N.L. has a problem with prescription meds — here's what's being done about it

Newfoundland and Labrador takes more antibiotics than the rest of the country and is at the top of the pack when it comes to sleeping pills, painkillers and medications used for heartburn and reflux.

Medical profession embracing new technologies, says Eastern Health and provincial officials

Newfoundland and Labrador rate of antibiotic use is higher than any other province in Canada. (Bruce Tilley/CBC)

As a province, Newfoundland and Labrador has a high rate of misusing potentially harmful medications, but new methods are being tested within the health care system to curb those habits.

Statistics show the province takes more antibiotics than the rest of the country, and is at the top of the pack when it comes to sleeping pills, painkillers and medications used for heartburn and reflux.

Different groups are taking new approaches to tackle those high rates, including an antimicrobial stewardship at Eastern Health committed to reducing the amount of antibiotic prescriptions in the province. 

New app

One way the team is trying to achieve that is with a new app, called Spectrum.

The "decision support tool" helps after a diagnosis is made. The user fills out a checklist of factors that could influence a patient, and then a suggested prescription tailored to provincial guidelines pops up.

Dr. Peter Daley, an associate professor of medicine at Memorial University, says N.L. patients' reliance on antibiotics is a problem for several reasons. (Eddy Kennedy/CBC)

"We know that physicians learn to use antibiotics at one point during their training and they tend to use the same pattern of drug usage throughout their career and unfortunately, in some cases, what they learned initially was overkill," said Dr. Peter Daley, an associate professor of medicine at Memorial University.

"They didn't need to use such broad spectrum, such powerful antibiotics, such long durations. Actually, they could change their practice and use lesser or shorter."

Patients also sometimes demand antibiotics, according to Daley, and physicians comply. 

The app was made available in the province about two weeks ago and now has more than 460 users according to Daley. The app can be downloaded on Apple and Android devices and Daley said doctors, pharmacists, nurses, nurse practitioners, students and the general public are signing on. 

A new app, Spectrum, gives prescription suggestions based on provincial guidelines. (Eddy Kennedy/CBC)

Over the next six months, his team will study the "appropriateness" of antibiotic prescriptions. They'll look at dosages doled out and how they've changed in the half-year timeframe in order to determine the app's effectiveness.

The app, which Daley says was developed in part by MUN med students in Calgary, is currently on a free trial in the province. He hopes evidence gathered during the trial will prove to Eastern Health that it should pay for a subscription.

Program cut

In 2015, the province launched an antibiotics adherence program to address antibiotic resistance. Pharmacists were paid to do initial and followup consultations with patients to make sure they were properly using their antibiotics and there weren't any other problems.

The province ended that program in January. Despite being given three days to answer questions around why that decision was made, the Department of Health did not provide any information until after the initial version of this story was published.

In an interview on Thursday, Health Minister John Haggie said the program was changed because it was ineffective. He said antibiotic prescriptions actually increased under the adherence program.

Kara O'Keefe, a pharmacist at Family Drug Mart on Bell Island, says the government shouldn't have dropped its antibiotic program. (Katie Breen/CBC)

But pharmacist Kara O'Keefe feels government could have reshaped the program to keep the profession involved.

The program tapped into pharmacists' knowledge base which, she said, is underused.

At the time of the launch, government said the adherence program was the latest initiative to expand the role of pharmacists within the province's health care system. 

"Given that Newfoundland has the highest rates of antibiotic use in the country, it was a mistake to cut out the antibiotic program," she said.

"Perhaps [government] could have been paying pharmacists to make suggestions if a different antibiotic may be more appropriate, or if a different dose may be more appropriate, then that would also encourage safe antibiotic use."

The $1 million that went towards the antibiotic adherence program was redirected to the province's latest initiative, SaferMedsNL, according to Haggie.

SaferMedsNL focuses on de-prescribing one medication a year over the next three years starting with proton pump inhibitors — medications used for heartburn and reflux — then sleeping pills and then opioids.

"And if that works, that's great. If that doesn't work, we'll look at something else," Haggie said.

Electronic prescribing system

Another initiative government is looking at is an electronic prescribing system. Haggie said it would work like the Spectrum app, but across all types of medications — not just antibiotics.

He said Canada Health Infoway, the company that runs the nationwide online service PrescribeIT, is interested in doing a demo of the software in Newfoundland and Labrador and could have it set up here within this calendar year.

The program would electronically transmit prescriptions from clinics to pharmacies which Haggie said would streamline things, calling the electronic way the "next generation of prescribing."

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