Research Profile - The Rx Revolution: Is it Making a Difference?

Are the new powers that provinces and territories are giving pharmacists improving health and keeping costs under control?

[ Back to main article ]

Across Canada, the role of the pharmacist is undergoing dramatic changes.

It started in Alberta, which enacted legislation in 2007 to allow pharmacists with appropriate training to initiate prescriptions for specific chronic conditions such as hypertension and asthma. Saskatchewan, New Brunswick and Nova Scotia have since followed suit, as has Quebec (when the prescribing power is delegated by a physician). While most provinces and the Northwest Territories now allow pharmacists to provide emergency prescription services and renew or extend prescriptions, a few jurisdictions have gone so far as to permit pharmacists to administer vaccines.

"This represents a significant change in the way that drugs can be dispensed to patients," says Dr. Michael Law, an Assistant Professor at the University of British Columbia's Centre for Health Services and Policy Research. The one hitch, he says, is that no one knows if these new powers and privileges are delivering health benefits to Canadians because "rigorous evaluations of these policies are conspicuously absent."

Funded by the Canadian Institutes of Health Research (CIHR), Dr. Law is in the second year of a three-year study to assess the impact of a 2009 decision by the British Columbia government to give pharmacists the authority to independently adapt and renew prescriptions. Dr. Law's hypothesis is that the move will increase patients' adherence to their medication regimes and reduce visits to family physicians.

"Imagine someone with a chronic condition has run out of their medicine," he says. "It's certainly more convenient to go directly to the pharmacy than it is to make an appointment, go to a doctor, get a prescription and then fill that prescription. In the case of someone who's short on time or runs out of pills, or forgets to make the appointment to renew the prescription, it's a much simpler process. There are potential benefits and there are potential harms. In our study, we're trying to explore different outcomes."

The potential benefit is obvious: the convenience factor helps the patient keep taking the meds he or she needs to stay healthy. The potential harms?

"The concerns that I've heard mostly revolve around ensuring continuity of care and the appropriateness of prescribing," says Dr. Law. "If somebody's getting a prescription renewed by a pharmacist, then that means they may not go in to see their health-care practitioner and may not get their routine follow-up and testing that's necessary with some of these medications. Similarly, some have expressed concerns about whether pharmacists have the clinical and diagnostic training required to make more sophisticated therapeutic modifications."

Dr. Law is conducting his study with the cooperation of B.C.'s Ministry of Health Services, which is making data available from PharmaNet, a computer network that collects information on all the prescriptions dispensed at B.C. pharmacies.

"We should have a good sense of what pharmacists are doing, what patients they're working with and how it has affected drug use and costs. We're also going to look at whether rates of family doctor visits and hospitalizations changed as a result of this policy."

"Because other provinces have similar policies in place, the research should have relevance for policy makers across Canada."
– Dr. Michael Law, University of British Columbia

Summary of Expanded Scope Activities by Province/Territory¹

Provide emergency prescription refills:
BC, AB, SK, ON, QC*, NB, NS, NL, PEI, NWT;
MB: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.
*Limited to oral contraception only.

Renew/extend prescriptions:
BC, AB, SK, ON, QC*, NB, NS, NL, PEI, NWT;
MB: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.
*When delegated by a physician with means of a prescription.

Change drug dosage/formulation:
BC, AB, SK, QC*, NB, NS, NL;
ON: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.
*When delegated by a physician with means of a prescription.

Make therapeutic substitutions:
BC, AB, SK, QC*, NB, NS, NL**
*When delegated by a physician with means of a prescription.
**Limited to non-formulary generic substitution.

Prescribe prescription drugs as part of a minor ailments scheme:
SK, NS

Initiate prescription drug therapy:
AB, SK, QC*, NB, NS;
MB, ON: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.
*When delegated by a physician with means of a prescription.

Order and interpret lab tests:
AB, QC*, NB;
MB, ON, NS: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.

Administer a drug by injection:
BC, AB, NB;
MB, ON, NS: Scope of practice regulations pending and may authorize pharmacists to perform this activity to some degree.

---

1. Source: Canadian Pharmacists Association: Pharmacists' Medication Management Services, Environmental Scan of Canadian and International Services April 2011.