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Discussion in 'Pre-Pharmacy' started by HeyyouETSU, Jan 4, 2008.
nice...I remember reading something on the internet like that too. this "autonomy" seem to be a future trend in pharmacy and all health care professional in general. "specialization", "autonomy" and "collaboration" are the future trend in healthcare. Who know in the future pharmacists might be able to establish their own little clinic at the drugstore like NP? CVS pharmacy will become CVS clinic/pharmacy. They don't have to hire NP at some CVS anymore.!!
That's good for patient too so they can get their medication right there for minor illness!!!
I guess part of the problem is that pharmacists don't get a lot of training in diagnosing compared to nurses and doctors. In a lot of other countries, pharmacists have the power to prescribe and it seems the U.S. is moving towards that trend too; however, the types of medications that they can prescribe is the problem that has to be dealt with.
Are you willing to work for 70k per year? Because thats what the average NP makes.
Nurses aren't good with diagnosis either. In fact, they are not trained to diagnose patients. I guess the more appropriate term would be "assess" patients, such as if he has a temperature, edema, bleeding, fever, etc...But a nurse won't be able to diagnose patient to conclude he has hypovolemic hyponatremia, etc...that's the medical job. Even medical doctors diagnose wrong a lot of times, too.
Yeah and the solution to that is to let people script who have EVEN LESS training at diagnosis than MDs and NPs.
You are probably also against the movement to allow psychologists to prescribe medications for mental illnesses.
Yes, the main thing we do is to "assess". However, the ability to assess patient at bed-side are also helpful to recognize symptoms and sign of the illness. But how come nurse practitioner earned "some" prescriptive authority without the supervision from MD but pharmacists don't. Is it because of higher lobbying power due to higher numbers? I assume that specialty NP also have some specialized knowledge about diagnosis from the training at school.
They can prescribe if they graduate from medical school and pass all three steps of the licensing exams.
Otherwise, they dispense.
I asked my pharmacist today and he said ambulatory care pharmacist can write prescription under the supervision of an MD. Also, pharmacists who work in a coumadin clinic.
In Illinois, any pharmacist who enters into a collaborative agreement can write a prescription as long as the agreement allows it. They new law doesn't limit by type of pharmacist.
Because of the conflicts of interests...Pharmacists main's role is dispensing (unless u do clinical pharm even so, it still involves in dispensing), not prescribing. If u can prescribe AND dispense? Wow...u're GOD
A lot of states have what are called collaborative medical agreements. These are formal agreements that pharmacists get with physicians to establish a protocol for diagnosing and prescribing for common illnesses. Most states allow only the prescription of refills, but as you mentioned, there are states like CA and WA that allow pharmacists a lot of freedom.
Emergency contraception is one popular drug included in a lot of protocols.
Washington State was the first to establish these back in the 1970s. I'll look for a link, but try looking up collaborative medical agreements, and that will lead you in the right direction.
I found this article as I was preparing for interviews. Might help.
View attachment evolutionpharmacy.pdf
this is really interesting...I wonder what states are adding this in the future...also maybe they will make it a specialization that requires a residency- I think that would help with the ability of pharmacists to be able to assess like doctors or nurses...honestly I think that I would feel better with a pharmacist dispensing than a nurse
pharmacists and doctors go to school for 4 years (graduate), nurses and PA's only go for about 2 years
if you think about it:
pharmacist spend most all of their education learning everything about drugs...but don't prescribe them
doctors spend most all of their education learning everything about assessing/ (prescribing) what is wrong with patients..but spend much less time learning a lot about drugs
Actually, pharmacology is a pretty big chunk of most medical school curriculum (2nd year) and I think most physicians get even more exposure to it during residency which are an additional 3-5 years. Does the pharmacy curriculum have any class that emphasize on diagnosis? I dont see any problem with pharmacist having the ability to prescribe if they have some training on diagnosing the patient, but i think it's pretty dangerous otherwise. You're basically talking about prescribing without any concrete information on the patient's condition.
I think pharmacists should be able to prescribe medication for minor things like birth control, pain medication, cough syrups, etc.
It doesn't take much brains to diagnose a sore throat. That way, instead of going to the doctor, waiting a few hours, the patient can go to the pharmacist, get some Tussionex and get their throat swabbed, anyone who has taken Microbiology is capable of running cultures.
Identifying the microbe isn't that hard, then after running a Blood Agar culture, you can tell what kind of hemolysis is going on and prescribe the appropriate antibiotic.
Minor things like that, pharmacists should be able to do.
Dr. Ron Paul is trying to get legislation passed that would allow pharmacists and nurses to do some of the basic things that physicians do.
I have no idea why this ******* McCain got the nomination over Paul. Why is it so hard for a person with Anti-Israeli policies to get elected in this country?
Oh yeah, to the guy a few posts above me.
**** the Phillies.
I completely agree...I think that simple diagnosing such as that which is learned during undergrad is a great example!!! so there is no reason why we should not be able to do simple things such as colds and such
That's the thing though. In most scencario, a sore throat is a sore throat and you dont even prescription to get medication for the common cough and colds. Most doctors will just tell you to get rest instead of prescribing anything for a common cold. But there are diseases that will give off simple symptoms but manifest itself into something much more serious and with those you do need to have some level of diagnosis and pathology training.
Stuff that I think Pharmacist should be able to give out is like Albuterol or those allergies medication that require prescription. It's such a pain to go make an appt with a doctor just to get some medication for seasonal allergies.
However, I'm against prescribing antibiotics unless the patient is in SERIOUS trouble. Otherwise, you are just encouraging the pathogens to get resistant to antibiotics.
Just treat the pain and fever so that the person can function.
The body's police department and SWAT team can take care of the body's criminals and terrorists. If you keep calling in the Navy Seals and the bloody SAS(antibiotics and vaccines), eventually the terrorists will catch on and be unstoppable.
I agree..but if you could eliminate the trip to the drs office for some things that would be great. I believe that doctors/media should educate the patient on the fact that antibiotics will help but also hurt in the fact that the strains will become resistant. Not many people at all understand that- if the doctor were to not prescribe them a z-pak and tell them to take a pain reliever to keep them comfortable they would just think they have a bad doctor!
as a student in one of the more progressive states on this movement I have a little input.
There is actually a bill in congress right now to get pharmacists recognized by medicare as medical practitioners so we can bill for our services.
Here in NM where we have a Pharmacist Clinician license you can prescribe under a set protocol between yourself and a physician.
99% of these Pharmacist Clinicians are not out to diagnose - although it does occur in rural areas where the pharmacist is more accessible than a physician (remember, this is New Mexico, it is not uncommon to be 4+ hours from a "town" containing a WalMart or the like. I still have trouble fathoming just how effing rural it is here).
More than anything else this is for disease state management. Patient is already diagnosed with CHF or diabetes. Due to the shortage of primary care physicians in this country pharmacists have been able to step up to close the gap on disease state management. It would be a waste to have a cardiologist managing every single run of the mill CHF patient. Patient is already diagnosed by a physician. Patient sees pharmacist in a clinic setting every couple weeks and is assessed for medications efficacy - according to a set protocol between the pharmacist and the physician the pharmacist adjusts medications accordingly. This could be maximizing a Beta-Blocker dose in a CHF patient or changing an ACE to an ARB due to side effects. It all depends on the particular protocol and practice agreement.
Many physicians who aren't familiar with the practice seem to think that pharmacists will be out willy nilly throwing drugs at people diagnosing zebras - this is not the case, and physicians who work directly in these settings are super appreciative of the pharmacist input.
Sounds like someone's in a microbiology class.
I disagree. The most important function of collaborative healthcare agreements is the ability for patients to have easy access to healthcare. I don't see any more effective use for this than in the realm of infectious diseases and epidemiology. Being able to provide vaccinations (like flu shots) and antibiotics are extremely important for people to have access to. And pharmacists have to follow a protocol, so it's not as if they will be sending out all sorts of antibiotics for every sore throat and runny nose that they see. The risk of resistance is a factor when improper usage of antibiotics occurs. But this happens with doctors prescribing too. As long as pharmacists are actively counseling patients and being sure to advocate proper use of medications, there shouldn't be any higher rate of resistance than in antibiotics prescribed by doctors.
Also... Mets are going down this year, buddy.
also, to achieve the pharmacist clinician designation (we were talking about the legislation involved today at an ASHP meeting) one needs to complete a 60-hr physical assessment course and 300 patients worth of primary contact. When logging the 300 patients they also log what assessments were done, why did the patient come in, etc. The protocols then set up for that pharmacist relate only to what they did in this training period.
IE: if you started out in a heart protection clinic (or anticoag or heart failure) you are only certified to assess patients using the methods used during that period. If you then got a job in a Family Practice clinic where they would like you to see DM, COPD, asthma, etc patients, you would have to do additional supervised hours to extend your protocol to these disease states.
I think most of the opposition comes from a lack of education and understanding of how this really works.
I read an article about a month ago (in the Washington Post) about how in the UK pharmacists are beginning to take on roles like this. They have to do some additional medical training, but essentially practice like general practice MDs with regard to diagnosis and perscribing drugs in that basic maladies they can diagnose, but have to refer the patient to a specialist for anything more serious. It said they could prescribe most medications but not things along the lines of morphine, codine, etc. Their health care system in the UK is very different than in the US but maybe this is the way we will be going too soon...
good for you. this sounds like consulting pharmacy which is exactly what I want to get into...it would be awesome to be able to write rx's though- this way you can evaluate the patient and possibly change their regimen to further their best interests
Thats the purpose of the pharmacist being able to prescribe. The idea is not so that they can go penning around the serious drugs (serious in terms of their effects/uses) but so that they can prescribe things that solve minor problems but are still stronger than OTC.
For example, someone comes in with a stronger than usual itch and needs topical hydrocortisone. Rather than giving the person the low strength OTC, the pharmacist would prescribe a slightly stronger than OTC; saving the person from going to the doctor to get the prescription.
At no point do I think the pharmacist should be prescribing antidepressants etc. unless they're "babied" with a physician.
I agree: antidepressants are too complicated...I don't even really think that medical doctors should deal with most cases that for a psychologist
Psyschiatrist are MDs
I highly doubt it. Once Pedro and El Duque come back, this team is gonna dominate. It sucks that the Marlins are leading the division with a less expensive payroll than A-Rod's yearly salary. Things should return to normal soon.
Here are my playoff predictions, mark my words:
Wild Card: Red Sox
Wild Card: Brewers
NL East is going to be impossible to tell until the last week. It all depends how healthy the teams are at that point. toughest division in baseball in my opinion... but I'm obviously biased.
I doubt the cubs can win the central two years in a row so I'm going to give it to the cardinals. I think they'll end up winning the division by about 15-20 games.
It's really a guess at this point. a long season and anything could happen.
But I can tell you for certain that the mets are going to miss the playoffs again. It's the phillies year.
Cardinals have been lucky. I mean, Adam Wainwright? Braden Looper?? Who are these no names?
Sorry, but the Phillies rotation and bullpen blows. The only reason they are playing so well right now is because Chase Utley is raking it.
Sparda, It might be wise to study more, complain less, and take your stinky METS somewhere else. No one wants to read EVERYTHING you write. Maybe your mother but that's the extent of it!
What, you guys don't like Baseball?
we all knew about it, sorry
I am definitely for pharmacists being able to write for lab tests to monitor medications. But medications... I'm all for expansion of professional responsibilities, but I'd be less comfortable with that.
In the coming years, we'll probably see the emergence of the third class of drugs aka behind the counter. Those will be drugs patients can get without a prescription but with a pharmacist's consultation. The drugs in that category are likely to be a combination of access drugs and lifestyle drugs. The FDA will probably start to move on it after the presidential election.
dude, I wish we could write for our own lab tests.
I would love to be able to write for a TSH rather than call the nurse, have her leave a note for the MD, MD order the lab work, wait for the nurse to call me and tell me the labs are ordered, get blood drawn, get a phone call a week later and discuss synthroid dosing.
I'd rather run a TSH when I know I've been compliant and come to the dr with a value (more like a diabetic).
I don't see why pharmacists can't be involved in chronic disease management. The pharmacist can prescribe and adjust after the diagnosis is made. Pharmacist have the training to identify any significant issues and refer back to the physician. This would leave physicians to have more time managing acute and complicated cases, leading to less wait times and etc.
Pharmacists doing injections and starting travel clinics would also be viable. A lot of time its just identifying resistant areas and knowing which vaccines and drugs needed = most from books/computer programs. Complicated cases again can be referred.
I wonder if pharmacists want this type of responsibility. I know many pharmacists don't want it, mainly due to financial accountability and the responsibility associated with diagnosing patients in addition to dispensing medication, especially when there is no financial incentive to do so on their part.
that's why it's optional to go for the further certification. if you don't want the responsibility, don't apply for it.
that's why it's set up the way it is.
Complications for pharmacists might arise if not given complete medical records with previous health conditions and allergies. Ideally, Pharmacists could simply ask their patients these things, but patients have been known to leave out crucial details (especially Alzheimers patients). The other option I can think of would require an extensive patient database that would be extremely security-compromising, if not outright violating patient-doctor confidentiality. It's tough issue to work out.
But for minor, low risk things like sore throats, I see no problem in letting a pharmacist prescribe some Cheratussin. Such things would greatly reduce medical costs by reducing doctor visits. Not only that, it would make doctors more available to those showing more serious symptoms like angina or bloody stools.
One question about pharmacist's capability to prescribe: I thought this was limited to prescription corrections. Such as if the pharmacist notices a dosage error, calls the doctor, and the doctor realizes the mistake, gives the pharmacist the go-ahead to "write a prescription" with the corrected dosage. Does anyone know for sure if you can just walk up to a pharmacist in one the above states and they can prescribe you a medication you have never had before? I personally have never heard of this...
In some states, such as NC, there are CPPs (Clinical Pharmacist Practitioners). They have to have a "supervising physician," but can write for prescriptions that the patient has never been on, and the supervising physician doesn't have to co-sign the prescription (they used to).
only doctors..but seasoned veteran nurses may be able to diagnosis some symptoms because of the exposure they have gained....
I agree that pharmacists should be able to prescribe for lite-medical conditions (sore throat, maybe ear aches, coughing, etc). If these pharmacist-run clinics start to become incorporated with Pharmacies, what about suturing/first aide type of stuff? Nurses/PAs etc can suture. Or what about dog bites, clumsy kitchen knife accidents, burns... etc. Do you really need to go to an ER/ED that type of stuff? Of course I see the moral hazard issue if pharmacists start to bite off more than they can chew. That would be an issue. Overall, what do you all think?
Although pharmacists are not trained to diagnose, they should be able to prescribe medications, including medications for serious illnesses, not just minor ones. After all, they are the drug experts, not MDs. Once the physician has made a diagnosis, the pharmacist should take over in recommending (prescribing) the proper drug treatment. According to Pharmacy Times, this is coming:
IT'S COMING: PHARMACISTS
A new report indicates that pharmacists will expand
their role to prescribing medications in at least 6
states in 5 years, according to report author
The state of Florida allows some prescribing off an
approved list, and many states allow prescription
choice from a physician diagnosis. The cost of
copays and time spent on physician visits will
increase the need for drug decisions to be made at
the pharmacist level.
The report, Prescribing Pharmacists, a Decision
Maker Emerges, details how pharmacists already
have a tremendous impact on drug revenues, and
companies that do not incorporate a marketing
strategy involving pharmacists will lose advantage in
the coming years. The analysis indicates that pharmacists are moving from their role of
dispensing medication based on physician instructions, to prescribing based on physician
diagnosis, to independent prescribing in some limited situations.
yes i read about this. pharmacists in florida allows around 200 drugs off of an approved list. it's pretty amazing!!!
as much as i hope that the general public could be more aware of a pharmacist's resourcefulness and their roles in decision making, (hence possibly leading to more respect for the profession), i don't actually think prescribing should become a part of their responsibility. if it does i'm actually a little worried..because ultimately the physician is the one who diagnoses, who has the best understanding of the patient's medical background, and THIS should form the basis of their ability to prescribe. if pharmacists are not educated this way (and lack this type of clinical experience), how are they expected to make as informed a decision as physicians?
health of the community should always come first. shaping the role of a health profession should come next, hence 'patient-centered pharmaceutical care'