The head of the organization representing Nova Scotia’s pharmacists and pharmacy technicians says more needs to be done to incorporate them into the primary health care system. 

“If utilized effectively, our pharmacy teams could support fundamental changes to how care is delivered in Nova Scotia,” Pharmacy Association of Nova Scotia (PANS) CEO Allison Bodnar told the legislature’s standing committee on health Tuesday afternoon.

“Health care is complicated and change is hard, but no health care provider should be waiting on the sidelines while patients are waiting for care.”

The meeting’s focus was the expanded scope of pharmacists. Bodnar opened by saying most prescription renewals — millions a year — should be done by pharmacists at a pharmacy.

“We should not be wasting valuable ER, urgent care, mobile care, virtual care, and physician time on most of these prescriptions,” Bodnar said. 

While the scope of practice for pharmacy professionals has expanded “somewhat” in the last three years, Bodnar said Nova Scotia has had one of the broadest scopes of pharmacy practice since 2011. What has changed is the recognition and acceptance of the role they can play. 

“Pharmacists are the medication experts in our system,” she said. “Pharmacy technicians are the experts in all the technical aspects of pharmacy, including dispensing, point of care testing, device demonstrations, and play a key role in the administration of injections.”

Wasting scarce resources

Stressing that immunizations and injections could also be undertaken at pharmacies, Bodnar asked why scarce resources are “wasted” treating minor ailments at emergency departments or urgent care clinics.

There are 315 pharmacies across the province. Given their extended and weekend hours of operation and the fact they’re located in communities across Nova Scotia, she said patients could seek primary care that falls within a pharmacist’s scope where and when they need it. 

“We need to lean into the infrastructure that’s in communities that already exists. We’re on Main Street. Our pharmacists are part of the community. They tend to live there. They tend to be involved with the community, patients know them,” Bodnar said. 

“So as much as I like virtual care, isn’t it better to have your renewals done by your pharmacist in the community than the physician that’s sitting in Ontario? We need to rethink about where is it best for patients to get care and how do we achieve that by maximizing the role of all of our health care professionals.”

With pharmacists working to an expanded scope, Bodnar said patients would have more options for timely access to care and make fewer annual visits to a general practitioner or nurse practitioner. She said this would open up opportunities for larger patient rosters as well as reduce the need to continually increase the number of providers.

41,000 services in six months

In February, PANS and the province announced a pilot project aimed at allowing pharmacists to use their full training (scope of practice) to help provide patients with more timely access to primary health care. 

Although 11 participating pharmacies were initially announced at the launch, there are now 24 across the province. At those specific locations, patients can book appointments to be treated for minor ailments (strep throat) or for chronic diseases like diabetes, asthma and chronic obstructive pulmonary disease (COPD).

In the first six months of operation, Bodnar said community pharmacy primary care clinics have provided more than 41,000 services. These include 10,000 strep assessments. 

“People that would have all needed to seek care elsewhere. It has also changed the professional life of the pharmacists who are working there. We hear things like ‘I am so grateful. I’ve waited 20 years to practice this way and now I’m finally here,’” Bodnar said.

Patient feedback has also been overwhelmingly positive. Calling on government to support the expansion of these clinics provincewide, Bodnar said 98% of users rate the pilot service an eight out of 10 or higher, with 89% rating it a 10/10. 

“They’re all saying it’s getting them care faster and it’s keeping them out of other centres,” she said. “So for me that is probably the most important piece is that this works for patients. The next piece for me as a representative of pharmacists and pharmacy professionals is that it works for our teams and our teams love it.”

Pharmacy technician shortage

While any pharmacy in the province can bill MSI for things that include prescription renewals, contraception assessments, and prescribing for Lyme disease, the most popular service offered at the pilot sites (strep assessment) isn’t even available for a fee at pharmacies that aren’t part of the pilot. 

“What we’re trying to do with this project is get to the point where we recognize the full scope of pharmacy practice,” Bodnar said. “And all pharmacies will eventually be funded to provide the full scope of pharmacy practice and we won’t be cherry picking this small subset of services for funding, leaving the rest to be paid privately.”

Bodnar also addressed what she called a “huge deficit” in current capacity and projected education capacity for pharmacy technicians. 

There are 250 licensed pharmacy technicians practicing in the province. These professionals have the technical skills required to accurately dispense and compound drugs, administer injections, and perform tests.

Bodnar said the province’s decision last year to increase wages and provide free education for continuing care assistant (CCAs) led to a significant drop in enrolment in pharmacy technician programs. She said this had a “huge impact” as enrolment dropped “to almost nothing.”

“We have had very little technicians to even be available to pharmacy in the last couple of years,” Bodnar said.

Bodnar will soon visit one institution that used to have two graduating classes of pharmacy technicians. This year, they had one class of just seven students. Of those, Bodnar said maybe half typically get licensed. The other institution had only 12 graduates. 

‘How do we evolve the system’

Acknowledging that more CCAs are needed, Bodnar said it’s also important to recognize the decision’s ripple effect. 

“It’s complex, and I don’t want to place blame on anyone because certainly our pharmacy organizations own some of it, the system owns some of it, just how it’s evolved with financial cuts over the last 12 years is part of it,” Bodnar said. 

“So it doesn’t really matter how we got here. We’re here, we know the potential for pharmacy to impact the system. So how do we work together to solve these problems and make sure we have these pharmacy professionals here and ready to go?”

While pharmacy is just a piece of the puzzle when it comes to rethinking health care delivery, Bodnar said it can play a “very important role” and it needs to happen. 

“So many times I’ve heard, but they’re (pharmacists) privately employed. So what. We can do lots by contract and agreement, and we can do a whole lot of things to make this work for the system,” Bodnar said. 

“And that’s what we need to focus on now. How do we evolve the system so that we are fully utilizing pharmacists and our pharmacy teams as well as other health care providers to their maximum scope for patients.”

‘Better care, not bandaid care’

Beverley Zwicker, CEO and registrar of the Nova Scotia College of Pharmacists, also addressed the committee. She said while pharmacists are often referred to as medication experts, they are that and much more. 

Zwicker said advances made in recent years to reposition pharmacy in the primary health care landscape are providing “better care, not bandaid care.” But the biggest barrier the college continues to face is “entrenched” ways of thinking. 

“Entrenched thinking that is rooted in an outdated and historic paradigm where physicians and nurses are the only professions recognised as having the breadth of knowledge necessary to provide primary health care to the population,” Zwicker said.

Because it exists across society, Zwicker said this kind of thinking impacts government and system planners. It also determines which professionals are at the table when it comes to planning and implementing health care system changes.

“It impacts what the public believes access to health care should look like, and what a fix to our health care system looks like,” Zwicker said.

To help dissolve some of those beliefs, Zwicker shared that there are 1,450 pharmacists practicing in Nova Scotia. She said these health care providers have a minimum six years of university education, with broad and deep education and competencies in health care. 

Redesigned health care system

They’re also trained in patient assessment, ordering and interpreting lab tests, focussed medical history-taking, health promotion and wellness, lifestyle, and other non-drug related strategies. 

We have stood up truly innovative health care delivery models in Nova Scotia over the past couple of years. Virtual care Nova Scotia. Mobile primary care clinics…and the pharmacy primary care clinics. And now we need to take these new pieces, and we need to not just try to retrofit them into an old system.

We need to intentionally build and incorporate them into a redesigned health care system with redesigned patient care pathways, new technology communication platforms that will connect these new pieces with the information between health professions, and a redesigned system of governance and oversight. Pharmacy the profession needs to be involved in planning and making decisions around this redesign.

PANS and the college have also long advocated for a ‘one patient one record’ (OPOR) system that includes pharmacists and connects all health care providers.

‘Going to take some rethinking’

Several initiatives aimed at bolstering the pharmacy workforce are currently underway. In addition to streamlining licensing requirements, Zwicker said they’re creating a recruitment campaign expected to launch this fall.

They’re also working on a project aimed at establishing a minimum staffing level for all pharmacies based on the amount of service they provide. 

Zwicker said while testing and treating strep and minor ailments are important services, what’s more important to the “long game” of ensuring a better quality of care is repositioning pharmacists to be the “authors” of drug therapy. 

“That the prescribing of medications, from the first prescription and ongoing, is the primary role of the pharmacist. And that’s going to take rethinking,” she said. 

“It’s going to take disrupting some entrenched ideas about whose role it is to do in the primary, and whose role it is to do it in the secondary. Who authors it and who edits it.”

Zwicker noted that medications are sophisticated and much more complex than they were years ago.

“It really does take expertise to be able to use them appropriately so that we’re getting the most from both our drug budget line,” Zwicker said. “But more importantly, so that we as Nova Scotians realize the health outcomes that we can and the best possible health care that we can.”

Zwicker concluded her committee appearance by encouraging Nova Scotians to rethink the role of pharmacy “so that we get to where we need to be for a redesigned and sustainable health care system.”

Yvette d’Entremont is a bilingual (English/French) journalist and editor who enjoys covering health, science, research, and education.

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3 Comments

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  1. Unless we have universal pharmacare, expanding the scope of practice for pharmacists is a form of privatization of the health care system. This is already being done in Ontario and being expanded to opening private practices within large pharmacies. Even if the intent of these pharmacists is inherently good, the uptake and expansion of this by large corporations (loblaws, metro, sobeys) will be swift and predictable.
    Efficiencies can be gained to ease doctor workload as long as it doesn’t further erode the public system.
    In the ‘wasting scarce resources’ the focus should first be on eliminating the ‘scarce’ part by properly funding the system…and then ensure there’s no waste in the system…

    1. If the pharmacies are billing MSI for the service, it isn’t any more privatisation than what currently exists. Doctors are not employed by the province, even those who work in Hospitals ultimately belong to their own corporations as a practice that bills the government for their services

  2. What a common sense, logical approach to helping, so i guess it will not be adopted to the full extent to help. It is apparent we have a world class groups of doctors, nurses and support workers however we have the administration and management of a multi billion health care system being run by not so smart people. If you need proof of this, just ask yourself the question why are we in this mess today? It is on us to expect the same group that have put us in this mess, we expect to fix. Like the pharmacists, the people working the system know what needs to be done, why not ask them and do what they say. Health care like the education system DO NOT NEED ANYMORE MONEY, they need to spend it better. Also, it is time that we take the training of health care professionals away from Dalhousie and put it at other universities in HRM and the province, who will train Nova Scotians first. Interesting what CBU has done in just months and now Dalhousie is ready to make changes; kudos to you Mr. Dingwall!