Expand Pharmacist Roles to Reduce ER Visits

Photo: Alef Perez
Our ERs are vast improvement over this kind of
third world medicine illegals get in their own countries.

As I have recently experienced during a recent ER visit in northern Virginia, many cases presenting themselves are cases of sniffles of illegal aliens and their children who use the ER as their primary physician because ER visits are free to them, paid for by the U.S. taxpayers.  

A seven-year study just released on January 10, 2019, by the University of Waterloo in Canada found that pharmacists could dramatically reduce ER visits by “incorporating them with an expanded scope into the community or hospital emergency departments,” thus reducing the overcrowding of emergency rooms (ERs).

Wasem Alsabbagh and Sherilyn Houle found that “almost one-third of non-urgent Emergency Department (ED) visits in Ontario were for conditions that could potentially be managed by pharmacists with an expanded scope of practice – available in other jurisdictions in Canada.”

“Overcrowding in EDs is a concern most Canadians can relate to, and we know that it can lead to increased mortality and a higher rate of patients who leave without receiving treatment,” said Wasem Alsabbagh, a professor at the Waterloo School of Pharmacy.

He added, “Our findings support that we need to see more pharmacists working with expanded scope in community practice or based in the ED. This may reduce crowdedness and free more resources in EDs to care for more acute patients.”

After the researchers examined data from 2010-2017 of all Ontario hospital Emergency Department (ED) cases, they found that one in five patients who sought emergency care had non-urgent health concerns. Such unnecessary visits could have been potentially managed by a pharmacist.

To ascertain the percentage of non-urgent care, the authors of the study used standard scales that measured the severity of the patients’ symptoms and used statistics to determine which cases could have been managed by pharmacists “working with an expanded scope.”

In the last decade, various provinces in Canada have allowed pharmacists to write prescriptions for minor ailments. Such is the case of Alberta where, since 2007, pharmacists were allowed to write prescriptions for minor illness, to renew prescriptions, to administer injections, and to give vaccinations.

In Ontario, in 2012 and then in 2016 pharmacists’ roles expanded and they could renew prescriptions and administer flu vaccines and others.

“Our study included all expanded scope services in use across Canada when assessing which Emergency Department (ED) cases pharmacists could manage,” said Alsabbagh. “Over the seven years of the study period, we found that pharmacists with an expanded scope could potentially have managed nearly 1.5 million cases in Ontario.”

What conditions could a pharmacist with an expanded scope of practice treat? According to this study, skin-related problems like dermatitis, coughs, and inflammation of the ear canal, nasal passages, and throat were some of the cases that could have been managed by a pharmacist.

The Journal of Research in Social and Administrative Pharmacy published Wasem Alsabbagh and Sherilyn Houle’s study called “The Proportion, Conditions, and Predictors of Emergency Department Visits That Can Be Potentially Managed by Pharmacists with an Expanded Scope of Practice.”https://uwaterloo.ca/pharmacy/news/pharmacists-could-dramatically-reduce-er-visits

As more doctors retire in this country, less students study medicine due to its difficult, long, and expensive training, nurse practitioners’ and physician assistants’ roles expand, and more doctors are brought from third world countries and medical schools, could pharmacists’ roles fill the vacuum and expand beyond vaccinations in the United States where Emergency Rooms (ERs) are equally crowded by minor cases? How would they define minor cases? What would the medical licensing boards and medical schools do under such circumstances? Would pharmacist training and medical liability have to change?

 

 

 

Mount Everest and Pollution

Mount Everest, en.wikipedia.org

Environmentalists have switched their assault on the world economy to a new frontier, previously unaffected by their agenda – peaks, Mount Everest to be more specific, located between China and Nepal in the Himalayas. The 29,029 feet mountain is in danger. What is the crisis? According to the National Geographic team, the mountain is “overcrowded with inexperienced climbers and polluted with waste.”

The nature of the pollution includes human corpses, human excrement, garbage leaking from glaciers, abandoned equipment, and overcrowding. How crowded could it be? Mark Jenkins described at 26,000 feet the dangerous inconvenience of more than 100 climbers moving slowly, forcing everybody else to move at the same pace. 

The humans who perished were left where they died; some were pushed by wind and ice by the side of the trail and some wound up in crevasses. Mark said that the “mountain is mobbed” by inexperienced climbers. “The two standard routes up Everest are not only dangerously crowded but also disgustingly polluted.”

He bemoans the days when in 1963 only six climbers made the arduous trek compared to 2012 when over 500 “mobbed the summit.” The National Geographic team reached the summit on May 25 but was unable to stand due to overcrowding.

Climbing the highest peak is not as glamorous as it used to be, he said. The club is no longer rarified – there are almost 4,000 who successfully reached the peak, some more than once. Guided climbers who pay $30,000-120,000 on expeditions to reach the top have created mounds of human excrement and left behind discarded equipment, other trash, and corpses.

Nepalese Sherpas remove their own trash, leaving little footprint behind. They even pick up some of the garbage left by climbers even though collection work is difficult in sub-zero temperatures.

What kind of micro-management do environmentalists propose in order to save this natural wonder, the mammoth toy that tests the mettle for the few and moneyed?

-          Restrain low budget outfitters by limiting the number of total permits per season and the size of each team (perfect weather data causes crowds on the mountain, all vying to reach the top during the same nice weather conditions)

-          Show respect for the mountain (I would think, that would be hard to do when caught in a storm and trying to survive)

-          Issue ID scanner tags with every permit (QR code) that might save a climber’s life (Would that reduce corpse pollution?)

I would never understand why humans push themselves to test the limit of their survival endurance in unforgiving environments, often paying with their lives, but it is a remarkable accomplishment that few have attained and I am not trying to minimize the extraordinary physical shape these men and women attain and the grueling training and dedication involved.

Previous pioneers have escalated peaks and treacherous territories trying to find new lands, develop maps, rescue lost teams, or to find mines of gold, silver, and other precious resources. They left behind discarded equipment, wagons, tools, ships, tents, and cooking utensils.

I wonder if environmentalists consider mountains polluted if they are covered with wildlife, their poop, and their carcasses. Animals are killed off, die of natural causes, sometimes partially or completely eaten; their remains and fecal matter decompose scattered on the ground. Is that environmentally hazardous to the mountain?

Civilized people love a clean environment and strive to keep it that way. At the end of the day, is it about pollution really and “showing respect for the mountain,” or is it about denying and controlling access to a natural wonder so that future climbers with a big ego, plenty of cash, and a burning desire to reach the peak, survive, often cheat death, and live to brag about it?