Pharmacists to soon prescribe in Ontario?

Discussion in 'Pharmacy' started by murdainc, Jun 1, 2008.

  1. murdainc

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    Awesome if this goes through... it would really set the trend for the rest of the country and possibly even North America!! I know that this is already in action in Alberta, but if Ontario follows suit, it would be a HUGE deal

    http://www.thestar.com/article/435052

    THE CANADIAN PRESS

    Ontario patients could soon get drug prescriptions from their local pharmacist as the governing Liberals look to join other provinces and expand the prescribing powers of pharmacists, nurses and other non-physicians.

    Despite concern from the country's doctors, Health Minister George Smitherman is asking for advice on who should be allowed to prescribe drugs and whether nurse practitioners – who have some prescribing power – should be able to write prescriptions for a wider array of medication.

    "You are seeing more and more the capability of the pharmacists being unlocked to serve patients," Smitherman said.

    "I think it's an appropriate thing to take a look at. Obviously it's got to be done with . . . an abundance of caution on behalf of patients but also recognizing that, for patients, it can be a matter of extraordinary convenience."

    The Ministry of Health is quietly commissioning a study which would examine whether those who have prescription authority now – like midwives, optometrists and nurse practitioners – should be able to prescribe more classes of drugs.

    The study would also look at the role of pharmacists and whether they could ease pressure on the health-care system by writing prescriptions.

    Ontario's interest comes after Alberta expanded the role of its pharmacists last year, allowing them to prescribe some drugs, give drug refills and inject vaccinations.

    New Brunswick is moving forward with legislation that allows pharmacists to refill prescriptions without a doctor's consent, alter the prescription if necessary and write prescriptions for minor conditions. Manitoba is also moving toward a system which would give pharmacists to not only the authority to prescribe drugs but also order and interpret tests.

    While doctors argue patients could be put at risk because pharmacists aren't trained to diagnose and prescribe medication, Smitherman said Ontario's pharmacists are well-qualified.

    "Pharmacists go to school for just about as long as doctor does so if we can deploy them more effectively as a front-line health-care provider, that could be advantageous to patients," he said.

    Having prescribing pharmacists would help take the pressure off clogged emergency rooms and doctors' offices, argues the Canadian Pharmacists Association.

    Executive Director Jeff Poston said pharmacists could help patients manage chronic illnesses which, in turn, would save them trips to the hospital. With the increasing scarcity of doctors, Poston said people in remote, rural areas also have more access to pharmacies than a doctor's office.

    Other provinces and countries around the world are increasing the authority of pharmacists so it's likely Ontario will follow suit, Poston said.

    "There is a definite trend," he said. "We're going to begin to see some real benefits for patients emerging from pharmacists and other health-care professionals having some increased authority to prescribe drugs."

    Pharmacists already diagnose and recommend medication for ailments like coughs, colds and diarrhea, he added.

    But Brian Day, head of the Canadian Medical Association, said today's pharmacy training doesn't prepare graduates for the responsibility of patient examination and diagnosis.

    A patient complaining of stomach pain could be given over-the-counter medication when they are actually suffering from a burst appendix, he said.

    "My father was a pharmacist and he had a great knowledge of drugs but he was never trained in diagnosis," said Day, adding prescribing pharmacists isn't the solution to the doctor shortage either.

    "To say this is an answer to the doctor shortage is ludicrous. The answer to a shortage of doctors is to produce more doctors."
     
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  3. Pharmavixen

    Pharmavixen foxy pharmacist
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    If George is still "asking for advice," looks like it's still years away.

    Dr. Day's objections would not be unexpected; he's very conservative. But already we're in partnership with drs. Where I work, they diagnose, and I sometimes tell them what to prescribe.

    Hey, now that we all have to buy $2M in liability insurance, we may as well ramp up the liability :p
     
  4. Pharmavixen

    Pharmavixen foxy pharmacist
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    More on the topic from the Canadian Pharmacists Association:
     
  5. aussiepharmer

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    Can American pharmacists also prescribe medications?
     
  6. Pharmavixen

    Pharmavixen foxy pharmacist
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    I don't believe any American pharmacists can prescribe. Liability is a much bigger worry for Americans compared with Canadians. For various reasons, Americans are significantly more litigious.
     
  7. RxWildcat

    RxWildcat Julius Randle BEASTMODE!
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    Prescriptive authority varies from state to state in the US, however pharmacists can prescribe in several states through a collaborative care agreement with a physician.
     
  8. Pharmavixen

    Pharmavixen foxy pharmacist
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    I stand corrected. How does it work?
     
  9. Priapism321

    Priapism321 Bursting with enthusiasm
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    Pharmacists on United States government property have prescriptive/order writing authority, sometimes unrestricted. Though actually, it would be more accurate to say that there is no federal law denying them this authority, and this lack of denial of authority is exploited quite liberally in some situations (get all that?). These prescriptions/orders, of course, are only honored on government property.
     
  10. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    Hold the phone!!! You mean you haven't prescribed from the fancy shmancy Florida formulary??? :D
     
  11. Priapism321

    Priapism321 Bursting with enthusiasm
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    Wow. Please. Let us not go there missy.
     
  12. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    Awww, so close.
     
  13. fungikid

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    An update:

     
  14. powertoold

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    I think allowing other health professionals to prescribe will decrease the load on physicians - perhaps allowing them to focus on more severe diseases.

    The problem is that, even though I support the pharmacy profession, I don't think many pharmacists are clinically prepared to write prescriptions. There has to be a certification exam in place to allow prescribing rights.

    I hope they initially impose harsh prescribing prerequisites and tone it down over time. This way, if it turns out to be a bad idea, pharmacists as a whole won't lose their credibility as prescribers.
     
  15. bigpharmD

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    i believe that canada does not use as many nps or pas so having pharmacist prescribing would be easier to get through than here...it is pretty funny how we have this PA who has no clue about medications used in a particular specialized patient population (lets say oncology) but a pharmd with specialized training and 20 years experience who teaches everyone about the medications has to jump through hoops/protocols to be able to write orders
     
  16. powertoold

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    It's all about playing the political game! Sad thing it is. I hope Canada's new policies work out in favor for pharmacists.
     
  17. Pharmavixen

    Pharmavixen foxy pharmacist
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  18. meister

    meister Senior Member
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    I think PharmD therapy changes in hospitals could be a very valuable thing.

    I don't think retail pharmacists should give out tylenol, let alone prescribing prescription medication. There is waaaaaaaaaaaaaaaaaaay too much variance, I know people who graduated 20+ years ago with a BSPharm who could not explain to me what clavulanic acid is or why it was paired with amoxicillin. My old pharmacy manager actually failed the boards the first time he took them, way back in like 1975.

    Lol.
     
  19. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Diagnosing? Nah. Managing pharmacotherapy? Sure.
     
  20. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Yes...a stewardess that knows more about planes in general that the pilot...and has to butt into the cockpit 30 times a day to tell them that they are flying wrong...and still gets ignored as the plane is bearing into a ****ing mountain.


    Yes...just like a stewardess...
     
    #19 WVUPharm2007, Sep 24, 2009
    Last edited: Sep 29, 2009
  21. Praziquantel86

    Pharmacist Moderator Emeritus 7+ Year Member

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    I'll disagree with that point - pharmacist input vastly improves the safety and efficacy of OTC medication use, as well as letting people know when it is inappropriate to self-medicate.

    The example you provided is a example of a bad pharmacist. I'm sure there are bad physicians, as well.
     
  22. meister

    meister Senior Member
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    My anecdotal evidence is all I have on pharmacist competency unfortunately. Only saw a handful of 'em worth a damn, all of them had PharmDs, all of them had graduated within five years.

    This was in retail though, and in Orange County, CA of all places. Probably the last place to go to find caring practitioners.
     
  23. GreyFox2002

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    I agree with many aspects of your posts and disagree with a few.

    I personally am against any pharmacist making a diagnosis for a potentially serious condition and prescribing a drug independently of a trained prescriber. I would not feel comfortable writing a script for Cipro 500 mg BID for 7 days because the patient is complaining of lower flank pain and burning while they pee. Why? Because I have no way of knowing if they have cystis or pyelonephritis (for example).

    I would however be extremely comfortable of putting together, optimizing, and monitoring an effective, safe, and economical drug therapy regimen for a newly diagnosed CHF patient who also is being treated for depression and DM Type II. I think any pharmacist who has completed a one or two year residency is more than capable, after taking a certification exam, for writing prescriptions based off of a physician's diagnosis and labs.

    I disagree with you on OTCs for the most part. Pharmacy schools train students on how to triage patients who have minor complaints, such as a head cold, headache, fever, allergies, from patients who may be more seriously ill. We ask a few qualifying questions and ask them about their history. From that point we know whether or not to recommend an OTC product, or to refer to their physician. Could you imagine how much it would cost the health care system if every patient went to their PCP (big shortage remember) for every minor ailment they had, as opposed to going to the pharmacy? A good example is sinusitis. The VAST majority of sinus infections are viral in origin, yet patients have a pretty good success rate in securing an augmentin (or avelox, shudder) script from their PCP with sinusitis complaints (i personally believe this is bad practice). So not only did that office visit cost the system $150, it cost the system another $50-$100 for an antibiotic that will have little use, and than you have to add in the fact that a small fraction of people may develop serious adverse effects to that antibiotic. This costs the system much more money. What the patient really needed was sudafed to relieve their symptoms, and some ibuprofen or tylenol to relieve the pain. A pharmacist would have given them that advice for free. Of course, any good pharmacist would ask them if they have hypertension or glaucoma before taking any nasal decongestant, and get a good medication history.

    There is a lot of value in pharmacists with their input on the proper usage of medications in this country. Its why we get educated for 6-8 years :) Its a shame our country doesn't want to take advantage of our talents, because all the studies show that pharmacists save money in medication usage costs and the prevention of drug related complications.
     
  24. meister

    meister Senior Member
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    I agree with all that you say really, but there are too many old geezers out there that don't know **** about medication management. So that's not going to happen in retail any time soon. We'd also have to fully integrate a standardized EMR so you could have access to the patient's chart. Honestly, there is so much potential for coordination and efficiency but we pretty much fail at everything at the moment.

    Just imagine single-payer with fully integrated EMR...sigh. Instead we rely on one MD to try and coordinate it all, meanwhile the patient is seeing specialists whenever they want, going to whatever pharmacy whenever they want, paying cash half the time, and the retail pharmacists are relying on **** third parties to pick up DURs and interactions. And nobody's listening to med advice from newly minted PharmDs.

    What a horrible system we have.
     
  25. Priapism321

    Priapism321 Bursting with enthusiasm
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    Amen.
     
  26. meister

    meister Senior Member
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    Kind of why I want to work for an HMO or something, I can't deal with insurance comapanies and schizophrenic reimbursement models after years in retail pharmacy and years working at a private physician's office.

    Yeah, I'll get paid hourly, probably won't ever make that much, and will have a boss who doesn't do **** but sit around and stare at excel charts all day, but at least I won't want to hang myself every day trying to navigate our crap delivery system.

    Maybe not an HMO, but somewhere in a hospital with a nice huge buffer from the real world.
     
  27. ffpickle

    ffpickle Thread Killer
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    hahaha.

    SDN should just hire you to post on here full-time.
     
  28. mikebob

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    Hey all, I am a pharmacy student at the University of Toronto.

    On the 9th of September the Ontario pharmacy association held a student conference regarding the new amendments to a series of by-laws regarding many aspects of healthcare. This includes the expanded scope of practice for pharmacists (as well as midwives, physiotherapists and dietitians). This proposed by-law amendment (bill 179), has already passed a first reading (yay!)

    The link below are the proposed expansions (as well as the limitations on perscribing):

    http://www.opatoday.com/documents/Executive%20Summary_%20Non-Physician%20Prescribing%20and%20Administration%20of%20Drugs_Nov12_2008.pdf

    The response of the association representing physicians of Ontario (OMA), was crass and uncalled for. Nonetheles, it is obvious that this proposal was only briefly skimmed over by the medical association, and the subtlety of the OPA definition of prescribing was overlooked.

    With regards to the other proposed expansions; many drug benefit programs as well as certain aspects of drug consultations remain unrecognized with respect to pharmacy reimbursement and OHIP. This means that prior to this bill, many aspects of what pharmacists do on a regular basis, are voluntary. For instance, the 'medscheck' program.

    By increasing the scope of practice, these aspects will be recognized and appropriate reimbursement issued. That is, the salary of the pharmacist will be increased.
     
    #27 mikebob, Sep 27, 2009
    Last edited: Sep 27, 2009
  29. devilpup

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    In Mexico, you can describe your symptoms to the pharmacist, explain how you can't afford a consultation by the corner doctor, and then ask what he/she recommends.


    They will diagnose on the spot and recommend a drug for you to purchase. I used to do that growing up in Mex...
     
  30. Pharmavixen

    Pharmavixen foxy pharmacist
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    I suspect OMA's reaction was by a few people with an axe to grind; if it were the CMA, that would say more about the systemic ignorance of doctors about what we do.

    I think pharmacists would be less likely to prescribe antibiotics for viral infections.
     
  31. try_infrared

    try_infrared Junior Member
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    I wouldn't count on it... McGuinty has already gone on record saying that we shouldn't expect to be reimbursed for altering/extending/modifying prescriptions. They're not doing this to make pharmacists feel all warm and fuzzy inside, they're doing it to save money, period.

    Sadly as a profession we're so wimpy and eager to please that we'll do it anyway...
     
    #30 try_infrared, Sep 27, 2009
    Last edited: Sep 27, 2009
  32. mikebob

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    The expanded scope of practice is not just limited to pharmacists prescribing. From the OPA conference, I was told that a variety of clinical services that pharmacists offer remain unrecognized. Moverover, the addition of new programs will also require appropriate reimbursement.
     
  33. try_infrared

    try_infrared Junior Member
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    I realize that an expanded scope of practice is about more than just prescribing, but I was talking about Bill 179 specifically. It's a good first step, but most of the stuff that OPA wanted to see included in the bill was shot down, and there's no extra reimbursement coming to pharmacists for the expanded acts that ARE part of the bill.

    In this province, it's going to take YEARS before any of this stuff really gets rolling, and probably years after that before we get paid for it.

    (p.s. I'm at U of T too :) )
     
  34. tjaze

    tjaze whateva i do what i want!
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    i guess we could also start drinking mexican tap water and see how that works out here.
     
  35. aussiepharmer

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    What about other provinces like Brit Columbia & Alberta? What are the situations like in these places compared to Ontario in terms of pharmacists' role/scope expansion & reimbursement?
     
  36. mikebob

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    I can wait :p
    I still have at least four more years!
     
  37. try_infrared

    try_infrared Junior Member
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    In Alberta, where pharmacists have been prescribing for two years (which includes not only adapting prescriptions but initiating new therapy) pharmacists still aren't being paid for these services. There's a task force in place that's working on developing a payment model for pharmacists, but it'll be at least 2010 before they come up with something.

    In BC pharmacists are only adapting scripts at this point, but they're already being paid for it - they get somewhere between $8.00-$17.00 CDN from the provincial government for each adaptation they make, and there are limits on the number of claims they can make for each patient.

    However, the health care systems in both of these provinces are light years ahead of what we have in Ontario. It seems like every initiative here turns into a bureaucratic nightmare and never actually gets put into place. We've been working on an EHR for over 10 years and still don't have even that in place! :(
     
  38. fungikid

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    Quoted for truth. It really feels like there are a million hoops to jump through, especially here where OMA has much influence and authoritative power.
     
  39. meister

    meister Senior Member
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    Maybe Mexico should start invading middle eastern countries or funding the overthrow of South American governments or dealing weapons to the Iranians for cash or hold people in jail indefinitely without trial and without access to counsel?

    Oh no wait those are completely irrelevant to this thread just like your idiotic comment.
     

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