Starting June 1, pharmacists in B.C. will have a new authority, the authority to prescribe some types of drug.
Currently, pharmacists are allowed to refill existing prescriptions for up to two years. This might happen if a physician prescribed a drug, but did not order refills.
They can also substitute one medication for a different but similar one. And as of last fall they can administer some drugs by injection, after they helped out in giving COVID shots.
These are relatively minor changes. They do not meaningfully alter the role of pharmacists in our health-care system.
However, the new authority to prescribe has that potential. It will permit pharmacists to prescribe drugs on their own, without a physician being involved. Given the dearth of primary care providers, this is a welcome step.
Yet viewed in detail, this new authority appears needlessly restrictive in scope.
In effect, prescriptions may be written for only a very limited range of minor ailments — 16 in all — such as acne, fungal infections and heartburn.
Oral contraceptives may also be prescribed.
But numerous long-lasting conditions like asthma, high blood pressure or elevated cholesterol levels are not included in the list of ailments that pharmacists can now treat.
The reason given is that chronic disorders of this sort sometimes mask more serious conditions that need physician treatment. As well, various diagnostic procedures may be required in tracking such ailments, such as blood tests or CT scans, which pharmacists are not allowed to order.
In an ideal world, with a health-care system operating efficiently, these limitations would do no harm.
Yet in B.C., and across the country, medicare is in crisis.
In this context, it would have been reasonable to extend the prescribing scope of pharmacists well beyond that now planned.
In Alberta for some years, pharmacists have been allowed to prescribe a wide range of medications, including for chronic disorders. They can also order lab and other diagnostic tests.
To ensure this is done safely, pharmacists who wish to take on these additional responsibilities must undergo supplementary training.
Yet nurse practitioners in B.C. already enjoy comparable authority to pharmacists in Alberta, including the authority to diagnose and treat a very wide range of ailments. Nevertheless their training program is no more rigorous, at least as regards drug therapy, than a pharmacy degree.
Adding weight to this point, there are nearly as many registered pharmacists in B.C. (6,703) as there are practising family physicians (6,884).
This is a huge resource that could be put to better use in difficult times like these.
That view is gaining ground abroad. The U.K. health department has calculated that allowing pharmacists in Scotland to prescribe antibiotics for urinary tract infections might save an estimated 400,000 family physician visits a year.
A similar arrangement in B.C. could reduce physician appointments by around 300,000, no small matter.
It must be noted that B.C. is not alone in limiting the authority of pharmacists. Several other provinces, Ontario and Quebec among them, retain similar restrictions.
And not every pharmacist might take the additional training required.
Yet the question must be asked, when we’re going to the ends of the earth to recruit more nurses and train more doctors, why we aren’t making full use of the pharmacists we already have.
Yes, patient safety is a must. But surely it is safer to allow pharmacists to handle cases of asthma or elevated cholesterol with well researched medications, than to leave such conditions untreated because a physician cannot be found.
For that reason we encourage the province to give pharmacists a wider role in managing the primary care crisis.
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