B.C.’s changes to prescription rules have reduced family doctor calls

The number of British Columbians getting their prescription medications renewed or adjusted at their local drug store, without first contacting a physician, has more than doubled since the province broadened the scope several months ago of what pharmacists are allowed to do.

Last fall, B.C. and Prince Edward Island gave pharmacists more prescribing powers, and Ontario and Yukon followed suit with similar amendments in January, while Nova Scotia has launched a pilot.

The changes across the country are meant to address a widespread shortage of family doctors, and long waiting times at walk-in and primary-care clinics that make it difficult for patients to refill prescriptions. Alberta pharmacists have had more leeway for more than a decade.

Newly released data for British Columbia shows that tens of thousands of additional patients are now able to get their prescription needs met.

Before the policy shift came into effect in October of 2022, pharmacists in B.C. would renew or alter a prescription 28,000 times a month, on average. Since pharmacists were authorized to adapt and renew prescriptions for a wider range of drugs and health conditions, that figure has been rising every month, with more than 66,000 adaptations in December.

The bigger change will come in March, when B.C. pharmacists will be allowed to prescribe drugs for minor ailments such as urinary tract infections and allergies, as well as for contraception.

Chris Stokes, a pharmacist at the Cridge Pharmacy in Victoria, said the change has relieved pressure for patients at a time when it is exceptionally difficult for many to see a physician to approve prescription changes or renewals.

Mr. Stokes said pharmacists were able to renew prescriptions prior to the policy change, but it wasn’t encouraged. “Before, it was almost like we needed to really watch our backs, and make sure we were still getting people to go see a doctor. Now they are telling us, ‘hey, we want you to help out.’ ”

In Victoria, the shortage of family doctors has been exacerbated by closings of walk-in clinics. That leaves many patients turning to the region’s urgent and primary-care centres, but those sites are also difficult to get into. On Sunday morning, every urgent and primary-care centre in the region was already at capacity, according to Medimap.ca, a website that allows Canadians to find health clinics and see current waiting times.

He still encourages people to see a doctor about their medications, but he can fill renewals, giving people more time to find a medical appointment. “There’s less stress about having to go on to Medimap to try to find a walk-in clinic, start calling at 8 a.m. to try to book an appointment, and not getting through.”

B.C. Health Minister Adrian Dix said the shifts are part of a suite of changes in health care, including bringing in more nurse practitioners and offering family doctors a better compensation package, to address some of the shortages that have become more acute since the start of the pandemic.

“It’s using pharmacists for things that are well within the scope of practice for pharmacists to improve health care systems, to save patients’ time, and to allow our doctors to focus on other things,” he said in an interview.

The measures to give pharmacists more authority might have been resisted by physicians in the past, he said, but the new payment model that B.C. doctors approved in December moves away from fee for service – which incentivizes short appointments including prescription renewals – to one that compensates doctors based on several factors, including the medical complexity of patients.

However, Doctors of BC president Joshua Greggain said there is still much more to do. Dr. Greggain spent the Family Day long weekend as a locum in a rural hospital emergency room on the north end of Vancouver Island, where the shortage of health care workers is acute.

He said the changes to pharmacists’ authority “is one of the elements that will be critically important as we continue to build the system for access to patients across the province.” Health care workers in rural B.C., like those at the Port Hardy hospital where he was putting in shifts, would welcome any relief, he said.

“I’ve now witnessed myself that they are definitely in a state of crisis. There is a level of desperation,” he said in an interview from Port Hardy.

“I spoke to one of the nurse managers, she is saying they would take anyone to help – family physicians, nurse practitioners, nurses, physician assistants – anyone to help keep things afloat.”