OCTOBER 2021 - Hajra Mirza can’t imagine not being able to prescribe for patients with minor ailments. “It’s an important part of the services we provide,” says Mirza, owner of Rossmere Pharmacy in Winnipeg, Manitoba. “It’s a meaningful personal interaction with patients and there is lots of problem solving.”
Mirza, who received her Pharm D from Purdue University in Indiana, jumped at the opportunity to prescribe for minor ailments when the provincial government expanded its scope to permit this authority in 2014. “This was an opportunity to help more patients in more ways.”
After completing the study program required by the College of Pharmacists of Manitoba, Mirza became one of the first pharmacists in the province to receive a certificate of authorization from the regulatory body to prescribe drugs for self-limiting conditions. Authorized pharmacists in the province can currently assess and prescribe for 12 conditions, including skin conditions and allergic rhinitis.
Prescribing for minor ailments builds on the work pharmacists already do, says Mirza. For example, for a patient with acne, all pharmacists can already suggest over-the-counter options such as benzoyl peroxide and provide some insight into the condition. Once authorized to prescribe, pharmacists are required to do a more thorough assessment and from there can offer more treatment options, if warranted.
“I must dig deeper to determine if an over-the-counter medicine can address the problem or a prescription is needed,” says Mirza.
Pharmacists must complete a patient assessment form, developed by the College, which includes the identification of any “red flag symptoms” that might require a referral. “You must take time to arrive at your diagnosis and proceed from there. Everything is documented,” says Mirza, who is also authorized to prescribe for smoking-cessation medications and supports.
The Winnipeg pharmacist, who opened Rossmere PharmaChoice in 2005, follows up with each patient a few days after the consultation, earlier if the condition is severe. An after-hours phone line, answered by one of the pharmacy’s two pharmacists, is also available for patients.
In a typical week before COVID-19, Mirza would see eight to 10 patients for consultations about minor ailments. Most of these would be walk-ins, although appointments are available. During the pandemic, this number dropped (often to zero) but is starting to pick up again as the province reopens.
Building public awareness
In the first few years of treating for minor ailments, Mirza also had to spend time with patients explaining “what we could do as pharmacists. Now patients are familiar with this role. Pharmacists Manitoba [the pharmacy association] has played an important part in creating awareness.”
Although not required to do so, Mirza notifies the patient’s family doctor via text or email of her consults for minor ailments. She is committed to collaboration outside of minor ailments as well. For example, upon invitation from Mirza a nurse practitioner opened a clinic within the pharmacy three years ago. “We are building bridges,” she says. “If you want expanded scope of practice, you need to be a collaborator.”
Currently, authorized pharmacists in Manitoba cannot bill the government for assessing and prescribing for minor ailments. “You have to charge patients or write it off,” says Mirza, who has opted not to charge for her services. While she is hopeful that Manitoba will eventually follow the lead of other provinces such as Saskatchewan and Quebec, which do remunerate for minor-ailment assessments by pharmacists, the lack of public funding should not be a deterrent. The benefits outweigh any financial loss, she emphasizes. “This is good for business. Patients appreciate the opportunity to save time, and you build trust.”
[PHOTO: REPRINTED FROM LOCALBEAT]