When Canadian pharmacists gained the ability to prescribe contraceptives and UTI treatments, the Government wouldn’t pay them… until patients themselves stepped in
Speaking at the APP conference on the Gold Coast, Christine Hrudka, chair of the Canadian Pharmacists’ Association, outlined the path towards pharmacists working to full scope of practice in Canada’s provinces and territories, particularly Alberta, which is leading the country in this space, and her own native Saskatchewan.
She took delegates through the process from 2005, when pharmacists were unable to provide a range of services, through to 2019, when Alberta’s pharmacists can: renew/extend prescriptions; change drug dosages and formulations; make therapeutic substitution; prescribe for minor ailments and conditions; initiate drug therapy independently; order and interpret lab tests; and administer a drug by injection.
Alberta also has regulated pharmacy technicians. Ms Hrudka outlined how the most recent tranche of minor ailments treatable by pharmacists saw patients themselves lobby for pharmacists to be remunerated for the service.
In 2018, pharmacists gained the ability to prescribe for several ailments including uncomplicated urinary tract infections, and to prescribe hormonal and emergency contraceptives.
“We got the ability to prescribe for UTIs and for contraceptives, but guess what: Government said ‘go ahead and do it, but we don’t have any money. We’re not going to pay.’ So in all these other cases we were getting CAD$18 (AUD$19.03) from Government to prescribe.
“So we [pharmacies] got together and decided, we’re going to charge CAD$20 (AUD$21.14). Interestingly, our discounters, basically just decided ‘we’re just not even going to prescribe’.”
This meant no pharmacies were able to discount the $20 fee for prescribing in these areas, meaning the other pharmacies weren’t being undercut.
“But every patient that came in would say, ‘Why do I have to pay $20?’,” Ms Hrudka said, saying that while patients appreciated the convenience and accessibility of pharmacist prescribing, the fee concerned them. Pharmacists urged them to get in touch with government representatives on the matter.
“Female advocates started on social media…Why is it birth control pills and urinary tract infections, that are women’s issues, are you not paying for?
“And guess what. Nine months later, Government made an announcement that, ‘You know what? We’re going to pay you for it’.
“The power of the patient is something I never, ever realised.”
Ms Hrudka said that doctors don’t like the growth of pharmacist prescribing, and have complained on social media that it poses dangers.
“But the interesting part is we’ve been doing this for 10 years; knock on wood, we have not had one incident.
“Not one incident, not one disciplinary hearing about prescribing.
“Pharmacists do a damn good job.”
She cited a 2018 study on pharmacist prescribing for UTIs in which researchers concluded that pharmacists followed the algorithms far better than doctors.
“So the whole group of ‘we’re going to have antibiotic resistance rampant because pharmacists can just at will prescribe?’ That did not come out in the study. We did a better job of following the correct algorithms.”
The algorithm for pharmacists included follow-up contact after three days, which initially concerned the pharmacists, as doctors were not under this obligation. Instead of becoming a problem, the pharmacists not only learned how their patients preferred to be contacted, the patients appreciated the contact.
“It’s really created a relationship, and the interesting part of that relationship is they’re coming back. They now know… that there’s a higher level of care, just because of this silly text that I fought tooth and nail!
“It’s a good thing. It has made us become more organised in our practice.”