Tuesday, November 4, 2008

Prescribing Pharmacists

The provincial government in British Columbia (BC) is planning on giving pharmacists the right to modify and refill prescriptions. They made this decision without consulting the British Columbian Medical Association (BCMA), which is the association representing the doctors in BC. The BCMA has since convinced the government that they need to discuss this paradigm shift with doctors in order to ensure patient safety.

Currently, pharmacists can only fill perscriptions. Their primary role is to ensure the prescribed drug will not have any unwanted side effects, like dosage toxicity or drug interactions. Pharmacists also teach their clients how/when to take the prescribed drug.

The new legislation would allow pharmacists to modify precriptions to a different, but similar drug or refill a perscription for upto a year. The former would be done if the initially perscribed drug was not working effectively or had unwanted side effects.

This legislation was proposed to counteract the doctor shortage we face in BC. If doctor's are not spending time refilling or changing perscriptions, then they can see more patients. This leglislation would also be more convenient for patients because they would not have to wait to see their doctor in order to get a quick refill.

The BCMA has a problem with the legislation because they feel that it will damage patient care. Many patients are given a limited prescription because the doctor wants to see them again quickly. For example, a diabetic may be given a 3 month perscription so that doctor will be able to see him again in 3 months and perform another checkup. If patients are getting their perscriptions refilled by their pharmacists, they may not bother to see their doctor for upto a year, which may be unnacceptable depending on their state of disease. From my time in the family clinic, I have seen many patients, usually men, come in for a prescription refill and then they bring up a number of serious health concerns. Do you think these guys would come to their doctor's office if they didn't have the pretense of needing a refill?

Another concern is miscommunication, if a pharmacist modifies the prescription drug or dosage, then the doctor may not be aware of this change when he is seeing his patient. I think this is a lesser concern because I'm sure that doctors and pharmacists would work together to establish a protocol to ensure these miscommuncations would not happen.

The BCMA is advising the government to modify the legislation because they are concerned with will negatively effect patient care. The pharmacists were supposed to gain prescribing power in January...we'll see what happens.

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