Prescribe three ways: Grattan


prescription

The Grattan Institute has released its submission to the Pharmacy Board of Australia’s discussion paper on pharmacist prescribing, recommending they be able to prescribe under all three suggested models

The Pharmacy Board’s discussion paper proposed that pharmacists could undertake this function via autonomous prescribing; prescribing under supervision; and under a structured prescribing arrangement.

Grattan Institute Health Program Director Stephen Duckett writes in the submission that pharmacists’ role in Australia is “far more limited” than in many countries.

“Australians miss out as a result,” he says. “People have to wait longer and travel further to see a GP for a service that their local pharmacist could just as easily have provided.

“Sometimes people get sicker in the interim, which increases costs on the individual and the health system.

“Evidence shows that pharmacists can safely provide repeat prescriptions to people with simple, stable conditions, and work with GPs to help patients manage chronic conditions. Allowing pharmacists to do so would improve the Australian health system by reducing pressure on the primary care system and improving people’s access to care.

“Pharmacists are already valued members of hospital health teams. Hospitals should be able to allow them to contribute even more.”

The submission proposes that pharmacists should be able to continue medications for long-term conditions, when the patient and GP agree, and when the patient’s condition is stable. This would be “straightforward,” he says.

“Depending on the condition, the GP could allow the pharmacist to issue continuing scripts for up to 18 months. Of course, if the patient’s condition changed, they would have to return to their doctor to discuss their condition and review their medication.

“Surveys of pharmacists in Australia suggest most are willing to take on this role, with further training.”

The submission also suggests that pharmacists need to work closely with medical practitioners, especially in primary care, and says that broadening the role of pharmacists should not undermine GPs.

“The work of the pharmacist in primary care should only be in collaboration with the GP.

“For this reason, pharmacist prescribing in the community should be within the context of a structured prescribing arrangement with each GP.”

The prescribing under supervision system outlined by Health Workforce Australia in 2013 – where “a prescriber undertakes prescribing within their scope of practice under the supervision of another authorised health professional; the supervised prescriber has been educated to prescribe and has a limited authorisation to prescribe medicines that is determined by legislation, requirements of the National Board and policies of the jurisdiction, employer or health service; and the prescriber and supervisor recognise their role in their health care team and ensure appropriate communication occurs between team members and the person taking medicine – should not be the way prescribing generally occurs outside hospitals, Mr Duckett writes.

“The ‘under supervision’ approach would allow a pharmacist, under the supervision of one medical practitioner, to change medications prescribed by a different medical practitioner, or to initiate new medications for a patient not under the care of the supervising medical practitioner.

“The only circumstances within which that should occur is if the pharmacist is subject to some form of accountability to both the supervising medical practitioner and to the medical probationer whose patients are having their medication changed.

“This might be appropriate where a pharmacist is employed in a group practice. It would also be appropriate in hospital care.”

Pharmacists should be able to assist with chronic disease management, he said, citing international evidence of pharmacist interventions improving management of blood pressure, blood glucose and cholesterol levels, and improving self-care.

In hospitals, pharmacists should be allowed to prescribe, he writes; they could be more autonomous than in the community due to the fact that hospitals have established clinical governance arrangement.

“Pharmacists with autonomous prescribing rights should have their scope of practice delineated by the hospital in exactly the same way medical practitioners’ scope of practice in the hospital is delineated.

“Hospital pharmacists might also prescribe under supervision of a hospital doctor.”

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