January 21, 2019
Pharmacists’ expanded scope may contribute to reducing ER crowdedness
Waterloo researchers have found that one-third of unnecessary ER visits in Ontario could be managed by pharmacists’ expanded scope.
Most of us know the uneasy feeling of waiting in a crowded emergency department for a minor condition. The person next to you has a wretched cough, you’ve been biding your time for over four hours to see a professional and your vending machine orange juice isn’t helping to distract you from the crowded hospital surroundings.
University of Waterloo researchers Wasem Alsabbagh and Sherilyn Houle have found that in Ontario, almost one-third of those who visit emergency departments (EDs) with non-urgent conditions could potentially be treated by pharmacists who hold an expanded range of practice. Empowering pharmacists to practice in the community with expanded scope or incorporating these pharmacists into EDs could substantially reduce the over-crowdedness that people have come to loathe.
“Overcrowding in EDs is a concern most Canadians can relate to, and we know that it can lead to increased mortality and a higher rate of patients who leave without receiving treatment,” said Alsabbagh, a professor at the Waterloo School of Pharmacy. “Our findings support that we need to see more pharmacists working with expanded scope in community practice or based in the ED. This may free more resources in EDs to care for more acute patients.”
This study analyzed all Ontario hospital ED cases from 2010 to 2017 in order to determine exactly how many non-urgent (or unnecessary) visits could have been managed by a pharmacist. Cases considered were qualified based on scales that measure the severity of patient concerns. Statistics were then generated to assess which concerns could be managed by pharmacists working with expanded scopes.
In Canada, the services provided by pharmacists have expanded over the last decade, but there remains considerable variability from province to province in which tasks pharmacists are permitted to carry out. Ontario has started to allow pharmacists to perform additional services such as prescriptions renewal and influenza vaccinations in 2012, as well as additional vaccines in 2016. However, in Alberta for instance, pharmacists have the ability to prescribe both independently and for minor ailments in addition to renewing prescriptions and administering injections.
“Our study included all expanded scope services in use across Canada when assessing which ED cases pharmacists could manage,” said Alsabbagh. “Over the seven years of the study period, we found that pharmacists with an expanded scope could potentially have managed nearly 1.5 million cases in Ontario.”
Approximately one in five patients who seek emergency assistance are considered to have non-urgent health conditions. These conditions, which could be managed by pharmacists with expanded scopes, include skin concerns like dermatitis, and conditions related to cough or inflamed ear canals, nasal passages and throat.
“Many pharmacists are capable and willing to help,” said Alsabbagh. “What we need now is support from the Ontario government to allow pharmacists to do what pharmacists in other Canadian jurisdictions are already able to do. Once on scene, pharmacists would make an immense and positive difference in how our EDs operate.”
