Should pharmacists be allowed to prescribe?


The industry is split down the middle when it comes to pharmacists taking on the role of prescriber

Professor Lisa Nissen brought up the topic of pharmacist prescribing at this year’s PSA conference held in Sydney, asking delegates “how would prescribing add to the pharmacist profession, in addition to the S2 and S3 – and what value does it add to patient care and the healthcare system?”

Pharmacists could make a positive difference in the lives of patients by having a broader role in managing medicines, she argued.

“Doctors have concerns about patient safety and quality. However, we know that [the system] doesn’t work well now.

“You look at young doctors coming out of contemporary medical practice prescribing things they don’t know what they are or what they do,” she said.

As “medicines experts”, pharmacists could add prescribing as an extra tool to the competencies they already have, she argued.

“While prescribing may not be the ‘Excalibur’ of the pharmacy system, we should be excited. We could be able to make a huge impact in the sector,” she said.

Prof Nissen last year published research on collaborative doctor-pharmacist prescribing in Australia, which she conducted with Dr Andrew Hale from Princess Alexandra Hospital, Queensland, among others.

Their research found high rates of satisfaction towards pharmacist prescribing and pharmacist consultations (>90%).

 

The “pharmacist prescriber” in general practice

The Pharmacy Guild of Australia supports the concept of the “pharmacist prescriber” particularly in collaboration with medical practitioners, it says.

Continued dispensing “is one of the advances of the Fifth Community Pharmacy Agreement, allowing pharmacists to dispense a certain limited category of prescription medicines [i.e. oral contraceptives and statins] in the absence of a script,” a Guild spokesperson told the AJP.

According to the Guild’s position statement, pharmacists working in the general practice setting should also be allowed to prescribe in order to better support people with chronic health conditions, particularly in regions in which there are GP shortages.

Not everyone agrees with this approach.

St George GP and former president of the Rural Doctors Association of Queensland, Dr Adam Coltzau, told the ABC in 2014  that allowing pharmacists to prescribe medication in rural areas would only be a short-term solution to the country’s doctor shortage.

He said only doctors have the right amount of training to prescribe medicines.

“What we would be concerned about is pharmacists prescribing new medications or medications that haven’t been reviewed and that could go on for years and years without the patients seeing their regular GPs,” Dr Coltzau said.

“Really what we need to do is not look at short-term stop-gap solutions like pharmacists prescribing.

“It takes a very long time to train as a doctor and a lot of that training involves making a diagnosis, coming up with a treatment plan, considering all the patients’ medical conditions, all the medications and the drug interactions that they are on and giving that in a pharmacy setting is not the best thing for the patient,” he said.

Consultant clinical pharmacist Debbie Rigby has also said prescribing should not be a focus of pharmacists’ role in general practice.

“I do not believe the role is contingent upon pharmacist prescribing. As it is a collaborative role, it certainly is not essential for pharmacists to be able to prescribe to provide meaningful and valuable input into the patient’s care and medication management.

“I think advocating for the role to be focussed on prescribing will impede the acceptance of practice pharmacists by medical organisations, funders and individual GPs,” Rigby wrote.

 

Conflict of interest?

Pharmacy critic Dr Edwin Kruys has also spoken out against pharmacist prescribing, saying there is an inherent conflict of interest in pharmacists delivering GP services – citing the need for separation of prescribing and dispensing.

Prof Nissen says the creation and enforcement of strong Professional Practice Standards by the PSA and Pharmacy Board would manage the issue of pecuniary interest.

“It’s about communication with other people in the team, and having practice processes and standards.

“There’s nothing wrong with pharmacists being part of making decisions with a patient, even though there’s a transaction involved. It’s about the lack of communication, not the transaction.

“As long as we have processes in place as much as our Canadian colleagues do, for example, then that issue should be taken care of,” she said.

Should pharmacists be able to prescribe?

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