Pharmacists prescribing for minor ailments—not a minor achievement

Many pharmacists and patients have embraced the expanded scope authorizing Ontario pharmacists to prescribe for 19 minor ailments. According to the Ontario Ministry of Health, 656,764 minor ailment assessments were completed in 2023, resulting in 566,352 prescriptions.1 Across Ontario, 94% of all community pharmacies participate in minor ailments prescribing, ensuring accessibility to this service with at least one participating pharmacy in each public health unit.1,2 Evident by these numbers, minor ailments prescribing has become an integral part of the pharmacist’s scope of practice and continues to grow as an essential pharmacy service with the recent implementation of six additional minor ailments for Ontario this past fall with more ailments proposed for the future. Along with the successes minor ailments prescribing has brought, pharmacists have also experienced some challenges in adapting to the expanded scope. Here are some key insights and takeaways for pharmacists providing minor ailments assessments and prescribing. Many Ontario pharmacists affirm that having algorithms for minor ailments prescribing is essential as it provides a quick reference to key assessment requirements and clinical pearls that they can incorporate into their practice. The Ontario College of Pharmacists provides two helpful algorithms on uncomplicated UTI and Lyme Disease prophylaxis to refer to.3,4 Minor ailment assessment tools and algorithms can be especially helpful for clinical pearls based on expert opinion, which may not be present in product monographs or guidelines if they have not been updated recently. For example, age limitations for products for conjunctivitis may be complicated as not all ocular antibiotics, antihistamines, and lubricants have the same usage criteria and age limitations in pediatrics. Another lesser-known clinical pearl is for impetigo, where ointments are not recommended for the oozing lesions that are characteristic of the condition.5 Interestingly, the ointment formulation of mupirocin is the only mupirocin product indicated for impetigo6; therefore, pharmacists may believe it is the best (and only) choice. Alternatively, practice tools that include expert opinion highlight mupirocin cream due to the preference to use creams for wet and weeping lesions.5,7 An algorithm for impetigo is available HERE. Referencing minor ailments guidelines and algorithms can also help pharmacists stay up-to-date with best practices for other conditions such as Lyme Disease prophylaxis, where the use of doxycycline has gained support in recent years for patients under 8 years of age.8 There has also been confusion around claiming minor ailments assessments when red flags are present. The stance of the Ontario Ministry of Health is that if an “immediate” red flag is identified, a minor ailments service fee cannot be claimed.9 Examples of “immediate” red flags include pregnancy or male gender for UTI and age less than two years for allergic rhinitis.9 If no “immediate” red flag is identified and it is appropriate to refer within a pharmacist’s professional judgment, a minor ailment fee for assessment can still be claimed if documentation, including clinical rationale, is provided and the number of claims is within the annual limit.9 Therefore, it may be best practice for pharmacists to ask about all red flag signs and symptoms at the beginning of any minor ailments assessment to ensure patients outside of our assessment scope are being referred appropriately. An opportunity for pharmacies that may be overlooked is situations where it is appropriate to bill for two minor ailments assessments together, for example with concurrent allergic rhinitis and allergic conjunctivitis. Similarly, if a patient presents with multiple ailments, pharmacists are able to bill different minor ailment services for that appointment – there is an exception, however, where assessments for insect bites and tick bites are not permitted to be billed on the same day.10 Despite the learning curve that pharmacists have experienced since the implementation of minor ailments prescribing, the benefit of these services is clearly recognized by patients and healthcare providers alike across Canada. In British Columbia, the ability for pharmacists to assess and prescribe for minor ailments and contraception was authorized on June 1, 2023, and as of November 2023, over 195,000 minor ailments and contraception service assessments were completed at more than 1,300 pharmacies.11 Along the east coast, Prince Edward Island has expanded its minor ailments program in July of 2023 to include hormonal contraception, impetigo and shingles.12 The impressive results brought about by the expansion of scope support the crucial role of pharmacists in ensuring the continuity of care and preventing delays in treatment.13 Pharmacists in Alberta, Saskatchewan, New Brunswick, Nova Scotia, and Newfoundland and Labrador have long been able to assess and prescribe for a wide selection of minor ailment conditions, far more diverse than those currently authorized for Ontario. Specifically, pharmacists in all provinces except Ontario and Manitoba and the three territories can prescribe for birth control and emergency contraception, which highlights the progress Ontario has yet to make in the expansion of scope, particularly to support access for women’s health.14 The results of the minor ailments program in Ontario has prompted the Ministry of Health to consider 17 additional minor ailments recommended by the Scope of Practice Advisory Group (SPAG), which includes birth control and emergency contraception.15 As the scope of practice for pharmacists continues to evolve, there is no doubt that we will continue to see pharmacists further demonstrating their value and making a difference for patients as the most accessible healthcare providers in Canada. References Ontario Ministry of Health. Minor ailments monthly summary. Dec 31, 2023. Accessed Jan 29, 2024.Scope of practice continues to evolve in Ontario. Pharmacy Connection. July 12, 2023. Accessed August 25, 2023. https://pharmacyconnection.ca/scope-of-practice-continues-to-evolve-in-ontario/Ontario College of Pharmacists. Assessment and prescribing algorithm for uncomplicated urinary tract infection (cystitis). Published September 2021. Accessed August 25, 2023. https://www.ocpinfo.com/wp-content/uploads/2022/12/assessment-prescribing-algorithm-urinary-tract-infection-english.pdf Ontario College of Pharmacists. Assessment and prescribing algorithm for pharmacists: antibiotic prophylaxis to prevent Lyme disease following a tick bite. Published April 2023. Accessed August 25, 2023. Barnes TM, Mijaljica D, Townley JP, Spada F, Harrison IP. Vehicles for drug delivery and cosmetic moisturizers: review and comparison. Pharmaceutics. Published November 26, 2021. doi: 10.3390/pharmaceutics13122012. Accessed August 25, 2023. Taro-Mupirocin. In: Drug Product Database. Health Canada. Published October 3, 2018. Accessed August 25, 2023. https://pdf.hres.ca/dpd_pm/00047763.PDF MAPflow. Impetigo assessment. Accessed February 12, 2024.https://www.mapflow.ca/Viel-Thériault I, Le Saux N. Lyme disease. In: Compendium of Therapeutic Choices. Canadian Pharmacists Association. Updated May 18, 2021. Accessed August 25, 2023. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search Ontario Ministry of Health. Updated questions and answers for funding for minor ailments services in Ontario pharmacies. Updated April 30, 2023. Accessed August 25, 2023. https://files.ontario.ca/moh-questions-answers-executive-officer-notice-pharmacies-en-2023-04-30.pdf Ontario Ministry of Health. Executive officer notice: update to funding for minor ailments service in Ontario pharmacies. Updated July 29, 2023. Accessed January 24, 2024. https://files.ontario.ca/moh-executive-officer-notice-en-2023-07-26.pdfGovernment of British Columbia. January 2024 PharmaCare newsletter. January 2024. Accessed January 29, 2024. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacare-publications/pharmacare-newsletters#admin Government of Prince Edward Island. New common ailments and conditions added to Pharmacy Plus PEI. July 10, 2023. Accessed August 25, 2023. https://www.princeedwardisland.ca/en/news/new-common-ailments-and-conditions-added-to-pharmacy-plus-pei Canadian Pharmacists Association. Prescribing authority of pharmacists across Canada. Updated July 20, 2023. Accessed August 25, 2023. https://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/PharmacistPrescribingAuthority_July23_EN.pdf Canadian Pharmacists Association. Access to contraception in pharmacies across Canada. September 2023. January 29, 2024. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Contraception-Access-in-Pharmacies.pdf Ontario College of Pharmacists. Board Recommends additions to pharmacists’ scope of practice. September 20, 2023. Accessed January 29, 2024. https://www.ocpinfo.com/board-recommends-additions-to-pharmacists-scope-of-practice/

Pharmacists prescribing for minor ailments—not a minor achievement

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