Atlantic Canadian pharmacists push for public funding of minor ailment treatment

The COVID-19 pandemic highlighted the value of pharmacies in the health-care system, but they can do even more to help ease the burden on Atlantic Canada's hospitals, say pharmacists across the region.

Pharmacists in Atlantic Canada have the ability to assess and treat more than 30 minor ailments, including cold sores, nausea, minor sleep disorders and nicotine dependence.

But if someone chooses to seek care at a pharmacy instead of a doctor's office or walk-in clinic, it typically comes with an out-of-pocket cost of about $25.

With lengthy emergency room wait times across Atlantic Canada and a family doctor shortage, pharmacist associations are advocating for public funding so their members can treat ailments within their scope of care.

They said they would also would like to see pharmacists take on a larger role in chronic-care management, particularly for people with diabetes or hypertension.

"It's an opportunity for the system to be more efficient and deliver care where people are at," Pharmacy Association of Nova Scotia CEO Allison Bodnar said in a recent interview.

"COVID has shone a light on the health-care centre that pharmacies are and the role pharmacy teams play beyond the important role of dispensing medication," she said.

About 1.35 million COVID-19 shots have been administered in Nova Scotia's pharmacies, which remained open alongside emergency rooms when other health centres -- like walk-in clinics and family doctors' offices -- shuttered during the early part of the pandemic in 2020.

Prescription renewals in Nova Scotia pharmacies started to be covered by the province in 2020, as did assessments and
prescriptions for uncomplicated urinary tract infections and for birth control.

That regulatory change kept some 40,000 people out of emergency rooms and walk-in clinics, Bodnar said. That same year, pharmacists did "several hundred thousand" prescription renewals, she added.

In January, neighbouring New Brunswick added UTIs and prescription renewals to its list of pharmacy services covered by the province. Newfoundland and Labrador's pharmacists are funded to renew some prescriptions and Prince Edward Island pharmacists are covered to treat UTIs.

"We know that right across the region, there are shortages of nurses and shortages of physicians," Erin Mackenzie, executive director of the Prince Edward Island Pharmacists Association, said in a recent interview.

"I think we need to use every health-care provider within the system, including pharmacists, to their full scope and potential. Human resources are very precious right now."

There are about 23,000 Prince Edward Islanders on waiting lists for family doctors. In Nova Scotia, nearly 86,000 residents are on the provincial doctor wait-list, and in New Brunswick, there are about 40,000. Newfoundland and Labrador has the largest group in need of primary care, with 98,000 on its wait-list.

Kara O'Keefe, a pharmacist in Bell Island, N.L., said that given the number of people in need of care in Newfoundland and Labrador, it's irresponsible for the provincial government not to fund pharmacists to treat minor ailments.

"We have this list of minor ailments because these are things that we know a pharmacist is trained to assess for," O'Keefe said in a recent interview. "There should be no difference between the assessment you're going to get from a physician and from a pharmacist or a nurse practitioner.

"Roughly 20 per cent of people across the province do not have a primary care provider, and there's a lot more that pharmacists could be doing to help relieve that burden," she said.

O'Keefe, Mackenzie, Bodnar and New Brunswick Pharmacists' Association executive director Jake Reid all said they would like to see pharmacists take on chronic-care management for people with diabetes or hypertension.

A 2017 report from the Canadian Pharmacists Journal found that treating hypertension in pharmacies
improves patients' outcomes and would save $15.7 billion across Canada over a 30-year span.

"It just makes a lot of sense" for some monitoring and care to happen at the pharmacy, Reid said in an interview.

"A person with diabetes may see the doctor a few times a year, but they might see their pharmacist every month."

Halifax physician Dr. Leisha Hawker said doctors support pharmacists having an expanded role in the health-care system, but she said some concerns arise when pharmacists take on more responsibilities.

"When patients get care at a walk-in or emerge (emergency room) or a private virtual walk-in, we don't always get the records in a timely way," Hawker said in a recent interview.

Patients treated elsewhere often don't know what they were prescribed or tested for, she said, "so we have to go and hunt that down, it's just fragmented. And it increases the administrative burden on the physician."

Nova Scotia's unfinished One Person One Record would likely solve this, Hawker said, but there's no timeline for when this medical record system, first announced in 2015, will be in place.

And while the majority of minor ailments treated by pharmacists are paid for out of pocket, Hawker said she worries about the "potential inequity in access."

"It essentially creates a two-tiered system," she said.