Don’t talk about ‘expanded scope’


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Canadian pharmacists, like their Australian counterparts, are discussing the importance of language when it comes to scope of practice

In an editorial published in the Canadian Pharmacists’ Journal, three pharmacists have written that it is “time to give up” on expanded scope of practice.

Ross T Tsuyuki, Sherilyn Houle and Hiroshi Okada write that “the terms we use to describe our profession are important”.

Terms such as “expanded,” “advanced,” or “enhanced” scope of practice send a message that such professional services are “luxuries or upgrades, that they are somehow optional (“nice to have”) or exceptional”.

“But, we know from the prodigious evidence… that these services improve patient outcomes and that patients want them,” the three write.

“Indeed, these are essential services. Services that all patients should expect and be entitled to receive. We call this ‘full scope’ of pharmacy practice.”

The full scope of pharmacist services includes “all proactive and comprehensive interventions that prevent or manage illness and are within an individual’s competency to perform independently”.

This includes injections (immunisations, travel medicine and other injectable medications), prescribing (refill authorisation, adaptation, independent prescribing and deprescribing), laboratory testing (lab tests, point of care testing and diagnostic testing such as pulmonary function testing) and disease management: screening, prevention, chronic disease management and acute (common ambulatory) conditions.

“This is not just a semantic argument,” the three write.

“Don’t all of our patients deserve access to their pharmacist’s full scope of expertise, no matter where they live?

“Shouldn’t the full scope of pharmacist practice be defined by evidence, not outdated and restrictive legislation and policy that differ across provinces and workplaces? And don’t all pharmacists deserve to practise in a workplace that supports these activities?

“It’s time to give up on ‘expanded scope’ and recognize full scope as the new standard.”

Pharmacy Guild of Australia national executive director David Quilty, referenced the editorial in Forefront last month when he wrote that pharmacy needs to “realign” the way it refers to pharmacist practice activities.

“References to pharmacists seeking a ‘broader’, ‘expanded’ or ‘enhanced’ scope of practice often arouse controversy in the health sector with some doctor groups and others seeing this as a potential intrusion into their areas of expertise,” he wrote.

“Maybe this inter-professional friction could be avoided by some more accurate messaging: pharmacists want to perform to their ‘full’ scope of practice – maximising the benefits for patients by using their expertise in medicines which is already acknowledged by regulatory authorities, albeit with some variations across States and Territories.”

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