The Pharmacist: Your first step in health care

It’s 2 pm on a Sunday afternoon…
• You’ve been taking an ACE inhibitor to control high blood pressure for the past few months and lately have developed a cough. It’s keeping you awake at night and an over-the-counter cough suppressant doesn’t seem to be helping.

• You’re taking iron supplements or codeine and have mild constipation.

• You’ve had occasional heartburn over the past few weeks and over-the-counter (OTC) antacids aren’t providing enough relief.

• You have high blood pressure which is managed quite well with medication, diet and exercise. But you’ve developed a bad cold.

So what do you do?
Do you try to make an appointment to see your family doctor, which might take a few days? Do you find a walk-in clinic or maybe spend a few hours in the hospital emergency room? If you’re like thousands of Canadians each day, you instead walk into your local pharmacy and talk to the pharmacist about the problem. As the most accessible health professional, pharmacists are often the first stop for health care.

What would the pharmacist likely advise in these cases?
After asking some questions to determine if you have a cold, the pharmacist might tell you that a cough can be a side effect of your blood pressure medication. If the cough is affecting your quality of life, he or she might suggest talking to your doctor about switching your medication.

The pharmacist might tell the person with constipation that gut movement can slow down as we age, and that a side effect of certain products (iron and codeine, for example) can be constipation. In this case, the pharmacist might suggest a change in diet to increase fibre and water intake, or perhaps a laxative.

In the case of heartburn, the pharmacist would review any other medications you are taking to determine if it could be a side effect. He or she might suggest another OTC product (e.g. ranitidine) and – based on your answers to questions about your symptoms – could also help you decide if you need to see a doctor to find a long-term solution.

Many people aren’t aware that certain cold products, such as decongestants, can raise blood pressure. In this case, the pharmacist would advise you on safe options to help relieve your cold symptoms.

Your pharmacist is the health professional who focuses on the patient’s drug therapy.
There are over 30,000 licensed pharmacists in Canada and in 2007, they filled about 448 million retail prescriptions. As the shortage of doctors and nurses in Canada worsens, pharmacists are increasingly taking on an expanded role in health care. In fact, Alberta passed legislation in 2007 that expands what is called pharmacists’ ‘scope of practice’. A number of other provinces either have limited versions of prescriptive authority or are working towards similar developments.

Pharmacists have at least five years of university education devoted to drugs and their use, and are considered the drug expert within the health care system. Their expertise lies in how medications should be used; how to maximize their benefits and minimize potential adverse effects; and how they interact with other medications, natural health products and food.

Why See a Pharmacist?
In addition to filling your prescriptions, a pharmacist can help you select the appropriate nonprescription product to treat a condition such as a rash, minor cut or cough, or advise when you should see a doctor. To make this assessment, he or she will ask specific questions about your symptoms and health history, and ‘take a look’ when appropriate. (In fact, most pharmacists at one time or another have had patients pull up a sweater or drop their pants to show them ‘the problem’. They are fairly unshockable.)

If the pharmacist detects any ‘red flags’, you would likely be advised to seek immediate medical help. Red flags can include bleeding, chest pain, high fever, severe pain, infection, dehydration, a potential adverse drug reaction, etc. Otherwise, the pharmacist may recommend a non-drug therapy (for example, a change in diet) or a nonprescription medication, along with suggested follow-up.

In addition to dispensing drugs and important advice, pharmacists also help Canadians manage their health by:

• taking medication histories and maintaining patients’ drug profiles to monitor interactions with other medications and health conditions

• counselling patients and caregivers on safe and appropriate use of drugs and the importance of complying with therapy

• making recommendations to physicians for adjustments to patients’ drug therapies

• providing education and advice on health care issues such as managing chronic diseases, smoking cessation, high cholesterol, high blood pressure and immunization

• hosting disease management and immunization clinics.

What’s Next for Pharmacy?
If you live in Alberta, pharmacists now have prescriptive authority, which is sometimes misunderstood. It doesn’t mean you can walk into your local pharmacy and the pharmacist will diagnose your condition and prescribe treatment independently of your doctor. What it does mean is that pharmacists can:

• prescribe prescription and OTC drugs to treat minor, self-diagnosed disease conditions (if it is the best course of action for you)

• monitor and refill existing prescriptions to ensure appropriate and effective care

• modify a prescription written by another prescriber to change the dose or provide an alternative

• monitor, initiate or discontinue a medication in collaboration with your doctor.

Pharmacists are also considered the ‘sentinel’ of our health care system. Since pharmacies are very accessible and open long hours, they can be the first to detect a public health crisis. In 2002, when Walkerton, Ontario experienced the most serious case of water contamination in Canadian history, pharmacists alerted the local public health department about the high number of residents purchasing anti-diarrheal medication. Many pharmacies also contribute data to FluWatch, an early detection system for influenza outbreaks that is coordinated by the Public Health Agency of Canada.

While pharmacists do a lot to improve the health of Canadians, their skills are often underutilized, making them the best kept secret in our health care system. So, talk your pharmacist today and start working together to improve your health.

Louise Crandall is the Public Affairs Manager for the Canadian Pharmacists Association.