To be clinically elegant is to seamlessly blend pharmacodynamics with pathophysiology.

31 January 2009

Prescribing Pharmacists

The next time you go to the hospital or clinic it might be a pharmacist that writes you a prescription for your medication. Ever since the clinical pharmacy movement started in the 1970s, the role of pharmacists has slowly taken on new roles and more responsibilities in addition to filling and dispensing drug orders, that in some cases includes prescribing. Many times it is the pharmacist who is consulted by nurses and doctors to choose an appropriate agent for complicated inpatient (or outpatient) issues. Pharmacists have been prescribing in Australia and Great Britain for many years now under the supervision of an already established prescriber, a practice which they call secondary prescribing. The Department of Health in the UK stated that as of the end of 2004, the first year that legislation allowed it, there were around 
1000 pharmacist prescribers. The Royal Pharmaceutical Society of Great Britain states, "Regulations to allow independent prescribing (without the supervision of a doctor/ mentor) by pharmacists came into effect in May 2006. Pharmacist independent prescribers can prescribe for any clinical condition but they must only prescribe within their professional and clinical competence." (see #1. below) Of the numerous studies examining the proficiency of, and need for pharmacist prescribers, the consensus has been that allowing this responsibility to pharmacists; improves patient care, frees physicians for more pressing cases, and saves a great amount of money for the healthcare industry and its patients. 

    One Irish study made some interesting discoveries after interviewing a number of new prescribing pharmacists and the doctor/ mentors that helped them during their first two years. The article was called: Pharmacists' and mentors' views on the introduction of pharmacist supplementary prescribing: a qualitative evaluation of views and context, and was published in the International Journal of Pharmacy Practice, 2007. They found that, "all participants [pharmacists & doctors] saw it [prescribing rights for pharmacists] as the next step, a natural progression for pharmacy and something that would formalize current practice." They make the claim that prior to this official legislation pharmacists had been effectively performing this type of prescribing only without receiving the due recognition for their input into patient care. One pharmacist was quoted saying, "I would like the ability to change that of my own accord without having to go to a junior doctor who knows absolutely nothing, just tell him to sign off something I've told him to do, which to my mind is ridiculous." Moving in this direction will require pharmacists to be more proactive than reactive. Pharmacists have always been seen as the 'safety net' with regard to correcting or 'catching' prescribing issues, but expanding the role to envelop prescribing within a professional and clinical area of competence or specialty, will bring pharmacists to the forefront of patient care and responsibility. It will save time and money to involve a pharmacist at the beginning of a patients' care rather than only to come behind to fix or catch mistakes that were out of his control. Its the difference between, "offering advice and making decisions," one pharmacist reported.

    Surprisingly, pharmacists have even been prescribing here in the US for some time now too. March, 1995 the Veterans Affairs Medical Centers (VAMC) received the go ahead from the FDA to issue a directive that allowed for an expanded scope of practice, including  independent prescribing privileges for Clinical Pharmacy Specialists (CPSs). In addition to the normal activities of a registered pharmacist, this new directive allows CPSs to prescribe new medications; including, initiation, continuation, termination or alteration of drug therapies, and the authority to perform, order, or review physical exams and lab tests. CPSs can now assist in emergency procedures, adverse drug reactions, patients with chronic and acute diseases, and administer medications. (See: Prescribing privileges among pharmacists in Veteran Affairs medical centers, American Journal of Health-System Pharmacists, 2001.) 

    Dare I say that there is not a more exciting time to be a pharmacist since Alexander Flemming discovered the antibiotic properties of penicillin in 1928! Independent prescribing rights for pharmacists is a major advancement for the career. It will necessitate current pharmacists to embrace a changing job description with increasing roles and responsibilities and it will require students of pharmacy to be engaged and alter their goals and outlook for their career.  I believe that in a decade's time we will look back and realize that prescribing rights for pharmacists was a logical advancement and we won't be able to imaging what it was like before they could. 
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    Pharmacists don't get old, they just loose their potency.