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How does the situation on pharmacist prescribing in Australia compare with other English-speaking countries? 

Australia continues to lag behind other English-speaking countries in the introduction of pharmacist prescribing models, potentially reducing access to primary health care and chronic illness treatment, researchers said.

Legislation supporting pharmacist prescribing has been implemented in the UK, Canada and New Zealand, but to date prescribing rights have not been extended to Australian pharmacists.

This is despite prescribing rights being extended to a range of other professions in Australia, including nurse practitioners, midwives, dentists, podiatrists and optometrists, said the authors of a recently published literature review.

Pharmacist prescribing has been a hot topic in Australia this year following the Pharmacy Board’s release of a discussion paper on the topic, and calls for movement in this area from pharmacy leaders.

Unsurprisingly, responses from doctor groups questioned the health outcomes from such a move.

Now, researchers from the Australian National University, Canberra, and other institutions, examined 64 peer-reviewed and grey literature articles on pharmacist prescribing from these three countries and Australia. They analysed the barriers listed in each of these topics, and the relationship to an Australian context.    

Among the commonly identified barriers to pharmacist prescribing are: 

  • Reservations from other health professions, especially GPs
  • Inadequate support for the concept from health authorities, employers and pharmacists themselves
  • The lack of a prescribing model for pharmacists was mentioned especially in Australian research as being a perceived barrier 
  • Poor awareness of models, including working overseas models, among stakeholders. This included one Australian study finding pharmacists themselves weren’t aware of examples of pharmacist prescribing in other countries.
  • Potential conflicts of interest between multiple pharmacist role – especially of compromise from commercial concerns in the shared roles of prescribing and retail

Surprisingly encroachment on GP turf was not mentioned in Australian literature but had been mentioned in the UK and Canada.

“Many barriers,,, described reflect that pharmacists do not traditionally have a role in clinical diagnosis and treatment,” the authors said.

“Hence, resistance to their roles as prescribers is unsurprising.” 

Three major gaps exist in research on pharmacist prescribing in an Australian context, the authors said. These are:

  • Policy development and implementation planning
  • Further exploration of the perceptions of key stakeholders about acceptance and feasibility
  • Developing well-designed prescription training courses

“A concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of pharmacist prescribing, and identifying specific funding, infrastructure and other resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional teams,” the authors said.

“Further research focusing on policy development and implementation in the Australian context will be essential,” they concluded. 

 

The research was published in the International Journal of Pharmacy Practice

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2 Comments

  1. Greg Kyle
    25/07/2019

    The problem in Australia for pharmacist prescribing boils down to:
    1. the influence of the Guild and their history; and

    2. pharmacists are a bunch of risk averse, anally retentive checklers.

    For many years, the Guild rallied against doctor dispensing as a financial conflict of interest saying separation was the best way to avoid this and look after patient safety ie. have a pharmacy (retail entity – ie. Guild member or potential one). Now the Guild is saying there will be no conflict if pharmacists prescribe in a retail pharmacy setting! Who has the vested interest?

    Pharmacists need to believe they can do this. Yes, there will need to be some upskilling, but not a lot – look at the report commissioned by the Pharmacy Board into how Australian pharmacy graduates knowledge against the NPS prescribing competencies. Today’s graduates do not want to work in a script hothouse – they want professional challenges. Working as a pharmacist practitioner (outside the confines of a retail pharmacy entity) would be a major drawcard!

    As a lead author on the National Health Workforce Taskforce report into non-medical prescribing in Australia (released by HWA in 2010), we addressed the exact issue of conflict of interest of prescribing in retail pharmacies saying there should be separation between prescribing and dispensing. It does not matter which health professional does the prescribing, the two tasks need separation. However, enter the Guild … they see prescribing as an additional revenue stream for their members, notwithstanding their position reversal (see above). Also, the whole antithesis to the Guild is having pharmacists working anywhere but in retail pharmacy entities. They Guild are just seeking seeking to control the profession – this is no different to the medical organisations seeking to control prescribing, or the GP’s organisations seeking to control all non-medical health professionals under a GP. Add to this the fact that the model of pharmacists in GP practices has been set up as an employee model, rather than a practitioner model (ie fee for service) and the profession has been sold out again!

    The health system needs a major overhaul away from egos and political power plays. The problem with all this squabbling is all the political hacks are forgetting the people who are the pawns in all their power games – the patients. Each of the players claims to have patients best interests as their position, but in actual fact, when you cut away the rhetoric and smokescreens, all the “professional” or other organisations (medical, pharmacy, nursing, etc) are playing a political game for power, and it really is tearing the health system apart.

    • Jarrod McMaugh
      25/07/2019

      I think it’s important to note that while a conflict of interest can exist between a person who prescribes and dispenses the same prescription, this is not the reason to separate the two activities.

      The reason to separate these activities is the same reason that journalists have editors, that architects have engineers – there needs to be two sets of eyes looking at a decision.

      In the case of prescribing, there are situations where that separate set of eyes – operating in an objective manner – can detect an issue that the first person does not detect.

      Conflict of interest exists in all transactions (including clinical ones) regardless of whether a medicine is supplied, whether surgery is recommended, whether an activity is recommended or not… if policy were developed with the intent of blocking all interactions/interventions that involved a conflict of interest (potential or actual), then there would be no capacity for anyone to do anything (ESPECIALLY in health, where reputation-based income is particularly subject to conflict of interest).

      Separation of roles isn’t important due to CoI (although it is a significant contirbutor) – it is important due to the need for objective/critical thinking.

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