CMA frowns on prescribing rights for pharmacists
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* Brad Mackay

The Pharmacists Association of Alberta (PAA) says its members should be granted expanded powers to prescribe medication, but the CMA is less than enthusiastic about the idea.

The PAA wants the province to give Alberta's 3054 pharmacists prescriptive authority within 18 months. “If a pharmacist is practising in a certain environment where [she has] a relationship with the patient and the patient's physician and [has] the appropriate facilities and information, [she] would be allowed to prescribe drugs,” said Trudy Holzmann, the PAA president. “With 5 years of university study, pharmacists have by far the most drug education. It makes sense that they be involved in drug therapy decisions.”

The push for the new powers started as a discussion at a conference 3 years ago, but gained momentum after submissions for health reform concerning the province's Health Professions Act were requested last year.

“Pharmacists have been ranked by the public in many surveys as the most trusted health care professionals,” said Holzmann. “We just want to ensure that patients get the best drug therapy for their situation, and we feel that that will translate into lower costs.”

CMA President Dana Hanson is skeptical. “The CMA does not agree with pharmacists having the right to prescribe,” he said. “We feel very strongly that this is not in the patient's best interest. There is a very definite set of skills that are refined and honed before a physician can enter practice, and pharmacists do not have this.”

Hanson says that while pharmacists offer convenience, they cannot replace a physician's multidisciplinary services. “One has to put the patient first. If you come into your pharmacy and you've got a cough, is the pharmacist going to take off your shirt and listen to your chest?

“We're not saying that there isn't an important role for pharmacists in a collaborative setting — there is. But there is a very firm line that has to be drawn with prescribing.”

Jeff Poston, executive director of the Canadian Pharmacists Association, says prescribing powers would be a natural extension of the pharmacist's role. He said they already have prescriptive authority for some drugs, such as those containing codeine.

As well, pharmacists in 3 provinces have already been allowed to prescribe emergency birth control, such as the morning-after pill, and pharmacists in some US states are allowed to administer vaccinations. In the UK, it was recently proposed that pharmacists and nurses be given “supplementary prescribing” rights for select drugs.

“This is part of a global trend,” said Poston, “and that's because it has the potential to take a huge load off family physicians. There's already a wide degree of leeway that some physicians give pharmacists to change some of their prescriptions, and we just want to build on those relationships. It's a matter of legislation catching up to practical realities.”

The Alberta proposal came as Roy Romanow prepared to release his report on medicare. The report devoted an entire chapter — 21 pages — to prescription drugs, and another chapter to primary care reform, including the relationship between pharmacists and physicians. — *Brad Mackay*, Toronto