Friday, February 8, 2019

Mary Jane and Breast Milk, a Safe Combo?

The legalization of marijuana occurred late last year and, once the excitement has died down, there remains a lot of consideration that need to be
addressed about recreational use of marijuana and its effects on different population groups.

To begin, the safety behind marijuana is murky at best. Many studies suggest that exposure to the psychoactive component of marijuana (THC) in adolescents (who have developing brains) may lead to or uncover incidents of psychoses, and in some circumstances, uncover underlying diseases like schizophrenia. However, other studies are investigating its use as a potentially safer alternative for pain management, an attractive therapy option considering the current opioid crisis arising from opioid overuse. Amidst the sparse data that is currently present (in a soon to be or already exploding field of research), one issue that still requires more conclusive answers is the effect of THC on infants or breastfeeding mothers.

As part of my rotation at the Center for Mental Health and Addiction, marijuana came up quite frequently as a topic of discussion. What effects did it have on the baby still in the womb who were exposed? If there were no immediate effects, would there be any long-term neurodevelopmental impacts on the babies who were exposed? One case that was mentioned to me in passing involved a parent who was unsure if they can smoke cannabis as a sleeping aid, while breastfeeding their baby in the evening time.  I imagine that the patient’s clinician did not have an easy time providing an answer.

From a pharmacological perspective, it is known that breastfeeding infants will be exposed to marijuana used by the nursing parent (regardless of how the parent takes in the substance, from eating edibles to vaping). The chemicals found in marijuana like THC and CBD are considered lipophilic molecules, which means they are easily taken up by and stored in adipose tissue and cells and would most likely pass easily from the mother to the milk. Once taken up by the infant, the molecules will be stored in lipid-rich tissues like the brain. These molecules tend to stay in the body for long periods of time, and even longer if the person tends to use marijuana on a regular basis, taking at least 30 days for the chemicals to completely clear the mother’s system. A recent study done by Bertrand et al. in 20181 also found that THC, the most psychoactive component of marijuana (and thus potentially the most damaging) was measurable abundantly in breast milk for at least 6 days after marijuana use.

From a clinical perspective, historically, there used to exist little conclusive evidence that marijuana ingestion by babies through breast milk causes harm, largely due to the lack of studies done in the area. To date, there is no conclusive data that adequately addresses the effects of marijuana exposure on long-term neurodevelopment. However, there is an emerging trend of immediate and negative effects on both parents and infant associated with marijuana use during breastfeeding. A study by Astley and Little2 suggested that exposure to THC through breastmilk in the first month of life could result in decreased motor development at 1 years old. In terms of the immediate effects of marijuana exposure through breastmilk, lethargy, less frequent feeding, and shorter feeding times have been observed.3

At the same time, a mother’s breast milk is one of the most effective sources of nutrition of a growing infant, and a fed infant will fare better than an unfed infant.  Breast milk is one of the best foods for babies as it is packaged with all that a baby may need, from carbohydrates, proteins, fats, minerals, vitamins, and hormones, to maternal antibodies. Psychologically, breastfeeding facilitates bonding between mother and infant. While it would benefit the parent to err on the side of caution and cease any marijuana use until the baby grows up to no longer require breastfeeding, parents who cannot stop marijuana use may be helped through a harm reduction approach of lowering dose and frequency as much possible while continuing to breastfeed. The risks and benefits of marijuana use during breastfeeding should be provided for breastfeeding mothers to address any misconceptions about marijuana use, and close support should be offered for both parent and the developing infant.

Undoubtedly, the question of marijuana's safety in adults, in pregnant mothers and every demographic in between is something every healthcare provider needs to review. As the use of marijuana becomes more and more accepted here in Canada, more and more patients and parents will be curious about very same things, and healthcare providers will need to help them navigate through these murky waters, hopefully giving them sound, evidence-based information to make an informed decision.


Resources


References
  1. Bertrand KA, Hanan NJ, Honerkamp-smith G, Best BM, Chambers CD. Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk. Pediatrics. 2018;142(3)
  2. Astley S, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990;12:161-8.
  3. Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. Illegal drugs. Washington, DC: National Academy Press; 199



Saturday, February 2, 2019

#Lets Keep Talking - How Pharmacists can be Mental Health Champions


On January 30th, Bell Media held its annual #Let’s Talk event, an initiative meant to move mental health forward in Canada by fighting stigma, improving access to care, supporting research and promoting positive workplace mental health. While this year’s event has ended, I wish to continue the conversation and discuss how pharmacy professionals can work towards providing optimal mental health care. 

Quick Facts on mental illness and addiction in Canada:1,2,3

In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.
  • Mental and physical health are linked. People with a long-term medical condition such as chronic pain are much more likely to also experience mood disorders. Conversely, people with a mood disorder are at a much higher risk of developing a long-term medical condition.
  • The disease burden of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together and more than 7 times that of all infectious diseases. This includes years lived with less than full function and years lost to early death.

Being one of the most accessible health care providers, those in the pharmacy profession -pharmacists, technicians, and students - are well situated to address the key concerns that are faced by individuals who experience mental illnesses and addiction. Pharmacy professionals can improve patient care and reduce the stigmatization of those living with mental health illnesses through simple changes that can be seamlessly incorporated into everyday practice.

1) Use people-first language:
Firstly, what is people-first language? The definition can be derived from the term itself, people-first language refers to the individual first and the condition second. The concept behind utilizing people-first language is that the mental or physical health condition is only one aspect of a person’s life and not the defining characteristic. Although it may be at first awkward rephrasing to include people-first language, use of such syntax is important. Not only does it challenge the existing tendencies of the public to view and treat individuals with mental health illnesses in dehumanizing ways, but it also helps individuals with mental illnesses feel respected as human beings rather than labelled as “abnormal” or “dysfunctional”.4

For example:
Use “s/he has a diagnosis of schizophrenia” or “s/he has schizophrenia” rather than saying “s/he is schizophrenic”.

When referring to individuals who are diagnosed with substance use disorders, use terms like “s/he has an alcohol use disorder”, in place of “s/he is an alcoholic” and avoid the terms “abuser” or “abuse”. It has been shown that these terms can evoke automatic negative thoughts about individuals with substance-related problems.By using more neutral terms to lessen stigma surrounding alcohol and other drug use disorders, individuals with these conditions may be more likely to seek help, stay in treatment, and achieve long-term remission.

2) Promote community supports and resources:
 Community pharmacists may the most visible part of the healthcare system and an accessible source of local information. Pharmacy professionals are valuable not only for their expertise but also for directing people to other healthcare providers or services and programs. They can leverage their skills in engaging patients, and their position as one of the most trusted healthcare professionals to provide appropriate signposting for members of the community who may benefit from local mental health and wellness services and resources.

Having information on local mental health and wellness services displayed in a prominent place can be a simple way for pharmacists and pharmacy technicians to promote access to mental health services. To best address the specific needs of the community, it may be beneficial to incorporate healthcare services that are specifically designed for a particular population subgroup; for example, community pharmacies located near university/college campuses may wish to incorporate information on campus resources available for students.

A good starting step towards building the list of resources may be to visit the website for the local Canadian Mental Health Association branch.

Of course, individual efforts are only the starting point to change the landscape of mental health support in Canada, and as a professional body, we can advocate for the development and implementation of pharmacist-delivered interventions in mental health care. In the face of growing demand and continued pressure on mental health services, it is crucial to mobilize the pharmacy professional body to address and lessen the gaps in mental health and addictions systems across the country.


References:
  1. Mental Health Commission of Canada. http://www.mentalhealthcommission.ca/English/system/files/private/document/Investing_in_Mental_Health_FINAL_Version_ENG.pdf. Accessed 09/07/2015.
  2. Ratnasingham et al. (2012). Opening eyes, opening minds: The Ontario burden of mental illness and addictions. An Institute for Clinical Evaluative Sciences / Public Health Ontario report. Toronto: ICES.
  3. Patten et al. (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population.Canadian Journal of Psychiatry, 50: 195-202.
  4. Jensen ME, Pease EA, Lambert K, Hickman DR, Robinson O, McCoy KT, Barut JK, Musker KM, Olive D, Noll C, Ramirez J. Championing person-first language: a call to psychiatric mental health nurses. Journal of the American Psychiatric Nurses Association. 2013 May;19(3):146-51.
  5. Kelly JF, Dow SJ, Westerhoff C. Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues. 2010 Oct;40(4):805-18.



Monday, January 28, 2019

An Exciting Journey Ahead


Hello Everyone,

My name is Lisa and I am excited to be part of the mdBriefCase team over the next few weeks! I am in my final year of pharmacy school and in about five months from now - should I pass the national licensing exam for pharmacists - I will be deemed to possess sufficient knowledge to be the medication expert of a healthcare team. It is an exciting and daunting thought to realize that not long from now, I will be directly responsible for the wellbeing of my patients. Equally as exciting and daunting is the question of what my first job as a pharmacy professional will be like. As pharmacists are discovering more and more career opportunities outside the traditional fields of retail or hospital pharmacy (like being a medical writer for CME providers), it becomes more challenging for me to settle on one choice.

Despite the uncertainty of my future career prospects, there are some certainties I am looking forward to in my future role as a pharmacist.:

  1. Working with patients living in remote communities: I have worked in fly-in Northern Ontario communities for two summers as a camp counselor and during my time there, I witnessed the disparity between healthcare access for patients who live in rural communities compared to urban dwelling patients. I feel there is an untapped opportunity for pharmacists to provide pharmacotherapy services to rural communities, and I am eager to see how pharmacists can integrate themselves into rural healthcare delivery models. I hope to find a role that will allow me to help improve the lives of those that live in areas that are underserved medically, specifically those in rural areas, so that they can receive the care that they need and deserve in order to reach their full potential and so that I can grow as a front line healthcare provider.

  2. Working within the field of mental health: Many people with mental health problems experience poorer care than they should, and much of this relates to getting the right treatment and support. As an advocate for mental health, I want to actively participate in leveraging the strengths of pharmacists (being medication experts and one of the most approachable healthcare providers) to improve accessibility to services to support people’s mental health. Pharmacists working across the health sector are ideally-placed to help patients through spotting early signs of mental health problems, managing long-term conditions, providing expert medication advice to colleagues or signposting to other forms of support.

  3. Opportunity for lifelong learning: I love learning, and the process of learning is as exciting for me, as is the content and results. I thrive in dynamic work environments where I can work on project-based tasks, where I can be expected to gain knowledge about different and new subject matters with each new project. I hope to find a role that will allow me to incorporate both direct and non-direct patient care elements in my responsibilities so that I can develop the skillsets unique to each focus. 

Returning back to the current moment, I look forward to delving into the world of continuing education during the upcoming weeks, and I invite to you follow alongside as I record my journey on this blog.

Cheers,

Lisa

Wednesday, November 14, 2018

Psychedelic Babbels


Hi everyone, my name is Vicky, and I’m a pharmacist rotating through mdBriefCase for the next 5 weeks. I’m very excited to learn about the world of medical writing, and content development. This blog will be my baby for the next few weeks, and I will be chatting to you about various topics that I find interesting.

But first, a little bit about me: I’ve been a practicing pharmacist for 5 years. I started out in community pharmacy, working for independent pharmacies that emphasized on patient care. A chance encounter placed me at the outpatient transplant pharmacy in London, Ontario where I was engrossed in all things solid-organ transplant related. That was also where I developed a fondness for nephrology and thrombosis.

A couple years later, I wanted to push myself therapeutically and took on the role of inpatient orthopedic surgery pharmacist. It was a big change for me to go from the fast-paced commercial world filled with patient interaction and drugs in nice packaging, to an equally fast-paced world filled with surgeons with swagger, bleary eyed medical residents, intravenous drugs, and patients so sick that code blues were called on the regular. It was like Greys Anatomy with none of the sexiness. I loved every minute of it.

Fast forward another couple of years when I met my husband in Toronto, and we decided that long-distance was not the key to happiness and longevity. I moved back to Toronto, taking on the position of float pharmacist at Humber River Hospital. As a float pharmacist, I covered everything from ICU/emergency/ nephrology/cardiology, to rehabilitation/ internal medicine. Humber was where I started writing policies and procedures for the hospital, and developing hospital specific guidelines. While I loved working at Humber, I couldn’t quite shake the feeling that there’s more for me to learn and to take on in this world. I heard about Medical Science Liaison (MSL) through a good friend of mine, and thought it would be something I could potentially be very good at. A chance encounter placed me in contact with Paladin pharmaceuticals, which was looking for someone to be the MSL for a new transplant medication. The world came in full circle, and I’m happy to say that I will be starting a new career as a MSL with Paladin.
It’s hard to believe that 5 years went by so fast, and I’m so grateful for the opportunities that have awarded me with such rich experiences. If there are interesting tidbits and experiences that I can share, they would be:
  • Orthopedic surgeries are bloody. Nails, hammers and bone saws are regularly used.
  • On the opposite of the spectrum, open heart surgeries are delicate and long. Patients sometimes have to be chilled slowly to preserve organ function, and warmed up slowly after the surgery.
  • Kidney, heart, and liver transplant patients are very different from one another. Kidney patients are usually healthy-ish except for the fact that they need dialysis or they’ll die. Heart patients are so sick they’re at the precipices of dying by the time they receive their transplant. And liver patients all have some degree of brain damage because of the ammonia that accumulates in their blood.
  • Internal medicine is not sexy. There’s a book called House of God that took a satirical approach at internal medicine. While terms like “gomers” (stand for Get Out of My Emergency Room) and “buff and turf” are mostly tongue-in-cheek, what’s not satirical is how brutal on-call hours can be for the newly initiated. A resident on call can be awake from 6 am of day 1 all the way to 10 am of day 2. Now multiple that by 3 days a week, for 4 - 6 years.
  •   Also not satirical is the emotional toll internal medicine can have on doctors. Dark humor was something we used to get on with our day in spite of the daily tragedies. One of my favourite books, When Breath Becomes Air, written by a late neurosurgery resident who discovered that he had terminal lung cancer, has a brilliant passage on how cynical all medical professionals become. The author, Paul Kalanithi, had just been paged out of his lunch – a diet coke and ice cream sandwich – to help a 22-year-old man with major head injury. He spent an hour trying unsuccessfully to save the patient, and then:
    • “I slipped out of the trauma bay just as the family was brought in to view the body. Then I remembered my Diet Coke, my ice cream sandwich . . . and the sweltering heat of the trauma bay. With one of the ER residents covering for me, I slipped back in, ghostlike, to save the ice cream sandwich in front of the corpse of the son I could not. Thirty minutes in the freezer resuscitated the sandwich. Pretty tasty, I thought, picking chocolate chips out of my teeth as the family said its last goodbyes.”

Outside of work, I’m a prolific reader, and a dancer. Some of the most awesome experiences I’ve had in the world of dance include when I went back to China for their Olympics of Chinese dance - Tao Li Cup, and when I auditioned for So You Think You Can Dance Canada.  Come talk to me about anything anthropology, history, sociology and spirituality related. I’d love to share ideas and learn from you. 

And that’s all for now. Stay tuned for the next issue!

 - Vicky

Monday, November 12, 2018

Staying Relevant in a Digital Age

At its roots, community pharmacy is a customer service field. A patient comes to a pharmacy with a prescription for the product that they need, the pharmacy prepares and packages the product, and the patient pays for the product and services. Although medications to treat or prevent disease are often valued higher than the products at a clothing store or fast food restaurant, buyers are still looking for the same things - convenience and efficiency.

Recent enhancements in automation and technology in the pharmacy field have been aimed to improve the ease of filling prescriptions. PopRx was the first application to make an appearance on the Canadian pharmacy technology scene in 2015.1 It is an app that allows people to send a picture of their prescription or medication vial to their local pharmacy and have the medication delivered to them on the same day. Other technologies have since been developed to improve accessibility. Pharmabox is an automated kiosk that sells personal care items and over-the-counter (OTC) medications that can be found in pharmacies.2



With technology disrupting the pharmacy landscape, pharmacists must come up with ways to stay relevant and avoid becoming overshadowed by the convenience of applications and automated machines. Here are thoughts on how pharmacists can add value to their services in a way that machines can't.

1. Remember our other products
Medications are not the only products sold in the pharmacy. Yes, medication is the first thing that comes to mind when you think of pharmacy, but our products go beyond technical services. Pharmacists can use their clinical knowledge to provide comprehensive medication reviews, disease screening and education, chronic disease management, smoking cessation consultations, and much more. Our cognitive services can never be replaced by technology. Instead we can use technology to grow these services, such as in the case of point-of-care testing or pharmacogenomic testing.

2. Filter information
In 2013, more than 50% of Canadians reported that they used Google searches to research or self-diagnose their symptoms.3 This number is only expected to be higher today with the widespread use of cell phones and social media. Although access to all of this information by means of technology is empowering for the public, it doesn't mean all of the information is true. In the pharmacy, I often field questions from patients asking if the latest health trends in the news or on the internet actually work or if we sell a product that Google recommended they try for their symptoms. Pharmacists shouldn't be discouraging people from using technology to research their health answers, but we should be encouraging them to let us help them decide what's factual and what's inaccurate.

3. Provide a personalized experience
Computers or automated services can't compete with the experience of face-to-face interaction. Pharmacists can provide patients with clinical services that are tailored to their needs, instead of reciting a laundry list of side effects or irrelevant information about a drug or disease that ultimately doesn't help the patient with decision-making. It's not just about having all the information, but it's also about knowing how to apply it to the patient that's in front of you. 

Having the knowledge and expertise to filter information and provide individualized clinical services for our patients is how the pharmacy profession will stay afloat amidst the rise of technology.

Chantel


References
1.     Hardy, Ian. (2015, November 24). PopRx, the "Uber of prescriptions" launches in Toronto. Accessed on October 22, 2018: https://mobilesyrup.com/2015/11/24/poprx-the-uber-of-prescriptions-launches-in-toronto/
2.     Harman, Megan. (2018, October 3). Automated Drugstore Concept 'Pharmabox' Aims to Disrupt Canadian Retailing. Accessed on October 22, 2018: https://www.retail-insider.com/retail-insider/2018/9/automated-drugstore-concept-pharmabox-plans-to-disrupt-canadian-retailing
3.     Oliveira, Michael. (2013, July 31). More than half of Canadians use 'doctor Google' to self-diagnose. Accessed on October 22, 2018: https://globalnews.ca/news/752415/more-than-half-of-canadians-use-doctor-google-to-self-diagnose/

Thursday, October 18, 2018

Are Pharmacists Ready for Recreational Cannabis?

On October 17, 2018, Canada became the second country to legalize the recreational use of cannabis.1 While the new legislation only authorizes recreational use for those 18 years or older with specific restrictions controlling the production, distribution, sale, and possession of cannabis, Canadians were still divided in their support of the legalization in the months leading up to the date.1,2


How do pharmacists feel?

Pharmacists proudly wear the title of medication experts, however 75% of Canadian pharmacists admitted to never asking about cannabis when reviewing a patient's medication to assess for drug interactions and 82% said that they don't know about the Canadian cannabis guidelines.3 Although cannabis for medical purposes has been legal since 2001, Canadian pharmacists generally feel unprepared the handle the influx of questions that will follow the legalization of recreational cannabis.3


Finding our place

Personally, I think pharmacists should embrace this new legislation as an opportunity to show the value of our profession to patients, rather than being too afraid to admit that we don't know all the answers right now. Here are some of the ways that I envision pharmacists applying their expertise to help patients using cannabis both recreationally and medically.

1. Harm Reduction
Legalization will likely increase people's comfort and openness to sharing their cannabis use with  healthcare providers. Coupled with the idea of pharmacists being the most accessible healthcare provider, pharmacists are in a good position to screen for a cannabis-use disorder. Similar to principles we use in harm reduction for alcohol or opioid dependence, we can provide patients with practical tips for reducing the harms of cannabis5,6:

  • Avoid driving for 4-5 hours after use
  • Shift away from smoking to other routes (i.e. vapourizers, edibles)
  • Delay use until after 25 years old since the brain is still developing
  • Avoid frequent (daily or near-daily) use
  • Store cannabis safely and away from children

2. Drug Interactions and Managing Side Effects
Using the current understanding of cannabis drug interactions, pharmacists are able to provide evidence-based answers to patients wanting to know how cannabis fits in with their prescription and non-prescription medications. In addition to using our unique knowledge of drug metabolizing enzymes, we can use our clinical judgment to examine the significance of cannabis side effects overlapping with prescription drug side effects.

Common unwanted side effects of cannabis include uneasiness, sedation, muscle twitches, and impaired memory or confusion.6 We can help patients manage these short-term side effects by encouraging them to reduce the tetrahydrocannabinol (THC) content of the strains being used or reduce the frequency or amount of cannabis being used.6 It is important to communicate with patients that the long-term side effects of cannabis remain unknown.6

3. Filling in Knowledge Gaps
One main barrier to conducting extensive research on cannabis is that it is not widely legalized. At present, what we know about cannabis for medicinal and recreational use is based on evidence gathered from small short-term studies. Despite this, pharmacists should be knowledgeable about the current information and be willing to share it with patients. Looking to the future, legalization in Canada can create an opportunity for further research in areas that are lacking - long-term side effects, optimal strains and dosages for medical uses, and impacts of legalization on society.

If you'd like to brush up on the current evidence on cannabis and its medical use in time for the recreational legalization, consider the course Medical Cannabis IQ: The Fundamentals on Advancing Practice or other continuing education courses offered by the Canadian Pharmacists Association.


Chantel


References

  1. Government of Canada. Cannabis Legalization and Regulation. Accessed October 15, 2018: http://www.justice.gc.ca/eng/cj-jp/cannabis/
  2. Navigator. Cannabis in Canada. Accessed October 15, 2018: http://www.navltd.com/wp-content/uploads/2018/03/Cannabis-In-Canada_03_2018.pdf
  3. Pharmacy5in5. "Recreational cannabis will be legal on Wednesday". Message to Pharmacy5in5 Mailing List. October 15, 2018. Email.
  4. Government of Canada. Understanding the New Access to Cannabis for Medical Purposes Regulations. Accessed October 15: https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/understanding-new-access-to-cannabis-for-medical-purposes-regulations.html
  5. Government of Canada. Cannabis in Canada: Get the facts. Accessed October 15, 2018: https://www.canada.ca/en/services/health/campaigns/cannabis/canadians.html
  6. Grindrod, K & Beazely, M. Cannabis 101. Accessed October 15, 2018: https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/cannabis_infographic_2_sided.pdf

Monday, October 15, 2018

Flu Season is Coming ... with Some Updates

"When are flu shots coming in?" is the most frequently asked question at every community pharmacy counter once Thanksgiving weekend rolls around. Although pharmacies will have to brace themselves for the increased workload and disruption to normal prescription workflow, it's great to see that so many patients understand the importance of protecting themselves and the people around them against the flu and its complications.


While flu shots are slowly making their way into community pharmacies, pharmacy students are also preparing for the extra volume of patients flu season brings. For some of us, including myself, this year's influenza vaccine will be the first vaccination we've ever administered.

On top of remembering documentation requirements, the correct process for land-marking an injection site, and procedures for anaphylactic reactions, we should also keep in mind the important update for those 65 years and older as we're handing out influenza vaccination questionnaires to patients.

What's the update? 

The Canadian Immunization Guide created by the National Advisory Committee on Immunization (NACI) details current evidence-based recommendations on the use of vaccines for disease prevention in different populations. In an update for the 2018 flu season, NACI acknowledges evidence that the high-dose trivalent inactivated vaccine (TIV) provides better protection than the standard-dose TIV against flu-related complications and hospitalizations in those aged 65 and older.1

When considering the evidence for provincial and territorial funding, NACI recommends that any of the four influenza vaccines indicated of those 65 years and older - standard-dose TIV, high-dose TIV, adjuvanted TIV, and quadrivalent inactivated vaccine (QIV) - can be used.On the other hand for individuals 65 years and older seeking to get vaccinated and clinicians who are advising individual patients, NACI recommends the high-dose TIV be offered over the standard-dose TIV.3

How will this impact community pharmacy?

Currently in Canada, Ontario is the only province to publicly fund the high-dose TIV for all adults 65 years of age or older, while Nova Scotia, Manitoba, Saskatchewan, and Prince Edward Island are only funding the vaccine for elderly people living in long-term care facilities.Ontario pharmacies will not be receiving high-dose TIV as a part of the Universal Influenza Immunization Program (UIIP) and so the vaccination will only be publicly funded if received at a physician or nurse practitioner's office, retirement home, long-term care facility, or hospital.

While sharing the demands of flu season with other healthcare providers may relieve some of the burden on Ontario pharmacies, it leaves us with a question - what should we be doing with patients 65 years and older? There isn't enough evidence to make a comparative recommendation between the high-dose TIV, adjuvanted TIV, and QIV.So should we be vaccinating patients over 65 in community pharmacies or send them straight to their doctor's office? We can't possibly expect physicians and nurses to vaccinate all Ontarians aged 65 and older, so how do we decide which patients to refer? Would turning patients away significantly delay vaccination or even discourage them from getting vaccinated?

How will you apply NACI's recommendations to patients over 65 wishing to get vaccinated in your pharmacy? Please send me your comments and experiences using the form to the right.

For more information on influenza vaccinations in older adults and how to approach vaccine hesitancy, see the Influenza in Older Adults - Ensuring Optimal Protection course offered on rxBriefCase.

I look forward to reading your comments!



Chantel

References

  1. Government of Canada. (2018, May 1). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018-2019. Accessed October 9, 2018: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2018-2019.html#1.1
  2. Sanofi. (2018, October 1). Sanofi aims to topple the flu as it marks National Seniors Day with a Guinness World Record attempt. Accessed October 9, 2018: https://www.newswire.ca/news-releases/sanofi-aims-to-topple-the-flu-as-it-marks-national-seniors-day-with-a-guinness-world-record-attempt-694786581.html
  3. Ontario Ministry of Health and Long-Term Care. (Updated 2018, September 19). Universal Influenza Immunization Program (UIIP). Accessed October 9, 2018: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/