While the Alberta College of Pharmacists maintains that a pharmacist will never replace the role of a family physician, legislation in recent years has created flexibility for pharmacists that could alleviate some of the pressure on emergency care facilities, hospitals and wait times at clinics.
“Pharmacists receive extensive training with regards to medication,” explained Reid McDonald, pharmacist and owner of Sunset Ridge Pharmacy.
“Not only do they learn about how drugs work and whether they need to be taken with food or not, they also learn how to assess a patient and their condition to ensure the medications prescribed are safe and effective.”
In 2007, provincial legislation was passed that allows Alberta pharmacists who have been in practice for at least one year to apply to get their ‘Additional Prescribing Authorization’ (APA) certification; some 788 out of 4,600 Alberta pharmacists possess their APA.
Pharmacists can also register with Alberta Health for certification to order lab tests.
Also since 2007, all pharmacists have been given authority to extend prescriptions for existing conditions that they are familiar with; this does not include narcotics and controlled drugs, which are federally regulated and must be prescribed by a physician or licensed nurse practitioner.
McDonald and pharmacist Anita Cumbleton (McDonald’s partner in business and in life) are both APA certified.
“The whole idea is that we’re supposed to work with family physicians,” said Cumbleton, adding that if her existing clients come visit her pharmacy for something simple — such as adjusting blood pressure medication or extending an existing prescription — it saves a lot of pressure and expense to the taxpayer, rather than that individual being admitted at the Urgent Care Centre.
“Pharmacists have an important role in providing a solution to the wait times and doctor shortages in Alberta’s health care system,” said McDonald.
“Pharmacists (who possess an APA) could also prescribe new medications to help a patient reach their target blood pressure. The ability of pharmacists to write for lab tests allows them to monitor other types of medications, including those used to control diabetes or high cholesterol.”
Grande Avenue Pharmacy in Cochrane currently has two pharmacists on staff, Ian Kruger and Shiv Nijjar, who possess their APAs.
According to Dale Cooney, deputy registrar for the Alberta College of Pharmacists, the additional authority granted to pharmacists and the improved collaboration among health care professionals allows for better patient care through administering initial therapies and managing ongoing therapies.
“It’s another tool in the pharmacist’s toolbox that helps them to practice and ensure appropriate drug therapy for their patients.”
He said that since 2007, pharmacists also have the ability to obtain ‘Authorization to Administer Drugs by Injection’; of the 4,600 licensed pharmacists in the province, 3,100 possess this certification — evident during flu season, where people over age nine can get their flu vaccines at their local pharmacies, in addition to walk-in clinics.
“The authoritative capabilities of pharmacists in Alberta are broader than in any other province in Canada,” he said.
Of the 788 pharmacists with their APAs, over 500 have received their APAs since February 2013; according to Cooney, this is evidence that the pharmacist community is embracing change.
According to Reid Kimmett, manager of Grande Avenue Pharmacy, with four pharmacists on staff with their injection authorizations — this has been one of the key areas where pressure on family doctors and the Urgent Care Centre has been alleviated.
“There’s definitely been a big shift…when we first started administering flu vaccines, we would see around 200 people come in and now we see around 1,000,” remarked Kimmett.
Dr. Ross Tsuyuki is a pharmacist and professor of medicine in the faculty of medicine and dentistry at the University of Alberta in Edmonton.
Since 2007, Tsuyuki has been involved with three studies that look at the role of pharmacists and patient care — one on diabetes, another on blood pressure and the third on high cholesterol.
He said that each of the studies have indicated ‘enormous improvement’ in patient care from working with prescribing pharmacists.
These three studies are now being incorporated in a fourth study — ‘the Reach Trial’, which examines contributing factors (data from first three studies) that contribute to heart disease and stroke patients (the number one killer in Canada). The study centers on pharmacist patient care of at-risk persons for heart disease and stroke and tries to reduce risks through therapy management led by pharmacists.
He said that while the study is not yet complete, the response from patients working with pharmacists is ‘markedly positive’.
Cooney emphasized that pharmacists would never replace the need for a family physician, but that the role of the pharmacist is evolving to allow for better efficiencies in patient care across the province.
According to Keith Bradford, communications manager with Calgary Foothills Primary Care Network (PCN) — one of seven networks in the Calgary area, “there are 17 clinical pharmacists currently working alongside family doctors with the Calgary-Foothills PCN and all 17 have prescribing privileges.”
Bradford added that only one Cochrane pharmacist is currently working in partnership with Cochrane PCN-member physicians.
He said there is currently not a shortage of PCN clinical pharmacists or those on a waiting list for Cochrane at the present time.
“Primary Care Networks are groups of family doctors who work with other health care professionals and AHS to deliver primary health care throughout the province…including access to health management nurses, clinical pharmacists, registered dieticians and behavioural health consultants (as well as other health care professionals),” explained Bradford.
To learn more about the Calgary-Foothills PCN, visit cfpcn.ca.
“Finding a ‘family pharmacist’ is probably just as important as finding a family physician,” said McDonald.
“Not only because pharmacists have been shown to provide a great benefit to patients when they are actively involved in their care, but also because a good relationship with a pharmacist will decrease the burden on family physicians.”
