Nova Scotia Pharmacists Cut Tick-Bite ER Visits in Half, Dalhousie Study Finds

A Dalhousie University study has found that giving Nova Scotia pharmacists the authority to assess tick bites and prescribe preventive treatment for Lyme disease cut emergency department visits for tick bites by roughly half. The province authorized pharmacists to provide this service in August 2021; the study, led by Dr. Emily Black, acting director of Dalhousie's College of Pharmacy, and PharmD student Larissa Doiron, reviewed 1,019 patient encounters for tick bites across three Nova Scotia emergency departments over a three-year period spanning before and after the change. The findings are most directly relevant to community pharmacies now providing this assessment service and to hospital emergency departments that previously absorbed this volume.

Emergency department visits for tick bites fell from 617 in the 16 months before pharmacist prescribing authority to 402 in the 16 months after -- roughly a 50% reduction -- and tick-bite visits dropped from 0.70% to 0.35% of all emergency department visits. Pharmacists prescribed the standard oral prophylactic antibiotic, doxycycline, in 67.7% of eligible encounters. The study also found that more than half of patients who did go to an emergency department for a tick bite spent over two hours there for what the researchers describe as a preventable condition. "Nova Scotians shouldn't have to visit an emergency department for a preventable condition when appropriate care can be provided in the community," Dr. Black said. In the most recent quarter alone (April to June 2026), Nova Scotia pharmacists assessed more than 8,000 tick bites province-wide.

The reaction from both pharmacy and emergency medicine has been positive. "We know when pharmacies contribute to the system we see real changes," said Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia, noting that before the change, "folks were really struggling to get access" as tick bites and Lyme disease became more common in the province. Dr. Matthew Clarke, commenting on the findings, said he has "noticed a significant difference" in his department, adding that pharmacists working to their full scope of practice gives patients "other avenues to get care" that are often closer to home and with less wait. Nicolas DesAulniers, owner of Mosaic Pharmacy & Clinic in Halifax, pointed out that many patients without a family doctor previously had no option but the emergency department for a tick bite.

Practice guidance for pharmacists

• Continue to assess and treat eligible tick bites under Nova Scotia's prescriptive authority rather than defaulting patients to the emergency department, since the evidence now shows a clear system-level benefit as well as a better experience for the patient.
• Emphasize early assessment to patients: Lyme disease is more straightforward to prevent and treat early, and later-stage disease can affect the neurologic system and the heart.
• Check ticks for degree of attachment and engorgement when assessing a bite -- a tick that has been attached for a while or appears engorged is a stronger indication for prompt assessment.
• Remind patients that ticks are active in Nova Scotia essentially year-round, since blacklegged ticks remain active until temperatures are consistently below 4°C, and mild winters mean bites can occur outside the traditional "tick season."
• Counsel on tick checks and safe removal after time outdoors in wooded areas, parks, and gardens, and mention that ticks can also carry Anaplasmosis and Babesiosis in addition to Lyme disease.
• If your jurisdiction outside Nova Scotia does not yet have similar prescriptive authority for tick bites, this study is a useful, published data point for advocacy conversations with provincial regulators or health ministries.

The study adds Nova Scotia to a small but growing body of published evidence that pharmacist-led minor-ailment and preventive services can measurably reduce emergency department burden, not just anecdotally but in reviewed patient-level data. With Lyme disease risk continuing to grow across much of Canada as tick ranges expand, other provinces weighing similar prescriptive authority now have a concrete outcome to point to.