Health committee  No, we don't.

Health committee  A good example is a physician could write “diagnosis: hypertension” on a script. It goes to the pharmacist, and then the pharmacist, based on the evidence and the clinical practice guidelines, could then manage the drug therapy. They can start insulin, adjust insulin doses, those types of things.

Health committee  It's a collaboration, it doesn't have to be a prescription—

Health committee  No.

Health committee  They would have to. You would have to get that diagnosis. A pharmacist would not start anti-hypertensives on a patient without some kind of collaboration with a physician.

Health committee  It is a problem. B.C. has had a province-wide drug network for more than 15 years. A pharmacist knows every prescription that is ever dispensed for that patient. We certainly don't have that here in Ontario. We need it. There are different things that have been put in place to try to prevent double doctoring and prescription drug abuse, but ultimately, province-wide drug systems, profile systems, electronic prescribing, electronic health records that everybody has access to are going to make a huge difference in addressing a lot of those challenges.

Health committee  If I could add to that, in Alberta it's best in class in the world what they do in scope of practice. I think in a few years time we won't have a chart, it will be green checks everywhere. But also the government pays for pharmacists to provide these types of services, and they have a very good payment model.

Health committee  The other thing to add to that is, “What's new?” Pharmacists have been doing that with over-the-counter medications forever. Now, with expanded scope, they can prescribe prescription-only medications to treat these types of minor ailments.

Health committee  Let me add to that, to clarify, that prescribing of narcotics and controlled drugs is federally regulated, and pharmacists don't have that authority. The government recently allowed a number of other providers to prescribe narcotics—midwives, nurse practitioners, podiatrists, maybe—but not pharmacists.

Health committee  It depends on the province. Alberta is the most advanced. They have something called additional prescribing authority, and the pharmacists can start new drugs and stop. It has to be within a collaborative practice model. The community pharmacist has to communicate with the family doctor, because they have to know of any changes.

Health committee  I think Alberta was first. It really was driven in a big way by the pharmacy regulatory body, and by their volunteer association as well. There was a lot of angst within the physician community, and we had many discussions with the Canadian Medical Association and others. But once it rolled out, it was not an issue.

Health committee  That's an excellent question because one of our top priorities is awareness and supporting a national public relations campaign. I think many Canadian patients have already accessed these services, but most Canadians don't even know. When they do experience it, they like it. It's fast; it's accessible.

Health committee  Thanks, Phil. To quickly summarize, CPhA is submitting three recommendations for your consideration. One, extend coverage of new pharmacist-provided services to federal populations; two, invest in education and training that supports practice change and expands its scope of practice; and three, increase the role and capacity of the federal government in pan-Canadian health human resources planning that includes pharmacy labour market studies and forecasting models.

Health committee  Thank you, Mr. Chair. I'm Janet Cooper. I'm the senior director of professional and membership affairs at the Canadian Pharmacists Association. With me is Phil Emberley, CPhA's director of pharmacy innovation. We're both pharmacists. CPhA represents the pharmacist profession in Canada.

Human Resources committee  We were actually part of the work that CNA and CMA did on looking at rurality, and Lisa spoke to what a lot of the issues are. There is a shortage. Often in small communities they're independently owned pharmacies as well, and a lot of the larger chains and franchises have a lot more opportunities to recruit--incentives and those types of things.