Tuesday, July 10, 2012

Pharmacist prescribing

It hardy seems like it, but Monday was the one year anniversary of my switch from retail/community pharmacy to the hospital setting.  After 16 years behind the counter I have spent the last twelve months behind a desk and have loved every minute of it.

Over this past year, I've been able to see the successes in the health care industry.  I've also seen some of the failures of the system.  Some of my more memorable moments have come when I have been able to work with our interdisciplinary team and contribute to positive patient outcomes.  I feel that I have earned the respect of the hospitalists and the nursing staff on our main patient floor.

One of the key things that I've found that has helped me earn their respect is to ask how the pharmacy service can help make their lives easier.  There have been instances where I have made their lives more difficult as well.  When that has happened, it didn't take long for somebody to explain the situation to me and I made the adjustments to correct the situation.  The key to this has been open communication and open minds.

Open communication.....


Over the past year I haven't seen a whole lot of news in the pharmacy world.  The only three "big" stories that I can think of are the Express Scripts-Medco merger, the move for more OTC/behind-the-counter medications, and pharmacists gaining prescriptive authority.

When I read articles/blogs/tweets on the prescribing issue, I keep seeing the same things.  Pharmacists are the medication experts, so why shouldn't we be able to prescribe.  I have my personal opinion on the issue, but I would like to ask a question that I haven't seen addressed anywhere.

Have we asked if the other members of the health care team want us to have have prescriptive authority?  Do the physicians want us to have that authority?  Has anybody in pharmacy actually communicated with the AMA and asked them for their thoughts on how the pharmacy profession can help the doctors?

It seems to me that pharmacist prescribing may be another idea dreamed up in academia that might not be able to fly in the real world.  I've seen links to several stories lately that shows that the medical doctors really don't want us to prescribe.

Does anybody know if this has been addressed with our medical colleagues?  If so, please share.


Ryan said...

The AMA would not want us to prescribe. They also did not want CNPs or PAs to have prescriptive authority either. They lost those battles. They would view pharmacists with prescriptive authority in the same way.

At this point, it doesnt really matter what the doctors think about pharmacists being able to prescribe. It will be healthcare costs that dictate the change. Healthcare costs will continue to rise, even with the ACA. Allowing qualified individuals to have some prescriptive authority will keep people out of the hospitals and doctor offices and will lower overall health care costs.

Anonymous said...

I feel that collaborative care is the way to go as far as prescriptive authority goes for pharmacists. I don't feel that we should have prescriptive authority of our own, since most pharmacists (in a retail setting at least) don't have a full enough picture of the patient's medical history to safely prescribe on their own. Collaborative care agreements should be used more often, especially in the more clinically based fields of pharmacy.

I do, however, think it should be legal for us to grant one time refills of maintenance medications to get a patient through until they can see they're physician.

Anonymous said...

What would we diagnose? Unless within limiting protocols (collaborative practice agreements) on what basis could we write for one ACE-I over another? This is why doctors got out of the prescription business to begin with. OTC counseling is something we should be doing already.

ClinCalc said...

Definitely a hot topic -- and I agree that the AMA would likely be very firm in rejecting the idea of a pharmacist prescribing.

In the current state of pharmacy, I don't think it would be a good idea to provide all pharmacists with independent prescriptive authority. Although (most) pharmacists are the "drug experts", as Anonymous points out, diagnosis is a very important step in the prescribing process and there is a wide discrepancy in the qualifications of pharmacists in the US. Not all practicing pharmacists have the knowledge or background to safely prescribe -- additional qualifications would likely be necessary.

In the future, though, I can certainly see pharmacists having a greater role, and perhaps even some having an independent prescribing role. For a minute, think about how much the field of pharmacy has progressed. Now, pharmacists are spending more time in school (PharmD) and many are pursuing 1-2 years of post-graduate training in a clinical setting (PGY1/2). Over time with more highly trained and qualified pharmacists, I do believe that a prescriptive door will start to open, particularly with increased costs and decreased availability of healthcare.

At least for the foreseeable future, I'm a firm believer in the benefit of multidisciplinary teams and collaborative practice, particularly in the hospital setting. Pharmacists are the "drug experts", but the benefit of the knowledge is best utilized in conjunction with a full team of experts in other fields.

Unknown said...

Dispensing pharmacists should not have prescriptive athuority. There's not the proper time to diagnose and then it will be like plan b, everyone will just get it. Do you really think the chains will let us turn someone down for medication for anything other than an absolute contraindications (think vaccines at Walgreens). Should it be like that with other meds . Or even that one ????

Unknown said...

I fear that other professions are starting to see us as ridiculous, since we're given more and more and accept it without boundaries.

We need to be pharmacists, not doctors. Our chains won't even let us be pharmacists.

Pharmd blogger said...

I have a doctor of pharmacy degree, and I do not think that we should have full prescriptive authority. I do believe that we should be able to change medications within a particular class for insurance purposes and be allowed to give one time refills. If we change the laws and let certified pharmacy technicians take on more responsibility by checking prescriptions, then I don't see why we can't have a collaborative agreement with physicians on what we can prescribe. By the way, physicians will never want to give up their power to prescribe!

Anonymous said...

Pharmacists cannot prescribe because they do not know the diagnosis. Do you let the plumber dig up your yard because your sink drain is clogged? The answer is, no. The pharmacy school I attended does not even teach human anatomy and barely touches physiology. Pharmacists just don't know which end to start at because, simply put, most of them just don't care. Medications are given for specific indications or to treat specific symptoms of a disease. I have met many ignorant pharmacists who think they can diagnose drug abuse by watching someone's hands. They also judge people on their background, what shoes they are wearing, and their speech pattern - all really inane prejudices that have no place in our modern multi-cultural society.