By Janice Harvey, RPh, CDE
Starting June 1, pharmacists in B.C. will be expanding their scope of practice to include prescribing medications for specific ailments. This new service, referred to as “Pharmacist Prescribing for Minor Ailments and Contraception” (PPMAC), is expected to relieve some of the strain on B.C.’s health care system and improve patient access to care. Many people have been asking us questions about this upcoming service and we don’t yet have all the answers, but let’s see if we can at least shed some light on how we anticipate this launching in our pharmacy.
What are “minor ailments”?
Minor ailments are health problems that can usually be diagnosed without the need for lab tests or imaging and they typically respond to a short course of treatment. They are often problems where the patient is already quite sure of the diagnosis (e.g., acne, cold sores, urinary tract infection), especially if they have previously experienced the condition. They are considered “minor,” because it is unlikely that the condition could be masking a more serious disorder.
For a list of the minor ailments that pharmacists will be able to prescribe for, please see our previous article.
Will all pharmacies offer this service?
As this service is new to us, and it adds to our already busy days, we think it will likely take some time before the service is available at all pharmacies. Before prescribing, pharmacists must make a declaration to the College of Pharmacists of B.C. indicating that they acknowledge their professional duties and will follow the legislation and guidelines for prescribing.
Pharmacists are not required to prescribe for minor ailments and contraception, and while all pharmacists have the education needed to provide this service, it is up to the pharmacists themselves to decide if they feel comfortable prescribing. Some pharmacists may choose to prescribe for only certain minor ailments; others may choose not to do so at all. Initially, while we see how best to fit this into our schedule, we may open up appointments for only specific minor ailments and only at times when we have two pharmacists working. It is important to us that each patient has our full focus during appointments and we are not interrupted by other pharmacy demands.
What will a PPMAC appointment be like?
In our pharmacy, PPMAC appointments will be conducted in the pharmacy. We will not be offering phone or online virtual appointments. However, appointments can be booked online and this will be most efficient, as some of assessment questions can be answered in advance. We will not be accepting walk-ins, as there is no way to predict how busy we will be in the dispensary at any given time.
Prior to prescribing any drug, a pharmacist must first perform a complete assessment. This will be based on information collected from the patient and may also include a review of the patient’s medication records. The pharmacist will review signs and symptoms of the minor ailment, risk factors, pregnancy and breastfeeding status, allergies and intolerances, medication history, and any other information that is needed to support a diagnosis and prescribing decision.
If the pharmacist determines that a prescription is appropriate, they will review all details about the drug with the patient, including directions for use and what to expect from the treatment. They will also plan for follow-up to ensure the treatment has been effective and to determine if additional medical attention may still be needed.
Will an appointment always result in a prescription?
There are limitations to what medications we can prescribe for each of the minor ailments, so it is possible that a pharmacist may not be able to prescribe what they feel is the best medication for a specific condition. A pharmacist might also determine that additional follow-up is needed. For example, if a pharmacist deems that lab work is necessary (e.g., frequent recurrence of urinary tract infections) or if a patient wants a prescription for a medication that pharmacists are not allowed to prescribe (e.g., oral medications for acne), then the patient will need to be referred to another healthcare professional.
Do you need to fill the prescription at our pharmacy?
We expect that people coming to see us for a minor ailments assessment will already consider us to be their preferred pharmacy, but there is no obligation to fill a prescription with us simply because we provided the assessment. On the other hand, if you go to a different pharmacy for an assessment (e.g., if we were unavailable for an appointment booking), you can still have us dispense the prescription. Our goal is simply to ensure that we are providing the best health care options for our patients.
How can you book your PPMAC appointment with us?
We have been planning to use an online booking platform developed by MedEssist, as it makes it easy to book appointments for PPMAC, as well as other types of appointments that we may want to set up, such as other vaccinations, diabetes consults, and more.
Other options, which are not yet ready to launch at the time of this article, include:
- The provincial online booking site – already in place for scheduling flu and COVID shots.
- PharmaConnect (website and phone app) – please register with us for PharmaConnect if you haven’t already done so, as it allows you to review your medications, order refills, get your tax receipts, and much more.
With less than two weeks before the launch of this service, we still do not have the information we need to make this decision. Regardless of the scheduling system we end up choosing, we will be adding a booking link to our website to make appointment bookings as easy as possible.
Do you still need to see your family doctor?
During a PPMAC appointment, the pharmacist will fully document all details about the assessment and any prescription medication or over-the-counter treatment recommendations and follow-up plans. When appropriate, or if requested by the patient, documentation will also be sent to the patient’s family doctor or other healthcare provider. This ensures collaboration amongst all healthcare providers.
Remember, pharmacist prescribing is limited to specific minor ailments and contraception. Patients who have a family doctor should still follow up with their doctor for their other healthcare needs. Whenever possible, patients should see their family doctor for prescription renewals, as this is the best way for them to continue to be fully engaged in their patients’ care. For individuals without a family doctor, the changes to pharmacist scope of practice may allow for easier access to treatment.