I must admit I do not know the answer to providing for areas of need but giving city pharmacists prescribing rights is not one. Grao, you say : " Of course we can't diagnose as we don't have at our disposal lab referrals etc but accurate history taking is not rocket science.
It would not be 'Rocket Science ' to guess which one of the 3 you are. I am a retired pharmacist in the United States. Private insurance companies control medical care in the USA. The patient receives those meds the Insurance co will cover not what the physician prescribes. Dr Kahn feels pharmacist prescrbing is very dangerous. Of course with prescribing the pharmacist would have to be taught laboratory medicine and authorized to order lab tests to monitor the therapy.
If Dr Kahn believes pharmacist prescribing to be dangerous, Im curious how he views prescribing by insurance employees with no pharmacological training. Slowly but surely the insurance companies are replacing doctors with nurse practitioners and physicians assistants. Not to benefit patient care, but to save money. I have worked as a pharmacist with nurse NPs calling in prescriptions and there often was a problem.
They have no knowledge of drug interactions. When I would call the NPs they would get quite upset. I am a pharmacist with 14 years experience, army, and hospital and I am more than qualified to prescribe the contraceptive pill and antibiotics. I am not advocating the change but I find the article an insult to my studies and experience, the main issue I have is taking work from Doctors and in some instances such as rural locations, it may be warranted.
I don't have the money to see a doctor or the time to find and wait for a bulk billing one. Nearest according to google is over 30 mins drive away. Nearest chemist is next door. Maybe the docs should diagnose and pharmies should prescribe. My experience working in community pharmacy has told me docs need help prescribing. Pharmacists are very good at deprescribing too. Also they need help with their practice in general..
Nurse management of GP clinics would greatly reduce human error and organisation. Do you think the govt is silly enough to continue paying hefty MBS fees for flu injections and simple consults.
Pharmacists — acutely aware of the risks and harms associated with prescribing — have been apprehensive about gaining prescribing skills on registration [7].
This curse of knowledge means that, despite being viewed by other professions as the experts in medicines and prescribing, we have always had a certain level of trepidation towards self-assessment of our own future potential.
A study of non-medical prescribers found that pharmacists were less likely to be responsible for prescribing decisions although this may be related to their role in medicines reconciliation and be indicative of their integration into the multidisciplinary team , and they also described themselves as less confident than other non-medical prescribers [10].
Yet a systematic review of stakeholders found largely positive views of pharmacist prescribing from patients and other clinicians, particularly when they had experienced pharmacist prescribing first hand [11]. Barriers to pharmacist prescribing have been well-documented: limited access to prescribing qualifications; few opportunities to use the qualifications once obtained; and a lack of support and understanding about the skills that pharmacist prescribers have [12].
In some cases, pharmacists have been unable to obtain mentors and yet, at the same time, clinicians are surprised that pharmacists are not prescribing more [8]. These external barriers to changes in pharmacy practice are commonly discussed, but one barrier to changing pharmacy practice is the profession itself.
We must address our lack of professional confidence, our paralysis in the face of ambiguity, our concern with the way our profession is perceived by others and our risk aversion when it comes to taking on new roles, such as prescribing [13].
As a profession involved in the training of others in prescribing, both formally and informally in clinical practice, we should have more confidence in ourselves. Other professions are confident in their prescribing abilities. Prescribing on registration is planned in nursing and is likely to quickly appear in evolving professions, such as the physician assistant.
If pharmacy is to deliver all it can for patients in the years ahead, pharmacy needs a change in professional culture [14]. Are pharmacists made, or do they self-select?
Large-scale cultural change requires a systemic approach. We need further reforms to pharmacy education, with a focus on clinical decision-making skills, to allow pharmacists to reach their full clinical potential [15].
We do, however, already have a good foundation to build on. Over the past ten years, pharmacy education has evolved and earlier education reforms have given us increased focus on clinical skills and the integration of science into practice. Although current educational standards have existed since [16] , it is only in the past three to four years that graduates from these new integrated curriculums have started in practice.
Criticisms of pharmacy schools often appear to be based on outdated ideas of the kind of graduates we produce. Graduates of today, in fact, leave university far more prepared for the cognitively demanding clinical roles they will face from the outset. While the MPharm curriculum has evolved, preregistration training has remained patchy in quality. Students have a variable experience, from well-designed rotational clinical placements to preregistration experiences with poor supervision and limited opportunities to develop clinical expertise.
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