What will it take to eliminate wait times in Quebec’s health-care system? There is no single answer to that question, no magic spell we can cast to make our access problems disappear overnight. But one of the things we can do is expand the role of our most accessible health professionals: pharmacists.
Only 22 per cent of general practitioners in Quebec report that most of their patients can get an appointment the same day or the following day when they need one. That figure is 59 per cent for Ontario doctors, despite the fact that Quebec has 15 per cent more family doctors than Ontario as a proportion of population. Partly for this reason, over 60 per cent of hospital emergency room visits in Quebec are for minor health conditions that could be better treated elsewhere.
By entrusting pharmacists with additional responsibilities, many patients will enjoy faster access to the care they need.
The Quebec government has actually already taken a step in this direction by adopting Bill 41 back in December 2011. This law authorizes pharmacists to offer seven new pharmaceutical services, including renewing or adjusting prescriptions, substituting drugs in cases of supply shortages, and prescribing drugs for minor ailments when no diagnosis is required.
Almost three and a half years later, though, these new consultations are still not on offer. Implementation of this reform has been delayed due to stalled negotiations between the government and the Association québécoise des pharmaciens propriétaires regarding the remuneration of these services. Despite the adoption of Bill 28 last week, according to which the government would remunerate just three of the seven new pharmaceutical consultations it has authorized, negotiations on this issue are ongoing.
Expanding the role of pharmacists in offering front-line services is without a doubt a step in the right direction. These increased responsibilities will likely improve patients’ access to care and lead to savings as well, which the public system desperately needs. But the reform should go further, along the lines of what has been put in place successfully in other provinces.
Today, in every province except for Quebec and Manitoba, pharmacists offer publicly covered medication review and management services. In Ontario, for example, the MedsCheck program offers certain patients suffering from a chronic disease the possibility of obtaining a complete individual consultation with a pharmacist once a year in order to optimize the effectiveness of their medication and encourage adherence. The government pays the pharmacist’s fee, which varies between $60 for a basic review in pharmacy and $150 for such a service provided in the home. Given the program’s success and popularity, the Ontario government decided to expand it in 2010 in order to make it accessible to a larger number of patients.
The governments of seven provinces also remunerate pharmacists for administering vaccines to prevent certain infectious diseases like the seasonal flu. These provinces all have higher influenza immunization rates than Quebec, where less than a quarter of the population receives the vaccine. In 2013-2014, over 765,000 Ontarians received the flu vaccine in a pharmacy. When surveyed, 99 per cent of Ontario patients said they would recommend pharmacist vaccination to their friends and family members.
The government’s decision not to remunerate some of the newly authorized professional services and to forbid pharmacists from charging a fee for these services runs the risk of discouraging pharmacists from providing them. And even taking into account the eventual implementation of the 2011 reform, Quebec still trails the other Canadian provinces.
We should aim to catch up to the rest of Canada, and entrust pharmacists with even greater responsibilities in order to improve patient access to care, all while lightening the load for our public health-care system.
Yanick Labrie est économiste à l’Institut économique de Montréal et auteur de « Accroître le rôle du pharmacien pour améliorer l’accès aux soins ». Il signe ce texte à titre personnel.