Health committee  Yes, exactly.

Health committee  Usually it would be, for example, for a month on a maintenance medication or three months. Again, it's at the judgment of the pharmacist. There's real judgment involved here. It's not simply a case of saying “oh, this is fine”. There is some degree of assessment that is required as well.

Health committee  Absolutely. You really need to do that assessment because there are definitely medications that are not appropriate for everyone.

Health committee  I think, to answer your first question, very often the person who presents in a pharmacy and is asking for advice or help over the counter is not in an immediate position to access their physician or an emergency room. Often you see them in the evenings or weekends. As a pharmacist, you are presented with what appears to be something self-limiting.

Health committee  Absolutely.

Health committee  The second part is, as many professions, we have a code of ethics. Our code of ethics in pharmacy is very much to do whatever it takes to meet positive health outcomes for patients. To suggest something or prescribe something to a patient that could ultimately cause side effects or make things worse, I think all pharmacists are aware that it is not in our interest to do that.

Health committee  I think there's widespread awareness that diagnosis is strictly a physician capability. We do not feel that pharmacists have the education to diagnose disease. We do, however, feel that pharmacists are the drug therapy experts, so they can definitely weigh in on which medications are most appropriate for a given diagnosis.

Health committee  Absolutely. Pharmacists perform that valuable function on a daily basis. Patients will come in with a bug bite or they have acne or they have an allergic reaction. Pharmacists are definitely capable of providing the medications to support and to treat those conditions. We're not talking strictly about diagnosis.

Health committee  Absolutely it does. It also takes away some of the pressure on emergency rooms, because they are really being inundated with patients presenting with varying degrees of severity. If minor ailments can be handled at the pharmacy level, it will reduce some of that strain, most definitely.

Health committee  One thing I want to make very clear is that we're talking about appropriate drug therapy to enhance patient outcomes. In many cases, the proper thing to do is not to recommend a medication. I think that pharmacists are in an ideal position to make that assessment. There's also an educational component to this, explaining the role of medication where it is warranted and explaining when drug therapy is not warranted.

Health committee  Or changing to a narcotic that might not be as problematic, as, for example, in the case of OxyContin changing maybe to another narcotic that is similar in terms of pain relief but doesn't have the same problematic attributes as a drug like OxyContin.

Health committee  Over the past several years, there has been a great deal of change with respect to the scope of practice of pharmacists in Canada, starting with legislative changes in Alberta in 2006. The level of change in practice is unprecedented in the history of the profession. This includes changes in pharmacists' prescribing, such as renewing prescriptions, prescribing in emergency situations, adjusting doses and dosage forms, and discontinuing or starting new medications.

Health committee  —for safety—

Health committee  In addition, we now have regulated pharmacy technicians in several provinces. They do a final check on dispensed prescriptions, freeing up pharmacists to focus on patient education, adherence, and medication-monitoring services. We have provided the clerk with a one-page summary of the range of expanded scope of practice for pharmacists across Canada, which members should have now in front of them.

Health committee  I think one advantage of the recent national opioid guidelines was that they were truly an interprofessional approach to the treatment of pain. For that reason I'm quite optimistic, because, really, it suggests that there's not simply a prescriber and a patient working together, but an entire team that helps to prevent situations in which the patient gets into trouble.