As a community pharmacist working in Alberta (Canada), I recognize that I am extraordinarily fortunate to be in a jurisdiction that gives me the opportunity to apply my pharmacy knowledge and experience to optimize treatments Doctors of my patients. It is a pleasure to share our history with pharmacists from other parts of the world. Alberta’s pharmacists have the authority to prescribe since 20071. It is a tool to help our patients improve their health and strengthen their access to the health system, which often struggles to meet the demands of patients.
The “Perfect Storm”
Both the profession, through the Alberta College of Pharmacists (the governing body of the profession in Alberta) and the Alberta Pharmaceutical Association (the profession Defense Agency in Alberta), as well as the Alberta government (especially some Key government people and some key elected officials), pressed to get the prescription authority. In a sense it was the ‘ perfect storm ‘, as in addition to having the right people in the right position, with the shared goal of improving access and the quality of assistance from Albertans, it was the time when the government was doing A review of the regulatory legislation of health professions.
As part of the process, the government wanted to eliminate the barriers and traditional professional areas, and instead wanted to allow all health professionals to Definiesen in which areas they could be involved according to their competencies. Pharmacists, as drug experts, considered that they should have the ability to prescribe drugs, since physicians, nurses, dentists, dental hygienists, dietitians, and Podiatrists also claimed the same Prescription authority.
Another aspect that helped us get this authorization was related to patient access to health care. At that time, approximately one third of Albertans claimed that they did not have a family doctor and that the waiting time to get a visit with one in some rural communities exceeded six weeks. That made pharmacists take years to renew “illegally” recipes to continue treatments. The Government recognized that allowing pharmacists to prescribe would improve access to health services.
Finally, at that time the government was also reviewing health services expenses, and realized that the commitment of pharmacists in this area could save some costs (for example, avoiding visits from patients to emergencies Just to renew chronic treatment recipes).
Currently, all Alberta pharmacists are allowed to prescribe almost all medicines, with the exception of narcotics and controlled drugs (such as opiates, central nervous system stimulants or benzodiazepines), because our legislation Federal still does not recognize pharmacists as possible prescribers of these drugs. Pharmacists are expected to prescribe collaborating with the patient’s primary prescriber, which is usually their family doctor. However, it is not a ‘ formal ‘ or ‘ defined ‘ agreement, but it is left to the pharmacist’s discretion. However, at least it is required to communicate what you have prescribed to other health professionals involved in the patient’s attendance, once you have completed the prescription. It is important to indicate that pharmacists are not intended to replace the patient’s primary care physician. Our prescription activities are designed to improve the effectiveness of health care and patient access.
While all pharmacists can prescribe medicines, we also have “reinforced” denominations that allow us to prescribe in a wider way.
All Alberta Pharmacists can:
• Renew prescriptions of established treatments for continued assistance.
• Modify doses, formulations or postology of new prescriptions. A pharmacist, for example, may reduce the dose of an original ciprofloxacin prescription (from 500 mg/2 times a day to 250 mg/2 times per day), if it detects that the clearance time of the patient’s creatinine is 30 mL/min. This reduces the risk of danger to the patient by not having to wait to be able to start an appropriate treatment, since the pharmacist makes the changes without having to consult the prescriber.
• Replace a new prescription drug on the other, if the drug provides a therapeutic effect similar to the one originally prescribed.
• Prescribe a drug in emergency situations, which are defined as a situation in which there is no other reasonably accessible prescribers for the patient, who also needs immediate medical treatment (the latter at the pharmacist’s discretion).
Other things we can do the Alberta pharmacists who have received an ‘ additional prescription authorization ‘ are:
• Initiate prescription drug treatments based on our own patient assessment. For example, a patient is presented at the pharmacy with seasonal allergy symptoms. The pharmacist, based on his own evaluation of patient symptoms, determines that the most appropriate treatment would be a nasal spray with corticosteroids and prescribes the corresponding medication to the patient. This intervention saves a visit to the doctor and provides better patient access to attendance.
• Prescribe medical treatment for a patient based on the recommendation of another authorized prescriber. An example would be a doctor who would like to administer a warfarin treatment to a patient and maintain an INR of 2-3. You can write, fax, or talk to the pharmacist to define the treatment objectives. The pharmacist would then request the necessary laboratory analyses, monitor the results, and prescribe appropriate warfarin dose changes to maintain the agreed therapeutic objectives.
Rules and guidelines
There are several rules and guidelines drafted by our regulatory body, the Alberta College of Pharmacists, which define the documentation and COMUNICACIÓN2 requirements of pharmacists participating in these activities. When the prescribing authorization came into force for the first time, all pharmacists in the clinical registry had to attend a training session before they could exercise as prescribers. All those who have obtained the degree after 2007 have to pass a jurisprudence examination to obtain the authorization, with which they confirm their knowledge of the legislative structure to be able to prescribe. Pharmacists who also wish to obtain an “additional prescription authorization” need approval from the Alberta College of Pharmacists. These practitioners must have been in direct contact with patients for at least one year and developed cooperative relationships with other regulated health professionals; In addition, they must provide evidence that they have the clinical trial and the knowledge necessary to engage in the prescription, and they have to show that they have the resources to manage the pharmacological treatment. They have to submit an application that includes three real cases of patients, and shows how they would have decided their prescription if they had been authorized to do so. These applications are reviewed by expert Pharmaceutical advisors who approve or deny designation according to the pharmacist’s request. Approximately 25% of Alberta’s pharmacists have Obtenido3, and the figure continues to go up.
It has not been easy to implement these changes. On the day the new legislation was announced, articles in newspapers and television news made patients attending to community pharmacy offices saying they were delighted to not have to wait in the doctor’s office or Having to ask for free time at work to get recipes. They saw the accessibility of their community pharmacist and the confidence in their knowledge as an opportunity to improve the comfort of the assistance service. It goes without saying that pharmacists, for our part, had to educate patients a little and explain how our new ‘ authority ‘ would actually apply. The same thing happened with doctors and other health care professionals. The misinformation worsened some relationships between pharmacists and physicians, relationships that we had to reinforce in order to obtain the outcomes that patients and the health system wanted. And while most patients now understand the scope of our new ‘ authority ‘, there are still some problems with doctors and other health care professionals. Creating and maintaining a relationship takes time: it’s a continuous job.
The logistics to take on these activities also posed their challenges. Pharmacists did not have management systems to allow this new activity. There was no coherent or clear guidelines on how to document our patient prescription activities, follow-up plans, scheduled follow-up and methods to share these assistance plans efficiently and efficiently with other Health professionals involved in the assistance of our patients. Fortunately, most support insurance confirmed right away that the recipes issued by the pharmacists would be reimbursed with the corresponding drug benefit plans, but there was no refund model for the longer and Responsibility of the pharmacists who assumed these new roles. The pharmacy’s workflow was designed solely on the basis of dispensing, but making a more detailed evaluation of patients required more time and raised new demands, and space needed to do so. Still, we had to start somewhere. And the main reason why pharmacists have to commit to these activities is that it is right for our patients. It was extraordinarily useful that the vast majority of our patients support our new ‘ authority ‘. The profession was inspired to meet these expectations. Pharmacists began creating document templates and checklists on paper, in Word or in Excel, created procedures for documenting activities that might work with management software at their fingertips, renewing Offices to create more efficient spaces that allow for in-depth consultations, and more involved their assistants and technicians of pharmacy in the process of dispensing: everything so that these new demands became a practical reality.
Now, in 2016, I believe that Alberta’s pharmacists have achieved substantial benefits by embracing this new role, but there are still many challenges. We are fortunate that the Alberta government has demonstrated its leadership, being the first to provide a legislative structure that allows pharmacists to use their skills to prescribe drugs, and also now compensate the Pharmacies for the vast majority of visits attended in connection with their prescribing activities. Pharmacists ‘ confidence to use this tool as part of their office work is on the rise. We have access to a province-wide electronic health record, which provides pharmacists with access to analytical results, as well as allowing them to request laboratory tests necessary to assess the safety and efficacy of Treatment.
However, in most pharmacy offices we still lack computer tools to manage the continuous process of planning and monitoring of patient assistance, and often we lack the necessary physical space and the flow of Work to meet the needs of our pharmacists and patients. We also lack an effective method to communicate clearly information on patient assistance between pharmacists and physicians. We also need to work on improving the role of explanations between doctors and pharmacists, to make sure that optimal drug treatment is not sacrificed for the benefit of the patient.
Reflecting my own practice and the experience shared by many of my colleagues, I recognize that many of the roles we assume with our new ‘ prescription authority ‘ eliminate some of the barriers to patient care. Now, pharmacists do not allow the patient to leave without antihypertensive treatment when the prescription has expired, or that a person will take an inadequate dose of antibiotics because we have not been able to contact the Doctor who prescribed them. We now have a tool that allows us to apply more effective health resources to our patients. And as other jurisdictions follow us, we will be able to break more barriers that we find on the road, until we reach the goal of improving the results of the drug treatments of our patients. Our goal is not a stone’s throw away, but just a step away. And I hope that my pharmaceutical colleagues in Spain can also give it.