Minor Ailments: Pharmacists Take on a Front-Line Role

The role of pharmacists has undergone rapid change in recent years. There are a number of reasons for this, the first being that pharmacists are trained to do much more than dispense medication, and this broader range of expertise is being increasingly recognized outside the profession.

Furthermore, with health care systems more overloaded than ever, we need concrete solutions to alleviate the pressure. To that end, legislative changes have been introduced across Canada to expand pharmacists’ scope of practice and make better use of their expertise.

In particular, pharmacists are increasingly being allowed to manage and treat minor ailments.

I believe that this shift has great potential to clear backlogs in front line care. That said, having experienced the work overload and staff shortages that are also rampant in the pharmacy sector, I wonder how my peers are managing to integrate these new services into their practice and deliver them effectively. What can we do to ensure that everyone benefits?

This is the question I would like to explore.

But First, a Definition

What exactly is a minor ailment? I've found several definitions from different sources, but I think the following is clearest:

"A minor ailment, also called a minor condition, is a health problem that can be managed with minimal treatment and follow-up, or through self-care strategies."

A few of the more common minor conditions are allergic rhinitis, gastroesophageal (acid) reflux, and insect bites.

Managing Minor Ailments at the Pharmacy: A Timeline

It's worth putting the evolution of the pharmacist's role in context by looking at some key moments in Canada regarding the management of minor conditions.

2006

• Alberta triggers a revolution in the profession by granting pharmacists with an APA (additional prescribing authorization) the right to prescribe during an initial consultation. Alberta is still the only province where prescriptions can be issued by a pharmacist without a list of predetermined conditions. The reimbursement methods are straightforward and unrestrictive, giving pharmacists considerable freedom to use their professional judgment.

2014

• New Brunswick authorizes pharmacists to prescribe for 34 minor conditions. Unfortunately, only 11 of these are reimbursable by the government to date, and only under certain very specific conditions.

2015

• Quebec gives pharmacists the right to prescribe for some 20 minor conditions. In 2021, the legislation was expanded to cover more than 30 conditions. The government reimburses the assessment of all these ailments under certain conditions.

2023

• On January 1, Ontario passes legislation approving pharmacy services for 13 minor conditions. Another six conditions are added on October 1. The government reimburses all these activities under certain conditions. Interestingly, 85 percent of community pharmacists performed at least one clinical service within five months of the legislation being passed, for a total of 244,630 minor ailment assessments over this period.

June 1, 2023

• British Columbia authorizes pharmacists to prescribe for 21 minor conditions, all of which are reimbursable by the government under certain conditions. Interestingly, 79 percent of community pharmacists performed at least one clinical service within eight months of the legislation being passed, for a total of 260,000 minor ailment and contraception assessments over this period.

For over four years, I've been involved in the development of Vigilance Santé’s RxConsultAction, a software program designed to support pharmacists who are providing clinical services in the pharmacy. In this capacity, I've been ideally positioned to witness the expansion of our profession across Canada.  What's more, the development of province-specific versions of RxConsultAction has enabled me to understand the distinctions that exist among them. This vantage point has also helped me understand the distinctions that exist from province to province.

It's clear that despite provincial differences in implementation, a trend is emerging across the country: the treatment of minor conditions in pharmacies has become well and truly established.

And this is just the beginning!

The Many Advantages of Using Pharmacists to Support the Front Line

There are many advantages to pharmacists taking on the assessment and treatment of minor ailments.

• For patients, it's often easier to book a consultation through a pharmacy than through other health care services. This means that their ailment can be addressed in a timely manner, thereby reducing the risk of complications.
• For the government, opening this activity to pharmacies helps reduce health care costs and frees up time for doctors to handle more serious cases.
• For us pharmacists, these consultations strengthen our relationships with the people under our care while opening up an attractive revenue stream.

I know that some pharmacists feel that these services will only add to their workload. While they may have a point, this new opportunity could be win-win under the right circumstances.

What Are the Right Circumstances? Here Are a Few Tips.

I think we as pharmacists need to focus on what we can control. Here are a few ideas for pharmacists who want to make the most of this opportunity.

Promote Your Services

• Although governments and certain chains and banners are already advertising and the public is increasingly aware of the services we can offer, many still aren't clear on which conditions can be managed through a pharmacy. This means that people don't usually see us as the first line service for minor conditions. As a pharmacist, I don't think we should overlook the need to advertise our services; it's an essential strategy for expanding our offer and reaching as many patients as possible.

Master the Legal Framework

• We can all agree that reading legislation and regulatory texts isn't very exciting, and that taking the time to truly understand their meaning and application can be taxing. Nevertheless, in the heat of the action, having a thorough understanding of our legal framework is essential. In my practice, I've witnessed colleagues refusing to perform clinical services a number of times, claiming that they weren't authorized to offer them. In reality, they were authorized to offer these services, but felt uncomfortable doing so because they didn't have a sufficient grasp of the regulatory framework.

Take Training Courses on Conditions You’re Authorized to Treat

• Training courses are a great way to learn the most common signs and symptoms, warning signs to look for, treatment options, and follow-up protocols. By learning about these conditions in advance, your consultation process will be much smoother and more efficient. Your patient will feel more confident in you if they see that you're in full control of the situation. This can greatly influence patient motivation and willingness to follow the recommended treatment plan to the letter.

Set up an Efficient Workflow

• In my opinion, every pharmacy has a unique reality, and as such there's no magic formula for optimizing workflow and incorporating clinical services for minor conditions. The important points are to standardize working methods within the team, clarify everyone's roles, and establish a procedure that's clear and understood by all. And if things aren't going smoothly or you notice certain stumbling blocks, there's nothing better than a team meeting to discuss the issues and find ways to improve. It's worth noting that a little effort at the outset will likely save significant time down the line.

Use a Quality Documentation Tool

• Professional orders and colleges are becoming increasingly strict in this respect: clinical services must be properly documented. I believe that adequate documentation is ideally achieved through a simple tech tool that's fit for purpose. A good tool must be easy to use, able to collate relevant information, and facilitate compliance with legislation and standards of practice. A tool that meets these criteria will make your consultation more efficient, as it will ensure you have all the information you need.

What About the Future?

Unfortunately, pharmacists still face a number of obstacles when it comes to developing a service offer for the treatment of minor ailments. The two factors I find most disappointing are the lack of remuneration and the administrative barriers.

In some provinces, remuneration for these services is inadequate or even absent altogether. Once pharmacists are fairly compensated for the effort they put in, it will be easier for them to invest more into these services. I invite you to read this article by the University of Waterloo providing insight about Ontario.

Pharmacists in certain provinces also face significant administrative barriers. In my opinion, Alberta has the most appealing model, one based on professional judgment and which doesn't burden the practice with specific criteria that don't always apply. 

Of course, there are other factors holding back the development of these services. But if the two points above were resolved, pharmacists would have more leeway to make clinical treatment services available. I'm convinced that we will get there eventually—hopefully not too far in the future.

Until then, let's keep working on what we can control!