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

摘要

With increasing pressure to commercialize primary carewithin the larger publicly-funded provincial health caresystems of Canada, bureaucrats and retail operatorsseem eager to show that new initiatives are worth public spending. A recent article by Raferty and colleagues[1] funded by the Canadian Foundation for Pharmacyattempts to justify the value of Saskatchewan’s “Pharmacists Prescribing for Minor Ailments” or PPMA service ina study that is fawed in design, assumptions, inputs andthus conclusions. Tough the authors state that such programs “aim to improve the efciency of care [and] reducephysician visits” [1], recent outcomes research into otherpharmacy services in Canada suggests otherwise [2, 3].Depending on the level of clinical expectations, qualityassurance research also calls into question the efectiveness of long-standing PPMA services in the United Kingdom [4]. Raferty and colleagues have assumed that thePPMA service is safe, efective and efcient in Canadawithout providing any direct evidence to support theseassumptions. Instead, they proceed with assessing “costsand savings” of a service that may cause more harm thangood (e.g., promoting more prescription therapy forminor illnesses). A formal outcome evaluation using onlyprimary data would have been a better starting point,expanding on the small convenience sample done earlierby Mansell and colleagues [5].