Charissa Tonnesen (left) and the pharmacy staff team at Tumbler Ridge Pharmacy.
By Lori Bonertz, BSc(Pharm) and Charissa Tonnesen, BSc(Pharm) PharmD (candidate)
As the days ticked down to the June 1 launch of the Minor Ailments and Contraceptive Service in British Columbia, we experienced cautionary feelings that the additional workload may be too much for existing pharmacy staff at the four locations operated by the HealthTeam Holdings Corporation.
Our stores serve the rural/remote communities of Tumbler Ridge, Fort St. John, West Kelowna and Keremeos. Similar to many other organizations, we are experiencing staffing challenges and two of the four pharmacies have just one pharmacist on staff per shift. On the heels of having already placed additional workload on our pharmacy team members through the COVID-19 vaccination campaigns, staff members questioned whether our pharmacists would have sufficient time to also perform minor ailment assessments.
It felt like the rollout happened very quickly. We organized a Zoom meeting for all staff across the four locations and determined that we would take a discretionary approach to minor ailments assessments and prescribing.
We knew there were going to be certain minor ailments that our pharmacists had greater confidence assessing or that were more straightforward to assess while contraception was identified as the area that pharmacists wanted to approach more gradually. We only have seven pharmacists within our organization, so each pharmacist was encouraged to choose to perform the minor ailment assessments they were most comfortable with or that they had time to perform.
Including the pharmacists, we have a total of approximately 30 staff across our stores. Generally, we have not had to place too much additional training on the staff to recognize when they should call a pharmacist over to see if a patient needs a minor ailments assessment. We ensured a list of all 21 minor ailments was placed beside each phone. That really helps our staff recognize the conditions that must be referred to a doctor versus the conditions patients can see our pharmacist for.
For many of the conditions, our pharmacists were already accustomed to assessing patients who would first present to the pharmacy seeking a solution. Now we are able to help many of them instead of sending them to the physician’s office.
Especially in the beginning when our staff were still familiarizing themselves with the documentation requirements, this slower approach allowed our pharmacists to build confidence and to experiment with how they could fit minor ailments into their existing workflow. We have not set quotas and each pharmacist has the option of how and when to perform minor ailment prescribing.
Initially, there was some thought that we could have patients attend the pharmacies during specific clinic hours. Some of our pharmacies offer regular clinic hours to focus on services such as immunizations and we thought that those clinic hours would be a great time to have patients come in for minor ailments.
The reality, to date however, is that very few of our patients use the online booking system or call ahead for an appointment. The vast majority are walk-ins and our pharmacists accommodate the patients right away if they have time or ask them to come back later in the day. Appointments are ideal from a workflow perspective, but based on what we’ve seen so far in the first two months, it seems that, at least for our locations, we will continue to see the bulk come in as intermittent walk-ins. This is especially noticeable during summer in our Fort St. John location, due to its location on mile 48 of the Alaska Highway. Travellers often see Fort St. John as the last stop before they continue on up to Alaska, with a significant portion of them from out of province. For the out-of-province/country patients, we decided to charge a fee of $25 to $30 per assessment. Cold sores, followed by urinary tract infections, have been the most common minor ailments for which treatment has been sought at each pharmacy.
One thing we have realized since launch is that the documentation process is time-consuming and the current fee for providing the service does not truly reflect the time commitment. To try to streamline the process, we are now exploring purchasing additional software that would automate filling out the patient profile, identify concurrent medications and conditions the patient may have, and even automates PharmaNet billing codes. There’s a growing number of vendors that are offering similar services and we are in the midst of exploring those options now. Having tested one of the options, our conclusion is that it really does speed up the process. However, currently we are still exploring our software options and just how much impact having that piece within our pharmacies is not something we have been able to measure yet.
Going forward we hope to set up clinic days for specific indications that do not present acutely, such as smoking cessation for which one of our pharmacists has done ongoing additional training. In addition, while the physicians in the four communities seem broadly supportive of minor ailment prescribing by pharmacists, we hope to further advertise it to physicians and to other health-care professionals locally to ensure our patients are receiving efficient, appropriate health care.
Lori Bonertz and Charissa Tonnesen (pictured) are two of the shareholders of Health Team Holdings Corporation, a pharmacy ownership group that owns and operates Tumbler Ridge Pharmacy, Andreen’s Pharmacy, Similkameen Pharmacy and Fort St. John Pharmacy & Wellness Centre.