Ottawa Citizen by Kelly Grindrod and Sherilyn Houle 25 July 2014
Earlier this summer, a debate was sparked by the experience of Kate Desjardins, an Ottawa woman who went to a walk-in clinic to renew her birth control prescription. She was handed a letter informing her that three of the clinic physicians were not prescribing birth control because of their “religious values.”
At the time, most media outlets noted that this meant she was forced to find another physician. But she had a choice that almost no one is talking about.
Her pharmacist could have also written the renewal prescription for her.
Since 2012, Ontario pharmacists have been able to renew prescriptions for long-term medications such as birth control pills and blood pressure medications. They can renew the prescriptions for up to six months at a time. Pharmacists must also offer to provide a written prescription that the patient can fill at another pharmacy, and must inform the patient’s primary care provider of all renewals given to ensure the patient’s records are updated.
Pharmacists can also renew or extend prescriptions to some extent in British Columbia, Alberta, the Northwest Territories, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Prince Edward Island.
Much like physicians and nurse practitioners, pharmacists are expected to renew prescriptions only after assessing the patient to determine the medication’s effectiveness, side effects and missed doses.
Joan Chand’oiseau of Calgary recently posted a photo on Facebook of a sign on her physician’s office door that read, “Please be informed that the physician on duty today will not prescribe the birth control pill.”
In Alberta, a pharmacist could have also assessed her and renewed the prescription for any length of time. Alberta Health would have even paid the pharmacist a $20 fee for their time and expertise in assessing the patient and providing the renewal.
In some cases, Alberta pharmacists who have been granted additional prescribing authority by the Alberta College of Pharmacists could have even started a new prescription for a birth control pill. Alberta pharmacists can get their prescribing authority after rigorously proving their competence as medication experts and their ability to work with the entire health-care team.
While the experiences of Desjardins and Chand’oiseau highlight the issues of access to contraception, the broader conversation is of access to care.
Health professionals must practice according to their professional ethics, organizational mission statements and the law. But Canadians live in a pluralistic and multicultural society. Health professionals are people, too, and have the right to live by their own religious or moral beliefs.
To respect the patient’s own rights, the expectation by regulators is typically that a clinician who has a moral or religious objection can deny care but only if they ensure their patient can access the same care from another clinician. However, concerns have been raised about patients’ ability to access other physicians in rural and remote locations, which often have fewer physicians per capita than urban centres.
Of all the health providers on the team, pharmacists are the most accessible, with over 30,000 practicing pharmacists across the country. Many pharmacists work in rural and remote locations and many more work in stores open until midnight or 24 hours each day, no appointment needed.
Pharmacists are also highly trained, with at least six years of university education, four of which focus almost entirely on learning how to assess patients to recommend, manage and monitor medications for safe and effective use.
As the debate continues, we should consider all the options. When we talk about ways to access medications, we can start by making sure the pharmacist is on the list.
Kelly Grindrod and Sherilyn Houle are both pharmacists and assistant professors at the University of Waterloo School of Pharmacy.