Are Pharmacists A Cure To Nova Scotia’s Ailing Healthcare System?
HALIFAX — Across the country, debates are raging about the state of healthcare: waitlists are too long, too many people don’t have a family doctor, and emergency departments are struggling to meet demand.
It has even spawned debates about the use of for-profit healthcare — a once taboo Canadian subject.
In Nova Scotia, the state of emergency rooms has been front and centre in the news, after two recent deaths of people in the ER waiting rooms. Data obtained by the Nova Scotia NDP through a freedom of information request suggests 558 people died in Nova Scotia emergency rooms last year, a rise of 10 percent.
Last week, Premier Tim Houston announced a series of changes to address the strain on ERs. But the opposition Liberals have ideas of their own and, more than a week ago, asked for the PCs to reconvene the House for emergency debates on healthcare.
Brendan Maguire, Liberals shadow minister for health and wellness, told Huddle his party never got an official reply, so he considers the offer rejected.
One of the avenues the Liberals want to explore is utilizing the skills of the province’s pharmacists. Maguire notes that many people are using walk-in clinics and emergency rooms for simple prescription refills and other minor medical needs.
“I have to go back every two months to get my prescription renewed. It just doesn’t make sense to me that I’ve been on the same prescription for 15 years, nothing’s changed, the dosage hasn’t changed; the pharmacist can ask those questions,” said Maguire.
“What we can do to start is allow all pharmacists to [renew some] non-narcotic prescriptions and allow them to prescribe and diagnose simple ailments. So those individuals do not have to go into the healthcare system. And we do not have to go into the emergency room and that’ll take a lot of pressure off the emergency room.”
Allison Bodnar, CEO of the Pharmacists Association of Nova Scotia, says the legal framework is already in place for pharmacists to do more, like prescription renewals and diagnosing. What is lacking is the provincial funding.
“Since 2011, pharmacists have had the scope to renew prescriptions, they’ve had the scope to assess and prescribe for 31 minor ailments, and it has been successive governments that have not funded those services,” explains Bodnar
“We have been advocating for the full funding of pharmacy services now for 12 years and we’ve had some limited success in the last few years.”
Bodnar says there is no estimate on how much it would cost to fulfill the entire scope of what pharmacists can, theoretically, do.
Pharmacists in Nova Scotia are already doing some prescription renewals, but it is limited. Bodnar says last year, 200,000 prescriptions were renewed by pharmacists. But it comes back to limited funding.
When it comes to a “controlled drug,” pharmacists can renew for 30 days at a time but they are only funded for four renewals a year. In such circumstances, that only gives a patient four months until they have to get a doctor’s renewal.
As for using a pharmacist for diagnosing minor ailments, that service only exists right now to those who can pay for it themselves, says Bodnar.
“The issue with minor ailments really is that it’s a privately funded service right now. So patients who can afford to pay the pharmacists to sit down and assess and then provide a prescription can have that service and those who can’t, can’t. It creates inequities in the system.”
Bodnar also believes pharmacists, if given the funding and resources, can do immunizations like flu shots.
But, if the Nova Scotia government does go down the road of using pharmacists for more, Bodnar notes there is a human resource problem. Pharmacists would need to be able to focus on the clinical side of patient care and not the actual dispensing.
But right now, says Bodnar, there is a lack of technicians in pharmacies for this to work. One of the reasons for a lack of technicians has to do with government incentives offered to students going into the continuing care program. Enrollment for technicians dropped as people switched over.
“Pharmacists can’t be doing the technical work of dispensing,” said Bodnar. “Pharmacists need to be focused on the clinical aspects. If we are effective at that, and freeing up pharmacists’ time, then yes, they can take on these roles.”
“What we really need is to ask every professional to work to their full scope. But the system has to support that. Do we have enough technicians if that happened tomorrow? No, we don’t.”
As for the current relationship between pharmacists and the Tim Houston government, Bodnar says dialogue continues as to the future of pharmacy in the province.
“Now we’re having bigger discussions about what more pharmacists can do in the future, but nothing sort of specific that I can pinpoint to today.”
Derek Montague is a Huddle reporter in Halifax. Send him your feedback and story ideas: [email protected].