Why are Doctors Threatened by Pharmacist Prescribing?

Monday, November 24, 2008 | Categories: Dr. Brian's Blog

In 2006, Alberta became the first province in Canada to permit pharmacists to prescribe certain medications. Under provincial legislation, Alberta pharmacists have two prescribing authorities. They can "adapt a prescription", meaning they are permitted to make changes to an original prescription and may also provide interim prescription renewals. As well, they may write prescriptions of their own provided they have taken a course and have demonstrated the competence to prescribe medications. That competence is specific to a particular condition. 

Other provinces have followed Alberta's lead. In October, New Brunswick became the second province to allow pharmacists to prescribe medications.

Pharmacists in both provinces can prescribe and dispense drugs for minor conditions such heartburn, athlete's foot, and seasonal allergies. They can't prescribe narcotics and don't have the authority to diagnose serious medical conditions such as diabetes and asthma.

Manitoba passed legislation that permits pharmacist prescribing that still requires implementing regulations. The Saskatchewan College of Pharmacists has proposed giving pharmacists the right to prescribe medications. The BC Pharmacy Association supports pharmacist prescribing as well.

Last week, an advisory council to Ontario's Health Ministry recommended the same for Ontario. The Ontario Medical Association has said it will study the proposal, but has already thrown cold water on the idea. Their argument? Doctors, not pharmacists, should be in the business of making diagnoses. Today on the CBC Radio One program Metro Morning, Dr. Ken Arnold, head of the Ontario Medical Association, said that what appears to be conjunctivitis or pink eye could in fact be glaucoma.

True enough. And indigestion might be a symptom of a heart attack. Yet that doesn't stop pharmacies from selling antacids and Pepcid over the counter, does it? So, what's really on the minds of some physicians?

I think they're opposed to pharmacist prescribing because it encroaches on their turf, in this case the traditional authority of physicians to prescribe drugs. That's a monopoly they'd like to keep, thank you very much.

We've heard that tune before. Many MDs and some provincial medical associations are positively allergic to the idea of nurse practitioners having indepedent family practices. Their solution? Make more doctors!

Here's the thing. It's estimated that up to 5 million Canadians can't find a family doctor. Many of those who don't have access to one come to emergency for prescription renewals that a pharmacist should be permitted to do. That would cut down on at least some unnecessary visits to emergency.

As for Alberta, the first province to permit pharmacists to prescribe? So far, the sky hasn't fallen there. That province has put appropriate checks and balances into the system. It has made certain that pharmacist don't put themselves into a conflict of interest between their prescribing and their dispensing roles.

Properly monitored, pharmacist prescribing adds a new player to a health care system that is cries for extra help.

Program Note: Check out this week's all new episode of White Coat, Black Art. I visit Telehealth to find out if it's true that they send every patient they talk to by phone to the nearest emergency department. Hint: they don't. Last week, we did a show on burnout among health professionals. We have reaction to that show that you won't want to miss. That's Monday November 24 at 1130 am (noon NT) and Saturday November 29 at 430 pm (5 pm NT).

Fonte: CBC Canadá