Pharmacists could significantly reduce ED crowdedness

Incorporating pharmacists with an expanded scope into the community or hospital emergency departments (ED) could significantly reduce ED crowdedness, according to a new study.

Researchers from the University of Waterloo found that almost one-third of non-urgent ED visits in Ontario were for conditions that could potentially be managed by pharmacists with an expanded scope of practice - available in other jurisdictions in Canada.

"Overcrowding in EDs is a concern most Canadians can relate to, and we know that it can lead to increased mortality and a higher rate of patients who leave without receiving treatment," said Wasem Alsabbagh, a professor at the Waterloo School of Pharmacy. "Our findings support that we need to see more pharmacists working with expanded scope in community practice or based in the ED. This may reduce crowdedness and free more resources in EDs to care for more acute patients."

As about one in five patients who seek emergency care have non-urgent health concerns, the study examined what proportion of non-urgent or unnecessary visits could be potentially managed by a pharmacist. The researchers analyzed data from 2010 to 2017, examining all Ontario hospital ED cases. They qualified cases based on standard scales that measure the severity of patient concerns and used statistics to assess which ones could be managed by pharmacists working with an expanded scope.

The services pharmacists can provide have been expanding in Canada over the last decade, though there is significant variety - both in the rate and scope - between provinces. In Alberta, for example, pharmacists were granted the ability since 2007 to prescribe both independently and for minor ailments, renew prescriptions, administer injections, and more. Ontario has expanded scope more slowly with the addition of services like prescriptions renewal and influenza vaccination in 2012. More vaccines were added later in 2016.

"Our study included all expanded scope services in use across Canada when assessing which ED cases pharmacists could manage," said Alsabbagh. "Over the seven years of the study period, we found that pharmacists with an expanded scope could potentially have managed nearly 1.5 million cases in Ontario."

The most frequent ED cases that could be managed by a pharmacist included skin related concerns like dermatitis and other conditions like a cough or inflammation of the ear canal, nasal passages, and throat.

The study by Waterloo professors Wasem Alsabbagh and Sherilyn Houle is called The proportion, conditions, and predictors of emergency department visits that can be potentially managed by pharmacists with an expanded scope of practice and was recently published in the journal Research in Social and Administrative Pharmacy.