Measuring the benefits of expanding pharmacists’ scope

With several provinces working to continue the expansion of pharmacists' scope of practice, how can we measure the broader impact of their contribution to healthcare in Canada overall? Not-for-profit think tank, the Conference Board of Canada's Value-based Healthcare (VBHC) research centre, recently conducted three targeted literature reviews to identify the context, impact and barriers to expanding the role of community pharmacists.The research team included a total of 34 sources from Canada and other high-income countries, spread over the last 10 years, in its review unveiled at the end of 2024. The review demonstrates the extent to which the expansion of community pharmacists' prerogatives can benefit the population and, more generally, the healthcare system, using the two examples of shingles vaccine and strep throat screening.Two key examplesEvery year, 90,000 Canadians aged 50 or over are affected by shingles, and the National Advisory Committee on Immunization recommends that all adults in this age group be offered the shingles vaccine, unless contraindicated. However, only 27% of adults in this age group are vaccinated in Canada.Quebec, meanwhile, has 27,000 cases of shingles each year, and 600 hospitalizations, according to the latest data from the Quebec Ministry of Health and Social Services. The majority of shingles cases occur in people aged 50 and over, and deaths occur mainly in people aged 80 and over. According to VBHC researchers, cost and access to the vaccine account for this low rate: 5%-to-15% of people not vaccinated cite problems of convenience or access, such as having to make an appointment or travel to see their doctor.By doing a case analysis to estimate the impact of expanding access to shingles vaccinations in community pharmacies, the authors conclude that, if people who agree to be vaccinated by a pharmacist and who reported that access was a major barrier were to be vaccinated in their community pharmacy, provincial vaccination rates could increase by 2%-to-7%. This would translate into the vaccination of an additional 300,000 to 800,000 people over the age of 50.“This relative increase in coverage of 7%-to-17% would mean that we could prevent between 1,400 and 3,600 people from suffering from shingles, and between 20 and 50 people from having to go to hospital,” said the study.In Quebec, this projected increase in vaccination rates would be between 2.1% and 5.9% in the 50-to-64 age group—where the vaccination rate is 19%; and between 2.3% and 6.2% in the over-64 age group—where the vaccination rate is 21.6%.$29 million in savingsWhile Canada experienced a record number of invasive Group A Streptococcal (GAS) infections in 2023—over 4,600 cases were sent to the National Microbiology Laboratory in Winnipeg, an increase of over 40% from the previous annual peak in 2019, according to the Public Health Agency of Canada—pharyngitis, 30% of which is streptococcal in children, is one of the most common reasons Canadians consult a primary care provider, walk-in clinic or emergency department.For the moment, only Alberta, New Brunswick, Prince Edward Island, Nova Scotia and Newfoundland and Labrador allow pharmacists to prescribe antibiotic treatment for pharyngitis; Quebec is well on the way, as the recently passed Bill 67 also provides for this.“We believe that, given the opportunity, many Canadians suffering from sore throats would choose to seek treatment at their local pharmacy,” said the VBHC researchers, who have managed to quantify the savings patients could make if they had a wider offer of places to receive their treatment. Using the model developed by pharmacist Nina Lathia in a study published in 2018, the team updated population estimates, indexed monetary values to 2023, explored the range of potential cost savings estimates and calculated estimates for Canada and the 10 provinces.The results showed that if 60% of Canadians with sore throats went to a pharmacy for screening and prescription instead of another healthcare facility, the healthcare system could save between $14 and $29 million, depending on the province. “The costs associated with a visit to a local pharmacy are significantly lower than those associated with visits to primary care clinics, walk-in clinics or emergency departments,” the authors pointed out.However, the study highlights a number of obstacles to the expansion of pharmacists' scope of practice and their closer integration into the healthcare system: service financing and remuneration modelslack of infrastructure to ensure coordination and continuity of care, such as a standard electronic medical record to facilitate communication between primary care providersthe still less-than-optimal layout of pharmacies, particularly the lack of physical spacethe outdated perception that community pharmacy services are not part of primary care or the public health system, despite the awareness raised by the COVID-19 pandemic“Seamlessly integrating community pharmacies into public health and primary care efforts adds value to Canada's healthcare systems by promoting more responsive and coordinated care, harnessing efficiencies, and addressing inequities or variations in access to care and services,” the VBHC researchers concluded.The VBHC team calls for coherent national policies to enable pharmacists to work within their scope of expertise; to develop care pathways that include pharmacy; to reinforce the importance and effectiveness of pharmacists' work; to improve collaboration with other providers; and to demonstrate the impact on reducing inequalities.Barriers highlighted by pharmacistsLack of resources, coupled with lack of time and training, are cited by pharmacists themselves as obstacles to expanding their role in Quebec. This is what emerges from another study exploring pharmacists' comfort level in changing their practice one year after the adoption of Bill 31 and published in the Canadian Pharmacists Journal in July 2024.“To our knowledge, no study has been published on how community pharmacists in Quebec have integrated these new prescribing activities into their daily work,” wrote the team led by Léonie Rouleau, doctor of pharmacy and researcher for the Réseau québécois des pharmaciens de GMF (RQP GMF). Via an online survey conducted from March 25 to May 28, 2021, among community pharmacists in Quebec, the researchers collected 146 responses to questions developed by the RQP GMF research, grouped into themes: respondent characteristicsworkload and work environmentcomfort level and obstacles to adjusting medication and monitoring pharmacological treatments (86 clinical situations evaluated)general obstacles and facilitators to implementationMost pharmacist respondents (71.9% women, 86.2% under 50) worked exclusively in community pharmacy (86.3%) and had over 10 years' experience (56.8%).“The main obstacles identified were lack of knowledge, experience and dedicated time, and difficulties in integrating these activities into the workflow; facilitators had the right environment and resources,” the authors point out.Indeed, the hourly workload for dispensed prescriptions was generally between 20 and 40 prescriptions per hour worked per pharmacist (64.3%), and only 6.2% of respondents claimed to have a period allocated to clinical follow-ups in their daily schedule. Most pharmacists (61%) estimated that they devoted 10% to 29% of their working time to clinical followup.Among other findings:43.2% of pharmacist respondents reported difficulty reaching physicians.Clinical situations in which pharmacists were generally less comfortable were related to bipolar disorder, major neurocognitive disorder, behavioral and psychological symptoms of dementia, COPD and asthma.69.9% and 68.5% of respondents said they were uncomfortable managing hypothyroidism in patients with recent thyroid surgery or a history of thyroid cancer, respectively.45% of respondents expressed discomfort with managing diabetes during pregnancy, and 56.8% with managing the use of topical pain treatments.Most respondents identified improved work organization (54.1%) and the availability of follow-up summary tools (50.7%) as their main avenues of solution.On the eve of a further expansion of their field of action—Bill 67 was passed in the fall, and will come into force once the regulations have been finalized—the authors conclude that “Quebec's community pharmacists are ready to adjust pharmacotherapy and provide followup in many clinical situations,” provided that changes are made, “to move from a distribution-oriented model to a clinically-oriented practice.”This could involve, for example, automation or the delegation of more activities to technicians, as well as mentoring and ongoing training.Read the full Conference Board of Canada report here: Community Pharmacy Integral to Delivering Primary Care: Impact and Opportunities for Value-Based System Transformation.

Measuring the benefits of expanding pharmacists’ scope

Register for free access or login.

Related Topics