B.C.'s PharmaNet ahead of Saskatchewan by a decade

Page 6

Saskatchewan Health has changed the way it keeps track of the use of prescription drugs in the province, expanding the scope of the monitoring system to include all prescriptions filled in the province regardless of who is footing the bill.

That means prescriptions not covered under the province's drug plan, or those paid for by the federal government-including those filled for First Nation patients and veterans-will now be monitored.

One of the goals of the system is to track the types of prescription drugs patients are using so that pharmacists can catch any possible adverse drug interactions. Another is to flag situations where people may be abusing prescription drugs by going to a number of different doctors to obtain drugs.

The changes to the province's monitoring system have been made in response to recommendations coming out of a coroner's inquest into the death of Darcy Dean Ironchild in February 2000. Ironchild, a 33-year-old Native man, died from an overdose of prescription medications. Testimony given during the inquest indicated that, in the year before his death, Ironchild had had more than 300 prescriptions filled.

The idea of a system that monitors every prescription filled in the province isn't a new one. In British Columbia such a system-PharmaNet-has been in place for about a decade. The primary reason PharmaNet was implemented in B.C. was to identify potential negative drug interactions among patients, said Michelle Stewart, communications director with Health Services in B.C. "Because prior to that it wasn't possible for pharmacists to be aware of what other medications an individual might be on at the time they were prescribed medication."

According to Stewart, First Nation leaders have never expressed concerns about the prescription-monitoring program. There were some privacy-related concerns that were raised when PharmaNet was first brought online, she said. "But those were addressed and we didn't have significant outcry from any particular group."

The program has strict controls in place to keep unauthorized people from accessing health information, Stewart said. "It's monitored, and if people are inappropriately accessing a file then that can be picked up on the system because everybody who goes on to the system has an identifier. Not even the Ministry of Health could access that information.

"The data is held by the College of Pharmacists. So no one in the Ministry, for example, could identify or have access to that database to potentially look up a patient, for example. That's all strictly controlled by the College of Pharmacists," said Michelle Stewart.

The decision to bring in changes to the way Saskatchewan Health monitors prescriptions filled in the province wasn't received well by the Federation of Saskatchewan Indian Nations (FSIN). A few days after Saskatchewan Health made its announcement, the FSIN made one of its own, with Vice Chief Morley Watson voicing his disappointment with the provincial department's move.

In the press release Watson, who holds the health portfolio for the FSIN, compared the situation to Health Canada's failed attempt to require Aboriginal clients to sign a consent form in order to receive health services and prescription drugs.

"Last year the federal government through its First Nations and Inuit Health Branch had proposed to adopt 'client consent' to obtain confidential information about First Nations people. First Nations across Canada vigorously opposed the legislation and the policy was never implemented," he stated in the release.

"One year ago we were discussing with the federal government on the issue of client consent. Our primary concern with client consent was protecting the privacy of First Nations. However, we were able to work with the federal government for a collective solution. Perhaps the provincial government should consider this avenue of discussion."

Provincial Health Minister John Nilson said that,although the FSIN press release linked the province's new system for monitoring prescriptions with Health Canada's failed consent form initiative, there is no relation between the two.

Assembly of First Nations (AFN) Regional Chief Bill Erasmus, who chairs the AFN Secretariat on Health and Social Development, also stressed that there is no connection between Saskatchewan's prescription monitoring system and the consent form issue.

While Saskatchewan's new system tracks prescriptions across the province, the AFN is working to create a program that accomplishes similar things, but on a national scale, Erasmus said. That program will be designed to protect the personal privacy of the people included in the system while working to prevent further abuse of prescription drugs.

Part of the challenge to putting together such a program is the number of jurisdictions that have to be involved, Erasmus said.

"You've got our own people that are caring for some aspects of health. You've got Health Canada that's involved. And you've also got the provinces. So each of the entities have to come to agreement on how to pursue this and that's part of the difficulty."