pharmacists are filling the gaps in health care and it's great news for patients
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'canadians see their pharmacist eight to 10 times more frequently than any other health-care provider, so we really do serve as community health-care hubs,' says sandra hanna, a practicing pharmacist and ceo of the neighbourhood pharmacy association of canada. getty
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if pharmacists were ever considered not much more than pill-counters, the pandemic dispensed with that notion posthaste. called upon to administer covid vaccines, stock ppe, provide antigen tests, and counsel patients on how to stay safe, pharmacists showed they could respond rapidly and effectively in a confusing and chaotic time. in the midst of it all, they became the go-to — sometimes the only — health professional for so many in their community.
‘we serve as community health-care hubs’
“at a time when access to other health-care resources were restrained or restricted, pharmacies stayed open,” says sandra hanna, a practicing pharmacist and ceo of the neighbourhood pharmacy association of canada. “they’re the most accessible health care providers in the system, with 11,000 pharmacies across the country. canadians see their pharmacist eight to 10 times more frequently than any other health-care provider, so we really do serve as community health-care hubs.”
and canadians have been accessing those hubs even more as the pandemic drags on, for their own medical needs and for up-to-date information on covid. “people were often scared to go to the hospital; they couldn’t always get in to see their doctor or walk-in clinic, so they went to pharmacies,” says hanna.
but the extra load was not without its challenges.
hanna says that, at the start of the pandemic, she and her colleagues were scrambling to stay afloat in these uncharted waters in terms of receiving the new vaccines, assessing the quickly evolving eligibility criteria, studying communications from government, and addressing vaccine hesitancy.
“the mrna [vaccine] was more complex in terms of storage and handling,” she says. “that was a learning curve for the entire country, but not one that was out of the realm of what pharmacists were already used to in terms of cold-chain management. we had the fridges and temperature logs already in place.”
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faith in pharmacists
jen belcher, vice-president of strategic initiatives and member relations for the ontario pharmacists association and, like hanna, a practising pharmacist herself, says consumer confidence helped ease her customers’ jitters.
“historically, we had always [rated] highly on the list of professions that people have a high degree of trust in,” she says. “but never before have we seen pharmacists talked about in the same light that we are now. we’re really strong communicators and health educators. we spend a lot of time talking to our patients about managing their diseases and medication, [as well as] preventative measures they can take so they can remain healthy. this is where the strengths of pharmacists came in [during the pandemic].”
beyond boosting prescription home delivery and upgrading computer systems to manage the surge in vaccinations and virtual consultation scheduling, belcher didn’t invest in any huge infrastructure changes to accommodate the wave of new responsibilities. most pharmacies already have private counselling rooms that are also used for administering other vaccines, such as for the flu. but that room couldn’t contain the flood of people eager to get a covid vaccine. so she got creative.
“during the warmer months, we used our parking lot for drive-through vaccination clinics,” she says. “we also brought on additional staff, including volunteers to coordinate traffic, check people in, get documentation, as well as additional immunizers to keep the lines moving. those drive-throughs became locally famous and we had great success because it was a convenient and efficient way of delivery.”
as asset to health-care teams
bridget miller (not her real name) knows first-hand how knowledgeable pharmacists are through her experience with angie chirila at safeway pharmacy in maple ridge, b.c.
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“i first met angie when i was looking for a new pharmacy to manage my daughter’s very complicated medication regime [for cystic fibrosis and crohn’s disease],” says miller. “we had experienced many issues with errors previously. angie immediately was so helpful, reassuring and proficient in managing my daughter’s meds and helping it all run smoothly.”
miller says her daughter’s condition ultimately worsened, but angie was always on top of the new drug regimens, and spoke with many of her daughter’s specialists to develop care plans.
with more than 17 million covid vaccine shots administered across the country, pharmacists have proven they play a critical part in health care. getty
then, miller’s husband suffered two undiagnosed heart attacks, culminating in severe congestive heart failure. “his regime was very complicated as well, [but] angie arranged to bubble pack his meds, and even helped to manage the [anticoagulant] warfarin,” she says. “i cannot tell you what it meant to me to have the additional worry managed by angie. she is a real asset to my health-care team, and to the community.”
miller’s story is not uncommon. pharmacists routinely counsel patients on how to manage diseases such as hypertension, diabetes, high cholesterol, as well as how to quit smoking and maintain a healthy body mass index. but it’s medicines and medication advice most people rely on them for, and rightfully so. they spend four to six years, depending on the province and program, studying medications in depth, says hanna, while physicians spend only part of their curriculum learning about drugs.
“in fact, today pharmacists are graduating as doctors of pharmacy, so certainly they are the medication experts,” she says.
belcher adds that the physicians she works with know and understand pharmacists’ education and expertise and are supportive of the expanded role they’ve taken on.
“there can be challenges if we don’t understand where the other is coming from,” she says, “and there can be some conflict, but overall, we all support working collaboratively.”
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more than 17 million covid vaccine shots administered across the country later, pharmacists have proven they play a critical part in health care, and hanna says they should be able to do more.
“one in four canadians have missed or delayed routine immunizations, such as hpv, shingles and pneumonia, over the past couple of years, and about 1.3 million children have missed or delayed a vaccine,” she says. “[in our polls] seven out of 10 said they may not have missed them if they had better access.
“we’ve been advocating strongly that pharmacies should play a big role in that area because we’ve demonstrated that we can mobilize and operationalize quickly, and that we have the infrastructure to offer those services.”
belcher agrees pharmacists are able and eager to take on more responsibilities, such as the treatment of minor ailments, administering travel vaccines, and writing prescriptions, such as for birth control pills, without the involvement of a physician.
“a variety of travel-related vaccinations [are given] in pharmacies across the country already,” says belcher, who also has a certificate in travel health from the international society of travel medicine. “the key point is whether pharmacists can independently prescribe travel vaccines, as they do in alberta. some provinces don’t have scope for that, like here in ontario.”
as for birth control, pharmacists in nearly every province and territory, except for nunavut, can renew or extend an existing prescription if a woman is unable to access her doctor. four provinces — alberta, saskatchewan, quebec and nova scotia — can prescribe contraceptives to varying degrees.
belcher and other pharmacists are advocating for the same authority in ontario because it does fall within their expertise. in addition, research from the canadian pharmacists association shows 72 per cent of women support pharmacists prescribing birth control.
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policy blocks pharmacists from using their expertise
hanna says policy and regulatory barriers block pharmacists from using their expertise. for example, she notes that while pharmacies in most jurisdictions are able to administer the shingles vaccine because the scope [of practice] is available, there is limited funding for the service and pharmacies often don’t have access to the public supply.
she also adds that pharmacists weren’t funded for providing increased virtual consultations during the pandemic — professional services stipulations require that patients be at the pharmacy in-person in order for pharmacists to be paid for that consultation and advice.
“we [eventually] advocated successfully with a lot of the provinces to allow pharmacies to offer those services and still be remunerated, even [via] video or telephone call,” she says.
“some of those services were offered temporarily to fill the gaps [created during] the pandemic, but we’d really like to see them become permanent expansions in the role that pharmacies play. the public now sees pharmacies as the go-to place for a lot of these services, and they will demand that [continued] access and convenience to those services they’ve become accustomed to.”
robin roberts is a b.c.-based writer.
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