Starting next year, Alberta pharmacists will be able to prescribe and initiate treatment for a variety of health concerns. In a statement by the Alberta College of Pharmacists available at http://pharmacists.ab.ca/newlegislation/faq.aspx, members will be able to “assess and triage each patient as required,” start “prescribing drugs to treat minor, self-diagnosed or self-limiting disease conditions…” and may even take “…full responsibility for establishing and maintaining a patient’s chronic drug therapy.”
Perhaps the most striking development is the positioning of pharmacists as primary care providers. Couched in terms of patient choice, “initial access prescribing” is described as “prescribing when a patient chooses you for advice about and treatment of minor, self-limiting or self-diagnosed conditions, about wellness programs, or in urgent or emergency situations.”
All of the above raises some very serious concerns. Knowing what a drug can do is one thing, making a diagnosis or knowing that a condition is minor is quite another, and the statement by the Alberta College that “Of all the health professionals in the system, pharmacists have the most education and training in the appropriate and safe use of medication” will make many doctors wonder why they wasted all that time in medical school actually looking after patients.
Will such lofty goals and clinical expertise come for free? It seems hard to imagine that the new breed of “prescribing pharmacists” will not seek further compensation. While the Alberta College states “money is not the issue here,” this could be yet another example of governments rewarding minimally trained “clinicians” with near-FP salaries for small jobs typically done for free by doctors.
The ideas of patient convenience, easy access, and quality of service have great merit. Given the excellence of computer drug and interaction databases to allay the old concerns of prescriber error and to monitor chronic therapy, a more efficient approach, (since conflict of interest now seems to be of little concern) would be to allow physicians to dispense.
—Lloyd Oppel, MD
Chair, Alternative Health and Therapeutics Committee, COHP
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