As Canada’s population ages, the number of people with chronic conditions such as diabetes and heart disease is rising. This makes access to quality and timely public health care important. At one time, a pharmacist’s main role was to prepare, mix and dispense medication prescribed by doctors. Today, with their unique skills and education, pharmacists play a larger role in health care. Pharmacists work with their patients and other health care providers to provide individualized care.
Pharmacists have always ensured that the correct medication and dose are prescribed and possible side effects considered, while confirming that the medication is effective. Sometimes, a prescribed medication may conflict with another. The pharmacist will contact the doctor to recommend one more suited to the specific needs of the individual.
Across Canada, changes to the pharmacy profession have allowed pharmacists to take a more active role (see Tables 1 & 2). In some provinces, pharmacists adapt and initiate prescriptions. Some are able to extend refills on existing prescriptions. Pharmacists provide medication reviews and give injections. They order lab tests to monitor drug therapy, and help people to stop smoking.
|Adapt a prescription||A dose, formulation (tablet, capsule, liquid) or routine may be changed, or a prescription renewed.|
|Therapeutic substitution||One drug is substituted for another drug within the same therapeutic class (family) of medications. This may be related to drug insurance coverage. (Insurance may fully cover only one drug from a therapeutic class.)|
|Medication Review||In a one on one consultation, the pharmacist reviews and assesses a current medication routine. Any drug-related concerns are identified, prioritized and managed. As well, health and lifestyle issues such as smoking are discussed.|
|Order and interpret lab tests||To manage specific medications, pharmacists may collect and interpret lab tests. They may make recommendations based on the lab results.|
|Assess and manage minor ailments||A pharmacist may be able to prescribe medications for medical conditions that resolve on their own and are not an emergency. Examples of minor ailments include cold sores, acne, and insect bites. A prescription may be written and dispensed.|
Each province has worked to change legislation, enabling the role of the pharmacist to expand. The legislation, regulations and bylaws vary in each province.
As of 2009, pharmacists in British Columbia can adapt and manage prescriptions, with certain limitations. This includes renewing a prescription. They are also able to administer a selection of injections, and provide medication reviews.
For many years, B.C. pharmacists have been able to provide an emergency supply of medications.
In order to give injections, pharmacists must complete a training course and receive authorization from the College of Pharmacists of British Columbia. They must make an annual declaration stating that they continue to meet all requirements to maintain this authorization.
Based on clinical need, patients who take more than five medications (prescription, compounded or certain injections) may be eligible for a medication review, the cost covered by the government, up to twice a year. Follow-up may occur four times per year.
The B.C. Smoking Cessation Program was first launched in 2011. This program provides an opportunity for pharmacists to support those who want to stop smoking.
More than in any other province, pharmacists in Alberta are highly active partners in health care. They are able to prescribe, adapt prescriptions, inject medications, provide medication reviews, and order lab tests.
Alberta was the first province to give pharmacists the ability to prescribe. All pharmacists in Alberta can adapt or renew a prescription, or prescribe in an emergency situation.
To initiate or change drug therapy, pharmacists must apply for additional prescribing authorization. To maintain this ability, they must do ongoing professional development through the Alberta College of Pharmacists.
To give injections, the pharmacist must complete an approved training program. Each year, they must fill out a professional declaration stating that they continue to meet all requirements, such as valid first aid and CPR certification.
Since 2012, pharmacists have been able to provide medication review services for people with chronic conditions. These reviews are done annually for people who have three or more medications or two chronic conditions, such as asthma and diabetes. Follow-up is done as needed.
All community pharmacists are able to order lab tests. They must know and follow the standards and guidelines for ordering lab data. As well, they must have a system in place to ensure that appropriate follow-up of critical lab results can occur on a 24 hour, 7 days a week basis.
Pharmacists in Saskatchewan also have some prescribing abilities. They can adapt prescriptions, extend refills, and provide an emergency supply of prescribed medications. They are able to administer medications by injection, such as vaccines and vitamin B12. As well, they can help people to stop smoking by meeting with them to develop a personalized quitting plan. Providing ongoing support can help them remain non-smokers.
Saskatchewan pharmacists can prescribe some prescription medication for minor ailments. (A minor ailment, like acne, cold sores and insect bites, is less serious and self-limiting, only lasting a short period of time.) Minor ailments often can be treated with an over-the-counter medication, without a doctor’s prescription. In some circumstances, certain prescription medications can be used.
Saskatchewan residents over the age of 65 may be eligible to meet with a pharmacist for a medication review. This service is available through the Saskatchewan Medication Assessment Program (SMAP). Seniors must live in the community in their own residence and take five or more chronic medications. People who live in an approved private service or group home are also eligible for this annual service.
In 2014, pharmacists in Manitoba were enabled to perform a number of additional activities. After an assessment, pharmacists can approve refills on prescriptions and will be able to order lab tests. Upon completing further training, pharmacists in Manitoba can prescribe medications for self-limiting conditions including medications to help stop smoking. Pharmacists can also collaborate with a doctor to prescribe medications.
Pharmacists are able to administer drugs through an ‘advanced method’ (by injection or intravenous). To do so, they must complete extra training through the College of Pharmacists of Manitoba. As in Alberta, pharmacists must complete an annual declaration stating they continue to meet the requirements for giving medication in this way.
Pharmacists in a specialized practice can apply to become an extended practice pharmacist. This allows them to prescribe prescription medications within the scope of their specialty. For instance, some pharmacists work as certified diabetes educators (CDE). They are able to prescribe medications related to diabetes, in collaboration with other health care providers such as a doctor. Extended practice pharmacists can order lab tests within their scope of practice and in relation to any medications they prescribe.
Pharmacists do not replace doctors or nurses. Instead, they work collaboratively with other health care providers to improve the health and wellness of Canadians. These health care professionals can answer all questions about medication. They are able to adapt and renew prescriptions, provide medication reviews, order lab tests, assess and prescribe for minor ailments, and provide injections. In short, pharmacists can help you with a wide variety of health and medication management needs. Talk to your pharmacist today to learn more about the services available to you.
Pharmacist Scope of Practice
|Prescribe independently for any prescription drug||NO||YES||NO||NO|
|Prescribe in a collaborative practice setting or agreement||NO||YES||YES||YES|
|Prescribe for minor ailments||NO||YES||YES||YES|
|Make therapeutic substitution||YES||YES||YES||NO|
|Change drug dosage, formulation or routine||YES||YES||YES||YES|
|Renew or extend prescription for continuity of care||YES||YES||YES||YES|
|Administer any drug or vaccine||NO||YES||YES||YES|
|Administer vaccines, travel vaccines or influenza vaccine||YES||YES||YES||YES|
|Order and interpret lab results||NO||YES||PENDING LEGISLATION||YES|
Adapted from the Canadian Pharmacists Association, Pharmacists’ Scope of Practice in Canada, January 2016