By Michael Mui
Communications Manager, BCPhA
Mahin Hanifian recalls how in her early days as a pharmacist, the idea of her profession writing prescriptions was virtually unheard of. It certainly wasn’t taught in school, where students were educated about medications, their manufacture, chemistry, interactions, effects on the human body, but not diagnosis or prescribing.
But times have changed since then.
Today, every province in Canada has enabled pharmacist prescribing for minor ailments, with B.C. implementing its Minor Ailments and Contraception Service (MACS) in June 2023. At the same time as the launch, the BC Pharmacy Association launched a massive public awareness campaign that has, to date, reached millions of British Columbians. The message of these campaigns: community pharmacies are now an additional way British Columbians can access health care. In the four months following, more than 3,500 pharmacists have collectively performed 135,000 assessments for minor ailments and contraceptives.
Mahin Hanifian is the associate owner of Shoppers Drug Mart #291 in North Vancouver.
For Hanifan, who runs a busy Shoppers Drug Mart pharmacy in a North Vancouver shopping complex with her team, she acknowledges that some with years of experience might find it challenging to adapt their well-established routines to a new scope, with public expectations, and build their confidence.
To those, she gives the following advice:
“This is an opportunity to learn. Things have changed, just like everything else in life, we should embrace it.”
Lack of confidence and fear of the unknown
In a BC Pharmacy Association member survey earlier this fall, a small number of pharmacists who said they weren’t interested in prescribing were asked why. Among the top reasons? Lack of confidence or not having enough time or resources to do so.
Some reported they still provided patient consulting and recommended over-the-counter products to patients when appropriate but didn’t have time or were not confident in their knowledge to complete the documentation required for the service.
For Vernon pharmacist Curtis Omelchuk, the idea of prescribing for minor ailments and contraception seemed a bit daunting at first. It had been more than 25 years since he graduated from pharmacy school, and prescribing wasn’t something that was on the curriculum.
While pharmacists had been asking for minor ailment prescribing, Omelchuk felt for some it may have been rushed to try to add to workflow and understanding the documentation process. He and others wondered how they would fit this new service into their day.
“There was fear that the documentation would have been laborious,” he said, noting that his pharmacy, Hogarth’s Clinic Pharmacy, purchased software that has made it easy to fit prescribing into the day.
Omelchuk has encountered others who are hesitant, but acknowledge they still want to prescribe.
“It’s something we’ve been pushing for,” he said. “With newer grads, that’s almost all they want to do, but there’s a balance. The business isn’t there yet, but it’s sure coming.”
And the numbers show it.
As of Oct. 17, more than 116,000 patients have visited a pharmacy for a minor ailment or get a prescription for contraception. The top three reasons for visits were for urinary tract infections (20 per cent), contraception (18 per cent) and allergic rhinitis (9 per cent). More than three quarters of MACS assessments resulted in a prescription, according to the latest PharmaCare data.
Workflow solutions help with confidence
Educated in Iran in the mid-90s, Hanifian first started her career at a drug manufacturer before she immigrated to Canada with her family in 2000. Since then, she practiced in Edmonton before moving to British Columbia in 2008, when she became associate owner of Shoppers Drug Mart #291, a pharmacy located in a in a busy North Vancouver shopping complex.
Each day, Hanifian’s team may see hundreds of patients just for prescription medications. Coupled with the busy fall influenza and COVID vaccine season, she had to come up with a system to accommodate MACS patients, who overwhelmingly prefer to walk-in. Hanifian refers to it as triaging, much like how she would when the bulk of work was dispensing.
“If there’s a prescription or refill that still had a week of supply that can wait until tomorrow, there’s not an urgency for me to take my time away from something that is more needed,” she said. “I think we need to shift our thinking to prioritizing, who needs me the most right now. Just like in an emergency room treating patients.”
Kunakar Pou, owner of Pharmasave Commercial Drive, said providing MACS assessments became easier over time as he developed his own system for documenting assessments.
Pharmacist Kunakar Pou, owner of Pharmasave Commercial Drive, said that as the proprietor of a smaller pharmacy, he too felt somewhat uncertain at first, particularly about the documentation. For him, the solution was to have a set of printed forms and resources readily available at hand. That way, he could easily refer to the various PIN numbers, conditions and drug products, while being able to fill out some of the required documentation without being at a computer.
“I found that sometimes, I realized I had done all the work but only after the intervention did I realize the interaction was a minor ailment assessment,” Pou said. “I think it’s still not in our culture to recognize that action that we’re taking. That time that you’re spending to have a consult with the patient is a consultation, whether you recommend an OTC product or refer the patient to a physician without a prescription, it’s still a valid intervention.”
As time went on, Pou began noticing that certain conditions were more common than others. This allowed him to build experience and confidence with those conditions that would most frequently arise.
“You don’t have to be an expert in all the different ailments we can cover,” he said.
Mario Linaksita, owner of University Pharmacy on the UBC University Endowment Lands, said pharmacists had already been doing the work well before MACS launched in June.
He acknowledged that for some pharmacists, the new scope can be intimidating.
“While the prospect of being tasked with new responsibilities and workflows is daunting, it should be approached with the knowledge that we are ready for this new role. Pharmacists have always been one of the first points of contact that a patient has with the health-care system,” Linaksita said.
“How can a patient access the free contraception being offered by the province if they cannot be prescribed it? Who will follow up if a patient’s urinary tract infection treatment was successful? These are roles we already fulfill in our daily practice.”
Hanifian, the Shoppers Drug Mart pharmacist, said in many ways that the process of becoming familiar with minor ailments is similar to how the profession embraced injection authority over time when that scope was enabled in 2009.
“It’s scary and it’s outside of our comfort zone. Every change sounds like that at the beginning,” she said. “With injections, at first it was like, oh no, I can inject now, how? Or why? Until we did our first injection. Then our second, and a third. Now it’s just – bring it on, whatever the vaccine or injection.”
And just like with vaccines, the public health need for pharmacists to provide accessible health care through the minor ailments assessment service is significant.
“The health system is in crisis right now. We all witnessed it and we all felt it, even in our own lives, of not having a family doctor or experiencing long waits in the emergency room. Just the other day, I read in the news that another hospital in B.C. had to close for a few days because of not enough staff,” Hanifian said. “Being a part of the health-care team and hearing these things is very unsettling. We should all try to be part of the solution.”
“It always happens towards the end of the week, or when there’s a holiday coming up. I see firsthand how many times our patients have suffered because of the lack of available health-care services,” Pou said. “We are really in the best position to help them. There is a need we can definitely see that was not met before.”
Mario Linakita, owner at University Pharmacy, said community pharmacists have already been doing the work involved in MACS assessments prior to June.