An overview of pharmacy practice in Canada
In this article, Zaheer-Abbas Karim and Anne Noott take a look at pharmacy practice in Canada and make some comparisons with practice in the UK
In the second of three articles, Zaheer-Abbas Karim and Anne Noott take a look at pharmacy practice in Canada and make some comparisons with practice in the UK
Canada covers about 40 times the land area of the UK, with a population size only 35 per cent of the UK’s. The vast majority live in the narrow strip of the country within 100 miles of the border with the US. There are approximately 31,000 licensed pharmacists in Canada. Around 80 per cent of these work in the country’s 7,000+ community pharmacies.
By comparison, the UK has 49,000 pharmacists and 13,000 community pharmacies. The average annual salary for Canadian pharmacists is around C$95,000 (approximately £59,350).
Unlike the UK, where 99 per cent of the population can reach a pharmacy by car within 20 minutes, many Canadians live more than 200 miles from their nearest community pharmacy. The Canadian government has, therefore, made available substantial grants to encourage community pharmacists to move to these remote areas. For this reason, and because the demand for community pharmacists in particular exceeds the supply available from Canadian schools of pharmacy, around 40 per cent of registered pharmacists in Canada originally qualified outside Canada or the US.
As in the UK, the role of community pharmacists (and their main source of income) still revolves around supplying and advising on the use of both prescription and over-the-counter medicines. Funding arrangements for healthcare vary between provinces but, generally, the Canadian equivalent to the UK’s national insurance scheme covers doctors’ fees but not prescription drug costs, except for those in receipt of state benefits.
However, most Canadian employers provide additional private health insurance, which covers prescription drug costs, as part of a salary and benefits package.
The pharmacist’s role has expanded in recent years, and Canadian community pharmacists are increasingly involved in providing a wide range of other services, many of which are government funded. These include smoking cessation, weight management, “MedsChecks” (similar to medicines use reviews), anticoagulant clinics, and palliative care services.
The situation regarding pharmacist prescribing varies widely between Canadian provinces. In Alberta, for example, all pharmacists were recently given prescribing rights, subject to undertaking appropriate training and demonstrating their ongoing competency in their chosen clinical area(s).
Unsurprisingly, this change was vehemently opposed by the provincial medical fraternity but, needless to say, the disasters that were prophesised at the time have not materialised and the service appears to be much appreciated by the public. In some provinces, however, pharmacists can in effect only recommend OTC medicines in much the same way as their UK colleagues.
Each province has its own drug formulary, although work is currently being undertaken to produce a federal formulary to cover the entire country. Some provinces, therefore, allow community pharmacists to prescribe to the extent that they can alter doctors’ prescriptions, where appropriate, to bring them into line with the provincial formulary recommendations.
Each Canadian province has its own faculty of pharmacy and graduates, on registering, are only licensed to practise in that province. Therefore, the extent to which prescribing is taught in the undergraduate pharmacy course in each faculty depends on the extent to which its graduates will be expected to prescribe on qualification.
Because provincial governments fund many of the services provided by community pharmacies, an increasing number of pharmacists are now employed in primary care, commissioning and monitoring the delivery of these services. Others may work in health centres as part of the integrated healthcare team, in much the same way as some UK pharmacists do.
Due to the scarcity of community pharmacies in some parts of rural Canada, there has, in recent years, been a great deal of interest in the introduction of automated dispensing robots remotely controlled by a pharmacist who may, in some cases, be several hundred miles away.
The patient inserts the prescription into a scanner in the machine. The pharmacist provides a clinical and professional check of the prescription, then counsels the patient by telephone, before remotely labelling and finally releasing the product. The machine can periodically be refilled with medicine supplies by a pharmacy technician without the need for a pharmacist to be present.
Needless to say, this extreme form of remote supervision has raised many interesting ethical issues, but since the alternative may be no pharmacy service at all for many Canadians, it is steadily gaining in popularity.
Apart from a few private institutions, hospitals in Canada are entirely funded by the provincial and federal governments, including all medicines and other treatment costs.
As in many other countries, including the UK, hospital pharmacy in Canada has undergone something of a change in recent years, having moved from providing largely a supply function to making extensive use of pharmacists’ abilities in improving patient care. Hospital pharmacists may therefore be involved in activities such as reviewing drug charts, medicines reconciliation, therapeutic drug monitoring, drug use evaluation, adverse drug reaction reporting, medication counselling and, increasingly, prescribing, again depending on the provincial laws.
In some provinces, such as Ontario, a higher PharmD qualification, rather than the more usual BScPhm degree, is needed for pharmacists to be able to undertake this more clinical role.
Both community and hospital pharmacists are often also extensively involved in training undergraduate pharmacy students, since the periods of internship (ie, preregistration training) needed to qualify as a pharmacist are increasingly being incorporated into Canadian undergraduate pharmacy courses rather than undertaken separately after a pharmacy degree.
The pharmaceutical industry provides another source of employment for Canadian pharmacists. Worldwide household names, such as Pfizer and AstraZeneca, based mainly in large cities such as Montreal and Toronto, employ around 28,000 people, including pharmacists.
Like their UK counterparts, Canadian pharmacists rely heavily on their pharmacy technician colleagues to undertake dispensing, management, accuracy checking and other vital roles in order to free pharmacists’ time for their own extended and more clinical roles.
As in the UK, some pharmacists have concerns about this expansion of technicians’ roles, particularly since professional registration for pharmacy technicians is still voluntary in Canada, although it is likely that it will become compulsory in the near future.
All Canadian pharmacists are currently required to undertake regular continuing education or continuing professional development. Although requirements (like so much else) currently vary between provinces, there is a plan to introduce a national scheme that will review pharmacists’ competencies on a five-year rolling basis, with a more in-depth check for those whose initial review gives cause for concern. Annual registration fees for pharmacists vary between around C$250 in the northwest territories, to C$800 in Ontario.
See related articles
Acknowledgement With grateful thanks to Zubin Austin, Leslie Dan Faculty of Pharmacy, University of Toronto, for his invaluable insight into pharmacy practice and education in Canada
Zaheer-Abbas Karim is a second-year pharmacy student at the University of Wolverhampton and student member of the Royal Pharmaceutical Society
Anne Noott, MRPharmS, is senior lecturer in pharmacy practice at the University of Wolverhampton and lead for the RPS Black Country Local Practice Forum
Citation: Tomorrow's Pharmacist URI: 11088547
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