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Oh, Canada. In some ways, you’re showing your much bigger neighbor in the south the way forward in taking pharmacy to a higher level of practice. And if we’re smart, we’ll pay attention to the results. I’m talking about last week’s announcement by the provincial government of Ontario to expand the role of pharmacists so they can offer services that were previously the exclusive turf of the province’s 25,000 doctors. Among them: the ability to renew most prescriptions for non-narcotic medicines without a doctor’s intervention and the right to prescribe drugs to help patients quit smoking. The new regulations also allow pharmacists to administer flu shots, a right already held by most of their American counterparts.
A report last week from the Toronto Star quoted Ontario premier Dalton McGuinty stating the obvious. McGuinty called the reform in provincial pharmacy practice guidelines “good news for families” in a talk staged, appropriately, at the University of Toronto’s Leslie Dan School of Pharmacy. McGuinty also acknowledged the critical contribution pharmacists can make to any health system’s efforts to lower costs, telling reporters that the ramp-up in responsibilities is “great news for our pharmacists and … great news for taxpayers as well because the more that we can do to keep people healthy ... the more money we’re going to save in the long run.”
That screamingly obvious truism — picture Homer Simpson smacking his forehead and saying, “D’oh!” — is at the heart of all efforts to bring some cost savings and economic sustainability to health care. And it should be the driving force that impels every government and regulatory agency in North America to remove post haste the roadblocks that keep pharmacists from “doing what they’ve been trained to do,” in the words of Dennis Darby, CEO of the Ontario Pharmacists’ Association.
The new pharmacy practice guidelines followed the release in February of the Drummond Report, a set of recommendations for Ontario’s cash-strapped healthcare system that urged, among other things, that pharmacists be engaged “to the full scope of their practice,” in efforts to make the province’s health delivery system more cost-effective, patient-centric and accessible. The move has the strong endorsement of pharmacy and health advocates, including the Ontario Medical Association, which claims it will relieve overburdened physicians and improve total care to patients.
One drawback: the new regulations provide relatively paltry compensation for pharmacists providing the new services: $7.50 for administering a flu vaccination and a “minimal” fee for other services like prescribing and related counseling. What’s more, “It’s still unclear how they will be compensated by the province for their healthcare work,” according to the Toronto Star.
Nevertheless, Ontario’s biggest pharmacy operators, Shoppers Drug Mart and Rexall Pharma Plus, are strongly in favor of the change. Shoppers announced it would offer flu shots in 460 of its drug stores this year, and Rexall’s CEO, Frank Scorpiniti, said the reforms would boost Ontario’s anemic inoculation rates and lead to “healthier communities and lower overall healthcare costs.”
What’s surprising is Ontario isn’t in the forefront of Canadian pharmacy’s evolution. In fact, it’s lagging behind the nation as a whole. The Toronto Star was quick to point out that the expansion of pharmacists’ scope of practice in the province was long overdue. “It’s about time Ontario caught up to the rest of the country,” the newspaper opined Oct. 14. “Across Canada, these highly trained medical professionals have long been able to offer such services — and more.
“In British Columbia, pharmacists can adapt and change the dose of a prescription within the same class of drugs based on side effects or risks,” noted The Toronto Star. “In Saskatchewan, pharmacists can prescribe for minor ailments like skin rashes or eye infections. Alberta expanded pharmacy services five years ago, and this year followed up with a billing plan for pharmacists offering the additional care.”
Pharmacists able to actually charge for their professional guidance and care? How novel.
If you’re a pharmacist practicing in Canada, or if you’re practicing in the United States and have something to say about Ontario’s reforms, pro or con, we’d like to hear from you. Just comment below.