‘We need it now’: Ontario pharmacists say plan to let them prescribe drugs doesn’t go far enough

Starting next year, pharmacists in Ontario will be able to assess and prescribe drugs for minor ailments, but some are calling on the province to expand that list and make the changes sooner to alleviate some of the pressure on the health system.

Justin Bates, CEO of the Ontario Pharmacists Association (OPA), says the changes are a good first step, but he would like to see more services added.

« We need to expand it. Ontario is taking a very cautious approach with only 13 conditions, » Bates told CBC News.

« Some provinces allow pharmacists to prescribe all drugs except narcotics and controlled substances. »

The Ford government is set to expand the scope of practice for pharmacists in January 2023. The list of 13 little ailments they may prescribe medication for pink eyes, urinary tract infections, and allergic rashes. While pharmacists welcome the news, they say more can be done to add capacity to an already strained system.

Since the start of the pandemic, pharmacists have performed COVID-19 tests and administered vaccines.

Kyro Maseh, a pharmacist at an east Toronto drugstore, says while he’s happy to see the changes, they should start « too late. »

« We need it now, » Maseh said.

« That should include other minor ailments; we shouldn’t have to go through all this trouble just to give this patient something for their osteoporosis that could potentially prevent a fracture. »

The changes would apply under the following conditions:

• Allergic rhinitis.
• Candida stomatitis (oral thrush).
• Conjunctivitis (bacterial, allergic and viral).
• Dermatitis (atopic, eczema, allergic and contact).
• Dysmenorrhea.
• Gastroesophageal reflux.
• Hemorrhoids.
• Herpes labialis (herpes labialis).
• Impetigo.
• Insect bites and hives (hives).
• Tick ​​bites, post-exposure prophylaxis to prevent Lyme disease.
• Musculoskeletal sprains and strains.
• Urinary tract infections.

All of the above conditions are short-term conditions that do not require lab results and are low risk to treat.

But Maseh says antiviral treatment for shingles should be included.

« I see it, it’s in front of me and I can’t do anything about it, » he said.

He says the same goes for Paxlovid, an often-prescribed antiviral drug for COVID-19 that requires a doctor’s prescription. The OPA says pharmacists should also be able to prescribe it.

Maseh says that since it must be administered within the first five days of the onset of COVID-19 symptoms, having to get a doctor’s prescription for Paxlovid wastes valuable time.

« It consumes system resources as a whole and as a result, we all suffer from it. »

Another challenge is not having a unified electronic health record, Bates says, « so we don’t have issues with repeat hospital visits. »

Bates says the lack of a unified record often leads to miscommunication between hospitals and pharmacies. He says this can lead to errors that force patients to be readmitted to hospital shortly after discharge.

Expanding services reduces ER visits, study finds

A study from the University of Toronto seems to support Bates’ claims.

Research found that nearly 35% of preventable emergency room visits could be managed by pharmacists prescribing for common or minor health conditions.

Pharmacists should be able to help fill these gaps in care, says Lisa Dolovich, dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto. She says research shows that when pharmacists are able to review prescribed medications with patients, they can identify and resolve potential problems before they arise.

“If people have been discharged from hospital and are being reviewed by their community pharmacist, it actually helps prevent them from being readmitted to hospital in a short period of time. “, said Dolovich.

“We have 17,000 pharmacists in Ontario, we have over 5,000 technicians, we have over 1,500 pharmacy students. So that’s quite a number of people who we think can be part of the solution.

Pharmacists are an essential part of health care: province

The Ministry of Health has confirmed to CBC News the regulatory changes that will allow Ontario pharmacists, students and trainees to prescribe drugs for listed conditions.

“Pharmacists, through their formal training and education, possess deep knowledge and strong clinical skills that are an essential part of the health care system,” a ministry spokesperson said in a statement.

« The changes that have been made to pharmacists’ scope of practice will provide more convenience and choice for patients in obtaining health care services. »

But Bates warns patients will have to pay for the services and says they should be publicly funded.

“Your socioeconomic status should not determine whether you can access services if we are really going to add capacity and create more access across the system,” he said.

« We cannot avoid the realities that costs are rising everywhere, patients and the public and health care providers. »