Nfld. & Labrador

Doctors slam 811 app for 'inappropriate' prescriptions, lack of consultation

The province's medical association is upset about a new "virtual walk-in" service which it says can lead to dangerous prescriptions and inappropriate patient care.

Long-time patients are turning to nurse practitioners disconnected from family doctors, NLMA says

A new app brings 811 to your smartphone, giving people across Newfoundland and Labrador access to a nurse practitioner seven days a week. (Ryan Cooke/CBC)

The Newfoundland and Labrador Medical Association (NLMA) is upset about a new "virtual walk-in" service which it says can lead to dangerous prescriptions and inappropriate patient care.

NLMA president Dr. Charlene Fitzgerald penned a letter to Health Minister John Haggie on Thursday after a news conference in which Haggie announced a new 811 app to provide people with virtual access to a nurse practitioner.

In the letter, Fitzgerald says the NLMA was not consulted and would have never approved of a plan that disconnects people from their current health care providers.

"Our members have been surprised, confused and disrespected as a result," Fitzgerald wrote.

The new 811 plan uses a private company, Fonemed, which has hired eight nurse practitioners to field requests from people calling and booking appointments through a mobile app.

While the app was launched Thursday, Haggie said the nurse practitioners have been doing phone consults since last month.

Dr. Charlene Fitzgerald is the head of the Newfoundland and Labrador Medical Association. (Jonny Hodder.CBC)

The health minister said it doesn't replace the need for more family doctors in the province, but is "another tool in the tool box" for primary care teams.

The NLMA doesn't see those nurse practitioners as part of a patient's team, however, saying there has been a lack of consultation between 811 and family doctors.

Fitzgerald's letter included five complaints from family doctors that she said the NLMA received unsolicited after Thursday's announcement.

This is incredibly frustrating.- Unnamed doctor writing to NLMA

In one message, a doctor said a longtime patient with complex mental health issues was prescribed a new drug after a consultation with a nurse practitioner over 811. The person was already on two other medications, and their doctor felt it was inappropriate to prescribe another without consulting a specialist.

"Making changes like this fall in the category of specialist care, sometimes at the level of family physicians, but never after a single phone consult," the unnamed doctor wrote.

Another doctor said they had a patient with a history of a known condition call about a high fever. They offered the person a same-day appointment, but the patient called a half hour beforehand and said the problem had been taken care of by 811. The doctor said the patient had been prescribed medication for an ear infection.

"I don't think I can do better than offering a same day appointment literally hours after a phone call. And I do not think this is an appropriate 'virtual visit' given no history of ear infections. This is incredibly frustrating."

This is a beautiful mix of local technology, local innovation and a made-in-Newfoundland and Labrador solution.- Health Minister John Haggie

Two others wrote about worries it could lead to over-prescription of antibiotics.

Fitzgerald said it's not a slight to nurse practitioners, but rather a critique on poor communication and a disconnected plan by the Department of Health and Community Services.

How it works

Fonemed — a Newfoundland and Labrador company that started 811 and branched out across North America — is responsible for the nurse practitioners on its staff.

It comes on the heels of a busy few months for the 811 staff. According to Fonemed CEO Charlene Brophy, 811 was fielding a maximum of 150 calls a minute during the height of the pandemic in the province.

Haggie said the new service is for urgent, non-emergency cases and will service as a virtual walk-in clinic. People can book appointments through the app by video, phone or text.

The Fonemed staff can prescribe a wide range of medications, except for controlled substances such as opiates and benzodiazapines.

Charlene Brophy is the CEO of Fonemed, the company behind 811. (Government of Newfoundland and Labrador/YouTube)

Fonemed ​​​​​​chief information officer Kevin Hillier said the app is in full compliance with federal privacy legislation and will fully encrypt all data to protect the privacy of its users.

"At no point, whether it would be when your data is being transmitted or while it's in storage, would it ever be in a state that is unprotected or unencrypted," Hillier said.

The app is available through Apple and Google Play app stores for free. Appointments can be booked seven days a week between the hours and 8 a.m. and 8 p.m.

"This is a beautiful mix of local technology, local innovation and a made-in-Newfoundland and Labrador solution," Haggie said during Thursday's news conference.

Fitzgerald and the NLMA do not see it the same way.

"We ask that you urgently direct your officials to start this dialogue to resolve the integration and coordination issues, and to realign the new walk-in service, so that it compliments existing services rather than creating unnecessary quality and coordination issues," reads the letter.

Read more from CBC Newfoundland and Labrador

About the Author

Ryan Cooke works for CBC out of its bureau in St. John's.

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