Note: Since the writing of this blog post, Minor Ailments regulations have been approved in Ontario.
After being exposed to and immersed in the profession of pharmacy for all 23 years of my life thus far (I am in the process of becoming a fourth-generation pharmacist), I had gotten to a point where I naively thought I knew almost everything there is to know about all things related to pharmacy. However, within one week of beginning my first co-op term at the Ontario Pharmacists Association (OPA), my perception of the profession was flipped on its head; I realized I had a lot of learning left to do.
While this epiphany was a strong dose of reality, it made me excited for what was ahead: the opportunity to learn. I am biased after my last four months working in the Professional Affairs department at OPA; however, I would like to think the best place to learn about the profession of pharmacy is from the inside out. At OPA, I have been given the opportunity to work alongside pharmacy pioneers who work tirelessly to better the profession by developing advocacy proposals, submitting responses to consultations, and launching first-rate communications, updates, and practice tools at superhuman speed. I felt as though any modicum of assistance I could contribute would be fulfilling and a substantial success on my professional journey.
The primary responsibility of the Professional Affairs department is advocating for the profession at all levels. Understandably, the projects in the works when I began in January were inundated with COVID-19 related topics and how to support the pharmacy professionals who have been working relentlessly throughout the entirety of the pandemic. Yet, simultaneously, the department was optimistic about the easing of restrictions in the near future and the non-COVID-19 doors that would open as a result. Consequently, I was tasked with working on updating the OPA Suggested Fee Guide for Uninsured Clinical and Professional Pharmacy Services. In doing so, I was able to gain a deeper understanding of the business of pharmacy by accounting for a wide range of factors to determine reasonable fees for uninsured services that are provided to patients on a daily basis. This soon to be released update also required the addition of several new services—notably, the addition of COVID-19 related services such as COVID-19 testing.
The fast-paced nature of this placement was best elucidated by three announcements related to expansions to scope of practice during my time at OPA. The first of these announcements was the regulatory change to enable pharmacy professionals (pharmacists, pharmacy students and interns, and pharmacy technicians) to collect a blood sample in order to perform specified point-of-care testing (POCT) in pharmacies which comes into force on July 1, 2022. As the resident student at OPA, I was put in charge of researching and developing a practice toolkit to help support pharmacy professionals with the rollout of POCT. With this fast-approaching deadline, I had to do something which is almost too well known to other members of my department: reassess and realign my current priorities to address a new and more urgent topic.
To support this upcoming scope expansion allowing pharmacy professionals to perform four different point-of-care tests—blood glucose, HbA1C, lipids, and PT/INR—for the management of the associated chronic conditions, I started by reaching out to POCT device manufacturers. By having discussions with these representatives, I was able to compile an extensive collection of data on all of the currently Health Canada approved POCT devices. Following over a month of research, I was able to consolidate the gathered information into a POCT-specific clinical practice tool, my OPA pièce de résistance. The tool is meant to support pharmacy professionals with initiating POCT discussions with patients as well as guide them through the framework of how the entire process could flow from start to finish. My hope is that this tool will be used by participating pharmacy professionals to assist them with integrating this new scope into practice in addition to supporting their conversations with patients to encourage them to take advantage of the increased access to care and the opportunity to improve the management of their medical conditions.
The second exciting announcement was regarding the Ministry consultation on proposed regulation changes, which, if enabled, will authorize Ontario pharmacists to independently assess and prescribe certain drugs for certain minor ailments. OPA has been advocating for the addition of prescribing for minor ailments to the pharmacists’ scope of practice for over a decade. The advancement of these proposed regulations to the next stage of the regulatory approval process brings us one step closer to another expansion of scope for the pharmacy profession, which would consequently also increase patient access to equitable care. While this consultation occurred near the end of my time at OPA, I was still able to be involved in discussions about OPA’s continuing advocacy efforts to advance this proposed regulatory change and ensure the sustainability of this service, e.g., through fair and reasonable remuneration, in addition to evaluating the need for tools and resources to ensure that all pharmacy professionals are as prepared as possible if the proposed amendments are approved.
Inevitably, while at OPA, COVID-19 remained a priority within the Professional Affairs department. Most notably was the advocacy work dedicated to the expansion of nirmatrelvir/ritonavir (Paxlovid) access for eligible patients through community pharmacies. OPA firmly advocated that pharmacists’ extensive drug therapy knowledge places them in an optimal position to identify and manage the clinical complexities associated with this treatment. This work not only led to the expansion of access to nirmatelvir/ritonavir (Paxlovid) treatment, but OPA was also successful in advocating for pharmacy remuneration of $13.25 (the highest dispensing fee payable under the Ontario Drug Benefit (ODB) program) for dispensing this medication. In addition, OPA was able to negotiate that a professional intervention fee under the Pharmaceutical Opinion Program may be claimed for individuals eligible to receive publicly funded nirmatrelvir/ritonavir (Paxlovid) (including for non-ODB recipients) if the pharmacist identifies a potential drug therapy problem during the course of dispensing a prescription for nirmatrelvir/ritonavir (Paxlovid), that requires collaboration with the prescriber to resolve, or if the pharmacist recommends to the prescriber that the eligible individual be prescribed nirmatrelvir/ritonavir (Paxlovid). This was an exciting initiative as it not only highlighted the important role that pharmacy professionals and the profession play in the healthcare system, but also ensured that patients would have greater access to this time-sensitive treatment for COVID-19 to support better patient outcomes.
Within four short months at OPA I have been able to witness three major developments in the profession of pharmacy from the inside out, all of which were markedly influenced and encouraged by the years of work done by the staff at OPA and its members. More importantly, I was able to have a seat at the table to witness and work alongside passionate pharmacy colleagues day after day to help enhance the profession. I know now, I do not know everything there is to know about pharmacy, and fortunately for me, I never will, as this means I can continue learning throughout my career. However, the wealth of knowledge I am leaving OPA with far exceeds the amount of knowledge I entered with, and that is all I could ask for. The knowledge I have gained and the skills I have learned and refined while at OPA will be imperative aspects of my professional journey, wherever it may lead.