COVID-19 shows pharmacists have bigger role to play in Canada's health-care system, experts say
Pharmacists are an easily accessible source of essential medications, advice and referrals
In the confusing early days of the pandemic when many family doctors' offices unexpectedly closed to in-person appointments, phones started ringing off the hook at pharmacies across the country.
"Pharmacists were the only health-care provider the patients could still see in person," said Kaitlyn Watson, a pharmacy post-doctoral fellow with the Epicore Centre at the University of Alberta's department of medicine in Edmonton.
Patients could still seek urgent care in an emergency department if needed, said Watson. But many were reluctant to do so.
Patients were avoiding "going to tertiary health-care centres and emergency departments out of fear of contracting the COVID infection, but were willing to go to pharmacies and seek pharmacists' help," Watson told Dr. Brian Goldman, host of CBC Radio's White Coat, Black Art.
This is borne out by research to be published this summer in Canadian Pharmacists Journal. Watson and her co-authors surveyed 740 pharmacists in 10 provinces and one territory from May to July 2020. Nearly three-quarters of respondents said they had patients who sought care at the pharmacy because they were afraid of other health-care settings, and 52.9 per cent said some patients came in to calm their fears and anxiety regarding the COVID-19 pandemic.
Watson and other health-care researchers say the pandemic has demonstrated how pharmacists can and should play a bigger role in Canada's health-care system, because they're not only a readily accessible source of essential medications, but also medical advice and referrals.
When you're in a pandemic and health care gets turned on its head, sometimes the pharmacy becomes the safety net.- Kelly Grindrod
Accessibility is a part of that. A trip to the pharmacist is often a short walk or car ride, as opposed to a longer journey to the nearest hospital, said Kelly Grindrod, a pharmacist and professor in pharmacy innovation at the University of Waterloo.
"I don't think it's … a criticism of other health-care professions so much as just the reality that when you're in a pandemic and health care gets turned on its head, sometimes the pharmacy becomes the safety net that catches the people who can't navigate the health-care system in this new pandemic reality," Grindrod told Goldman.
Big role in disasters of all kinds
The role of Canadian pharmacists was expanding even prior to the pandemic. For years, they've been a big part of flu vaccine campaigns, for instance, and pharmacists also administer harm-reduction therapies for people with substance use disorder.
Alberta has the most liberal approach to pharmacists' scope of practice, allowing them to independently write prescriptions for a group of medications known as Schedule 1 drugs.
But a crisis such as COVID-19 highlights pharmacists' critical work, said Watson, who has researched how pharmacies responded to disasters including the Australian wildfires, SARS and 9/11.
"They can sometimes be the only health-care provider available in the immediate aftermath when community services collapse."
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When we consider health care in a disaster, most people think of services like search and rescue and emergency departments. But people's chronic conditions may be forgotten, Watson said.
"For example, if you're evacuating from a wildfire or from a flood, most people don't think to take their medications, their prescriptions, their money, their ID, so … pharmacists have a huge role to play in that continuity of care."
'Their work ethic is crazy'
That's what happened during the Fort McMurray forest fires in 2016, she said, and pharmacies in the surrounding cities stepped up to keep evacuees healthy.
Jessica Culo of Edmonton counts herself among those who are far more aware of a pharmacist's value after turning to hers with questions about COVID vaccines — like whether they would interact badly with the shingles shot she had around the same time, and whether they were safe to give to her kids.
"I have … really admired not only their expertise and their suggestions and recommendations but their availability. Their work ethic is crazy," said Culo. "Even this past Sunday … the pharmacist replied to me at night, and stayed late yesterday after the pharmacy had closed to give us our second vaccinations."
Denise McIntyre has been in her local chain pharmacy in Calgary a lot during the COVID crisis. She said her pharmacist of 20 years knows her better than her own doctor, and provided COVID-related support in addition to regular prescriptions.
"I have bad allergies that are sometimes so bad that I can't breathe, so she recommended that I go on a … steroid inhaler, just in case I ever got COVID, because I would have a really bad reaction," said McIntyre. "When I talked to my doctor, she agreed and put me on it."
Watson said she thinks COVID is the first disaster in which pharmacists have received recognition for what they do on the front lines. "They've been identified as an essential service. They're actively being encouraged and thanked for their contributions, for putting themselves at risk to help their patients."
While some have asked if pharmacists are in a conflict of interest because they sell the drugs that, in some cases, they recommend or even prescribe, Grindrod said they're bound by the colleges that govern them to put patient's needs first, just like any other health-care professional.
"We often think of pharmacists as business people, but we don't realize that most health-care providers are in a very similar situation," she said. "Most physicians are business people. Physiotherapists are business people. Dentists are business people."
Part of primary care team
Walter Wodchis, a professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto, said it's becoming more common for pharmacists to be embraced as members of a primary care team, either through physically sharing clinic space with other health-care providers or just collaborating remotely.
That's sensible given our aging population, said Wodchis, whose research focuses on complex, high-cost patients.
"People at older ages have more chronic conditions, and with multiple chronic conditions come multiple medications," he said, adding that these are best overseen by pharmacists, who have the most expertise in how drugs interact.
In some jurisdictions, pharmacists now have discretion to renew prescriptions, which keeps patients from filling up doctor's appointment books for routine renewals, he said. That's critical given physicians are themselves an aging cohort, while pharmacists are, on average, younger and cheaper to put through post-secondary education.
David Cai, who graduated in 2017, is the pharmacist at Owl Drugs in the heart of Vancouver's Downtown Eastside, the epicentre of B.C.'s opioid crisis. Even without the complexities added by COVID — which has only served to exacerbate the addiction crisis — Cai is intimately involved with many of his clients' health care.
In many cases, he administers daily drug-replacement therapies to help people suffering from addiction to safely manage their dependence on opioids and other drugs. But they connect with Cai on other aspects of their struggles as well.
"They talk to me while I'm working. They say, 'I don't have a place to sleep tonight.' Then I'll say, 'Well, you've got these other shelters around that you can consider going to.' And then I'll give them a little sheet of paper with the addresses on it and then they can go check those places out."
Cai said that helping people with more than just their medications is what has kept him in this challenging role.
Providing medication is "my job and I have to make sure I do it correctly. But it's when I get to know these people and am able to help them in other ways — I think that's really how I find fulfilment in what I do."
Written by Brandie Weikle. Produced by Rachel Sanders, Jeff Goodes and Amina Zafar.