Making the case for pharmacists’ expanded scope of practice in BC

“My family doctor has retired and I can’t find anyone to renew my medications”  

“I have been calling all day to get an appointment with my doctor and I can’t get through”

“The online virtual clinics are all booked up for months”

As I sit down to write this article, I reflect on my daily experiences as a community pharmacist here in Victoria, BC. On a regular basis, I hear the struggles and frustrations from patients navigating the current healthcare system. From simple things like getting renewals of their medications, to obtaining proper treatment for their chronic disease, patients are finding it increasingly difficult to receive proper care in a timely manner. This became evident to the residents of Victoria when an elderly citizen was forced to take out an ad in the local newspaper to request medication renewals by any physician⁴.

Victoria’s aging population puts a high demand on our healthcare system and the lack of family physicians further stretches this already thin system. There are an estimated 100,000 people in Victoria without a family doctor, and with the closing of many clinics in the past year, many more patients are struggling to find routine care.

All parts of Canada are facing similar healthcare issues, such as: a shortage of family physicians, overworked healthcare professionals, staffing shortages, an aging population, limited resources and so on; yet all provinces except BC are tackling these issues by better utilizing their other healthcare professionals.

In particular, other provinces have done this is by planning the expansion of pharmacists’ scope of practice, which enables pharmacists to provide timely routine care that improves patient outcomes and reduces burden to their healthcare system. For example, effective January 2023, Ontario pharmacists will be able to prescribe and treat for minor ailments², which will reduce unnecessary visits to urgent care. In Nova Scotia, where pharmacists already have an expanded scope, they are working collaboratively with nurse practitioners in walk-in clinic settings.³ This team-based approach will further help to improve patient care. Alberta, a province that has implemented a full scope of practice for pharmacists for over a decade, has now taken an even bolder step by opening a walk-in clinic led by pharmacists only⁵; this will improve access and continuity of care for many of their patients. Therefore, it begs the question: why has British Columbia not moved forward like all other provinces (and Yukon) by legally expanding pharmacists’ scope of practice?

Pharmacists are the most accessible healthcare professionals in the community and they are trained to assess and optimize drug therapy. However, BC pharmacists are underutilized as a result of the limited scope of practice currently in place in BC. Expanding pharmacists’ scope of practice will allow easier access to effective and safe care for the public, optimized drug therapy which will lead to better outcome for patients, reduced burden to the healthcare system and ultimately save healthcare costs. Therefore, fully utilizing pharmacists’ training by expanding their scope of practice similarly to other Canadian provinces should be an obvious solution for the province of British Columbia.

Currently, 1 in 5 British Columbians is without a family physician. Even those lucky enough to have a family physician are still finding it difficult to access them in a timely fashion. There are approximately 6,700 licensed pharmacists practicing in BC⁶, with the majority of them working in community pharmacies⁶. Community pharmacies are highly accessible with much longer hours of operation than most medical clinics. Therefore, with an expanded scope of practice for pharmacists, patients would have better access to routine care and minor ailments such as mild acne, oral thrush and uncomplicated urinary tract infections (UTIs) to just name a few. The expansion of scope to allow pharmacists to treat for minor ailments across other provinces has found success. A Saskatchewan study found that minor ailment conditions treated by pharmacists improved the condition by 80.8%⁷. Another study found that 94.5% of patients being treated for UTI by pharmacists had reached clinical cure with adverse drug of reaction being transient GI reported in 7% of the patients ⁸. Therefore, by providing pharmacists with an expanded scope of practice in BC, it will improve access to effective and safe care for British Columbians.

Pharmacists are highly trained and skilled medication experts. Their clinical role includes assessing and optimizing drug therapy to achieve the best health outcomes for their patients. Pharmacists across Canada have stepped up throughout this pandemic to keep their communities safe, which in turn has further increased public’s trust and reliance for obtaining care through their pharmacy teams. An expanded scope of practice that would allow pharmacists to prescribe medications independently will result in better patient outcomes and reduce pressure on the healthcare system. There is “a growing body of research on pharmacist prescribing [that] has captured the early impact of prescribing on patient outcome”¹². A study found that pharmacists prescribing resulted in a clinically important and statistically significant reduction in blood pressure (BP) and a “substantial improvement in the proportion of patients with initially uncontrolled hypertension reaching their target BP” ⁹. Another Alberta study evaluating the impact of pharmacist in treating patients with dyslipidemia found that pharmacist prescribing and follow up resulted in greater than 2-fold reduction in LDL cholesterol¹⁰. Yet another study evaluating pharmacists’ intervention for poorly controlled type 2 diabetes found that 51% of patients achieved their target HbA1c of ≤7% when pharmacists prescribed.¹¹ Therefore, given that pharmacists are qualified to assess and optimize drug therapy, providing an expanded scope of practice to independently prescribe and manage patients here in BC will enable pharmacists to improve health outcomes for patients to reduce burden to the healthcare system.

Lastly, providing pharmacists with an expanded scope of practice can save our healthcare dollars. Total health expenditure in Canada rose by 12.8% in 2020 due to the pandemic, with money being spent mostly in the hospital (25.1%), on drugs (13.9%) and paying physicians (13.5%)¹⁴. Here in BC, healthcare accounts for 40% of the province’s spending with the government committing to spend another $3.2 billion dollars over next 3 years on healthcare¹⁵. In a 2017 report put forth by the BC Pharmacy Association, it is estimated that “allowing community pharmacists to prescribe for minor ailments could result in annual savings to BC’s healthcare system of more than $32 million”¹³. Additionally, physicians’ time would be saved to provide care to more complex conditions. Allowing pharmacists to prescribe and treat for minor ailments have proven to be cost-saving in other provinces. For example, in Saskatchewan it was found that pharmacists prescribing for minor ailments saved the province $546,832 in direct and indirect cost in 2014 and it is projected to save the province $3.5 million by 2019¹⁶. Therefore, with the ever-increasing cost of healthcare, an expanded the scope for pharmacists can provide much needed cost savings for BC.

In conclusion, pharmacists are the most accessible healthcare professional that are highly trained and skilled to assess and optimize drug therapy. Pharmacists’ expanded scope of practice would allow them to utilize their knowledge and skills to improve access to routine care, optimize therapy to reduce our overburdened healthcare system and provide savings to our ever-growing spending on the healthcare system here in BC. Pharmacists have proven to be an essential part of the healthcare system throughout this pandemic which has earned them the trust of the public. Furthermore, all other provinces, except BC have come to realize the value that pharmacists can add to our healthcare system and have implemented plans to better utilize them by expanding their scope of practice. BC is now the only province not moving forward with pharmacists prescribing for minor ailments. The BC Ministry of Health needs to consider this as a viable option now as British Columbians continue to struggle to find the proper timely care they deserve.

References:

1. https://www.cbc.ca/news/canada/british-columbia/er-closures-bc-long-weekend-1.6572198
2. https://www.ocpinfo.com/practice-education/expanded-scope-of-practice/minor-ailments/
3. https://www.nshealth.ca/news/nova-scotia-health-partners-sobeys-and-lawtons-drugs-pharmacy-walk-clinic
4. https://www.timescolonist.com/local-news/central-saanich-couple-without-a-family-doctor-turn-to-newspaper-ad-to-get-prescriptions-filled-5651845
5. https://www.mylethbridgenow.com/25767/news/new-walk-in-pharmacist-run-clinic-looks-to-help-alleviate-healthcare-pressures-in-lethbridge/
6. https://www.napra.ca/national-statistics
7. Mansell K, Bootsman N, Kuntz A, Taylor J. Evaluating pharmacist prescribing for minor ailments. Int J Pharm Pract. 2015 Apr;23(2):95-101. doi: 10.1111/ijpp.12128. Epub 2014 Jun 16. PMID: 24930999.
8.  Beahm NP, Smyth DJ, Tsuyuki RT. Outcomes of Urinary Tract Infection Management by Pharmacists (RxOUTMAP): A study of pharmacist prescribing and care in patients with uncomplicated urinary tract infections in the community. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2018;151(5):305-314. doi:10.1177/1715163518781175
9. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.
10. Tsuyuki RT, Rosenthal M, Pearson GJ. A randomized trial of a community-based approach to dyslipidemia management: Pharmacist prescribing to achieve cholesterol targets (RxACT Study). Can Pharm J (Ott). 2016 Sep;149(5):283-292. doi: 10.1177/1715163516662291. Epub 2016 Aug 2. PMID: 27708674; PMCID: PMC5032933.
11. Al Hamarneh YN, Charrois T, Lewanczuk R, Tsuyuki RT. Pharmacist intervention for glycaemic control in the community (the RxING study). BMJ Open. 2013 Sep 24;3(9):e003154. doi: 10.1136/bmjopen-2013-003154. Erratum in: BMJ Open. 2013 Oct 03;3(10):e003154corr1. PMID: 24068762; PMCID: PMC3787489.
12. Faruquee CF, Guirguis LM. A scoping review of research on the prescribing practice of Canadian pharmacists. Can Pharm J (Ott). 2015 Nov;148(6):325-48. doi: 10.1177/1715163515608399. PMID: 26600824; PMCID: PMC4637852.
13. https://www.bcpharmacy.ca/system/files/assets/paragraphs/file/file/16-September23.pdf
14. https://www.cihi.ca/en/where-is-most-of-the-money-being-spent-in-2021
15. https://www.timescolonist.com/local-news/funds-earmarked-for-new-medical-centres-paramedics-and-surgeries-5091700
16. Rafferty, E., Yaghoubi, M., Taylor, J. et al. Costs and savings associated with a pharmacists prescribing for minor ailments program in Saskatchewan. Cost Eff Resour Alloc 15, 3 (2017). https://doi.org/10.1186/s12962-017-0066-7