Minor ailments, major problems: a critical appraisal of Rafferty et al. (2017)

Excerpt

With increasing pressure to commercialize primary care within the larger publicly-funded provincial health care systems of Canada, bureaucrats and retail operators seem eager to show that new initiatives are worth public spending. A recent article by Rafferty and colleagues [1] funded by the Canadian Foundation for Pharmacy attempts to justify the value of Saskatchewan’s “Pharmacists Prescribing for Minor Ailments” or PPMA service in a study that is flawed in design, assumptions, inputs and thus conclusions. Though the authors state that such programs “aim to improve the efficiency of care [and] reduce physician visits” [1], recent outcomes research into other pharmacy services in Canada suggests otherwise [2, 3]. Depending on the level of clinical expectations, quality assurance research also calls into question the effectiveness of long-standing PPMA services in the United Kingdom [4]. Rafferty and colleagues have assumed that the PPMA service is safe, effective and efficient in Canada without providing any direct evidence to support these assumptions. Instead, they proceed with assessing “costs and savings” of a service that may cause more harm than good (e.g., promoting more prescription therapy for minor illnesses). A formal outcome evaluation using only primary data would have been a better starting point, expanding on the small convenience sample done earlier by Mansell and colleagues [5]. …