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Pharmacists in Alberta get prescribing powers...
- Thread starter WVUPharm2007
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What amazes me is that pharamcists can prescribe whatever they want (controlls excluded) at certain VA's and nobody seems to care. Let me clarify. I'm not amazed that they are allowed to prescribe, I'm amazed that this isn't the rally cry of more progressive pharmacists. I talked to one of the prescribing pharmacists at the VA who said they have prescribed everything from hydralazine to zoloft to lipitor. Wouldn't this be a good place to start making an argument? Of course this is a horrible point for me to make because i don't really care and will not be doing anything about it. thank you
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I think it's an excellent step forward.
I'd have no problem doing whatever extra training is required to get the prescribing priviledge. Any steps that entail retail pharmacy applying more clinical knowledge is excellent.
I'd have no problem doing whatever extra training is required to get the prescribing priviledge. Any steps that entail retail pharmacy applying more clinical knowledge is excellent.
Hi everyone, I'm new to this forum. Currently, I'm a pharmacy student in Alberta and thought it would be nice if I could share some information with those who are interested.
Definitely lots of mixed feelings in Alberta about prescribing. But I think its mostly from the older pharmacists who were not trained as extensively in pharmaceutical care. The actual layout of prescribing is still not very clear. But, from what I understand, is that all pharmacists will be able to change dosage forms/strengths, initiate emergency therapy, and renew refills (indefinitely). Pharmacists have the right to opt out of this apparently. Specialist pharmacists like cardiac, ID pharamcists will need to do an interview with the college, and then will be able to prescribe all drugs within their specialty. We're taking baby steps right now, and most of the pharmacists are quite conservative, and will prescribe when absolutely needed and will probably refill the Rx for a month or so. We'll probably see more action coming this fall.
As an aside, Alberta is also rolling out a program called NetCare. Essentially it will have the patient's whole medical/medication history, diagnosis, lab values etc. linked to their health number. Pharmacists will be able to access relevent information, hence support their prescribing practice. Alberta is definitely the guinea pig, but I'm aware that our neighboring provinces are also developing their pharmacist prescribing regulations, and so I'm assuming it will spread across the country in the near future. I don't know if this is going to affect our US counterparts. What do you guys think?
PS. Sorry for so much typing, I'll keep it down next time.
Definitely lots of mixed feelings in Alberta about prescribing. But I think its mostly from the older pharmacists who were not trained as extensively in pharmaceutical care. The actual layout of prescribing is still not very clear. But, from what I understand, is that all pharmacists will be able to change dosage forms/strengths, initiate emergency therapy, and renew refills (indefinitely). Pharmacists have the right to opt out of this apparently. Specialist pharmacists like cardiac, ID pharamcists will need to do an interview with the college, and then will be able to prescribe all drugs within their specialty. We're taking baby steps right now, and most of the pharmacists are quite conservative, and will prescribe when absolutely needed and will probably refill the Rx for a month or so. We'll probably see more action coming this fall.
As an aside, Alberta is also rolling out a program called NetCare. Essentially it will have the patient's whole medical/medication history, diagnosis, lab values etc. linked to their health number. Pharmacists will be able to access relevent information, hence support their prescribing practice. Alberta is definitely the guinea pig, but I'm aware that our neighboring provinces are also developing their pharmacist prescribing regulations, and so I'm assuming it will spread across the country in the near future. I don't know if this is going to affect our US counterparts. What do you guys think?
PS. Sorry for so much typing, I'll keep it down next time.
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As long as I don't have to give anyone a prostate exam, it's all good.
Thanks for your insight.
I mentioned this last year when I was in BC, Canada. Apparently, you have areas which have tremendous mileage between their prescriber and themselves - and you are in the middle.
Although I can see your position, given your geographic circumstances, I don't see that happening here. Altho we have many rural areas with large distances (think WY, MT......not - WVU!!!😛 ) it is not unmanageable yet. Are there specific parameters which are to be followed?? (ie - similar to our collaborative practice agreements).
I am far more interested in your NetCare. That would be a tremendous help in our current practices.
Currently, in the US, there are substantial issues related to the adequacy of education & clinical experience to just provide medication management by pharmacists. I think, here, we are a long way from prescribing & actually, I can't even see its needed (& I'm in an area with difficulty in access to providers - not due to geography, just due to population density).
I just wish we could do what we are supposed to do, which is be good pharmacists .....well!
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WVU isn't a state....it's a college....geez....
Having those that have that whole BCPS thing next to their names starting it off is probably a good idea.
Having those that have that whole BCPS thing next to their names starting it off is probably a good idea.
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The "netcare" June described is coming into our province in 2008, although the exact name here I'm not sure of.
Basically you can access a pt's Dx, lab values, condition, prescriptions, notes etc and hospital admittances.
Pretty sweet.
Basically you can access a pt's Dx, lab values, condition, prescriptions, notes etc and hospital admittances.
Pretty sweet.
ooops!!!!I DO NOT know why I can't get that right......I guess its VA, WA...then you - WVA, who is, I know this - from a rural state, but not with great distances (see - I'm teachable - it just takes me awhile longer). I cannot separate you from the state - I guess you gotta stay.
But, sorry - WV is indeed the state & one to be proud of!!!
In fact....dr sdn & I have just spoken that on one of our trips to see MSIII we need to go see WV (got it right this time😀 ) since neither one of us has ever been there...
Again - my apologies😳 .
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I DO NOT know why I can't get that right......I guess its VA, WA...then you - WVA, who is, I know this - from a rural state, but not with great distances (see - I'm teachable - it just takes me awhile longer). I cannot separate you from the state - I guess you gotta stay.
But, sorry - WV is indeed the state & one to be proud of!!!
In fact....dr sdn & I have just spoken that on one of our trips to see MSIII we need to go see WV (got it right this time😀 ) since neither one of us has ever been there...
Again - my apologies😳 .
Aint nothing to see in WV.....move along...
Yeah...but.....MSIII is too busy now to see us very long. We did GA, SC, NC last time....
OK - maybe the north & come south - start in Maine & go along the coast that way????
Why are you online at this time of day??? Don't you have some dop you need to harrass?😀 Hmmm - I'm betting you're either about to tee off or just got off the course.....consultant my Aunt Fanny😡 !
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Historically, we are the ballsiest people in the country.
Seriously though, are most people in the West that oblivious to the rest of the country? It seems to be that way to me observing over here on the other side. Every time I mention WV to someone on the internet, they tell me something like they "have an uncle in Richmond." I mean, heck, even *I* - the ignorant West Virginian - knows Oregon is a state.
Then throw in the irony of people thinking everyone in WV is still an ignorant yokel, barefoot, and without teeth and it gets a life of it's own within the public lexicon. If I'm not married to my cousin or have multiple teeth missing, they are disappointed when they see me. Heck, I actively perpetuate the myth just because it amazes me that people still believe the stereotypes.
That's right. We don't like it when the English come pokin' round our business.
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Another thread successfully derailed by you guys😡 😡
Mein herz brennt!
Mein herz brennt!
Sorry, sorry, sorry👎 👎 👎 😳
I wish I could be involved in a dialog, but truly - I don't know you're system, the influences, the politics, and anything else which is involved. My only thought about your NetCare is envy. I wish we could have something like that here, but I'm afraid the US fear of privacy invasion will derail it for a bit.
Its not that I don't want to hear about it......so - carry on our Canadian friends🙂 !
Oh - I've already said - I was in BC last year - absolutely beautiful!!! But, I digress again🙁 ......
This time, I'm paying very, very close attention - I promise😀 !
I wish I could be involved in a dialog, but truly - I don't know you're system, the influences, the politics, and anything else which is involved. My only thought about your NetCare is envy. I wish we could have something like that here, but I'm afraid the US fear of privacy invasion will derail it for a bit.
Its not that I don't want to hear about it......so - carry on our Canadian friends🙂 !
Oh - I've already said - I was in BC last year - absolutely beautiful!!! But, I digress again🙁 ......
This time, I'm paying very, very close attention - I promise😀 !
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I have no idea. People like to visit to stare at trees, hike up mountains, go fishing, go white water rafting, go skiing, go golfing....and other boring such things. I guess if you are the outdoorsy type, it'd be right up your alley.
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I'll derail my own thread as much as I want.
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Don't forget base jumping after a good day of white water rafting.
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Oh, yeah, and crazy people like to jump off bridges...thanks....
Could we please go back to the topics of prescribing power for PharmD, specifically in the US please?. My hospital pharmacy director is a BCPS and she says it depends on the hospital/places you work at, you'll be allowed certain priviledges. Plus the BCPS test is hard and requires a lot of clinical knowlegde and skills. SO I wouldn't mind taking it to be certified as a prescriber...
I said I'd be good...so, here I am in the US.
We've always had prescribing rights - oh, well, as long as I can remember as a hospital pharmacist, which goes back to 1976 - so maybe not always. The way you function as a pharmacist within a hospital is dependent on what your P&T committee sets.
At my very first job - in 1976 (I was an intern at the time), the pharmacists had therapeutic interchange rights. When I became licensed & worked as a pharmacist at that same job, that meant changing Keflin orders to Kefzol 🙂) -the real deal - no generic at that time!).
The last hospital job I worked at full-time, the pharmacists actually wrote orders. The physician might write tpn per protocol or heparin per protocol or change IV ms to po per pharmacist....many others. We would then initiate the protocol then change it daily within parameters set by the P&T.
When it came to "fine tuning" things like electrolytes in tpns or titrating changed narcotics.....depending on the physician, I would either call the physician before I went outside the protocol then change the order, or vice-versa.
In an outpatient setting, the VA has many, many pharmacist prescribing circumstances. Remember, the VA does not function within any state laws - they only operate under federal law. So they can set & do whatever they want. I can't speak for all of them, but the SF VA has their pharmacist prescribing protocols set by a hospital committee similar to a P&T.
Now large clinics - like Kaiser & many in southern CA have prescribing protocols for anticoag, pain management, wound care, etc...in which pharmacists prescribe. These function within CA under collaborative practice agreements. They work just like immunizations and Plan B for minors.
Medicare Part D has mandated medication therapy management and there are some instances of large & complex management of pts for many disease states - htn, diabetes, etc... For the most part, they are not occurring in CA outside of Kaiser pts (a very few smaller pharmacies do it). There are some commercial companies which provide this service to some Part D patients via telephone.
There are discussions going on within the US pharmacist community with regard to MTM. As your director pointed out, it requires tremendous clinical skills since the risk of doing it poorly far outweighs the advantages of doing it at all. At this point, BCPS is not required, and the discussions are going on if that is the credentialling which will be required or if there will be another specialty added to the mix of current credentialling. In some instances, something like a CDE - certified diabetes educator might be sufficient. I expect there to be a decision & parameters in the next 2-3 years.
Yes, the BCPS is difficult - moreso than any licensing examination - and you have to be recertified every 2 years. But - it is not an unreasonable thing to do if you are going to take on the monitoring & changing of therapy.
Within CA, I think this will, at least for the foreseable future, be done within cpas. Our medical board will want there to be maintenance of physician direction of care & I really can't argue with that. As a patient, too many cooks can spoil the broth as they say...and I would not want one person, who is not a cardiologist telling me to change my htn medications, when my cardiologist is saying something different. So - there must be collaboration, which in itself, speaks against independence.
I apologize for the long post...but you asked ......😀
Now...back to base jumping - seriously??? Why do people do that??? I could perhaps see parasailing,, but not off a bridge.
So...lvp - does that give some answers? I think your dop will be a good resource for you.
Thanks so much. Your response is very thorough. I remember my director told me that she has to renew her BCPS every 7 years though. I can't quite recall correctly. Plus, there is another pharmacist in the hospital telling that a freshly grad can't just go on and take the BCPS but he/she has to have residency OR practice for a certain period of time before taking the test. By the way, anyone know what CGP is? (not the diabetics one). I was interviewed by a professor for pharm school who has both BCPS and CGP. HOw could there be so many smart people out there LOL Looking at them make me feel like I am a slacker
I said I'd be good...so, here I am in the US.
We've always had prescribing rights - oh, well, as long as I can remember as a hospital pharmacist, which goes back to 1976 - so maybe not always. The way you function as a pharmacist within a hospital is dependent on what your P&T committee sets.
At my very first job - in 1976 (I was an intern at the time), the pharmacists had therapeutic interchange rights. When I became licensed & worked as a pharmacist at that same job, that meant changing Keflin orders to Kefzol 🙂) -the real deal - no generic at that time!).
The last hospital job I worked at full-time, the pharmacists actually wrote orders. The physician might write tpn per protocol or heparin per protocol or change IV ms to po per pharmacist....many others. We would then initiate the protocol then change it daily within parameters set by the P&T.
When it came to "fine tuning" things like electrolytes in tpns or titrating changed narcotics.....depending on the physician, I would either call the physician before I went outside the protocol then change the order, or vice-versa.
In an outpatient setting, the VA has many, many pharmacist prescribing circumstances. Remember, the VA does not function within any state laws - they only operate under federal law. So they can set & do whatever they want. I can't speak for all of them, but the SF VA has their pharmacist prescribing protocols set by a hospital committee similar to a P&T.
Now large clinics - like Kaiser & many in southern CA have prescribing protocols for anticoag, pain management, wound care, etc...in which pharmacists prescribe. These function within CA under collaborative practice agreements. They work just like immunizations and Plan B for minors.
Medicare Part D has mandated medication therapy management and there are some instances of large & complex management of pts for many disease states - htn, diabetes, etc... For the most part, they are not occurring in CA outside of Kaiser pts (a very few smaller pharmacies do it). There are some commercial companies which provide this service to some Part D patients via telephone.
There are discussions going on within the US pharmacist community with regard to MTM. As your director pointed out, it requires tremendous clinical skills since the risk of doing it poorly far outweighs the advantages of doing it at all. At this point, BCPS is not required, and the discussions are going on if that is the credentialling which will be required or if there will be another specialty added to the mix of current credentialling. In some instances, something like a CDE - certified diabetes educator might be sufficient. I expect there to be a decision & parameters in the next 2-3 years.
Yes, the BCPS is difficult - moreso than any licensing examination - and you have to be recertified every 2 years. But - it is not an unreasonable thing to do if you are going to take on the monitoring & changing of therapy.
Within CA, I think this will, at least for the foreseable future, be done within cpas. Our medical board will want there to be maintenance of physician direction of care & I really can't argue with that. As a patient, too many cooks can spoil the broth as they say...and I would not want one person, who is not a cardiologist telling me to change my htn medications, when my cardiologist is saying something different. So - there must be collaboration, which in itself, speaks against independence.
I apologize for the long post...but you asked ......😀
Now...back to base jumping - seriously??? Why do people do that??? I could perhaps see parasailing,, but not off a bridge.
So...lvp - does that give some answers? I think your dop will be a good resource for you.
Thanks so much. Your response is very thorough. I remember my director told me that she has to renew her BCPS every 7 years though. I can't quite recall correctly. Plus, there is another pharmacist in the hospital telling that a freshly grad can't just go on and take the BCPS but he/she has to have residency OR practice for a certain period of time before taking the test. By the way, anyone know what CGP is? (not the diabetics one). I was interviewed by a professor for pharm school who has both BCPS and CGP. HOw could there be so many smart people out there LOL Looking at them make me feel like I am a slacker
CGP = Certified Geriatric Pharmacist
How can you be a slacker....you've only begun!
I've been in it for years & years - so no worries.
Please, do you know what are teh requirements to sit for the BCPS? Thanks a lot. Please clatify also: in order to keep your BCPS license, you need to reamin within clinical practice or do what? I am just fascinated by this certification thing as I've seen it involves a lot of clinical knowledge from my director. She's really sharp on dealing with drug-interaction cases, consultation... (hopsital ones not retail). I hope one day I can be like her. SDN1977, sir, are you a BCPS? Thanks a bunch!
lvp - I'll give you the info so you can access it yourself - ok? go to www.bsweb.org & you can get the information you need.
In a nutshell (which is actually as big as a poundcake, but whatever) - each speciality has its own credentialling requirements. Currently, there are 5 specialties - nuclear, nutrition support, oncology, pharmacotherapy & phychiatric pharmacy. There is talk about adding another speciality & this one dealing more with outpt services to deal with MTM than pharmacotherapy does (which I'm guessing your dop has).
I might have misspoken to you earlier - recertification used to be every 2 years - now it is every 5-7 depending on the speciality. Remember - this is NOT a license - it is a certification.
To my knowledge...you can work in every field without special credentialling, but some fields & some employers might require it for certain positions. Kaiser for one requires some of their positions to have credentialing, but they will also pay for that to occur.
It is not an inexpensive process - I think each examination is now about $600 and each recertification is about $400 for the exam. Some allow recertification by CE, but it is specified CE, so you'll pay the same no matter what.
The requirements for sitting for the examination are spelled out in the website. For new pharmacists, like yourself, if you have a PharmD & a residency, that qualifies you. Without a PharmD, you must be able to demonstrate 3 years of qualified experience. Again, each specialty will have its own requirements - this is for pharmacotherapy.
By no means is this without discussion within the professional community. In fact, the discussion sometimes is as heated when the debate took place to have the entry level degree changed to a PharmD. When you look at the website, you can see how few BCPS certified individuals there are - only about 3700 pharmacotherapy pharmacists in 2006 - that is a drop in the bucket of practicing hospital pharmacists across the country. However, if you look at nuclear pharmacy, I'm going to venture that a higher % of those pharmacists are certified.
Why? Because certification is not yet recognized as a standard of practice. In fact, the BPS actually sees that as a barrier in addition to the lack of differentiation of practice settings among those who are board certified & those who are not. Perhaps an analogy is similar to emergency medicine 50 or more years ago. Many IM or general practioners would staff em depts, but now it has become specialized to the point that most urban em depts require their physician groups to be either board eligible or board certified in emergency medicine. However, still, in many areas, ems are still staffed with IM, or FM physicians & they do a fine job. It is in those very specialized circumstances in which the pt will need that individual who can rapidly & reliably make those decisions that rely on the skills of a specially trained individual.
We currently are in that place as those ems of 50 yrs ago. We have pharmacists who do great work without credentialling. But, will that stay in place - I'm not sure. I'm going to guess that for something as new as MTM, it will ultimately be restricted to whatever board certification they decide.
As for myself - no, I am not board certified - but that is due to circumstance - not as a deliberate effort on my part. At the time pharmacotherapy took place as a specialty - 1988, the examination was extremely difficulty, far more expensive (in those $s) than now & only permanent faculty were obtaining certification. Likewise, the renewal was every 2 years by examination only. I had this already very full job, which was predominantly critical care & nutritional support. I was not doing nutritional support full-time and I had no need for that. Likewise, the exam did not address those areas in which I was most skilled. I would have had to go back and review - in great detail & depth - outpt tx of things like hypo, hyperthyroid disease, contraceptive choices, etc.....things I wasn't involved in and I had been out of school for 11 years. At that time, I was also a young mother of 2 children less than 6 yrs old with a husband who was looking at brain surgery. So - no....I had other things to do than to take this exam. It has never hampered my career.
But...that is not to say I wouldn't recommend it for a young pharmacist beginning or one just getting out of a residency. I do feel that we will ultimately get to that point. In fact, for MTM, I would indeed sit for the exam now, especially if they alter it to fit the skill set required. I'm good at what I do, but these examinations just don't fit what some of us do, altho I will admit, I've not looked at the pharmacotherapy one in quite a few years now.
As for inpt pharmacists....I'd advise taking the exam as soon as you're done with your licensing examination. I know its a lot of money & a lot of money to maintain it, but it may pay off for you.
I hope this gives you the answers you're looking for. Ask again if I can help.
Good luck!
Thanks so much sdn for taking your time writing these meticulous answers. The website is very helpful. I'll look at it more later. What amazes me is that you are a lady LOL I thought you were a gentleman before. And you have kids also !!🙂 There are so much for me to plan/do ahead and I'm not getting any younger at all. LOL Thanks again! I hope your husband is OK now...
I thought you were a gentleman before. And you have kids also !!🙂 There are so much for me to plan/do ahead and I'm not getting any younger at all. LOL Thanks again! I hope your husband is OK now...Thanks so much sdn for taking your time writing these meticulous answers. The website is very helpful. I'll look at it more later. What amazes me is that you are a lady LOL
I thank you so much and yes, indeedy, I am a lady. I can't honestly believe you've missed all the comments on my legs (oh - I wear short skirts - not tooo short mind you, just short enough😉 ). I am the kind of pharmacist who makes dops crazy😛 .And - yes, my husband is fine - that was a looong, time ago. But, it did put us in a position of reevaluating what is important in life at a very young age. Thus, I have a great life, great kids & a great career.
So.....choose wisely. Sometimes things must shift when priorities shift. Sometimes you get lucky - we got very lucky to be in a place with great cutting edge medical care 20 years ago.
