Pharmacists seek bigger role in new virtual care scheme

New Brunswick’s pharmacist association says the Holt government has missed an opportunity to include its members in the planning and rollout of the province’s new virtual care system. Heidi Liston, the group’s CEO and a former deputy minister of health, said details remain to be worked out about how pharmacists will fit into the new [...]

Article content New Brunswick’s pharmacist association says the Holt government has missed an opportunity to include its members in the planning and rollout of the province’s new virtual care system. Heidi Liston, the group’s CEO and a former deputy minister of health, said details remain to be worked out about how pharmacists will fit into the new model. It has been five months since news broke that the province was changing its virtual care provider from eVisitNB to Foundever, the company that already managed the province’s phone-based Tele-Care 811 service.

The transition happened at the end of June. In an interview with Brunswick News, Liston pointed to pharmacists’ close engagement with communities of all sizes. She said there are about 1,000 pharmacists in the province and at least 230 community pharmacies.

“We have a tremendous community-based network,” she said. “We reach urban, rural and smaller communities and we are open evenings and weekends, so patients are using their community pharmacists every day as a front door to care.” Liston said that, at this point, the pharmacists association has not received detailed information from the Department of Health on the criteria or workflow being used by the new virtual care system.

Health Minister John Dornan said in a statement Thursday the Department of Health has been in contact with the New Brunswick Pharmacists’ Association and will continue to work closely with pharmacists. “Pharmacists are valued and trusted members of New Brunswick’s health-care system, and we appreciate the essential care they provide to patients in communities across the province every day,” Dornan said in the statement. But Liston said her organization was not meaningfully involved in planning the transition away from eVisitNB.

“It’s not that we haven’t had some early discussions,” Liston said in an interview. “(But) pharmacists tend to be an afterthought, and how to use community pharmacists tends to be an afterthought, instead of working together. We can bring a lot to the table in co-design and planning.”

“If the government wants pharmacists to be part of the virtual care navigation model we need to be able to have a view into what’s happening,” she said. The province has combined virtual care and Tele-Care 811 under the Virtual Care NB banner. The services are intended to fill the gap for people needing treatment, prescription renewals and tests but who don’t have a doctor or can’t access their doctor in a timely manner.

Brunswick News has reported on a rocky rollout in the early days of the new system. Some patients complained of long waits and the triage process steering them away from virtual meetings with a nurse practitioner in favour of other care options, such as emergency departments or walk-in clinics. In an earlier statement, Dornan defended the new Virtual Care NB service, saying it’s designed to be better integrated with the broader provincial health-care system.

“And pharmacists are an important part of the model.” For example, he said pharmacists can renew many prescriptions and may be able to help New Brunswickers with a health need, depending on a person’s specific medication and situation. He emphasized virtual care appointments are not appropriate for all medical needs, including prescription renewals, and that patients with complex and chronic cases still require in-person assessments depending on the circumstances.

Liston said it’s too early to say how the new virtual service is working but, anecdotally, pharmacists are seeing patients who are confused about how to navigate the system. She said she understands that patients who are already attached to a physician or nurse practitioner may be directed back to that provider for prescription renewals, instead of virtual care. “The challenge is that some patients are arriving at pharmacies because they cannot get an appointment in time, or because they have already run out, or are close to running out, of important medications.

This may be further compounded during the summer months when some offices have reduced hours or providers are on vacation.” Dornan’s statement included a link to a provincial webpage listing conditions for which pharmacists may assess patients and prescribe medications. The list includes seasonal allergies, cold sores, pink eye, contact allergic dermatitis, contraception, mild to moderate eczema, fungal infections, thrush, shingles, urinary tract infections, tick bites and gastroesophageal reflux disease.

However, pharmacists at six locations were previously able to assess and treat a broader range of conditions under a pilot program launched in September 2023, including chronic conditions such as diabetes and asthma. The Liberals elected not to renew the pilot in February of last year, pointing to the improvements forthcoming through collaborative care clinics. A spokesperson with the health department provided a statement at the time saying: “The government is focusing investments on funding pharmacists to work in local family health teams, rather than a solo practice service delivery model.”

Asked by Brunswick News about the early rollout of Virtual Care NB, Premier Susan Holt said in an interview: “Every day they’re making changes and responding because we’ve had some instances where the waits are too long.” Liston said that at the end of the day, pharmacists share the same goals as the health department: better access to care and more patients attached to collaborative-care clinics. “We hope they see us as a constructive partner and we want to make sure we are part of the conversation when it comes to decisions that are being made about how community pharmacist resources can be used,” she said.

“We really have an opportunity here in New Brunswick to build a true medical neighbourhood which means designing pathways with all community providers, including pharmacists, from the beginning.”