By John Chenier
On January 1st, access to healthcare for residents of Lowertown took a major step forward. As of that date, pharmacists in Ontario are now allowed to prescribe drugs for 13 minor ailments. The news will be especially good for those who have to rely on and endure long waits in hospital ERs waiting to see a doctor.
All the pharmacists interviewed for this story were certain this will have a positive impact on the delivery of healthcare in the community. Ibraham Elfizy of IDA Rideau Pharmacy says, “It is definitely a start.”
Jennifer Muller, owner of Shoppers Drug Mart on Dalhousie Street agrees that the increased access at the local level will help ease the strain brought about by the shortage of family physicians and reduce the demand on ERs.
Ontario is actually behind the other provinces in allowing pharmacists to write prescriptions. One pharmacist noted that the province where he studied, Nova Scotia, adopted these measures years ago. Faculties of Pharmacy across Canada have been training their students in anticipation of an expanded scope of practice for pharmacists in the delivery of healthcare.
Mariam El Dalil, owner of Remedy’s Rx Rideau Compounding Pharmacy, was able to prescribe drugs when she practiced in Quebec. She believes that the role of pharmacists in the delivery of healthcare in Ontario and elsewhere will continue to expand. She hopes Ontario will soon follow the example of Quebec and allow pharmacists to order lab tests.
According to our survey of the 12 pharmacies serving Lowertown, all are keen to embrace this “expanded scope of practice” and will participate. However, some indicated they will be writing prescriptions for only some of the ailments on the list. (See box for list of ailments)
All the pharmacists say they will offer the service to any who walk into their pharmacy. There is no need to be a regular customer or to have a prescription at that location.
What you need to know
What should you know and what will you need to have when seeking a prescription from a pharmacy?
According to Ibraham Efizy, the most important thing you must have with you is your Ontario health card. The cost of the consultation is covered by the government of Ontario, who pays the pharmacist for the consult, but not the cost of any medicines prescribed. A health-card number may be needed to complete the reporting requirement for any prescription given. So, no health card, no payment, no record and likely no prescription.
Pharmacists are required to have a consult before writing a prescription. They will need to know all the current prescribed medications, vitamins and herbal remedies you are taking. If you don’t go to your regular pharmacy, it would be a good idea to have a list of your prescribed medications, as they will not be able to access a list from another pharmacy. Expect the usual questions about allergies, previous adverse reactions as well as what you may have used to remedy the ailment prior to seeking a prescription.
Sara Azad of Pharmacie Brisson notes that pharmacists can now enrol in the Connecting Ontario Clinical Viewer platform. The high demand to enrol has caused a bit of a backlog, but once enrolled, pharmacists will be able to see the results of any lab tests you have had.
All this information will assist them in ensuring there are no “red flags” as they move along the decision tree issued by the Ontario College of Pharmacists (OCP) meant to serve as a guide for the pharmacist.
OCP has posted a useful guide for the public which can be found at https://www.ocpinfo.com/wp-content/uploads/2023/01/minor-ailments-frequently-asked-questions-patients.pdf
Challenges
As with any change, there will be a learning curve. In the last few years, people have come to rely on the local pharmacies for their regular vaccinations for flu, pneumonia, shingles and, of course, Covid. But the surge in demand for vaccinations, especially in the midst of Covid surges, overwhelmed some of the pharmacies in the community.
Some had to stop offering vaccinations when they found that the time and resources required was more than their pharmacists could spare from their normal duties of dispensing prescriptions and consulting with clients. Others chose to restrict appointments to specific days, and some brought in nurses on those days to administer the vaccines.
This experience with vaccinations has made some pharmacists wary of the effect the “expanded scope” could have on their current operations. Jennifer Mulley cautions that not all pharmacists embrace or feel comfortable with all that is involved in writing prescriptions. She says, “No one knows exactly how this will affect the normal work day routines.”
A major concern seems to be about instances when a pharmacist has to say, “No”, recognizing there will likely be those not ready to take no for an answer.
Ms. Azad advises that a patient shouldn’t consider it as “simply coming in for a prescription.” She hopes the public will understand when and what a pharmacist can and cannot prescribe and the process they are obliged to follow before writing a prescription. For most minor ailments, the patient should be able to self-diagnose their condition. However, that does not mean the prescribed medication is the proper (or permitted) course of action.
All pharmacists interviewed mentioned the many red flags along the way to a decision that the patient may not have seen or understood. It may take time to explain the reasons and explore the other options open to the patient. Patients also need to know that there are no refills. These are meant to be one-time, short-term solutions to minor ailments.
There will be kinks to be worked out. Every pharmacy has a different mix of customers with different needs, and no one knows what impact this will have on their own pharmacy. How it will affect the demands on a pharmacist’s time and whether the shift in the nature of the work take a toll.
Pharmacists, like many other healthcare professionals, are a scarce resource susceptible to burn-out. A story in the USA Today of January 28 reported that the two largest pharmacies in the USA, Walmart and CVS, are cutting back their opening hours due to a shortage of pharmacists and the need to improve their working conditions. This will affect all 4600 Walmart locations and over 6000 of the 9000 CVS outlets.
It is worth noting that the two newest pharmacies in the community, Rideau Compounding Pharmacy and the Guardian Rideau Clinic Pharmacy are compounding pharmacies, meaning they can manufacture drugs from raw materials. Also, both have walk-in clinics.
List of minor ailments
- Pharmacists will be able to offer prescriptions for:
- hay fever (allergic rhinitis);
- oral thrush (candidal stomatitis);
- pink eye (conjunctivitis; bacterial, allergic and viral);
- dermatitis (atopic, eczema, allergic and contact);
- menstrual cramps (dysmenorrhea);
- acid reflux (gastroesophageal reflux disease (GERD));
- hemorrhoids;
- cold sores (herpes labialis);
- impetigo;
- insect bites and hives;
- tick bites (post-exposure prophylaxis to prevent Lyme disease);
- sprains and strains (musculoskeletal); and
- urinary tract infections (UTIs) (for women only) .
- Have more questions? You may want to check out this from the Ontario College of Pharmacists: minor ailments – frequently asked questions for patients (ocpinfo.com)
Pharmacies serving Lowertown
- Dalhousie Street Pharmacie Brisson, 270 Dalhousie St 613-241-6273
- Shoppers Drug Mart, 298 Dalhousie St 613-241-1871
- Rideau Street Guardian Rideau Clinic Compounding Pharmacy, 574 Rideau St 613-424-9577
- Remedy Rx Rideau Compounding Pharmacy, 541 Rideau St · 613-789-5151
- Pharmasave Astley’s, 423 Rideau St 613-233-8454
- I.D.A. – Rideau Pharmacy, 390 Rideau St 613-789-4444
- Loblaw Pharmacy, 363 Rideau St 613-789-3346
- Shoppers Drug Mart, 322 Rideau St 613-789-9700
- Respect Rx Pharmacy, 306 Rideau St 613-454-0323
- Rexall Drugstore, 200 Rideau St 613-789-7884
- Shoppers Drug Mart, 50 Rideau St 613-236-2533
- Beechwood Ave Guardian – New Edinburgh Pharmacy, 5 Beechwood Ave. 613-749-4444