IMM: L19 Minor Ailments Prescribing

Goals of PPMAC initiative:

• Improving patient … to care

• Improving patient …

• Preventing and resolving …-related problems

• … emergency room visits and hospitalizations

• Improving safe and timely access to … drug therapy

• Improving … of care

access, outcomes, drug, Reducing, necessary, continuity

Pharmacists Regulations Authority to Prescribe

• Pharmacists Regulation—regulatory standards which define scope of practice and restricted activities that pharmacists are authorized to perform

  • Gives pharmacists authority to make diagnosis and/or prescribe … drugs for treating select diseases, disorders and conditions and for the purposes of contraception.

  • Provides parameters for pharmacists for prescribing of Schedule 1 drugs by establishing list of … and drug ….

Schedule 1, conditions, categories

Pharmacists Regulations Minor Ailment

• Permits pharmacists to make a diagnosis and prescribe drug to treat a disease, disorder or condition specified in … if the patient’s signs and symptoms indicate the condition:

  • Presents a … risk of masking an underlying disease, disorder or condition, and

  • Can be readily diagnosed … the need for laboratory or imaging tests, and

  • Can be reasonably expected to resolve with only …-term or … treatment

Schedule A, low, without, short, episodic

Permits pharmacists to prescribe a Schedule 1 drug for the purpose of:

• …, or

• … contraception

Contraception, Emergency

What drug category can pharmacists prescribe for acne?

Topical drugs

What drug category can pharmacists prescribe for allergic rhinitis?

Intranasal, ophthalmic, and oral antihistamine drugs

What drug category can pharmacists prescribe for conjunctivitis (allergic, bacterial or viral)?

Ophthalmic drugs

What drug category can pharmacists prescribe for dermatitis (allergic, atopic, contact, diaper or seborrheic)?

Topical drugs

What drug category can pharmacists prescribe for dysmenorrhea?

Non-steroidal anti-inflammatory drugs

What drug category can pharmacists prescribe for dyspepsia?

Gastric acid-reducing drugs

What drug category can pharmacists prescribe for fungal infections (Onychomycosis, Tinea corporis infection, Tinea cruris infection or Tinea pedis infection)?

Topical drugs

What drug category can pharmacists prescribe for gastroesophageal reflux disease?

Gastric acid-reducing drugs

What drug category can pharmacists prescribe for headaches?

NSAIDs

What drug category can pharmacists prescribe for hemorrhoids?

Topical drugs

What drug category can pharmacists prescribe for herpes labialis?

Topical and other types of antiviral drugs

What drug category can pharmacists prescribe for impetigo?

Topical drugs

What drug category can pharmacists prescribe for musculoskeletal pain?

NSAIDs

What drug category can pharmacists prescribe for nicotine dependence?

Nicotine cessation drugs

What drug category can pharmacists prescribe for oral ulcers (canker sores or aphthous ulcers)?

Topical drugs

What drug category can pharmacists prescribe for oropharyngeal candidiasis?

Antifungal drugs

What drug category can pharmacists prescribe for shingles?

Antiviral drugs

What drug category can pharmacists prescribe for threadworms or pinworms?

Anthelmintic drugs

What drug category can pharmacists prescribe for urinary tract infections (uncomplicated)?

Antibiotic drugs 

What drug category can pharmacists prescribe for urticaria, including insect bites?

Topical and other types of antihistamine drugs

What drug category can pharmacists prescribe for vaginal candidiasis?

Antifungal drugs

Pharmacists can only prescribe for the specified minor ailments and the corresponding drug category as per …

Schedule A

The Regulation amendments do not give pharmacists authority to prescribe … drugs. Pharmacists can … Schedule II drugs as appropriate.

Schedule II, recommend

Competencies, Knowledge and Professional Ethics:

• Pharmacist may make a diagnosis or prescribe a drug for a patient:

  • Only within the … of their education, training and competence, and

  • If they have the … knowledge and … of the patient need or condition and the drug being prescribed

scope, appropriate, understanding

Competencies, Knowledge and Professional Ethics:

• Must … to appropriate healthcare professional when making a diagnosis or prescribing are beyond the scope of practice or knowledge, skills and abilities of the pharmacist

• When making a diagnosis or prescribing a drug, the pharmacist:

  • Must obtain … and voluntary consent from the patient or patient’s representative

  • Must act in the … interest of the patient

  • Is … responsible for their treatment decisions

refer, informed, best, solely

Competencies, Knowledge and Professional Ethics:

• When prescribing for a patient, the pharmacist must:

  • Take all appropriate steps to ensure the prescribed drug is … for the patient

  • Ensure the prescribing decision and selected drug are based on patient … and clinical suitability

  • Ensure patient has … information about prescribed therapy to make an … decision (including risks vs benefits)

  • Only prescribe a drug for an indication … by Health Canada

• In Community Pharmacy Practice settings, the pharmacist must:

  • Inform the patient of the option to have the prescription dispensed at … pharmacy, and

  • Provide the prescription to the patient at the patient’s …

safe, need, sufficient, informed, approved, another, request

The assessment must include the following factors (as feasible and applicable):

• … information

• Medical …

• Medication …

• Signs and …

• … and intolerances

• … factors

• … and lactation status

• … assessment

• Laboratory or other diagnostic …, if available

• Patient …, values and preferences, and

• Any other information deemed necessary

Demographic, conditions, history, symptoms, Allergies, Risk, Pregnancy, Physical, tests, needs

Pharmacist who prescribes a drug must provide the patient with drug information, including patient-specific information:

• … and … of the drug

• … of the drug

• … for use

• Expected … outcomes, and

• … to seek additional medical attention

Name, strength, Purpose, Directions, therapeutic, When

A pharmacist who prescribes a drug must establish and document a … and … plan appropriate to the patient’s needs and the prescribed treatment

follow-up, monitoring

A pharmacist who prescribes a drug for a patient must document: patient information, including:

• Personal health number (PHN), if available;

• Acknowledgement of … consent;

• Patient assessment;

• Prescribing decision and rationale, including …;

• Prescription information, including all information that is required for a prescription

• … provided to the patient, including the monitoring and follow-up plan;

• … of the patient’s primary health care provider or other health care provider that was notified and the date of notification, if applicable; and

• Patient … to treatment, if applicable

informed, diagnosis, Instructions, Name, response

Documentation: Prescription Requirements

• … of the prescription

• Name of the …

• Name of the … or ingredients and …

• … of the drug

• Dosage … including the frequency, interval or maximum daily dose

• … authorization if applicable, including number of refills and interval between refills

• Name and signature of …

Date, patient, drug, strength, Quantity, instructions, Refill, practitioner

Limits:

• Only a … pharmacist may perform the restricted activities of making a diagnosis or prescribing a Schedule I drug and may only do so for the purposes set out in the Pharmacists Regulation

• A pharmacist must … prescribe for themselves or a family member

full, not

BC PharmaCare: Minor Ailments and Contraception Service (MACS)

• BC pharmacies can claim a MACS fee of $… for providing the service to:

  • Eligible … residents

  • Whether or not assessment leads to a prescription

• If MACS is provided to eligible patient, pharmacies must … request or accept additional fees or payment from patient or third-party payer.

20, BC, not

BC PharmaCare MACS: Patient Eligibility Criteria

• The patient must:

  • Be a BC resident

  • Have a BC Personal Health Number (PHN)

  • Not be covered under PharmaCare Plan … (Long-term care)

  • Have a clinical … for service

    • Patient must … as having a minor ailment listed under Schedule A or a contraception need, and … a request for MACS

B, need, self-identify, initiate

BC PharmaCare MACS: Required Activities

• To claim MACS fee, a pharmacist must:

  • Carry out MACS with the patient …

    • Not by phone or other electronic means

• Provide MACS in a suitable area that:

  • Patient accepts as respectful of their right to …, and

  • Meets their requirements for cultural safety

• Document MACS in accordance with requirements of PharmaCare policies on MACS form

in person, privacy

Which assessment type for claiming MACS fees is this?:

• Schedule 1 drug being prescribed

• Patient was not advised to seek medical attention from another HCP

RX

Which assessment type for claiming MACS fees is this?:

• Schedule 1 drug being prescribed, AND

• Patient was advised to seek medical attention from another HCP

RX other HCP

Which assessment type for claiming MACS fees is this?:

• Recommended non-prescription and/or non-pharmacological advice

• Patient was not advised to seek medical attention from another HCP

No RX

Which assessment type for claiming MACS fees is this?:

• Recommended non-prescription and/or non-pharmacological advice, AND

• Patient was advised to seek medical attention from another HCP

No RX other HCP

BC PharmaCare: MACS Time interval between assessments

• … days = minimum interval between assessments for the same minor ailment/contraception for the same patient

  • If claim is submitted on Monday, patient will be eligible again on Friday

3

PharmaCare will not pay pharmacies the fee for MACS provided:

• To … patients or

• For … services

ineligible, virtual

Pharmacy can charge patients … for MACS if patient is not eligible for MACS

directly

Plan … covers a variety of … products that can be recommended as part of MACS

W, OTC