Pharmacists want to prescribe medication for more minor ailments

At a drugstore in downtown Toronto recently, pharmacist Michael Demian was doing what he typically does on any given day — dispensing health care advice to a regular customer. On this day, it was about how to treat a stubborn skin rash.

The customer, 71-year-old Brian Rhodes, was also picking up a refill of a prescription to treat his allergies. He says he appreciates the advice he gets, and the quick and easy convenience of coming here.

"They are strategically placed in our communities, they're close by, and they have capabilities that go well beyond what we are using them for," Rhodes says of his pharmacist.

Demian, a pharmacist for nine years agrees. "All of the pharmacists I know in my graduating class always say how we don't use what we learned in school. I think pharmacists are just excited for the opportunity to use more of our education and help our patients, besides, here's your prescription, here's how to take it."

But that may be about to change as pharmacists across Canada are stepping up and into a bigger role in health care. From prescribing birth control to providing instant strep throat tests, they're taking over the care of minor ailments from an overtaxed system.  

Relieving stress on health-care system

"To see a physician, the wait times are very long," says Nardine Nakhla, a community pharmacist, and professor at the School of Pharmacy at the University of Waterloo. "To go to your ER, you're waiting a long time as well. So we're hoping to relieve some of the stress on that formal health-care system by diverting some patients to access some of our services in the pharmacy, rather than maybe their traditional physicians or urgent care or emergency departments.

For now, what pharmacists in Ontario can do is limited. "We currently can extend prescriptions. We're able to refill prescriptions that don't have any refills for a certain period of time. We're able to do flu shots and certain immunizations — that came a few years ago. And that's pretty much it," says Demian.

He says pharmacists in Ontario can also renew medication for chronic conditions like high blood pressure and cholesterol. 

The Minor Ailments Advisory Group will be providing guidance and making recommendations to the Ontario College of Pharmacists who will then submit draft regulations to the provincial government.They hope to have the additional powers by summer.

Across Canada, the scope of what pharmacists can and can't do depends on where you live. For example, in Nova Scotia they can prescribe for minor ailments like acne and cold sores. British Columbian pharmacists can give strep throat tests. Saskatchewan pharmacists can prescribe birth control and bladder infection medication.  In Alberta, they can authorize antibiotics.

Alberta has been at the forefront when it comes to additional prescribing authority, says Stony Plain, Alta., pharmacist Carlene Oleksyn. She's been assessing minor ailments for the past seven years. It's in the best interest of patients, she says.

"It really is working collaboratively with our physician colleagues because we can take care of the minor things that don't require a physical assessment by the physician and then we can prescribe if necessary for that patient."

Most doctors agree treating patients with chronic illnesses like high blood pressure is well suited for pharmacists. But some are worried, calling it a slippery slope. They say if pharmacists do more diagnosing, mistakes can happen. 

Doctors push back

"There is some potential risk," says Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta.

"Some things are really not suited to be done in a pharmacy. I think the skills of a pharmacist are really strongest in therapeutics. In medicine, we spend a lot of time learning how to diagnose and treat common illnesses. A big part of that is figuring out when a common illness is actually an uncommon manifestation of something dangerous. That depth is something that would be hard to replicate in a community pharmacy and with the training that people have."

She says what would be helpful is some form of evaluating the impact of the changes that have already happened in the provinces where pharmacists have had additional prescribing authority.

But School of Pharmacy's Nakhla believes doctors and pharmacists can collaborate. "This is in no way shape or form stepping on physicians' toes. We want to optimize patients' outcomes and that's what were here to do. And if it can free up the system a little bit more and help remove some of that stress or burden on the system, then, we're here for them."