Associate Professor College of Pharmacy, Dalhousie University Halifax, Canada
Background: Pharmacists’ scope of practice in Nova Scotia (NS) has expanded, since 2011, to include assessing and prescribing for various approved conditions, to utilize pharmacists’ expertise more fully.
Objectives: Using administrative health data, this study aims to determine (1) pharmacist prescribing patterns and uptake by patients, and (2) the impact of policy-related changes (e.g., funded substitution prescribing for drug shortages) on pharmacist prescribing.
Methods: Administrative health data from the NS Drug Information System identified community pharmacists who prescribed at least once between October 1, 2016 and March 31, 2020. Drug Identification Numbers for common and minor ailments, approved conditions, and drugs involved in shortages that had funded substitution programs were identified. Differences in the number of pharmacists prescribing, and the frequency of prescribing were analyzed across fiscal years (April 1 – March 31, 2017/2018, 2018/2019, 2019/2020) using one-way ANOVA with Bonferroni correction for multiple comparisons. Drug shortage data and government funded services during the study period were compared descriptively.
Results: The number of prescribing pharmacists, and the average number of medications prescribed per month was higher in 2019/2020 (n=1000, 32.5±23.6) compared to 2017/2018 (n=987, 24.6±21.3) (p < 0.05). The average number of medications prescribed per year for shortages and funded substitution programs was significantly higher post-shortage for angiotensin receptor blockers (293.0 post, 232.0 pre) and proton pump inhibitors (15.2 post, 10.2 pre), and lower for H2 receptor antagonists (ranitidine: 0.4 post, 1.4 pre; famotidine: 1.3 post, 1.4 pre). The government funded pharmacist prescribing for three conditions on January 1, 2020. Average prescribing per quarter was higher in the last fiscal period studied (January 1-March 31) of 2019/2020 compared to the last fiscal period of the previous year for the three funded conditions: herpes zoster (2.1±1.4 versus 1.7±1.1), uncomplicated cystitis (3.3±2.5 versus 1.2±1.0), and contraceptive management (4.5±3.7 versus 2.3±1.6).
Conclusions: Over a 3-year period, the average volume of prescribing by pharmacists per month was higher in 2019/2020 compared to 2017/2018. Drug shortages affected pharmacist prescribing. After the implementation of government funding for herpes zoster, uncomplicated cystitis, and contraceptive management, prescribing by pharmacists increased for these approved conditions.