So, how does this new prescribing thing work? Your peers across Canada share their experience

The year 2023 kicked off with an expanded scope of practice for Ontario pharmacists that included minor ailments prescribing—a clinical service that’s now offered by pharmacists in all but three of the country’s provinces and territories, with B.C. expected to roll it out this spring. As many Ontario pharmacists ramp up to provide this service, some aren’t quite sure what their newly minted ability to prescribe for 13 minor ailments will look like in actual practice. To get the perspective of experience, Pharmacy Practice + Business spoke with a number of pharmacists in provinces where the profession has had prescribing authority for several years. Here’s what they told us about their experience with this clinical service. Read: 'Big year' for pharmacists with new prescriptive powers, drug shortages: association Paul Bowman, pharmacist and owner, PharmaSave Bowman’s Drugstore, Fredericton, N.B. Good to know Time spent per assessment: About 15 minutes Assessments per day: At least one Most common ailments assessed: Urinary tract infection is number one. Other common ailments are seasonal allergies, fungal skin infection and mild to moderate eczema. Also often prescribes for shingles and hormonal birth control. Impact on revenue My overarching thought around business is if you’re doing something solely for money, you’re not going to be content. The ability to help patients does bring more satisfaction to me. There’s a shortage of primary care, so our communities are screaming out for other providers to help serve their needs and this is one of the ways pharmacists can help. Walk-in or by appointment? Right now for the most part it’s walk-ins, but I would triage appropriately. For example if someone else is already there waiting for a prescription, I attend to that patient first. Turning an inquiry into an assessment It depends on the situation, of course. Where it makes sense to advance a patient’s question into an actual assessment, I would just tell them, 'OK, I think I can help you. Why don’t you come into my clinic room?' Useful tech? One word: medSask There seems to be a lot of panic in Ontario around whether or not pharmacists have the right technology to do this. I use medSask. You don’t necessarily need to follow the checklist of all the questions. Once you get comfortable with it, you start to do it organically and you start to just automatically ask all the right questions. Working it in It wasn’t like the doors blew down and hundreds of people were asking for minor ailments prescribing. I’m a relatively new pharmacy that’s getting busier year after year so I’m adding more staff anyway. but it’s not necessarily because we need more people for minor ailments prescribing. Promoting the service I was promoting it all the time in the beginning. I was always using social media to get the word out there to promote the scope of our pharmacy practice. Read: When will our workplaces catch up with our practice scope? Jahnaya Mann, relief pharmacist and director, pharmacy operations, Neighbourly Pharmacy, Swift Current, Sask. Good to know Time spent per assessment: 15 to minutes, usually longer for birth control Total assessments per day: Five to 10 Most common ailments assessed: cold sores, eczema, rashes, birth control, urinary tract infection In the beginning It seemed overwhelming at first, with forms to fill out, algorithms to follow. We were lucky we had medSask to build the entire thing for us, including the technology and training. Most other provinces don’t have that. Working it in We used to set time aside for this, but not anymore—it’s completely integrated into workflow. It used to be that when a patient came in for an assessment, it would be a matter of the “brave” person stepping forward to do it. But now everyone’s comfortable doing it. Handling resistance from physicians In the beginning, physicians were resisting. Some resistance was based on protecting turf but also based on fear and concern for the patient, like, 'How will pharmacists assess and not miss things that could result in more problems?' But our guidelines are very tight, you can’t stray from the algorithm. So with some physicians, we actually invited them to come over and see the algorithm, and after they saw it they were okay. Impact on revenue I wish you could say, 'yes, it’s made a significant difference.' I don’t think we’ve gotten to the point where this is a money-making service. But I’m really happy we have it—it’s another way we can take care of our patients even if our scope within prescribing is still very narrow and limiting. Advice to Ontario pharmacists Just do it. Every small step we take is one step closer to pharmacists’ being able to work to our full scope of practice. As pharmacists, we often forget how brilliant we are and capable of doing this work. It’s not a stretch from what we’ve learned—it’s an extension. You have the skills to do it. Show Ontario doctors what you can do If you have physicians who are nervous about this, show them what you do. They’re not aware half the time of what you’re capable of doing and how you’re doing it. Read: Pharmacists have major ailments - 3 things we need before prescribing Colleen Macinnis, pharmacist and owner, TLC Pharmasave, Shelburne, N.S. Good to know Has offered the service for about 12 years Time spent per assessment: 15 to 20 minutes How many assessments per day: Hard to say. With seasonal conditions such as Lyme disease, the pharmacy could see as many as 10 cases a day during tick season. Most common ailments assessed: Urinary tract infection, Lyme disease, cold sores, hemorrhoids, eczema Why offer the service? We’re in a rural area and access to family doctors and emergency care is an issue. There are no walk-in clinics so it was a service we knew would be useful. It’s just one piece of a very large puzzle we’ve built to provide, safe, efficient and sustainable services for our patients. Adapting the pharmacy’s space and workflow We’ve adopted our space and workflow to make it possible to offer this service. We have private consultation rooms that have computers and phones in them, that look like a traditional healthcare practitioner’s office. We’ve also changed our workflow to let the pharmacy technician complete the checking of prescriptions so that the pharmacist sees the prescription at the beginning, verifies them and doesn’t need to see them again. Walk-in or appointment only? We do accommodate a bit of walk in but 90% are by appointment only. That’s the only way to make it work and most of the time we can schedule an appointment within two hours of patient calling. Impact on revenue It’s still a non-funded, out-of-pocket service so this does limit people’s access. We charge $25 for it and some people find it’s worth paying the fee to avoid going to emergency. It’s hard to tease out the impact on our revenue. We look at pharmacy services as separate from our dispensing services. But this goes beyond the actual economic advantages to the business. We do it for the community. How staff pharmacists feel about it My ability to retain pharmacists has improved because of our ability to provide clinical services. Staff want to feel like they’re contributing and using the knowledge they gained at school. Advice to Ontario pharmacists You can do this. Once you’ve done it once or twice, you’ll realize you’ve been doing it all this time anyway. My best piece of advice is to be prepared. Give yourself a few minutes to look through the patient’s file and take the time to become familiar with the technology platform. One more thing . . . Do the work first and then chat. If you start by making small talk with the patient you can easily eat up 20 minutes of time. Get the assessment done and then ask about the grandchildren. This is a great tip I learned from a friend. Read: Four tips for pharmacists prescribing for minor ailments Kara O’Keefe, pharmacist-in-charge, Family Drug Mart, St. John’s, N.L. Good to know Total assessments per day: No definite number but total time spent per day on this service is 20 to 30 minutes per day Most common ailments assessed: Herpes labialis, fungal skin infections, dermatitis, allergic rhinitis—all ailments with available products over-the-counter. “However pharmacist intervention allows for more effective assessment and prescription options. It also promotes better follow up.” Who’s using the service? People who feel they require quick access to care or medication and have disposable income. It’s not always about not having a primary care provider as most patients can’t get same day appointments with their providers for non-urgent needs. In Newfoundland and Labrador, wait times to see a pharmacist in a community pharmacy are almost always shorter than a family medicine clinic or emergency department. Walk-ins or by appointment? A mix of walk-ins and same day appointments. Patients know the pharmacy is a busy place so they will usually call ahead and ask what is a good time to come in. Having a registered technician on the team helps We have not increased staffing. Our pharmacy is generally busy dispensing in the morning so my afternoons are when I focus more on non-dispensing roles such as prescribing, injections, et cetera. It is much easier to focus on these tasks when I know the majority of prescriptions needing to be filled have been taken care of. Working with a registered technician makes this more efficient. Impact on revenue It has made a minimal difference given that many patients opt to seek out assessment where it is covered such as a physician’s office, emergency room, or virtual care. Better technology would be better Enhanced access to note making and interactions in our EHR would allow for more seamless care when it comes to pharmacist assessment. At the present time, prescriptions we dispense in are stored in our provincial EHR for other providers to see. However, we are unable to enter clinic notes or document any interactions at the pharmacy. Allowing practice-based EMRs and pharmacy software to better communicate with our provincial EHR would be an asset. Anything else? If this were publicly funded for all citizens, I could see this taking closer to an hour per day or even more. Read: Pharmacists as diagnosticians and prescribers: a doctor's perspective Trish Molberg, pharmacist manager, Neighbourly, Calgary Good to know In Alberta, pharmacists can prescribe independently for any Schedule 1 drugs. Most common ailments assessed: Urinary tract infections (top assessment prescribed for), allergic rhinitis, oral thrush, conjunctivitis, GERD, cold sores Walk-ins or by appointment? The reality of minor ailments is that patients don't often know they have a minor ailment often until the day of. To accommodate this, I've left spots in my appointment schedule so that patients that need to see me or have me return their call to see if I have opportunity within my schedule. I do almost always book appointment to ensure I have enough time to complete a thorough assessment and documentation Working prescribing into the workflow We have grown the business to support two full time pharmacists per day. One works at the counter dispensing, seeing patients for vaccinations and injections and also doing clinical services. I am seeing patients by appointment. Fortunate to be focused on clinical services We are fortunate in Alberta and with my employer of Neighbourly Pharmacy that they have allowed me to be solely clinically based. I do very little dispensing so most of my day is spent seeing patients in person or virtually, and prescribing and managing medications and following up. Impact on revenue Perhaps when I first started prescribing, my inefficiencies did not allow it to be as profitable, but as our whole team has become more efficient and streamlined with processes, it has been successful in terms of revenue and income. Fair compensation matters We are compensated fairly in Alberta in my opinion and experience. We are thankful to the Alberta Pharmacists’ Association for negotiating and continuing to advocate for pharmacists for our fee reimbursement. Read: Ready when you are: Vigilance Santé bringing its tried-and-tested minor ailments prescribing software to Ontario

So, how does this new prescribing thing work? Your peers across Canada share their experience

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