Should pharmacists or nurses be licensed to prescribe medications?

[David Baxter PhD]

Prescriptive Authority - Are Pharmacists “Write”?
By Jennifer Gibson, PharmD
June 29, 2008

Pharmacists are integral members of the health care team in the US. The profession is composed of highly-educated, well-trained health-care providers. Pharmacists promote themselves as “drug experts” for good reason: the four-years of education required to obtain the Doctor of Pharmacy (PharmD) degree encompasses the etiology, pathophysiology, clinical manifestations, prevention, and management of human disease states. Pharmacists study the clinical application of pharmacology, biopharmaceutics, pharmacokinetics, therapeutics, adverse drug reactions, laboratory data, and drug information to the management of disease states. This training enables pharmacists to identify and prevent drug interactions, plan patient evaluation of drug-related problems and recommend changes in pharmaceutical care plans, and evaluate and interpret pharmaceutical data.

Still, these drug experts are not granted prescriptive authority under state or federal laws. Of course, physicians, osteopaths, dentists, and veterinarians have long-standing authority and experience in writing medication orders and prescriptions. In most states, these practitioners are granted full prescribing rights to any medication available, whether or not it falls within the scope of his or her practice. Each state governs its own laws regarding the prescriptive authority of more specialized practitioners, including podiatrists, nurse practitioners, and physician assistants. In some states, these practitioners have broad prescribing powers, while other states limit the type or schedule of medication allowed to be prescribed, or require strict collaborative practice agreements with physicians. Yet, almost no state allows pharmacists to prescribe or manage medication therapy outside the strict bounds of tightly controlled protocols for relatively routine medications.

...

Still, pharmacists are the profession with the most education and experience in drug therapy. Expanded prescriptive authority for pharmacists would have benefits in cost and safety for the public. Pharmacists already govern the dispensing of some medications in a quasi-prescriptive role. Such “behind the counter” medications require pharmacists to consult with patients prior to the sale of medications that do not require a prescription, but do necessitate some level of supervision by a health care provider. The pharmacist is required to assess a patient for medical history, current medications, and drug allergies before dispensing the medication. Many professional groups advocate for an expanded “pharmacist-only” class of over-the-counter medications to increase the public’s access to medications.

 

[Retired]

Pharmacists are well-trained and well-educated medical professionals with richly-developed clinical judgment and scientific skills that are unparalleled by any other medical profession.

I would challenge that statement as being too broad and overly optimistic about the skills of many pharmacists.

If a pharmacist has worked in a hospital pharmacy, there is a greater likelihood that person has developed diagnostic skills and judgment.

However IMO and based on a professional relationship with this profession throughout my career, many if most pharmacists in a retail setting do not possess the knowledge or diagnostic skill or intuition to effectively treat patients, not to mention the potential for a conflict of interests at several levels.

The line between professional health care provider and retail business owner is blurred in retail pharmacy, and many of the behind the scenes business dealings in retail pharmacy might well bias a pharmacists judgment.

I have met a few nurse practitioners over the years and have been favorably impressed by the dedication and expertise of the ones with whom I have had contact.

Furthermore, in the jurisdictions in which these particular practitioners work, they collaborate closely with a partner physician when prescribing.

In conclusion, allowing a substitute to the lead physician to prescribe a renewal prescription or even initiate a therapy in some situations, there is always the risk of confusion or error unless there is a procedure for ultimate verification by the lead physician.

Too many cooks spoil the broth ----Grandma was right

 

[David Baxter PhD]

I agree. And if you extend this legal right to pharmacists and nurses, where does it end? In some jurisdictions, psychologists are demanding (or have been granted) prescribing rights - I think this is also dangerous.

 

[Kanadiana]

I like the idea of "team work" and good communications/consults between my doc/s and the pharmacist, with prescriptive powers staying with my doc who knows (or should know) my full status and conditions regards health, med history etc etc etc! I want BOTH paying attention to everything to do with meds.

When I first got to this town I had a doc who was not too swift (understatement) and he prescribed a new powerhouse drug for me while not bothering to take me off another one (both the new and old were high dose!) and they were contraindicated.
My pharmacist noticed, and very concerned talked to me and told me to talk to my doc about taking me off one or the other asap ... which I did, but I stopped one immediately before seeing him next time and explaining what pharmacist said anyways!

It's SO important for docs and pharmacists to work together when it comes to meds, and I totally trust my pharmacists expertise and knowledge and will go running back to my doc with any advice/suggestions/warnings from my pharmacist, as they know theier stuff ... and again, I want prescribing powers to stay with my doc who knows my file and care (or should know )

Chronic conditions and multiple meds makes it extrmely important, I say, for both to work together and pay attention on each end.

That's my 2 cents worth and I'm stickin' to it

 

[Daniel E.]

Times have changed:

My husband's current psych prescriber is a clinical pharmacist (PharmD) at the Veteran's Administration. The PharmD is just as good (or better) than any of his previous psychiatrists as far as medications and "bedside manner." And he does have to refer out to a VA psychologist or psychiatrist for some things like diagnosing.

Most prescribers I see now are not MDs. Not only is my primary care a nurse practitioner (NP), so is my psych provider. Same thing with dermatology.

Related thread (also from way back):

Ontario pharmacists get prescription renewal authority

Ontario pharmacists get prescribing power CBC News Mar 31, 2011 Patients having trouble filling a prescription in Ontario may find things easier this spring, because they can turn to their pharmacist rather than their family doctor. Recent changes to the provincial Drug and Pharmacies...

forum.psychlinks.ca

 

[David Baxter PhD]

I know that up here they are trying to expand the number of health care professionals who can prescribe. That includes psychologists which seems a bit dodgy to me. Pharmacists and nurse practitioners I can see though.

 

[Daniel E.]

Prescriptive authority for psychologists movement - Wikipedia

en.wikipedia.org

Currently, in states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral degree (PhD/PsyD), a license to practice independently, and completion of a Master of Science in clinical psychopharmacology (MSCP) degree or equivalent. Current programs that offer the MSCP degree are: The California School of Professional Psychology at Alliant International University, The Chicago School of Professional Psychology, Fairleigh Dickinson University, Idaho State University, and New Mexico State University...

Prescriptive authority for psychologists has been controversial, even within the healthcare community, which has created entire organizations dedicated to objecting to prescriptive authority for clinical psychologists. Specifically, critics within the medical profession have expressed concern that they have no medical training. The current RxP model explicitly states that this movement includes no medical training, but this can be accomplished with a master's degree in psychopharmacology, typically from a postdoctoral education program at a professional school. Some opponents claim this would culminate in substantially fewer years and hours compared to physician assistants and nurse practitioners, who are granted full prescriptive authority, and can elect to specialize in psychiatry, unlike the majority of psychologists.[19][20]

However, proponents have rebutted this assertion by describing their sequence of training (e.g., 4-year undergraduate degree, 5-year doctoral degree, 1-year internship, 1-year residency/fellowship, 2-year master's degree in psychopharmacology, national psychopharmacology exam, supervised clinical experience). In addition, survey research comparing prescribing psychologists' training against that of nurse practitioners and physician assistants has demonstrated that when presented with un-labeled training programs side-by-side, prescribing psychologists' training is perceived to be more rigorous overall than that of psychiatric nurse practitioners or physicians assistants in their ability to prescribe psychiatric medication.[21]This perception was found to be true of physicians, mid-level providers, psychologists, non-prescribing therapists, and general members of the public.