scope of practice for pharmacists
Neveen Abdelsayed, BSc.Phm.,RPh.,CDE
Elaine McKenzie, BSP, MBA
Source: Perspective – Winter 2013 by TELUS Health
Plan sponsors in Ontario may have heard that in October 2012, the Ontario government approved regulations to allow pharmacists to offer more services to Ontarians.1
The most visible change in Ontario is certain stores have specially trained pharmacists who may now administer the publicly funded flu vaccine as part of Ontario’s Universal Influenza Immunization Program (UIIP). This provides employees additional choice in where and when to get the flu shot.
Is this unique to Ontario?
While new to Ontario, pharmacists in British Columbia, Alberta and New Brunswick are already providing this service in these provinces.
What might this mean to plan sponsors?
Employees get protection from the flu – the province pays the pharmacist fee and the cost of the vaccine in Ontario and Alberta, with
no additional cost to the employers.
But flu vaccination is just one of the new services pharmacists are now offering across Canada.
Do certain employees have chronic medical conditions such as diabetes, asthma or high blood pressure? Encouraging those employees to have an annual medication review can help them optimize their health outcomes and help ensure the drug benefit that plan sponsors support is providing value for both the plan sponsor and member. While the scope of the medication review varies across Ontario, Alberta, British Columbia and Saskatchewan, individuals with chronic medical conditions may meet with their pharmacist annually to review their medications, gain a better understanding of the medication treatment and ensure they are using the right medicines in the right way. This service is funded by the province, regardless of the employee’s private coverage status.
What other services are pharmacists providing to employees?
Table 1: Summary of Pharmacists’ Expanded Scope of Practice Activities across Canada2
These services can support employees in a variety of ways. For example:
- Emergency prescription refills and renewing existing prescriptions – the pharmacist can now renew the prescription for the child whose asthma prescription has run out in the evening or the employee who needs to renew their prescription for a blood pressure medication before a business trip. There is no delay awaiting a visit to the physician or leaving work to make a visit to the walk-in medical clinic.
Specifically, a pharmacist can now authorize refills of a quantity of a drug that is the lesser of:
a. The quantity that was originally prescribed, including any refills that were authorized by the original prescriber; or
b. A six month’s supply.
- Administer a drug by injection – the pharmacist can help the patient administer and / or administer the injection minimizing the need for an additional visit to the physician office during office hours with time off work.
- Therapeutic substitution – when the pharmacist identifies a potential drug-related problem, they may recommend to the physician a change in the prescription. The decision to change or not change the prescription is in collaboration with the physician. The pharmacist recommendation must be to improve patient outcomes not to implement Maximum Allowable Cost pricing or switch patients to a 2nd line vs. 1st line therapy.
- Minor ailment prescribing – where approved, the pharmacist may initiate treatment for a minor ailment such as minor acne, cold sores or allergic rhinitis. Treatment can be initiated eliminating the need for a physician visit.
Alberta is the most advanced in the implementation of expanded pharmacist services and the Alberta government funds the full range of pharmacist services for all residents. In Ontario, the compensation model has not yet been developed. With the exception of the flu shot, today pharmacies may charge a minimal fee for the services.2
Why should plan sponsors show interest in pharmacist services?
Change is needed to ensure Canadian healthcare remains sustainable for the future. Provincial governments across the country are looking to improve access to health care, improve health care through greater inter-professional collaboration and communication, optimize the contribution of all health care professionals and enable individuals to take a more active role in their own healthcare through prevention and management of chronic disease.
Optimizing the safe and effective use of drugs is essential to avoid the costs of adverse drug reactions and the long-term costs of suboptimal care. The World Health Organization has stated: “Public health interventions, pharmaceutical care, rational medicine use and effective medicines supply management are key components of an accessible, sustainable, affordable and equitable health care system which ensures the efficacy, safety and quality of medicines. It is clear that pharmacy has an important role to play in the health
sector reform process. To do so, however, the role of pharmacists needs to be redefined and reoriented”.3