Not everyone on medication has a doctor, but everyone on medication has a pharmacist.
That’s why, early in this provincial election campaign, it is encouraging to hear the party leaders talk about an expanded role for pharmacists in improving access to health care for New Brunswickers. We are already here, already fully trained, fully qualified and eager to help.
Successful pilot
The New Brunswick Pharmacists’ Association has just concluded a one-year Pharmacist Care Clinic pilot, in which six pharmacies around the province self-funded clinics where patients could access chronic disease management for diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and asthma, as well as assessing, testing and prescribing for Strep A.
Though the data will be available for review in late October, the pilots were so successful, the provincial Department of Health has provided partial interim funding so that the six pharmacies can continue offering these services throughout the fall, until government establishes a sustainable funding model in order to expand these services to additional pharmacies throughout New Brunswick.
Improving access to health care
Access to health care isn’t as simple as whether you have a primary care provider. Many of the patients in our Pharmacist Care Clinics have a doctor on paper but not in practice. It can take weeks or months just to make an appointment that is then weeks or months away. For many patients, the health-care system is not capable of monitoring them on the timeline their condition requires.
Before treatment was available at their pharmacy, these patients would be forced to navigate the patchwork of virtual and temporary health-care programs or visit a walk-in clinic or emergency department, placing pressure on resources that could be focused on more complex or critical needs.
Regulation prohibits ordering lab tests
Though we are proud to have helped thousands of patients in our pilot, we could have helped many more if one bureaucratic barrier had been removed.
Pharmacists are fully qualified by our regulatory body, the New Brunswick College of Pharmacists, to order and interpret lab results. However, a provincial government regulation prohibits anyone who is not authorized by a regional health authority to order lab tests. That means your community pharmacist cannot order your blood work, despite being qualified.
While this posed a significant challenge for our Pharmacist Care Clinics, it highlights the larger issue that all pharmacists in New Brunswick have been qualified to order and interpret lab tests since 2014, but are prohibited. Pharmacists are the medication experts, and we need to be able to order lab tests and monitor the results to determine if a medication adjustment is necessary. This would relieve pressure on the health-care system and improve patient care.
It is essential that this bureaucratic barrier be removed so that pharmacists can order lab tests for our patients.
Collaborative practices
Each of the parties is talking to some extent about creating collaborative practices, where doctors, nurses, pharmacists and other allied health professionals can practice together, improving patient access and care through collaboration. But there are serious challenges to be overcome in New Brunswick before collaborative practices can have the impact intended.
First, electronic medical records are essential to the framework of establishing collaborative practices. To facilitate collaboration, any of the patient’s health-care providers need to be able to access their complete, updated file at any time from any location. However, the use of electronic medical records in New Brunswick is approximately half the national average and last among the provinces.
While we are supportive of new collaborative approaches that will reduce wait times and improve patient outcomes, the collaborative practices the parties are discussing appear to be a long-term goal at best.
In the meantime, as pharmacists, we speak with patients every day who need help now, which is why in this election we are advocating for changes to public coverage and pharmacists’ scope of practice that could improve the situation immediately without diminishing the long-term goal of establishing more collaborative practices.
Second, unless steps are taken to protect the sustainability of the pharmacy profession in New Brunswick, we will not have a sufficient labour force of pharmacists and pharmacy technicians. Pharmacists will play a critical role in a collaborative practice, however they should not be removed from their hospital or community practices, which would leave an even greater void.
Sustainability
The pharmacy profession in New Brunswick is projected to experience a shortage equivalent to half of its current labour force in the next 10 years, according to a recent workforce planning study commissioned by the New Brunswick Pharmacists’ Association and the Canadian Pharmacists Association.
New Brunswick has fallen far behind other provinces. While pharmacists are qualified to assess and prescribe for 33 minor ailments, there is public coverage for only 12, and eight of those were added just last year. That means there are nearly two dozen conditions that government will only pay a doctor or nurse to treat, even though a patient could be seen, often the same day, at their community pharmacy by a pharmacist who is equally qualified to treat those conditions.
In addition to this severe limitation on our ability to practice to the full extent of our expertise, the reimbursement schedule for pharmacy services under the New Brunswick Drug Program has not been updated in over a decade, and the Department of Health refuses to bring those fees to a sustainable and equitable level.
If you limit their practice and pay them less, it is incredibly challenging to attract pharmacy graduates to practice in New Brunswick when they don’t face these barriers in any of our neighbouring provinces.
Pharmacy is a helping profession, and the way to reverse the projected labour shortage in New Brunswick is to eliminate these barriers to helping people. Entrust pharmacy professionals with patient care and empower them to have the same impact on patients and the health care system that we’re seeing in other provinces.
Nova Scotia’s success
We are asking parties in this election to commit to expanding public coverage for pharmacy services, including an updated reimbursement model and more Pharmacist Care Clinics throughout the province.
We are confident this approach will improve access to primary care and reduce pressure on the overburdened health-care system, because it’s an approach that is having enormous success in Nova Scotia.
Since launching a similar pharmacy primary care clinic pilot in February 2023, more than 190,000 services have been accessed at these Nova Scotia clinics, contributing to a 9.2 per cent reduction in emergency department visits for less urgent conditions.
Just last month, the Pharmacy Association of Nova Scotia announced 14 new pharmacies will join their pilot this fall, bringing the total number of clinics to 45. They have achieved this success because they have been empowered to practice to their full expertise, services are publicly covered in pharmacies, and the provincial government has funded each stage of their growing provincewide rollout.
Conclusion
As a pharmacist for more than forty years, I am proud of the six pharmacy teams that have stepped up to offer Pharmacist Care Clinics here in New Brunswick. They provided thousands of patients access to primary care for the yearlong pilot at no charge to patients and despite unnecessary limitations on their practice.
We are confident the data from our pilot will show not just the impact these clinics can have on patients, but the impact pharmacy can have on the health care system. We have so much more to offer as pharmacy professionals, and with the freedom to practice to our full expertise, under a fair and equitable compensation model, we can improve access to health care and help transform the way primary care is delivered in New Brunswick.
Anne Marie Picone
Interim Executive Director
New Brunswick Pharmacists’ Association