Practising to your ‘full’ scope


Language is important, argues David Quilty, especially when it comes to the way we describe pharmacist activities

The profession needs to realign the way it refers to pharmacist practice activities to minimise confusion, says Pharmacy Guild Executive Director David Quilty in his latest editorial.

“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 writes.

“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.”

Mr Quilty refers to a recent article in the Canadian Pharmacists Journal led by Dr Ross Tsuyuki, which called on the profession to realign the use of terms such as “expanded scope of practice”.

“Expanded scope and similar terms suggest that these are luxuries or upgrades, that they are somehow optional (‘nice to have’) or exceptional,” writes Dr Tsuyuki.

“But, we know from the prodigious evidence (a focus of the Journal), that these services improve patient outcomes and that patients want them,” he says.

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

“Full-scope pharmacist services include all proactive and comprehensive interventions that prevent or manage illness and are within an individual’s competency to perform independently.”

A recent evaluation of 12 systematic literature reviews, four non-systematic reviews and five original studies found community pharmacy interventions have led to improved asthma control, detection of diabetes and cardiovascular risk factors, reduction in smoking rates and weight, and identification of drug-related problems.

The narrative review also found the availability of vaccination services in pharmacies has contributed to increased vaccination rates, and pharmacy support programs for drug users has seen the transmission rate of blood-borne diseases decrease.

Pharmacists have been found to effectively provide lifestyle and medicine management support to reduce cardiovascular disease (CVD) risk, and screening for diabetes and CVD.

Evidence also shows that independent pharmacist prescribing has been demonstrated to be as safe and effective as doctor prescribing.

The Guild says its Community Pharmacy 2025 project has identified major health trends that are having an impact on the core medicines role of community pharmacy, including the growth of personalised medicines, biologics and biosimilars, and a focus on vaccines.

“Now more than ever, it is vital that pharmacists – the trusted medicines experts – operate uniformly and nationally to the full scope of practice, making maximum use of their clinical skills and knowledge, collaboratively with other health professionals,” says Mr Quilty.

He says the greater utilisation of pharmacists:

  • Will greatly benefit patients;
  • Will be within existing limits of pharmacists’ expertise;
  • Is regulated by a national practice board;
  • Is already in place in many comparable countries;
  • Will always be conducted collaboratively with doctors and other health professionals;
  • Will save money in the health system; and
  • Relieve some of the stress on GP surgeries and emergency departments.

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