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B.C. pharmacists welcome new prescription powers, but eye administrative burden

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VANCOUVER — Pharmacists in British Columbia are welcoming an expansion of their powers to prescribe drugs and give vaccines, but they also say that how the changes are implemented will matter.

Cathy Wang, pharmacist and owner of 360Care Denman Pharmacy in Vancouver, described the shift as “very positive.”

“It’s a very exciting day for us,” she said, adding it will mean more access to care for patients.

Health Minister Adrian Dix announced the expansion last week as part of a plan to address human resource challenges that are contributing to an ongoing health-care crisis.

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Starting Oct. 14, B.C. pharmacists will be able to administer more vaccines and renew prescriptions for up to a two-year period for people whose family doctors have retired or left their practices.

Next spring, they will begin prescribing drugs for minor ailments like urinary tract infections and allergies, as well as contraception.

The changes bring British Columbia in line with guidance from Health Canada and other provinces. Alberta gives pharmacists more leeway, including allowing them to administer things like cosmetic injections and order lab work, while Ontario was the last province before B.C. to empower pharmacists to issue prescriptions for minor ailments.

As the changes are rolled out, B.C. pharmacists said the smoothness of the transition will depend on the reimbursement model, staffing supports and whether there’s an added administrative burden.

Like many health professionals, pharmacists have faced burnout and labour shortages since the COVID-19 pandemic began.

A survey of 1,399 pharmacists and pharmacy technicians early this year commissioned by the Canadian Pharmacists Association found almost all pharmacy professionals — 92 per cent — reported being at risk of burnout. Nearly half report abuse or harassment from patients on a weekly basis.

“The unrelenting demands, coupled with added administrative burdens and staffing challenges, have pushed us to a tipping point,” chief pharmacist officer Danielle Paes said in a statement when the survey was released in May.

As an independent, Wang said she has some control over the workload, but she said she’d like to see supports in place to protect others from unreasonable demands.

At the same time, she said expanding the scope of pharmacists may actually help with retention. It’s been discouraging for some pharmacists not to use their skills and training to their full potential, she said.

“There’s actually a lot of young practitioners who have left the profession because there’s not enough reward. There’s a huge gap in what we learn in school, in terms of clinical practices,” Wang said.

“I think, in short, there may be a little bit more workload but it will probably increase the morale.”

Wang also said she’ll be keeping an eye on the reimbursement model. Currently, when doctors give an injection, they receive a fee for service, she said. Unless the government supports the same for pharmacists, the costs may be passed on to patients, she said.

In a submission to the B.C. government ahead of Budget 2023, the Neighbourhood Pharmacy Association of Canada proposed a professional services fee of $20 per assessment, which it said is in line with other provinces with remuneration frameworks. In Saskatchewan, it estimates that every $1 invested in the program saves the health-care system $2.53.

The association estimates B.C. pharmacies could assess about 60,000 minor ailments a year for $1.2 million.

A pharmacist working in the Fraser Valley, who wished to go unnamed because he didn’t want to put his job at risk, said he supports the changes but hopes they don’t come with too much extra administrative work, which already involves one to two hours per day.

“We already have a lot of filings that we have to do behind the scenes,” he said.

Giving COVID-19 and flu shots has added extra work, he said. However, the bigger concern is the need to report data through a provincial portal that is cumbersome, taking more than 15 minutes per patient, he said.

“The COVID shots and this year’s flu shots, they changed the whole system. That is definitely a little bit more pressure to us,” he said.

However, the pharmacist said it’s overall positive to expand the scope of pharmacists to better use their skills and training.

It should also help reduce bottlenecks, like when a patient asks for a refill and the pharmacist has to contact the doctor — a process that can take one or two days, he said.

Parm Johal, pharmacist and owner of Wilson Pharmacy, said he’s generally happy with the news.

The COVID-19 pandemic gave pharmacists the opportunity to step up and show their value, he said. The new changes mean they’ll continue being able to help relieve pressure on other health-care providers and ensure continuity of care.

“We feel it’s a long time coming,” he said. “There’s a few of us who have always been advocating for it.”

This report by The Canadian Press was first published Oct. 6, 2022.

 

Amy Smart, The Canadian Press

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What’s alarming pediatricians about surge in children’s respiratory infections, the flu & COVID-19

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Oscar G. Gómez-Duarte, M.D., is chief of the division of infectious diseases, department of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB, and director of the PediUBatric Infectious Diseases Service at John R. Oishei Children’s Hospital. (University at Buffalo photo)

Tue, Nov 29th 2022 01:10 pm

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Oscar G. Gómez-Duarte, Jacobs School’s pediatric infectious diseases division chief, discusses why physicians are so concerned – and how to keep kids healthy

Submitted by the University at Buffalo 

The request by children’s hospitals nationwide this month that the federal government declare a formal state of emergency given the surge in respiratory syncytial virus (RSV) and flu cases was no surprise to Oscar G. Gómez-Duarte, M.D.

As chief of the division of infectious diseases, department of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and director of the pediatric infectious diseases service at John R. Oishei Children’s Hospital, Gómez has seen firsthand the jump in cases of both RSV and flu, and the resulting increase in hospitalizations of children.

By September, Oishei Children’s Hospital reported having seen more patients admitted to the hospital with RSV than it had seen during the entire 2019-20 respiratory season, along with higher rates of flu infections, some requiring hospitalization.

Gómez says the surge this early in the season is unusual and especially concerning since there are very low vaccination rates for COVID-19 and flu in children. Cases may rise this winter, especially among unvaccinated children in addition to the rise in RSV cases.

How would you characterize this season so far for RSV and flu in kids?

“What’s concerning to us are not only the number of infections, but the severity of these infections leading to a high number of emergency room visits and hospitalizations. The surge in cases is putting pressure on hospitals nationwide. This is a very dramatic increase over what we normally see, especially at this point in the season. This year, we have been seeing significant increases in cases and this is even before the winter season has begun. We saw RSV cases peak over the summer this year and then another peak was reported in October. This RSV infections pattern is quite different from what we normally saw pre-COVID-19 pandemic.”

How do you think COVID-19 has influenced this increase in other respiratory viruses?

“It’s very possible that this jump in respiratory viruses that we are seeing now is related to the dramatic changes in community behavior during the past two years due to the COVID-19 pandemic.

“Those behaviors significantly limited the normal exchange of viruses that people typically have through interactions with each other. That’s especially true of young children, who exchange different viruses with each other at day care, at school and public gatherings. That exposure allows children to develop a natural immunity to common respiratory viruses at a young age.

“During much of the pandemic, that exchange of viruses wasn’t happening, and there was a gap in natural protective immunity. Now that children are again attending day care and school and other gatherings, getting exposed to these viruses that they haven’t been exposed to in the past two years has resulted in a high peak of infections and an overwhelming number of ER visits and hospital admissions. We are seeing increases especially in RSV, and some of these cases are severe.”

What factors make children especially susceptible to developing RSV?

“RSV tends to affect the very young, those under 2 years of age. Infants at the highest risk are those who were born prematurely or who are immune-compromised.”

Is it mostly children with underlying conditions who are being hospitalized with RSV and/or flu?

“We are seeing hospital admissions for RSV and/or flu among previously healthy children with RSV who have no comorbidities; but we are also seeing it in children with underlying conditions, such as asthma, cardiac conditions, neurological disorders, among other chronic conditions.”

Are you seeing cases where a child gets infected with two viruses at once?

“Yes, some children are getting what we call coinfections, where they become infected with more than one virus at a time. In some instances, a child becomes initially infected with flu, begins to recover and subsequently comes down with rhinovirus (a common cold virus), RSV or any other respiratory virus. These coinfections tend to be more severe than when the child just has one infection. Different viruses can attack different receptors and use different mechanisms to damage respiratory cells, and this can worsen the disease and, in some cases, may require that the child be admitted to the intensive care unit for management.”

What kinds of treatments are available for children hospitalized with either RSV or the flu?

“While we do have specific treatments for flu and COVID-19, there is no specific treatment for RSV or other respiratory viruses. The mainstay management of respiratory infections is supportive care, such as hydration, control of fever and supplemental oxygen if needed. When the child’s breathing is very compromised, we will put the child on oxygen and, depending on the severity of the respiratory compromise, they may even require more intense measures such as mechanical ventilation.”

Can children be immunized against RSV?

“Passive immunity in the form of monoclonal antibodies is available for premature infants during RSV season. This FDA-approved monoclonal antibody named palivizumab has the ability to block RSV and decrease the severity of the RSV infections.

“There is no approved active vaccine against RSV in the U.S. for children or adults. There is evidence, however, that pregnant mothers do transmit antibodies against RSV to their babies. It was recently reported that pregnant mothers who received an experimental vaccine against RSV did pass those antibodies onto their babies and these infants were at lower risk of developing RSV infections. These developments are very good news for the future, so that maybe pregnant women who are immunized can pass this protection to their babies.”

How concerned are you that along with RSV and the flu, children may begin to get sick from COVID-19 this winter?

“COVID-19 will stay among us in the same way as RSV, influenza and any other respiratory virus. Accordingly, we expect to continue to have COVID-19 infections in children, along with RSV and the flu. Current variants of the COVID-19 virus are becoming resistant to preventive measures such as monoclonal antibodies, although vaccines remain protective.

“It is concerning that the vaccine coverage for COVID-19 and flu vaccine among children in our community is low. Nationally, only 4% of children younger than 5 and fewer than a third of children ages 5 to 11 have had any COVID vaccine series. There is strong evidence that vaccines prevent infection, prevent hospitalizations, and prevent deaths due to COVID-19.

What should parents watch for?

“The first and most important way to protect children is to make sure they get vaccinated against the diseases where vaccines are available, among them the flu and COVID-19.

“If a child acquires a respiratory infection, the child will likely experience upper respiratory symptoms, such as fever, sore throat, cough and nasal congestion.

“Parents should be vigilant for more concerning symptoms, such as shortness of breath. If a parent notices that the child’s breathing is labored and difficult, this is an emergency situation that requires immediate attention, such as taking the child to the closest emergency room or calling 911.

“Most respiratory infections in children, though, are self-limited, and are not associated with shortness of breath. In most cases, a call to the pediatrician for advice is the best measure to take.”

••••••••

The views and opinions expressed in this commentary are based on the opinions and/or research of the faculty member(s) or researcher(s) quoted, and do not represent the official positions of the University at Buffalo or Niagara Frontier Publications.

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Awareness, usage of prostate cancer genetic testing are low vs other cancers

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November 28, 2022

“The other aspect of this study that really fascinated us was how patients are getting information about cancer genetic testing,” says Sameer Thakker, MD.

In this video, Sameer Thakker, MD, discusses noteworthy findings from the Urology Practice study, “Attitudes, Perceptions, and Use of Cancer-based Genetic Testing Among Healthy U.S. Adults and Those With Prostate and Breast/Ovarian Cancer,” for which he served as a study author. Thakker is a urology resident at New York University Langone Health, New York City.

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Got cold or flu symptoms? Guelph’s COVID-19 assessment clinic expands to treat more people

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People in Guelph who have cold and flu symptoms will be able to be assessed and treated through an assessment centre set up for COVID-19.

The centre, located at 400 Southgate Drive, has been where people have gone to get tested for COVID-19 for two years. Starting Thursday, it will become the Guelph COVID Cold Flu Care Clinic.

The goal is to help people in the city get care while also “ease the pressure on the emergency department at Guelph General Hospital,” a press release said. The clinic is run by the hospital and the Guelph Family Health Team.

People will be able to make appointments at the clinic seven days a week, although weekend hours will be shorter. People are encouraged to contact their family doctor before booking an appointment at the Guelph COVID Cold Flu Care Clinic.

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“People with mild respiratory symptoms are advised to monitor their symptoms, rest, and drink plenty of fluids,” the press release said.

The release also noted “most people in the community with symptoms are not eligible for COVID-19 testing” because they must meet provincial guidelines, which prioritizes people at increased risk of severe outcomes and people who live and work in high-risk settings.

 

Cold and flu season started early this year, and it’s still going strong. Many adults are dealing with ongoing coughs and other symptoms. Calgary urgent care doctor Dr. Raj Bhardwaj spoke with CBC Calgary News at 6 host Rob Brown about why coughs can stick around and when you should seek medical attention.

Feel sick? ‘Do not go and join the party’

Marianne Walker is president and CEO of Guelph General Hospital and also the hospital lead for Waterloo Wellington’s COVID-19 response.

She says in Waterloo region, Guelph and Wellington County, hospitals are over capacity with both adult and child patients.

“I think our major issue right now is managing the issues with very sick children and so we are working with Ontario Health to look at taking a provincial approach to that,” Walker said.

To help manage capacity in the health-care system and make sure “not everyone is getting sick at the same time,” Walker says people should listen to public health experts who are recommending people get vaccinated for COVID-19 and get their flu shot, wear masks, avoid large gatherings and stay home if not feeling well.

Walker says that advice is particularly important right now as December is a time when many people might get together with family and friends.

“The big thing too is making sure that if you’re sick, do not go and join the party,” she said.

 

The Morning Edition – K-W6:48Not feeling well? Skip the holiday parties until you’re better, Guelph hospital’s CEO says

Marianne Walker, president and CEO of Guelph General Hospital and the hospital lead for Waterloo-Wellington’s COVID-19 response, talks about what local hospitals are facing right now and what people can do to avoid getting sick during a busy time of year.

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