Explaining Pharmacist Activities
Activity	Definition or Example
Adapting a prescription	This can include changing a prescription (a dose, formulation, regimen), or renewing a prescription
Therapeutic substitution	A drug from the same therapeutic class of medications is substituted for another drug within the same class. This may have to do with drug insurance coverage, as when the blood pressure medication ramipril is substituted for enalapril.
Prescribing in an emergency	If someone runs out of a medication on a weekend and has no prescription, a pharmacist can prescribe a certain quantity of medication. This means there is no interruption in the drug treatment or the person’s care.
Refusal to fill	A pharmacist will not fill a prescription that is inappropriate. For instance, the dose could be too high or the prescription illegal.
Administering a medication by injection and immunization	The vaccine Zostavax® prevents shingles in people over age 50. Depending on the province, a pharmacist may inject this medication and inform the doctor about the vaccination.
Comprehensive medication management	This is an in-depth review of how medications are being taken. Concerns about medications are addressed, and questions related to healthy lifestyle discussed.
Interpreting and ordering lab tests	To manage specific medications, pharmacists may collect and interpret lab tests. They may take action based on the lab results.
Minor ailment assessment and management	For medical conditions that resolve on their own and are not an emergency, a pharmacist may be able to prescribe medications. For instance, minor ailments include cold sores, acne, or insect bites. A prescription may be written and dispensed.
Medication reconciliation	When a patient leaves hospital and returns to community, there may be confusion about medications. A review allows the pharmacist to provide a complete list.
Adapted from the CACDS (Canadian Association of Chain Drug Stores) website.

Pharmacists support health and wellness in many ways. They initiate, adapt and renew prescriptions, assess and prescribe for minor ailments, review medications and give injections. They also provide health screening clinics on topics such as diabetes and sun awareness, and services such as checking blood pressure.

Do I need a doctor if pharmacists can prescribe medication?

You still need to see your doctor. For a pharmacist to be able to prescribe medications, a cooperative relationship must exist between you, your doctor and the pharmacist. First, your pharmacist will assess your need for therapy. You will be asked questions to make sure an adaptation is appropriate. Once this is done, your pharmacist

has the ability to prescribe a medication, or adapt an existing one. Your doctor must continue to assess your medical needs. Generally, a pharmacist may adapt medication to treat a chronic condition. (This is one that requires the same medication with no changes, for a period of more than six months.) As well, narcotics, controlled drugs, and targeted substances cannot be renewed or adapted by a pharmacist.

Other than filling prescriptions, what do pharmacists do?

Pharmacists are now able to extend refills on existing prescriptions. They can prescribe a supply of medication in an emergency. Depending on the province, pharmacists can offer services like immunization, medication review, adaptation and prescription, and prescribe for minor ailments. They can help patients monitor their own blood glucose, and suggest strategies and medications to stop smoking. Pharmacists order lab tests to help monitor drug therapy, and provide anticoagulation (blood thinners) and asthma services. Additional activities depend on the legislation, regulations and bylaws in the province.

Some pharmacists are able to prescribe after an initial consultation with the patient. Generally, they are in a collaborative practice arrangement with a doctor. If a pharmacist prescribes or adapts a medication, or immunizes, the prescribing doctor is informed via fax.

Some pharmacists have extra training concerning those with diabetes or asthma, or the health of women, men, or seniors. They are able to discuss these concerns in more detail.

What is a medication review?

A medication review is a one-on-one consultation with a pharmacist. It gives you a better understanding of your medication routine. Current medications, herbal products, and non-prescription medications are reviewed. Drug related concerns are addressed. For instance, you may wonder why your medications have been prescribed, and how to take them. Your pharmacist can check that the medications are appropriate, making sure they are safe and effective. Health and lifestyle issues, such as smoking, nutrition, and exercise, can also be addressed.

Generally, a session takes about 30 minutes. A detailed medication history is provided after evaluation and health goals identified. A plan is put in place to prevent future medication issues. Your doctor will receive notes about the session.

What is happening in each province?

British Columbia

In British Columbia, pharmacists have been doing emergency supply prescriptions, under their own name, since the 911 disaster. In January 2013, pharmacists became able to review a patient’s immunization history. They can now write an assessment, and dispense any vaccine that is part of the province’s regular immunizations without a prescription from a doctor. These vaccines include Twinrix® for hepatitis A and B, and Zostavax® for shingles.

Pharmacists are able to adapt certain prescriptions, administer select injections, and do medication reviews. Patients with more than five medications (prescription, over-the-counter, compounded or injection) can have the government pay for a medication review. A new medication review and a pharmacy consult can be done once every six months, with follow up four times per year. Pharmacists may receive a fee for dispensing smoking cessation medication including bupropion and varenicline.

Alberta

In Alberta, recent laws have allowed pharmacists to be a more active partner in patients’ health. Pharmacists have been adapting medications for several years now. As of July 2012, those who have chronic conditions qualify for a yearly medication review. Recently, coverage changed to include people on three or more medications or with two chronic conditions, including asthma or diabetes. Pharmacists are able to authorize prescription refills, modify a prescription, give the flu shot and other vaccinations, and help manage medical conditions through medication reviews. Pharmacists can also order lab tests to check that a medication is working properly.

Saskatchewan

In Saskatchewan, pharmacists do medication reviews and emergency prescribing. Saskatchewan is unique in that pharmacists may prescribe for minor ailments. This includes medication for mild acne, cold sores, insect bites, allergic rhinitis, mild to moderate eczema, headache and migraine, dys--pepsia (indigestion), hemorrhoids, diaper rash, and canker sores. (Minor ail-ments usually run their course without medical intervention, and could be self-diagnosed.) Pharmacists also help with reducing tobacco use.

If you smoke, you can have up to 90 minutes of smoking cessation counselling with your pharmacist, your doctor or both.

Manitoba

In Manitoba, legislation has only allowed limited expansion to the pharmacist’s abilities. Expected changes to the Pharmaceutical Act would allow pharmacists to give immunizations and adapt medications. Some pharmacists do medication reviews and provide medications in emergencies. Currently, the government does not fund medication reviews. Once changes to the Act are in place, pharmacists will be able to take on new tasks similar to those in other provinces.

Ontario

In Ontario, a pharmacist may give publicly funded flu vaccine, renew or adapt existing prescriptions, and prescribe medication to help people quit smoking. They support people with chronic diseases like diabetes, and help monitor the condition. They may demonstrate how to use an asthma inhaler or inject insulin. Pharmacists are allowed to pierce or lance a patient’s skin to educate and monitor chronic disease. For instance, a pharmacist can show how to use a glucometer and lancet correctly. Any information demonstrated during the session is documented.

The role of the pharmacist in different provinces
Pharmacist Scope of Practice	BC	AB	SK	MB	ON
Provide emergency prescription refills	✔	✔	✔	P	✔
Renew and extend prescriptions	✔	✔	✔	✔	✔
Change drug dosage and formulation	✔	✔	✔	✘	✔
Make therapeutic substitution	✔	✔	✔	✘	✘
Prescribe for minor ailments	✘	✔	✔	✔	✘
Initiate prescription drug therapy	✔	✔	✔	P	✔
Order and interpret lab result	✘	✔	✘	P	P
Administer a drug by injection	✔	✔	✘	P	✔
✔ = implemented in province P = pending legislation or regulation or policy ✘ = not implemented Adapted from the Canadian Pharmacists Association, Summary of Pharmacists’ Expanded Scope of Practice Activities across Canada, October 2013

The role of the pharmacist in the health care system is expanding. Pharmacists can initiate, adapt and renew prescriptions, assess and prescribe for minor ailments, do medication reviews, and provide injections. A pharmacist can answer any questions you have about your medications. They are the medication management experts!

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