Tough times, hard choices: Alberta pharmacists are pushed to their limits

With influenza vaccines set to roll out this Monday in Alberta and his pharmacies’ calendars already booked solid for COVID-19 shots, Randy Howden called a team huddle to ask his staff if they can–and should–try to do it all. “Some patients have back-to-back COVID and flu shots booked and we have a bunch of third COVID doses for seniors booked somewhere in the middle of all these appointments,” said Howden, owner of two Medicine Shoppe pharmacies in Calgary. “We’re used to being busy, but each new thing adds another layer to our workload, so we as a team had a discussion about what we have the capacity to do while ensuring that we’re still doing everything correctly.” Like Howden and his team, pharmacists across Alberta are struggling under the heavy and multiple demands of COVID-19 and, now, the incoming flu season. While influenza vaccines became available to the general public on October 18, pharmacists in the province had already started to give flu shots to high-risk Albertans at the start of October. At the same time, many patients were coming in for booster COVID shots, which were approved in August for patients with certain immunocompromised conditions and for Albertans travelling to countries that don't recognize Covishield/AstraZeneca or mixed-series doses. Read: A different kind of flu shot season starts in pharmacies across Canada On October 6, the province expanded the groups eligible for third COVID-19 shots to include Albertans 75 and over and First Nations, Inuit and Metis people 65 and older. 'The problem is, when the Alberta government makes these announcements they don't communicate with us ahead of time–usually they hold a press conference and they say it starts tomorrow," said Howden. "So patients think they can come in tomorrow, except I don't have enough vaccines because I didn't get a heads-up." Pharmacists are also facing increased demand for rapid COVID testing, largely from unvaccinated Albertans whose employers are mandating the tests. These all add up to more work and pressure for Alberta pharmacists, who are also in the unique–and for the most part, enviable–position of having the most expansive scope of practice in Canada. That means that, in addition to dispensing medications and administering COVID and flu vaccines, they're providing a wide range of clinical services. They're also working in a province that at last tally accounted for the largest percentage–almost 40%–of the country's total number of new COVID-19 cases and deaths, and that have had the highest levels of vaccine hesitancy. "The question gets down to how much do we want to do as a team and where do we want to spend our effort," said Howden. "I know there are pharmacists doing all of the above–COVID vaccines, flu vaccines, COVID testing, clinical services–but I'm concerned about burnout among my team and errors occurring, like somebody getting the wrong vaccination or device, or not being provided the appropriate education because we're too busy and too tired." For now, said Howden, he and his team are not doing COVID testing. "After we get through giving the flu vaccines, then we'll revisit COVID testing," he said. "The question won't just be whether or not we have the time but also how we're feeling." Read: Alberta tech plays key role in COVID-19 vaccination clinics Bruce Winston, president of Sandstone Pharmacies, which operates 20 locations in Alberta, said the demand for rapid COVID tests is notably stronger in areas with low vaccination rates. "One of our stores in Medicine Hat has the most usage of rapid tests compared to any of our other stores because it's sitting in an area next to northern Alberta, which has the lowest vaccination rates in the province," said Winston. "I've also seen messages from our pharmacists asking if we can work out some kind of discount for people who have to come in a couple of times a week for rapid testing." An unexpected challenge for many the pharmacists at Sandstone was just seeing the number of tests coming back positive. "It was shocking to pharmacists, the number of positives they came across," said Winston. "Last year we had some positives but not many, but now the reality is staring them in the face and they're having to deal with the shock of knowing that so many of these people who are positive are coming into the store." Read: COVID-19 vaccine mandates for health workers: a look at their implementation across the country Another big challenge–one that isn't surprising given the province's high levels of vaccine hesitancy–is the unvaccinated status of many pharmacists, said Winston. "We know that a lot of stores have pharmacists who are not vaccinated themselves, and my organization is no exception," he said. "The best we can do is try to ensure that their personal decision doesn't reflect on their professional recommendations to patients, and I'm comfortable that at least in our case that is true." Close to 77% of Albertans aged 12 and older are now fully vaccinated, leaving about 600,000 eligible vaccine recipients still unprotected from COVID-19. Some of these holdouts are finally coming in for their first shots, said Howden at the Medicine Shoppe. But many are still resisting. Winston recalled patients who got their children vaccinated just so they could participate in group sports. But the parents themselves would have none of it. "They came right out and asked our pharmacist if they could just get the paperwork saying they were vaccinated," said Winston. "It's disheartening–early on patients were clamouring to get vaccinated and it was such an emotional experience for pharmacists to be able to give them the vaccine because you felt like you were giving people some freedom. Now the conversations are changing." Read: Neighbourly poised to become second-largest pharmacy chain in Alberta

Tough times, hard choices: Alberta pharmacists are pushed to their limits

Register for free access or login.

Related Topics