Pharmacy Check-in: Enav Zusman

Valerie Leung

Enav Zusman, PharmD MSc (she/her)
Graduate researcher, Contraception & Abortion Research Team (CART)
Women's Health Research Institute
Vancouver, BC

Dr. Enav Zusman is a PhD student in the Women+ and Children's Health Sciences (WACH)/Reproductive and Developmental Sciences program at the University of British Columbia (UBC) and a researcher with the Contraception & Abortion Research Team (CART) at BC Women’s Hospital. Enav’s research interests include pharmacoepidemiology, perinatal epidemiology and reproductive health. Prior to commencing her PhD studies, Enav obtained a Doctor of Pharmacy (PharmD) and an MSc in Experimental Medicine from UBC, and a BSc in Medical Sciences from Tel Aviv University (Israel). Enav is a current holder of the Vanier Canada Graduate Scholarship, Killam Doctoral Scholarship and the UBC Four-Year Fellowship. She is a strong advocate for empowering patients to make informed decisions about their reproductive health and making reproductive health care available and accessible to all. In her research work, Enav combines her knowledge as a pharmacy graduate with her research knowledge to better support informed decision making, improve access to contraceptives, emergency contraceptives and abortion medications, and improve patient care and outcomes across Canada.

Q&A with Enav

We caught up with Enav to talk about the important role pharmacists can play in providing sexual and reproductive health care to their patients.

What is the #1 thing pharmacists can do to support their patients in the area of reproductive health and wellness?

The #1 thing pharmacists can do to support their patients in the area of reproductive health and wellness is to provide comprehensive and non-judgmental care, empowering patients to make informed decisions. Given that reproductive health is a broad term, such care includes offering information and education on various contraceptive methods and emergency contraceptive options when needed, administering human papillomavirus (HPV) vaccines, discussing family planning options and prenatal care, educating patients on STI prevention and testing, and emphasizing the importance of regular health check-ups. As the most accessible health-care professionals, pharmacists should create an open and safe environment for patients to ask questions, raise concerns and seek guidance regarding their reproductive health choices.

What role can pharmacists play in ensuring access to medication-based abortion? Why is it important for pharmacists to be involved?

Pharmacists play a key role in ensuring equitable access to medication-based abortion care by regularly stocking, dispensing and counselling on Mifegymiso (mifepristone/misoprostol) and making sure that prescribers and other pharmacies in their area are aware that they stock Mifegymiso so that patients can be referred to them. What makes pharmacists so special and why it is important that they are involved is that they are accessible. You can find pharmacies all over our beautiful country, including in underserved rural and remote communities and they are available for extended hours of the day.

What role can pharmacists play in ensuring access to contraception? Why is it important for pharmacists to be involved?

Pharmacists also play a key role in ensuring access to contraceptives. In addition to regularly stocking, dispensing and counselling on contraceptives and emergency contraceptives, in some provinces pharmacists can now also prescribe them. As mentioned above, pharmacies can be found all over Canada, including in rural and remote communities that do not have a physician on site, thus increasing access to reproductive health choices. When it comes to prescribing, having pharmacists prescribe simplifies the process for patients. Where permitted, patients can walk into any pharmacy and speak with a pharmacist, a trained and experienced health-care professional, and obtain contraceptives on the spot. Decisions about sexual and reproductive health are important and personal. Delaying access to such services can have significant implications for both individuals and families and may result in unintended pregnancies.

How can pharmacists empower their patients in this area?

Empowering your patients starts with helping them make informed decisions about their reproductive health. It involves educating them about their health and options, supporting patient-centred care and involving them in all decision making. This is crucial to promote self-management skills and support and respect their autonomy. Please remember that language matters. What you say and how you say it may affect your patients in different ways so be mindful of cultural diversity and show empathy. The interactions you will have with your patients should be supportive, non-judgmental, and empowering, not traumatizing. Your patients are likely seeing you in a sensitive time in their lives; be remembered as kind and supportive and make them feel like they can trust you and come back to you if they have any questions or concerns.

When it comes to abortion care, please educate yourselves on language to avoid and language to use.

Do current legislation and regulations in Canada give pharmacists enough authority to effectively and appropriately provide comprehensive reproductive health services to their patients?

Canadian pharmacists are authorized to provide a range of reproductive health services and have become more proactive and involved in the continuum of care for reproductive health over the years. However, the extent of their authority varies by province and territory, which leads to disparities in the care provided to patients across Canada. Ideally, all Canadian pharmacists should be able to prescribe contraceptives, prescribe and administer injectable contraceptives, renew prescriptions for oral contraceptives and administer the HPV vaccine.

As health professionals, how can we protect access to reproductive health services for our patients and our communities?

There are many things pharmacists can do as health-care professionals to protect access to reproductive health services. Some examples include:

Continue to support and advocate for pharmacist prescribing of contraceptives and dispensing of Mifegymiso across all Canadian provinces and territories.
Advocate for public and private insurance to fully cover reproductive health services to minimize or eliminate a financial barrier to accessing these important health services.
Ensure that reproductive health options are accessible and timely by regularly stocking contraceptives, emergency contraceptives and medical abortion medications.
Protect the patient’s autonomy and support their informed reproductive health choices, providing non-judgmental patient-centred care and serving as a source of empowerment.
Be aware of reproductive health services in your community and know when and where to refer a patient.
Support and offer sex education. Educating your patients on safe sex and their reproductive health options can make a huge impact.
Support interprofessional collaboration and work together with your patient’s health-care team towards improving your patient’s outcomes.
Conduct or participate in research studies that assess and highlight the contributions of pharmacists to patients’ reproductive health care and how an expanded scope of practice for pharmacists affects patient care and outcomes.

What is the most rewarding part of your work?

As a researcher, the most rewarding part of my work is seeing how my research work advances medical knowledge, improves patient outcomes and translates into policy change while highlighting the key role pharmacists play in patients care and the importance of expanding their scope of practice.

Is there anything else you’d like to share?

To support the dispensing of Mifegymiso (mifepristone/ misoprostol) in community pharmacies, a guideline-based mifepristone checklist and resource guide for pharmacists were published in April 2018 by the Contraception and Abortion Research Team (CART- GRAC).