This is Part One in a three-part series on pharmacist prescribing. Part Two reviews pharmacist prescribing in community settings and Part Three discusses prescribing in hospital settings. Yes, pharmacists, like me, do work in our hospitals!
Pharmacists in Alberta, and across Canada, have recently joined other health care professionals as prescribers of medications.
Since 2007 Alberta, as compared with other Canadian provinces, allows for the broadest pharmacist scope of practice in Canada, and arguably the broadest in the world. As Albertans, we should be proud of our progressive stance in this area of health care, but what does it actually mean to you, the patient?
Based on a wide review of Canadian research studies, there are some well documented benefits to having a clinical pharmacist with prescribing ability manage your medications. The research studies show improvements in blood pressure control, blood sugar control, and heart disease risk factor control, when clinical pharmacists work with patients and prescribe and monitor their medications.
Authorization and Training
Now you are probably wondering what special training or certification pharmacists in Alberta must hold in order to prescribe.
In Alberta, you can divide prescribing into two broad categories: general prescribing by any pharmacist, and additional prescribing authorization for designated pharmacists. Other provinces have or are developing a similar approach such as the certified pharmacist prescriber process in British Columbia.
The bottom line is that all pharmacists can prescribe for you in cases of medical emergency (think anaphylaxis), to provide for continuation of your long-term medications (think running out of your blood pressure medications), or to modify an initial prescription written by another prescriber (think a dose that isn’t correct for your weight).
The next level, which is often referred to as “additional prescribing authorization” allows for designated pharmacists to prescribe all medications, except for narcotics and controlled substances. I’ve described here how to find a pharmacist with additional prescribing authorization.
To obtain this additional authorization, pharmacists are judged by their peers, after submitting a lengthy application that demonstrates their competency to prescribe using real-world patient care cases.
I have additional prescribing authorization, and I use it regularly to streamline and improve medication therapy for my patients in the intensive care unit. This is of course done with constant communication with the patient (when possible) and their other health professionals such as nurses, and physicians.
What Medications Can My Pharmacists Prescribe?
As described above, In Alberta, practically all medications can be prescribed except for narcotics and controlled substances. Most drug insurers now cover pharmacist prescriptions as well.
Other provinces have adopted different approaches to pharmacist prescribing which may limit prescribing to certain low-risk medical conditions, or a list of specific medications. To find out more about what your pharmacist can prescribe if you live outside of Alberta, check with your pharmacist or the website of your provincial pharmacist regulatory college.
What to Expect When Your Pharmacist is Prescribing
Before your pharmacist writes you a prescription, they need to explain what they would like to do, and how this will benefit you. Generally they should see you in person, so that they can complete a thorough assessment of your current health and medication needs. They will obtain your consent and document the discussion in their health records.
After writing the prescription, they will notify your main prescriber, such as your family physician, of your new prescription.
Risks and Conflicts of Interest
Clearly there are a number of risks that come with pharmacist prescribing. For me, the biggest professional risk is the potential conflict of interest when the pharmacist who is prescribing, is the same pharmacist who is dispensing your medication.
The Alberta College of Pharmacists standards of practice state the pharmacists should strive to separate dispensing and prescribing. However, in practice I have not seen this rigorously enforced in most community settings.
This is why I always operate as an independent clinical pharmacist, who does not dispense the medications that I have prescribed.
If your pharmacist is in a position to prescribe and dispense, you should have a conversation around how they are being paid and if this may influence their reason to prescribe. In addition, many pharmacists working in community pharmacies are under increased pressure by employers to increase the number of prescriptions written, since, in many cases, each prescription written (and dispensed) may be billed to a government payer.
Other risks include pharmacists not having sufficient knowledge about your health issues and specific health conditions. Prior to writing a prescription your pharmacist should be aware of all your health conditions and current medications, similar to any other prescriber. This is to avoid dangerous drug-drug or drug-disease interactions, which can result in a worsening of your health conditions.
I think that the positive impact of pharmacist prescribing generally outweigh the risks so long as pharmacists address potential conflicts of interest and openly collaborate with other members of your health care team.
If you have a question about pharmacist prescribing or a story you’d like to share, please leave a comment below.