Alberta pharmacists lead Canada in filling care gap
Ontario pharmacists, like most in Canada, can now prescribe for minor conditions
UPDATE | May 17, 2024:
Last October, Ontario expanded the number of conditions for which pharmacists can write prescriptions, and earlier this year, the Alberta government announced an expansion of private pharmacy clinics across the province as a significant relief valve for family doctors and emergency rooms under strain.
Original story, published April 8, 2023, appears below:
As many Canadians struggle to find a family doctor — or even a walk-in clinic — pharmacists in some provinces are stepping up to dispense remedies for minor ailments without the need for a doctor.
Ontario is the latest province to empower pharmacists to prescribe for medical issues such as urinary tract infections, shingles and eczema. Pharmacists in Ontario were granted rights to prescribe in January of this year.
Most other provinces have granted similar rights to pharmacists over the last five years.
However, Alberta pharmacists have been able to prescribe since 2006, and have the most comprehensive authority of any province or territory in Canada. Pharmacists in Alberta can prescribe almost any medication except narcotics, and provide a useful test case for the rest of the country.
Alberta's graduated system
Medi-Drugs Mill Creek Pharmacy in Edmonton resembles a doctor's office more than it does a drugstore, with its waiting room and examination room filled with diagnostic equipment.
Dylan Moulton has been working as a prescribing pharmacist at the store since 2019. He estimates he's renewed or modified doctor's prescriptions for 90 per cent or more of his patients. But beyond modifying, where he may adjust dosing or find an equivalent replacement drug for one that's not available, he also writes new prescriptions after assessing patient illnesses.
"There are huge issues in Alberta accessing physician care," he told White Coat, Black Art host Dr. Brian Goldman. "It's just an overwhelmed system right now."
Moulton estimates that he's written "initial access prescriptions" — which pharmacists there can write without consulting a doctor first — for about 15 to 20 per cent of his patients.
But not all pharmacists in Alberta are permitted to write those initial access prescriptions. Before being allowed to do so, they must be granted additional prescribing authorization, which is only given after practising for at least a year. A pharmacist must then submit a formal application to demonstrate competence, which is peer-reviewed and evaluated.
"I can prescribe any [non-narcotic] product that I want to prescribe and more importantly, that I feel competent prescribing," Moulton said.
He acknowledges that there are limitations to his ability to diagnose. One patient, Kelly Carter, said she came in with what she thought was a urinary tract infection. Moulton sent her for urinalysis, prescribed antibiotics, telling her to follow up in several days with a Telehealth doctor.
"But I did get more pain and I went to urgent care," Carter told Goldman. It turned out that Carter had a ruptured appendix. She spent nine days in hospital after surgery.
Moulton said Carter's case highlights some of the limitations Alberta pharmacists face, particularly when it comes to sending patients for further diagnostic tests. "And that's where we lose the capacity because we don't have the ability to order those things. And in all honesty, we're not necessarily trained to assess them either. So that's usually a situation where I would have referred [to a doctor]," Moulton said of Carter's case.
Some doctors in Ontario have expressed concern that pharmacists don't have the necessary skills to properly diagnose potentially dangerous conditions. Another pharmacist has argued that their time would be better spent relieving doctors of managing chronic conditions rather than being primary care providers treating acute medical conditions for which they aren't trained.
Nese Yuksel, one of the first pharmacists in Alberta to be granted permission to prescribe, understands physicians' concerns. "We wouldn't say we do a medical diagnosis, but we do all the assessment to provide some approach, some conclusion, to be able to make some decisions about what to do," she said.
So far, about 60 per cent of practising pharmacists in Alberta have been granted additional prescribing authorization, she said.
"So I think that we do provide a very important role for some of those maybe non-complex patients, and pharmacists are doing this every day."
A recent survey by the MAP Centre for Urban Health Solutions suggested that some 6.5 million Canadians don't have access to primary care with either a doctor or nurse practitioner.
Yuksel said Alberta's experience demonstrates that pharmacists can fill an urgent need. "I know a lot of patients don't have physicians, so if they can see someone to even ask their questions, then why not ask the pharmacist who could potentially refer on and maybe make sure that they get that help," she said.
"Otherwise, they may not ever ask those questions and they may not get screened for specific things or they may deal with a symptom and just leave it."
WATCH | Pharmacists say they could relieve strain on ERs:
Kelly Carter said she has no regrets seeing her pharmacist as a primary care provider.
"I was desperate because I didn't have a doctor to go to and I didn't want to go sit for hours and hours in pain [in an emergency waiting room]."
Produced by Amina Zafar
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