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  1. #1
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    New Laws Give Alberta Pharmacists the Power to Prescribe

    New Laws Give Alberta Pharmacists the Power to Prescribe Certain Medications
    by: JAMES STEVENSON
    Mar. 31, 2007

    CALGARY (CP) - Pharmacists in Alberta will soon have the precedent-setting power to prescribe medications, but grave concerns remain over their ability to make the right diagnoses.

    Laws that take effect Sunday morning will make Alberta pharmacists the first in North America to be legally and independently allowed to prescribe drugs for minor conditions or in urgent situations.

    They will also be entitled to modify or alter the dosages and duration of prescriptions written by doctors.

    Pharmacists are hailing the changes as a logical way to improve patients' drug therapy while easing the strain on overworked family physicians and jammed emergency rooms. They hope pharmacists in other parts of Canada will soon get the same powers.

    Some doctors say too many questions remain unanswered - including what types of conditions and medications are involved and who is ultimately responsible when there's a disagreement between pharmacist and physician.

    Jeff Poston, executive director of the Canadian Pharmacists Association, says the changes to Alberta's Pharmacy and Drug Act and Health Professions Act could be a shot in the arm for the health system.

    "There are numerous examples where I think patients can get treatment for a number of disorders from a community pharmacy. They don't need to see the physician, they don't need to go to the ER and the pharmacist is going to be perfectly competent in terms of managing them," Poston said from his Ottawa office.

    "Pharmacists are not going to be stupid about this. The patient who's got a headache and is also dizzy and has blurred vision, you're not going to sell them a new headache tablet. You're going to refer them to the emergency room straight away."

    But the president of the Alberta Medical Association says doctors remain unpersuaded that pharmacists have the education and training to assess and diagnose patients accurately.

    "If you're going to recommend a new treatment or new drug, you need to know with 100 per cent assurance that you're treating the appropriate thing," said Dr. Gerry Keifer, a pediatric surgeon in Calgary.

    "That's why we go to medical school."

    Keifer insists that concerns over the pharmacists' new powers derive not from "turf protection" but from concern that patients get the best care possible.

    Some doctors say pharmacists should be held to the same standards as they are for care and accountability, including rules on record keeping, liability insurance and strict protocols on contacting physicians when prescriptions are altered.

    Greg Eberhart, registrar of the Alberta College of Pharmacists, says many of the changes coming to Alberta on April 1 simply recognize what pharmacists have been doing daily for years.

    "We are not talking about these pharmacists venturing into the world of diagnosis as physicians know it," Eberhart said from Edmonton.

    "We're talking about pharmacists continuing to manage and work with patients and care for conditions that are presented in symptomatic form at pharmacy counters every day."

    He argues the new laws are an extension of changes over the years that have allowed pharmacists to "prescribe" such over-the-counter medications as common anti-inflammatories or anti-ulcer drugs and nasal spray - all of which were once prescription only.

    It will probably take until this fall for the college of pharmacists to start extending "additional prescribing privileges" to members who have clearly demonstrated knowledge and ability.

    Eberhart says pharmacists will not be authorized to prescribe narcotics or controlled substances such as opiates or anabolic steroids.

    Harvey Voogd, co-ordinator of the Edmonton-based Friends of Medicare, says his group is concerned about potential conflicts of interest.

    He said pharmacists could prescribe medication and then charge a dispensing fee, and could possibly also get paid by pharmaceutical companies.

    "I think we are concerned with the potential conflict of interest with pharmacists not only being retail operators, selling drugs, but now being in the position to prescribe.

    "It's not yet clear . . . how that issue's going to be dealt with."

    But practising pharmacists, including Carol Vorster in Fort McMurray, Alta., say the changes are a step in the right direction for the public.

    Vorster said the changes will come in small steps that shouldn't alarm anyone. "We don't want the public to start thinking that we can start prescribing like a physician," said Vorster.

    "The prescribing is really very limited and it's within a prescribed framework and definitely always in collaboration with other healthcare professionals."

  2. #2
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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    I think this is a very worrisome development indeed. There are the obvious conflict of interest concerns, and the lack of knowledge about the patient's personal and family medical history and risk profile.

    There's also the fact that pharmacy is already a very stressful profession. This is going to add to the stress levels which will increase the risk of human error.

    Frankly, I think this is a disaster waiting to happen.

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    At the present time, many pharmacists, particularly those whose experience is mainly in retail pharmacy, do not have the training to take on such a serious responsibility.

    There are some pharmacists with higher levels of training, and those who work in hospital pharmacies who routinely work in cooperation with physicians may have greater insights, but IMO still lack the competence to actually prescribe.

    It sounds like the College of Pharmacists in Alberta succeeded in lobbying the politicians on the basis of saving health care costs and freeing up emergency rooms, a politically attractive argument.

    It will be interesting to learn more about what their scope of responsibility will be and how the individual's level of competence will be assessed.

    I would be very hesitant to consult a pharmacist to recommend a medication to treat me. This is not the what a the profession is supposed to do and, as has been alluded to there is the obvious conflict of interests concern...a very real concern in a profession whose interests are to sell and to make a profit.

    There have been more than a few cases (not necessarily in Alberta) of pharmacists engaging in less than professional tactics in the interests of financial gain.

    Color me skeptical at this time.

    Steve

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    Quote Originally Posted by David Baxter View Post
    This is going to add to the stress levels which will increase the risk of human error. Frankly, I think this is a disaster waiting to happen.
    I agree completely. My immediate thought was not only for the patient/consumer safety, but also from a legal standpoint of just how many more lawsuits are going to be initiated like you said, as a result of human error. I am sure that the pharmacists' insurance will be much higher as well because of their liability for lawsuits/malpractice claims much the same as doctors are.

    This is definitely a disaster waiting to happen and in my opinion the only ones who are going to benefit in the long run are the lawyers.

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    This decision scares me alot. I don't know all the ins and outs, but I'm assuming that the pharmacist cannot (or ethically, should not) over-ride my doctors prescriptions/advice.

    I don't agree with this decision at all, and like I said, it scares me. I don't want to be taking a Rx in to get filled and have the pharmacist say "Well I gave you something else instead because I think it'll be better for you". Hopefully they won't be allowed to do that...

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    Quote Originally Posted by TSOW View Post
    It will be interesting to learn more about what their scope of responsibility will be and how the individual's level of competence will be assessed.
    I agree with Steve on this point. It will be interesting to see how this plays out.

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    In another article located here the portion of it that I find really frightening is this:

    But before pharmacists can perform all services now permitted under provincial law, they must be approved on an individual basis by the Alberta College of Pharmacists. With proper approvals from the college, they will be able to write new prescriptions, administer vaccines, significantly adjust medication doses and change drug therapies. The approval process won't be ready until fall.
    More specifically that a pharmacist will have the power to changes doses and therapies.

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    Nancy,

    That's the part that freaks me out...I don't understand...hopefully it won't mean that I go to get a Rx filled and they say "you don't need this much, we'll half it"...I don't understand why a pharmacist, who does not know the patient's history other than what's on a computer, can have this ability...a patient certainly should not be able to just adjust it...I think I read somewhere that we (the patients) have the right to say no to any recommendations they may make...I only hope that that is true...

    This whole thing scares me alot....

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    Re: New Laws Give Alberta Pharmacists the Power to Prescribe

    This scares me too. It's an underhanded way to get people to pay out of pocket for their health care... if you seek the opinion of a pharmacist you will be charged a dispensing fee, as it says in the article, whereas if you went to the physician for the same thing, alberta health care would be billed. I really don't want anyone mucking with my prescriptions.

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