Canadian Pharmacies Emerge As ‘First Stop’ for Primary Care

At its national summit on the future of primary care, the Canadian Pharmacists Association (CPhA) envisioned “a system where pharmacy is recognized as a first stop in the primary care journey for all peoples in Canada.” Recent evidence suggests that this vision is being realized in some parts of the country.

“Pharmacy-led clinics, where pharmacists provide direct patient care away from the dispensary area, have emerged as effective alternatives for nonemergency health issues,” Danielle Paes, PharmD, CPhA’s chief pharmacist officer, told Medscape Medical News. “Every healthcare service provided by a pharmacist is a potential avoided trip to the emergency room, especially for those Canadians without a family physician or nurse practitioner.”

Nova Scotia is “leading the way” with such clinics, she noted, citing the almost 10% decline in emergency department (ED) visits since the province embraced this model.

A key reason for the impact is the support of governments across Canada for expanding pharmacist prescribing for minor ailments, she said. In addition to Nova Scotia’s success, data show that Ontario has recorded more than 1 million minor ailment assessments since pharmacists’ scope of practice was expanded in January 2023. “In British Columbia, pharmacists were granted that authority in June 2023 and provided more than 340,000 minor ailment and contraception assessments as of March 2024,” said Paes.

Furthermore, in Prince Edward Island, pharmacists recently completed 100,000 assessments as part of their Pharmacy Plus program, she added. “These numbers illustrate that Canadians are increasingly turning to their pharmacists for care that they otherwise may have sought elsewhere, including emergency rooms.”

Working With Government

Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia, provided context for the success of the pharmacy-led clinics that are serving as a model for other provinces. In 2021, Nova Scotia elected a new government that developed an Action for Health plan with the goal of ensuring that all healthcare practitioners, including pharmacists, were working within their full scope.

“Part of our role as a professional body, within our contract with government, is to run pilot programs to demonstrate the value of pharmacy services,” Bodnar told Medscape Medical News. One project currently underway involves community pharmacy primary care clinics.

The clinics, which are in areas with the highest number of people without a family doctor, provide services at no charge to people with a Nova Scotia Health Card. These services include assessment and prescribing for strep throat, pink eye, and urinary tract infections; chronic disease management for diabetes, asthma, and chronic obstructive pulmonary disease; prescription renewals; vaccines; and medical injections.

“We launched the project with 12 sites,” said Bodnar. “The government immediately asked us to double that, and we now have 30 sites and are looking to increase some more.”

Action for Health has also implemented mobile care clinics that travel from town to town on weekends, as well as urgent care and virtual care, she noted. Pharmacy-led clinics are the fourth new access point, and the one that provided about 50% of the new access services as of April 2024.

At a meeting of Nova Scotia’s public accounts committee in May, Derek Spinney, vice president of corporate services at Nova Scotia Health, reported a 9.2% drop in ED visits for nonurgent care (ie, care at levels 4 and 5). Spinney attributed the “extraordinary” drop to the newly instituted access projects in the face of continued population growth and a 9.7% increase in the more serious level 1 and 2 visits.

Increased Awareness

The pandemic hastened the development and implementation of these new projects and highlighted the role that pharmacists can play in delivering primary care, said Bodnar. “Pharmacists were among the only healthcare practitioners open during that time, and we also led the country in vaccine delivery. This opened the eyes of policymakers and the public that pharmacists could take care of vaccinations, prescription renewals, contraception, and so forth.”

Currently, the provincial government is helping raise awareness even more with radio advertisements and social media, she said. “We’re now in what I’d call an enviable position. There’s a lot of interest in what else we can do. But we need to balance trying to fully move the profession into primary care and maximize the scope of practice with making sure we can grow at a pace that our practitioners can handle.”

Policymakers and the public are recognizing that pharmacists have, much like Canadian physicians, gone to school for 6-8 years after high school, said Bodnar. They have more drug therapy education than any other provider, including doctors. “Policymakers are starting to figure out that we’ve missed the boat by not tapping into the full scope of practice not only of pharmacists but also of nurses and emergency medical technicians, among others.”

“The key to improving primary care and effectively utilizing our limited health system capacity is through interprofessional collaboration,” said Paes. “All healthcare providers have unique skills and education, and we need to work together to improve health outcomes for Canadians.”

US Pharmacists ‘Underappreciated’

Sarah J. Billups, PharmD, director of population health pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, said that pharmacists in the United States are not working within the full scope of their practice. “In general, I think the healthcare system underappreciates the clinical care that pharmacists deliver and hasn’t even thought about” how they might reduce ED visits, she told Medscape Medical News.

In the United States, efforts to use pharmacists’ skills more effectively and reduce ED visits are underway in individual health systems. For example, Billups and colleagues are developing an outreach process for patients with migraine, with the aim of filling treatment gaps in patients at a risk for a preventable ED visit. But the “tricky part” in getting the program implemented is identifying the appropriate population, she said.

An earlier project involved a transitions-of-care model for post-ED follow-up among older adults, but the project did not affect readmissions, she said.

At the University of California, researchers set up a “quasi-experimental study” that examined the impact of an intervention that embedded pharmacists in primary care to provide a consultation and medical review for patients with poorly controlled diabetes. The intervention decreased ED visits by a predicted 21%, and the researchers concluded that “clinical pharmacists are an important addition to clinical care teams in primary care practices.”

On a national scale, the American Pharmacists Association is trying to enlist member support to encourage legislators to cosponsor two bills currently in Congress. Legislation aimed at equitable community access to pharmacy services would ensure that patients continue to have access to pandemic services provided by pharmacists, including vaccinations and testing and treatment for influenza, respiratory syncytial virus, and strep throat.

The Pharmacy and Medically Underserved Areas Enhancement Act would grant pharmacists “provider status” for Medicare patients.

Paes, Bodnar, and Billups declared no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.