Study examines work of Nova Scotia pharmacists, the pandemic’s ‘unsung heroes’

If not for community pharmacists, many Nova Scotians would have had nowhere to turn for their primary health care needs during the pandemic.

That’s one of the takeaways from a新的研究论文, ‘Community Pharmacists’ Expanding Role In Supporting Patients Before and During COVID-19: An Exploratory Qualitative Study.’

“I would say that we have proven our ability to be a really important part of the healthcare system during COVID, and that hopefully we can maintain that and have funding to maintain that,” one Halifax area pharmacist told the study’s authors.

“A lot of patients, and in particular unattached patients, would have been really left without anybody if they didn’t have their pharmacist during COVID.”

The study’s authors found the role played by Nova Scotia pharmacists in delivering primary care during the pandemic has highlighted an “urgent need” for funding, legislative, and structural changes that can help pharmacists better fill health care gaps.

在由于Covid-19导致预先存在的挑战加剧的农村地区，这尤其如此。

“The [rural region], like we deal with a large shortage of family physicians … that’s always been challenging to try to get people the appropriate amount of care that they need,” one pharmacist from outside HRM told researchers.

“As pharmacists, we do as much as we can. But obviously there comes a point in time where they need to see a doctor.”

Currently under peer review with the International Journal of Clinical Pharmacy, the study’s goal was to explore the role of Nova Scotia’s community pharmacists in caring for patients before and during the pandemic. It also sought to identify “barriers and facilitators to optimizing patient access.”

新研究是加拿大卫生研究院的一部分资助PUPPY study(shortened from ‘Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients in a Pandemic Year’).

Interviews for the study were conducted earlier in the pandemic (between September 2020 and January 2021) and before the COVID-19 vaccine rollout.

Pharmacists ‘kept showing up’

“What just keeps coming back loud and clear to me from all the work we’ve been doing is that we’ve been overlooking the role they (pharmacists) have been playing and how important it is,” Dalhousie University College of Pharmacy professor, and the paper’s lead author, Jennifer Isenor said in an interview.

“当事情变得非常糟糕时，他们只是继续前进，他们一直展示，他们一直在提供所有的关心，并在任何时候都在以上。”

The research paper notes how pharmacists play an important role in primary care and access to care for both unattached patients (people without a primary health care provider) and attached (those who had one).

“药剂师通常不会被归功于初级保健提供者。然而，他们当然真的是，“Isenor说。

“They’re often the first point of care and access for patients to the health care system. We really saw how that changed and emerged for both attached and unattached patients.”

该研究还突出了一群被称为半附着的患者的大流行期间的出现。这些是有家庭医生或护士从业者的人，但如果有的话，无法及时进入它们。

Isenor said the role played by pharmacists for those semi-attached patients was “huge” and further increased the workload for community pharmacists.

“（药剂师）能够为卫生保健系统为公众提供这么多，为公众提供这么多，他们可以从其他人身上取消应变，”Isenor说。

“But we don’t want to put more strain on them either, so having some infrastructure and funding in place would remove some of the strain.”

Some Nova Scotians ‘go years’ without family doctor

根据最近的每月报告数据from Nova Scotia Health (NSH), 85,856 Nova Scotians (8.6%) were on the ‘Need a Family Practice Registry’ as of March 1. In February, 7,476 people had added their names to the list.

“在NS中，未连接的患者可以在没有常规家庭医生或护士从业者的情况下变得多年，从而为获得诊断测试和专业护理（例如，内分泌学家）至关重要的预防性保健和维护现有的健康状况，”研究说明。

Isenor said one of the many benefits offered by pharmacists is their accessibility, with 40% of Nova Scotians living within walking distance of a community pharmacy and 79% within a five-kilometre drive.

“This degree of accessibility, and the resulting frequency of pharmacy visits (14 times per year on average), provides pharmacists with multiple opportunities to address health issues among their patient population,” the study states.

“Most Canadians trust the care they receive from pharmacists and are open to visiting their pharmacist for healthcare services beyond filling a prescription.”

尽管具有立法权限令和解释诊断检验，但本文的作者强调了资金和运营障碍防止新斯科舍的药剂师提供这些服务。例如，如果药剂师可以下令后续实验室测试，以确保药物治疗没有意外后果，那么这将是有帮助的。

Some study participants also expressed the need to be able to refer patients to specialists for issues requiring further assessment. This was seen as especially important for those who rely on a pharmacist as their primary health care provider.

“这些人认为，这些人被认为是良好的机会，特别是对于那些无附加的患者来说，”伊森尔说。

‘I fear things are going undiagnosed’

Pharmacists who participated in the study also suggested they be allowed to provide other publicly funded immunizations beyond influenza and COVID-19. They also wanted to see mental health and addiction services such as theBloom programmade available in more pharmacies across the province.

They also pointed to Health Canada’s issuing of exemptions for prescribing controlled substances during the pandemic. This enabled pharmacists to extend and deliver prescriptions, transfer to other pharmacies, and accept verbal orders for extensions or refills.

他们建议这些变化保持大流行后，因为它们有助于消除患者的不必要的障碍。

“我们看到人们与慢性病haven’t seen a physician in months, maybe a year, year and a half. You know, people getting sicker or people who are coming into us are much sicker than they were prior to all of this,” one pharmacist working outside of HRM told the study’s authors about the impacts of primary health care barriers on patient care during COVID-19.

“We’re kind of left with … a small toolbox of things that we can do for them. But people are getting sicker. And I fear things are going undiagnosed. And you can just see it in your patients, that they’re failing. So, yeah, there’s been a big impact.”

Another pharmacist identified as being from” outside the provincial capital” recalled the story of one patient they were used to seeing regularly who came in during those early months of the pandemic. The pharmacist looked at the patient and could tell she wasn’t feeling well.

And she said, “I am not well. Something is wrong. I don’t know what it is. I just…” You know, this was a lively, active, very, you know, tough woman… she said, “I had bloodwork done, but no one can read it because I don’t have a family doctor.”

Because I didn’t order the bloodwork, it’s technically out of my scope of practice to then go and look at the bloodwork. But I did anyway because what am I going to do?

Identified some issues and told her to go back to emergency and just kind of say… that someone needed to take a look at this. Which they did, and now have done follow-up things, and she may have cancer.

‘Unsung heroes’

The study notes that unattached patients often receive “fractured” primary health care. They often have no choice but to seek care at different locations and from different providers who are unfamiliar with them and their medical history.

如果药剂师能够提供额外的服务，它将改善那些患者的医疗保健。

“Unattached patients have reported seeking care in walk-in clinics and emergency departments for referrals and bloodwork, but often having referrals not made or lost, resulting in delayed or missed diagnoses,” the report states.

“Pharmacists can close this care gap and lessen the demand for care within overcrowded walk-in clinics and emergency departments, especially outside the provincial capital. Community pharmacists are under-utilized PHC (primary health care) providers that are accessible and distributed throughout the province.”

Isenor said the words “unsung heroes” frequently run through her head when she thinks about community pharmacists and all they’ve done throughout the pandemic to provide care.

“我们一直在听到大家，但我认为......药剂师一直在提供英勇的努力，”Isenor说。

“They haven’t been seeking credit, but they have been working their butts off just as much of the health care system has, and I hope lots of people go thank their pharmacists and pharmacy team and say, ‘I really appreciate what you’ve been doing.’”

Expanded scope of practice

Evidence supports the role of pharmacists in chronic disease management like high blood pressure, heart failure, diabetes, COPD and asthma, as well as the treatment of self-limiting conditions.

The study notes how the scope of pharmacist practice in Nova Scotia has expanded further in recent years. Community pharmacists can administer drugs by injection, assess and prescribe for minor ailments, contraception (including emergency contraception), uncomplicated urinary tract infections, and medications for smoking cessation.

They can also offer prescription adaptations and therapeutic substitutions, order and interpret lab tests needed to manage drug therapy (with access through the provincial electronic health record system, SHARE [Secure Health Access Record]) and prescribe renewals.

有关的：Pharmacists, nurse practitioners to provide collaborative health care in pilot project at two Nova Scotia pharmacies

“We’ve never shown people the degree of work and expertise that our teams have,” Pharmacy Association of Nova Scotia (PANS) CEO Allison Bodnar said in an interview.

“所以这对许多人来说是一个真正的惊喜，人们不断低估我们拥有的价值和投入，并且我们是医疗保健系统的一个组成部分。”

Describing the role played by pharmacists in maintaining the health system throughout the pandemic as “integral,” Bodnar said pharmacies were among the few health care facilities open in the early days of the pandemic.

“We were getting all sorts of different types of requests and different people relying on us to provide care that quite frankly we could have provided previously, but people were unaware or had alternatives,” Bodnar said.

Much like other health care providers, Bodnar said pharmacists are experiencing burnout and exhaustion. In a recent PANS workplace survey, 50% indicated they hadn’t previously worked regular overtime. Now, just 30% say they aren’t regularly putting in excess hours.

But despite the fatigue, she said the province’s pharmacists are proud of the work they’ve been doing.

“There’s this renewed sense that people are finally recognizing the value that pharmacy brings,” Bodnar said.

“Much of our scope of practice has been in place for a decade or more, but it hasn’t been publicly funded or it hasn’t been necessarily recognized.”

‘Real opportunity to rethink how we deliver care’

从提供附加，未附加的和半附着的患者的护理，以更新药物并提供其他评估，这家省的药剂师 - 并且仍然是 - 忙碌。

Bodnar重申了Nova Scotia Pharmacies如何在疫苗送货上的国家领导者，通过每个人均药房提供更多的Covid-19疫苗，而不是加拿大的其他任何地方。

“他们认为，在所有其他服务之上，他们仍然在仍在处理Covid和感染控制政策和实践的现实的同时，扩大了他们的范围。”

Bodnar said COVID has opened the eyes of many policymakers and members of the general public who are increasingly recognizing pharmacists as an “incredibly well-trained, compassionate and effective” workforce that can help address some of the province’s health care system woes.

“We have a real opportunity to rethink how we deliver care in this province,” Bodnar said.

Much like pharmacists, she said other health care professionals — including nurses, nurse practitioners, and those working in emergency health — have scopes of practice that aren’t being maximized.

She said the opportunity to reshape the health care system could include rethinking who patients see for specific ailments.

“We’ve been very well trained in our health care system that we’re not allowed to go to a specialist without going through a triage through a family physician first,” Bodnar said.

“为什么我们不想创建另一层，如免疫或续约等简单的东西，不符合昂贵的资源我们为什么不放在另一层分类？“

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