Ask the Pharmacist

Q. You mentioned in previous columns that pharmacists will be able to prescribe for impetigo and other minor ailments in the new year. What are “minor ailments” and how will that work?

A. Beginning on January 1, 2023, pharmacists in Ontario will be able to prescribe medications for 13 specific minor ailments. Minor ailments are conditions that are often self-limiting (will resolve with time on their own without treatment) or can be managed with minimal treatment. For a health condition to be described as a minor ailment, the following criteria need apply;

· Short-term condition
· Lab results not necessary
· Treatment not likely to mask underlying conditions
· No red flags that would indicate a more serious condition
· Minimal or short-term follow-up required

The 13 minor ailments that people may seek help from their pharmacist in Ontario are;

1. Allergic rhinitis
2. Candida stomatitis (oral thrush)
3. Conjunctivitis (pink eye)
4. Dermatitis (atopic, eczema, contact and allergic types)
5. Dysmenorrhea (menstrual pain)
6. Gastroesophageal reflux disease (GERD)
7. Hemorrhoids
8. Herpes labialis (cold sores)
9. Impetigo
10. Insect bites and urticaria (hives)
11. Tick bites, post-exposure prophylaxis to prevent Lyme disease
12. Musculoskeletal sprains and strains
13. Urinary tract infections (uncomplicated)

Ontario is just the latest province to give pharmacists these prescribing rights. Alberta began this initiative in 2007 with Nova Scotia and Saskatchewan in 2011 and Manitoba, New Brunswick and Prince Edward Island following in 2014. Other provinces are also working out the details for their pharmacists. Many feel that this is coming at an opportune time.

Health care in Canada is challenging for many to say the least. To be able to see a health care provider in a timely fashion is nearly impossible these days. The next alternative when you live in a rural setting with no access to walk-in clinics, is to go to your nearest emergency room. If you have what is deemed to be a minor ailment, it is not considered to be an emergency. It is an expensive solution for the individual (long, unproductive wait times) and the province (the average cost of an ED visit in Canada without requiring the use of special services like an x-ray was $158 in 2018/19).

However, we are left with little choice if we are unable to see our primary health provider within a few days. Some of these minor ailments are time sensitive such as preventing Lyme disease after a tick bite. Soon, Ontario pharmacists will be able to alleviate some of these issues that fall within our new scope of practice. If you are wondering how this will be funded, that is still to be decided. The hope for the government is that the money saved in emergency wards & walk-in clinics will easily fund this initiative.

It is important to note that Ontario pharmacists are not allowed to diagnose. Rather, we are only able to affirm a previously suggested diagnosis. Thus, we are at the mercy of people “self-diagnosing” themselves and asking pharmacists for help in treating that ailment. We are also not allowed to order lab work to assist in confirming a diagnosis. In some cases, such as urinary tract infections (UTIs), this would be extremely helpful obviously.

Bringing forth your minor ailment to a pharmacy for a consult may not result in you leaving with a prescription for that ailment.

First off, each minor ailment has red flags associated with it that the pharmacist has to review to ensure that there is not the potential for a more serious or underlying condition that needs attention (for instance, we cannot prescribe antibiotics for bladder infections in males due to the increased risks that these symptoms might be a result of a more dangerous undiagnosed condition). If any of the red flags are discovered, you will be referred to another health care provider for further assessment.

Secondly, though Ontario is allowing pharmacists to prescribe for the above minor ailments, not all pharmacies will be participating in this endeavour. Pharmacists are already dealing with an increased demand on their time with vaccinating the public against COVID-19, influenza and other important vaccinations along with the ever growing number of medical related questions that people are seeking help with. Add that to the ever-expanding list of medications that are on a shortage and must therefore be replaced (a time-consuming and frustrating experience for all involved). It therefore would not be a surprise to learn that some pharmacies may not have the staff nor the time to properly add this service to their workload (renumeration from OHIP is expected to be small so hiring another pharmacist, even if there was one available, would not make financial sense).

Thirdly, pharmacists are required to educate themselves on each of the minor ailments before they can confidently assess and prescribe. Your pharmacy of choice may be participating in minor ailments prescribing but may not yet be educated or confident in the minor ailment that you are seeking help with. It is best to phone ahead to avoid disappointment. For more information on this or any other health topic, contact your pharmacist.