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Introduction
MINOR AILMENT PRESCRIBING GUIDELINES

I. Background
The Pharmacy Act, 1996 was originally amended effective September 1, 2003 giving
pharmacists authority to prescribe drugs which at that time was limited to emergency
contraception. On March 3, 2010 the Saskatchewan Minister of Health announced his
intention to approve regulations and bylaws expanding this authority to other drugs. In
the meantime, stakeholders from various groups involved in drug management (e.g.
physicians, nurses, dentists, pharmacists, etc.) were involved in the Advisory Working
Group which developed the policies for pharmacist prescribing. The Saskatchewan
College of Pharmacists Council approved these policies and drafted the regulations and
bylaws awaiting ministerial approval
Level 1 of enhanced prescribing authority for pharmacists includes the provision for
pharmacists to prescribe Schedule 1 drugs for the treatment of minor, self-limiting and
self-diagnosed ailments such as rashes, cold sores and hay fever. Similar minor ailment
models have been piloted and implemented in Great Britain within the past decade.
Preliminary data from Britain suggests that these programs have increased access for
the public to healthcare for minor ailments, increased access to physicians for patients
with more serious conditions and reduced costs to the national healthcare system. In
Nova Scotia, legislation approving expanded prescribing authority for pharmacists
including prescribing for minor ailments has just been passed. Similar programs are
being considered in many other Canadian provinces.
In a minor ailment program, the pharmacist is the first point of contact for the patient.
The patient approaches the pharmacist for advice about treatment of a self-diagnosed
condition. If the self-diagnosis is reasonable based on the pharmacist’s assessment and
the best treatment option in the pharmacist’s judgment is a Schedule 1 drug, the
pharmacist can initiate a prescription. If the pharmacist is unable to confirm the patient’s
diagnosis and / or the patient’s symptoms are severe, the pharmacist will refer the
patient to a physician or other appropriate health care provider. The prescribed drug
must be (1) listed in minor ailment guidelines and (2) have an approved indication for the
patient’s self-diagnosed condition. The pharmacist is required to record the prescription
with the Pharmaceutical Information Program and to notify the patient’s doctor of the
prescription. Physician or other practitioner authorization is required for repeat or
maintenance therapy.
II.
Developing the Guidelines
The Saskatchewan Drug Information Service was contracted by the Saskatchewan College of Pharmacists to prepare the Minor Ailment guidelines. Our first step was to review the literature and consult with other Canadian pharmacy organizations. From this information, we compiled a list of conditions that could potentially qualify as minor ailments and a list of prescription drugs that might be suitable for patient self-care of these conditions. Our next step was consultation with Saskatchewan community pharmacists through nominal group meetings; the first in Saskatoon (Jan. 5th, 2010) and
the second in Regina (Jan. 12th, 2010). We asked the groups to (1) select criteria to
define minor ailments and prescription drugs appropriate for pharmacists to prescribe for
these conditions and (2) to use these criteria to select the conditions and drugs
appropriate for the minor ailment program in Saskatchewan. The results from the group
meetings are summarized below.
Criteria for Minor ailment conditions
• Can be reliably self-diagnosed by patient • Lab tests are not required for diagnosis • Treatment will not mask underlying conditions • Medical and medication histories can reliably differentiate more serious • Only minimal or short-term follow-up needed
Criteria for prescription drugs suitable for pharmacist prescribing for patient
minor ailments

• Has an official indication for the self-care condition • Has valid evidence of efficacy for the self-care condition • Dosage regimen for treatment of self-care conditions is not complicated
Using these criteria, the conditions and Schedule I drugs listed in Table 1 were
considered appropriate for the Minor Ailment program.

TABLE 1: Schedule I drugs appropriate for prescription by pharmacists for
specified conditions
System

Condition
Drug Class
Specific Rx Drug

clindamycin phosphate clindamycin / BP erythromycin / BP erythromycin / ethyl alcohol / parsol erythromycin / tretinoin Corticosteroids, low hydrocortisone cream 1 %, 2.5 betmethasone valerate clobetasone butyrate diflucortolone valerate hydrocortisone valerate mometasone furoate triamcinolone acetate nizatadine 150, 300 mg ranitidine 150, 300 mg esomeprazole 20, 40 mg lansoprazole 15, 30 mg omeprazole pantoprazole rabeprazole Hemorrhoids Corticosteroid HC / zinc sulphate celecoxib diclofenac ketoprofen mefenamic acid naproxen sodium mometasone furoate fluticasone proprionate TABLE 2: Schedule I drugs appropriate for prescribing by pharmacists for self-
diagnosed recurrences of specified conditions after initial diagnosis by physician

Condition
Drug Class
Specific Rx Drug
Comments
Obesity not considered a self-limiting condition Participants in the group meetings had the following suggestions regarding the guidelines: • Include information used by physicians for diagnosis • Include time frame for follow-up with patients • Include criteria for referral of patients to family physician • Include comparisons of drug efficacy, side effects, etc. to help in choice of • Include limitations on quantity of drug prescribed and duration of treatment • Flow charts or algorithms would be helpful • Have the guidelines posted on the Drug Information Service website for ready Guideline Format / Content
The purpose of the guidelines is to provide community pharmacists with tools to
facilitate the decision-making and documentation processes of prescribing for minor
ailments self-diagnosed by patients. Each guideline consists of three documents; (1)
an overview of pathophysiology, patient assessment and treatment for each
condition (2) a treatment algorithm and (3) an assessment and treatment checklist.
1. Overview
1) Brief description of pathophysiology and epidemiology of condition 2) Common symptoms - To assess patient self-diagnosis. 3) Differential diagnosis / when to refer – alternative diagnoses, patient characteristics (e.g. age, concurrent medical conditions), red flag symptoms that could indicate more serious conditions 6) Schedule 1 drug options appropriate for pharmacist prescribing – points to consider in choosing which agent to prescribe 7) Advice/Monitoring parameters - special directions for use, onset of effect, when to follow-up with patient, when to refer to physician, advice on prevention, etc.
2. Algorithm
• Visual treatment decision tree for quick reference
3. Pharmacist Assessment / Treatment Checklist
• Checkbox list of criteria for diagnosis confirmation, physician referral and choice of treatment (recommendations and / or prescription) • Can serve as documentation of patient intervention. Document prepared by Karen Jensen MSc, BSP
Manager, Saskatchewan Drug Information Service
April 28, 2010

Source: http://napra.ca/Content_Files/Files/Saskatchewan/IntroductionMinorAilmentPrescribingGuidelines.pdf

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