By Sally Ginson Duke, BSc(Pharm), ACPR
Lucy Lin, B.Sc. (Pharm), R.Ph
With the province’s healthcare system under pressure, British Columbia pharmacists are taking on greater responsibilities to help residents manage their medication therapy. In many cases, pharmacists ensure continuity of care through prescription renewals or adaptations. However, some cases may fall outside the scope of pharmacists or become complicated when a patient doesn’t have a regular primary care provider, or their prescriptions for chronic therapies are expired.
To support pharmacists and patients in these circumstances, the B.C. Ministry of Health recently launched the Provincial Prescription Renewal Support Service (PPRSS). This virtual service receives requests directly from pharmacists anywhere in B.C. for patients who do not have a dedicated primary care provider, and who need a prescription renewal for one or more chronic therapies (not including cancer medications, cannabis, narcotics and controlled substances).
The PPRSS interdisciplinary team of pharmacists, physicians and support staff are from various corners of B.C. The virtual clinicians are licensed to practice in B.C. and have experience in acute and primary care.
As of April 30, 2023, the PPRSS team has completed 317 cases and 208 prescription renewals.
Pharmacists send patients to PPRSS
Pharmacists submit a request to the PPRSS team by completing an electronic form (eForm), noting the medication(s) needing renewal, their contact information, and information about the patient.
- Requests can be made when the:
- Prescriber’s licence is inactive (temporarily or permanently)
- Prescription is expired (2 or more years old)
- Pharmacist is unsure whether the patient is stable for renewal/adaptation and would like the opinion of a physician
- Pharmacist believes the patient needs one or more laboratory tests to confirm clinical stability
Pharmacists exercise their best judgment in determining whether to:
- Provide an emergency supply of medication(s) while the PPRSS team is consulted. A 10- to 14-day supply is suggested
- Send the patient for a local in-person health assessment, for example if their health appears unstable
As a new service, improvements are constantly being made. An early challenge was reaching patients by phone. The eForm now prompts the pharmacist to verify the patient’s current phone number and preferred contact time.
PPRSS team manages referrals
For every submitted eForm, a patient file is created in a secure shared record system. Files are transferred to the virtual pharmacist first.
The virtual pharmacist consults CareConnect to confirm health history, including laboratory results and PharmaNet record, then phones the patient to verify actual medication use. They identify prescription renewal needs, document their assessment, and then transfer the file to a virtual physician, noting the best time for a follow-up call to the patient.
After reviewing the information, the virtual physician speaks with the patient to finalize their assessment and determine which prescription renewals they can provide. For some cases, they may send the patient for lab work or recommend an in-person assessment (e.g., at a walk-in clinic or Urgent and Primary Care Centre). The PPRSS physician follows up on any lab work that they order.
When prescription renewals are issued by a PPRSS virtual physician, they are faxed to the pharmacy that submitted the eForm.
With patient consent, once an assessment is completed, the PPRSS team documentation is uploaded to CareConnect.
Real-life Case 1
Vulnerable adult in his 80s living with spouse. Primary care provider closed practice, so they are without one. Prescriptions are invalid and out of pharmacist scope for renewal as primary care provider license is inactive.
Community pharmacist submitted eForm, listing the patient’s three regular Rx (phenytoin, donepezil, escitalopram). PPRSS pharmacist confirmed health history and medication use with spouse (with the patient’s permission), determined reported use appears effective and well tolerated, suggested renewing the three Rx for 90-day supply and transferred care to PPRSS physician.
Renewal provided for three Rx. Prescriptions faxed to originating pharmacy.
Real-life Case 2
Person in their early 50s, with longstanding type 2 diabetes and dyslipidemia. The patient’s physician is now retired. Prescriptions are invalid and out of pharmacist scope for renewal as primary care provider license is inactive. The patient is highly motivated to self-manage chronic conditions and has registered themselves on a local family physician waitlist.
eForm to PPRSS submitted by community pharmacist in April 2023, requesting renewals for linagliptin, metformin ER, rosuvastatin. PPRSS pharmacist consulted CareConnect for relevant laboratory results, from December 2022.
PPRSS pharmacist confirmed with the patient:
- Allergy information: None known
- Best Possible Medication History (BPMH):
Rx: 1. Trajenta (linagliptin) 5mg DAILY; 2. Metformin 2000 mg ER DAILY; 3. Rosuvastatin 10mg DAILY
- Diabetes therapies:
- Taking metformin for ~15 years; current dose ~ 10 years; past issues with regular release tablets; tolerates extended-release formulation well
- Started linagliptin at current dose about 5-6 years ago
- Reports A1C ranges between 6.6 and 7.1 and fluctuation largely diet-based; previously had standing order for labs to check every three months. Since physician retired, unclear if standing order for labs will be accepted
- Dyslipidemia therapy:
- Taking rosuvastatin for eight years and reports no side effects
- Lipid values slightly above targets for patients with diabetes of LDL <2 or 50 percent reduction (baseline LDL unknown) and non-HDL <2.6.
PPRSS pharmacist recommendation:
Blood work and renew for three months if results support renewal. PPRSS physician reviewed file and forwarded lab requisition for hemoglobin A1C to local laboratory.
Lab Result April 2023: Hemoglobin A1C 6.9 percent.
PPRSS physician able to issue prescription renewals to originating pharmacy after bloodwork reviewed.