rxPassport Pharmacy Newsletter
 
June 2014
 
 
The Minor Ailments Program: Addressing Uptake Barriers
 
Meet Our Patient - Jerry
 
  • Jerry is a 23-year old student at the University of Saskatchewan
  • Although he has been a chronic sufferer of seasonal allergies, he has been symptom-free for over 2 years and has not needed any medication
  • Last week, he started some home renovations and he has been constantly sneezing, and has a stuffy and runny nose
  • He is also very uncomfortable and having trouble sleeping
  • Jerry just came from the walk-in clinic and there was a 3 hour wait
  • He wants to know if there is anything you can do to help him.
  • The Minor Ailments Program
     
    Currently, the Minor Ailments program is approved in 4 provinces across Canada – Saskatchewan, Alberta, Nova Scotia, and most recently Manitoba. It may come to other provinces in the near future. This expanded scope of practice allows pharmacists to use their expertise to assess patients and prescribe Schedule 1 medications for a minor ailment or known as a self-limiting condition. For more information on minor ailments and what the program entails, refer to here.
     
    Why Is It Important?
     
    With a growing and aging population, healthcare utilization and costs are increasing. It is becoming increasingly apparent that there is a need to use resources efficiently to meet the growing demands of patients while maintaining a sustainable healthcare system. The Minor Ailments program has immense potential to benefit patients, physicians, pharmacists, and our healthcare system. The stakeholders in this program and their potential benefits are reviewed in Table 1.
     
    Table 1. The Potential Benefits of the Minor Ailment Program to Key Stakeholders
     
    Click to enlarge
     
    Figure 1. Other Resources Patients Would Use If The Minor Ailments Program Was Not Offered7
     
    Helixia Logo
     
    Source: Pharmacy Association of Nova Scotia 2013
     
    The Problem: Uptake Barriers
     
    The reality is that there are many barriers to the uptake and progression of the Minor Ailments program. Many challenges have been identified in the pharmacy community, as well as in a pilot study conducted by the Pharmacy Association of Nova Scotia (PANS) of the Minor Ailments program5 (PANS study). Some of these challenges and potential solutions5 are presented in Table 2.
     
    Table 2. Challenges and Potential Solutions for the Minor Ailments Program
     
    Challenges Potential Solutions
    Pharmacists’ lack of confidence
  • Many pharmacists don’t feel comfortable assessing and prescribing
  • Dramatic change in the pharmacists “traditional” role
  • Mandatory training (currently in place), such as Manitoba’s Self-Limiting Conditions Independent Study Program
  • Continuing Education programs - Interactive component
    practice with example scenarios using standardized patients, interact with peers, and use of discussion forums
  • Set treatment algorithms for each minor ailment. Many pharmacists find this useful and would like to see more. See Saskatchewan’s Treatment Algorithms
  • Videos showing standards of care and best practices to motivate pharmacists
  • Pairing up with another pharmacist in the assessing and prescribing process initially until comfortable
  • Other Challenges
    Difficult to integrate into daily workflow
  • Human resource - difficult for one pharmacist to manage the dispensary and Minor Ailments service at the same time
  • Time - lengthy assessment process and documentation
  • Involve all team members. Physicians spend at least 18% of their time caring for patients with minor ailments2
  • Integrate technology into the assessment and documentation by using computers to enter patient demographics, medical information, and documentation notes
  • Cost to patients
  • One third of patients said they would not use the service if they had to pay out-of-pocket5
  • Advocatefor government or third party insurance to cover patient costs
  • Pharmacists demonstrate value to patients by emphasizing the benefits even if the pharmacist does not prescribe anything
  • Difficulty recruiting patients
  • Lack of patient and healthcare provider awareness of the program
  • Promotional campaigns - Communicate with physicians and nurse practitioners to refer patients to pharmacies
    Send out marketing material targeted to patients
  • Some physicians work on a fee-for-service model
  • More cost-effective use of resources to direct these qualified individuals towards more complex patient cases
  •  
    The Future of Pharmacy
     
    As our healthcare system becomes more and more demanding, there needs to be more cost-effective use of resources. Pharmacists have the expertise to alleviate a substantial burden on physicians and the healthcare system, and to increase access to and optimize healthcare for patients. Pharmacists are often the first contact patients have with the healthcare system. The Minor Ailments program is a strategic way to target patient access to primary care. With prescribing rights for pharmacists, this becomes one of the first steps in showcasing the unique role of pharmacists in frontline healthcare. Confidence becomes key.
     
    Revisit Our Patient - Jerry
     
  • Jerry looks like he’s suffering quite a bit so you decide to introduce the Minor Ailments program to him. He seems to become less skeptical as you explain it to him.
  • You use the treatment algorithm for seasonal allergies and ask him the appropriate questions
  • At the end, Jerry receives a prescription for mometasone nasal spray, and recommendation for a second generation oral antihistamine
  • Jerry comes back one week later for his follow-up with you and thanks you as his symptoms have greatly improved and he is able to sleep well again
  •  
    By: Monica Tran, PharmD Candidate
     
    With appreciation to Mike Boivin
     
    A pharmacist’s perspective
     
    “The confidence just builds the more you do. At first I was looking at it as, oh my god, look at all the ailments. And then when you actually go through each one and you kind of get your head around them. So I feel like I’m leaps and bounds, or above and beyond what most other pharmacists in the province are, you know in terms of confidence and capability to do this”5
     
    A patient’s perspective
     
    “It is great to know that I can come in to the pharmacy to get something for my cold sore rather than waiting at the doctor’s office.”8
     
    Interactive Poll
     
    How confident do you feel about providing the Minor Ailments program?
     
     
    Very confident
     
     
    Somewhat confident
     
     
    Not confident
     
     
    Not applicable
     
     
     
    Check Your Answer
     
    A Scotland success story
     
    Scotland shows a prime example of enthusiasm for the Minor Ailments program, which has the potential to do wonders for their healthcare system. A pilot study in 2001 showed that visits to physicians for a minor ailment were reduced by 33% to 37%1. In 2008-2009, approximately 1.2 million products were prescribed in the program6 and dramatically rose within the first 2 years6 since the service was implemented.
     
    Did You Know?
     
    Saskatchewan pays their pharmacists a patient assessment fee of $18 when the pharmacist prescribes a drug for either mild acne, cold sores, or insect bites.9
     

     
     
    Read Monica's Blog Entry
     
     
     
    References
     
    1. 9000 Points of Care. (2013, April). Improving access to affordable healthcare. Retrieved May 20, 2014, from 9000 Points of Care: View Reference
     
    2. BCPhA. (2013, March). Clinical Service Proposal Treatment of Minor Ailments. Retrieved May 20, 2014, from BCPharmacy: View reference
     
    3. NAPRA. (2014, January 1). National Statistics Provincial/Territorial Statistics - Pharmacies. Retrieved May 20, 2014, from NAPRA: View Reference
     
    4. NAPRA. (2014, January 1). National Statistics Provincial/Territorial Statistics - Pharmacists. Retrieved May 20, 2014, from NAPRA: View Reference
     
    5. PANS. (2013, October). Pharmacy Association of Nova Scotia. Retrieved May 20, 2014, from Evaluation of the Provision of Minor Ailment Services in the Pharmacy Setting Pilot Study: View Reference
     
    6. The Translator. (2013). Expanding the scope of practice: Pharmacist’s role in the management of minor ailments. Retrieved May 20, 2014, from Canadian Pharmacists Association: View Reference
     
    7. Pharmacy Association of Nova Scotia 2013, Where Patients Would have Gone for Care if the Minor Ailment Service was not Available at the Pharmacy, digital image, Pharmacy Association of Nova Scotia, accessed 20 May 2014, View Reference
     
    8. J. Mann, E. Read, L. Perrault. (2014). Minor ailment prescribing in Saskatchewan. Retrieved May 30, 2014, from Canadian Pharmacists Association: View Reference
     
    9. National Coordinating Office. (2012). Saskatchewan starting minor ailment fees. Retrieved June 5, 2014, from Blueprint For Pharmacy: View Reference
     
     
       
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