On December 15th, 2009 the Regulated Health Professions Statute Law Amendment Act, 2009 (Bill 179) received Royal Assent in the Canadian province of Ontario. The resulting legislative amendments were intended to strengthen government oversight of the health regulatory colleges, improve patient safety, promote interprofessional collaboration, and make better use of health professionals’ existing skills and training by enhancing the scope of practice for several health professions to improve health system efficiency. Among the most notable scope of practice enhancements were those given to pharmacists, who would now be permitted to: modify and renew existing prescriptions; prescribe a limited range of drugs independent of a physician; and administer medications such as vaccinations via injection or inhalation.
The reform was driven in large part by the government’s concerns over the rising cost of health care, the public’s desire for greater access to services, and demonstrated successes of similar reforms in other jurisdictions. The reform was intended to increase health care access by allowing pharmacists to practice at their fullest scope, providing Ontario residents with a greater choice in providers for some services. In addition, the Ontario government was encouraged by the success of similar reforms in other jurisdictions such as New Zealand, the United Kingdom, the United States and the province of Alberta (Canada) which have all allowed, to varying degrees, pharmacists to independently or collaboratively prescribe some medications or renew prescriptions.
During a consultation period in which individuals and interest groups had the opportunity to provide feedback on the proposed reform, it became clear that there were diverse opinions on the topic. While the pharmacist groups, such as the Ontario Pharmacists Association and the Canadian Pharmacists Associations, were clearly in support of an expanded scope of practice for pharmacists, some physicians raised objections and appeared to be concerned about another profession encroaching on their traditional practice territory. However, since the government’s proposed reform included changes to the scope of practice for numerous professions, it seems that the sheer volume of support left physicians who opposed specific elements of the reform in the minority.
While the Ontario reform has had some clear success, such as expanding the public’s access to influenza vaccinations, to date, the evidence of achieving other goals remains weak. In particular, there is no clear evidence of improved health system efficiency and associated cost effectiveness. Moreover, because Ontario’s regulatory model permits overlapping scopes of practice, it is possible that this umbrella regulatory model may be making interprofessional collaboration more, rather than less, difficult to realize.