Pharmacists changing prescriptions - thoughts?

[dr nomis]

BCMA sounds alarm on pharmacists' new powers

Prescription policy is aimed at relieving the burden on doctors, government says

 

 

Mary Frances Hill, Vancouver Sun

 

Published: Friday, September 19, 2008

A new provincial policy that will give pharmacists the power to renew and adapt prescriptions without prior approval from a doctor could be dangerous for patients, according to the B.C. Medical Association.

Starting Jan. 1 next year, pharmacists across B.C. can exercise a new authority to renew customers' prescriptions and make limited changes to them based on their own judgment, and without consulting the patients' doctors.

The policy was initiated by the Health Ministry last spring, and announced in the throne speech.

It came up again Thursday after a B.C. Pharmacists Association document detailing discussions over fees for the services was leaked to media.

B.C. Pharmacy Association chief executive Marnie Mitchell said pharmacists will be given the authority to renew prescriptions for up to one year and to change a prescribed dosage if they judge it's appropriate.

"The pharmacist will not make any of these changes unless they have adequate information to understand that this is in the best interests of the patient," she said.

B.C. Medical Association president Bill Mackie said the new rules give pharmacists powers that are far too broad, and could open the door to serious errors on the part of the pharmacists and abuse by patients.

"What if things go wrong? Even [getting pharmacists] to renew a year of prescriptions may give some people the opportunity to hoard them," Mackie said.

"We've had doctors who've said, 'What about medicines that have the potential to cause suicide or enable suicide?'

"There has to be some tracking of how the medication is working for an individual."

He said doctors would be happy with limited renewals, or a renewal in case of emergency -- when a patient runs out or misplaces medication while travelling, for instance -- but it takes medical training to identify whether a patient requires a prescription renewal.

Health Minister George Abbott said his ministry initiated the changes partly in response to the success Alberta's health ministry has experienced with a similar program, and in order to relieve the burden on doctors.

Alberta pharmacists have exercised similar powers for more than three years. In that province, select pharmacists are empowered to write prescriptions and give immunizations. Abbott said earlier media reports that claimed customers would be forced to pay for each renewal were false.

"I was surprised and disappointed to hear the suggestion that somehow the public will be paying for this," he said.

"We have never at any point envisioned a public fee for renewal of a prescription."

But Mitchell said her association and the government still haven't ruled out fees for what she called "value-added" pharmacists' services, and payments from Pharmacare may not be out of the question.

"Those discussions [over reimbursements for pharmacists] haven't produced concrete results at this time," she said. "We're working towards having a publicly funded support for this service."

The B.C. Pharmacy Association includes 2,100 pharmacists and 670 pharmacies in its membership.

The B.C. College of Pharmacists has put some rules in place, including that pharmacists can deal only with prescriptions which are still valid, and that they must report every renewal to the original prescriber of the medication -- most likely the client's family doctor, said college spokeswoman Lori DeCrou. "It's our place to say, 'If pharmacists do this, do they really have the skills, knowledge and abilities to do this?' We think so."

Mackie said he understands how the average person would consider it convenient to visit a local pharmacist to renew a prescription, rather than make an appointment and endure long delays in a doctor's waiting room for a quick appointment. But he said it's far safer to take the precaution of consulting a medical professional.

"The government has tried to solve the issue of people waiting in the doctors' waiting rooms by changing the rules," Mackie said. "Do you want your doctor who knows you and knows what you came in for originally to renew your prescription, or a pharmacist [who doesn't know you] to do it?"

John Tse, vice-president of pharmacy for London Drugs, said he's confident his company's pharmacists can adapt to the new responsibilities if they're comfortable with them.

They will get extra training before the rules come into effect, and aren't obliged to take part.

[monkey799]

This is effectively taking away the bread and butter "easy cases" of family medicine, leaving family doctors to deal with the complex patients.

 

I assume that now pharmacists can renew prescription and bill for the "visit", and in case of difficulty or mistake, send the patient to the family doctor for help.

 

It's easy to imagine the potential mess things can get - you as a family doctor prescribe a medication after carefully evaluating the patient, and 2 wks later, are notified by the pharmacist that she has changed the prescription to a preferred drug (perhaps higher margin of profit for the pharmacy). A week later the patient came back with more problems because of the change.

 

I think the bottom line is that this is about money, not patient care.

[youbrokeit]

The intent of this policy change is to reduce pressure on doctors and to make life easier for patients. Example: doctor prescribes "pensaid", expensive (not covered by drug plans either) liquid topical diclofenac. Pharmacist can change the prescription to much cheaper diclo-gel (which IS covered) and sticks where you put it. Another example is switching from commercial to generic, or between preparations of the same drug for cost savings or because the prescribed medication isn't in stock (ex: switch 20mg tablet to two 10s). Before, they'd have to call the physician to do this. Pharmacists know more about drugs than we do and know when this is safe. they won't change someone's LMWH prescription as there is variation b/w brands.

 

 

Although there are SOME provisions for initiating therapy and doing basic examinations, these are unlikely to be used by pharmacists in centers where physicians are available. Their purpose is to 'tide over' a patient until they can access their primary care physician. This takes the load off ER departments for minor non-emergent concerns such as ear infections, UTIs, etc. In most cases pharmacies will avoid this practice, as they don't bill for counselling/examining, and the pharmacy makes money solely by prescription volume.

 

These policies aren't made to step on doctor's "territory" but to make everyone's lives easier.

[meme me]

This is effectively taking away the bread and butter "easy cases" of family medicine, leaving family doctors to deal with the complex patients.

 

I assume that now pharmacists can renew prescription and bill for the "visit", and in case of difficulty or mistake, send the patient to the family doctor for help.

 

It's easy to imagine the potential mess things can get - you as a family doctor prescribe a medication after carefully evaluating the patient, and 2 wks later, are notified by the pharmacist that she has changed the prescription to a preferred drug (perhaps higher margin of profit for the pharmacy). A week later the patient came back with more problems because of the change.

 

I think the bottom line is that this is about money, not patient care.

This is an unbelievably narrow-minded, arrogant view and if I were a pharmacist, I would take enormous offense. You're demonizing them. Why don't you consider the implications of what you're saying before you hit the submit button.

[Satsuma]

These policies aren't made to step on doctor's "territory" but to make everyone's lives easier.

 

Just wondering...if these are considered an attempt to relieve the burden on physician workload...did they consult with physicians before accepting these policies?