Alberta pharmacists may get prescribing powers
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* Alicia Priest

Confusion and accusations of conflict-of-interest surround new regulations that would give Alberta's roughly 3500 pharmacists the broadest scope of practice in Canada and one of the broadest in the developed world. 

The regulations will allow pharmacists to prescribe many Schedule 1 drugs and blood products, as well as administer some injections. But they will be prohibited from prescribing narcotics and controlled drugs such as barbiturates and anabolic steroids. The change is expected to take effect in 2007.

Dale Cooney, deputy registrar of the Alberta College of Pharmacists (ACP), says the move has been in the works since the Health Professions Act was passed 7 years ago.”We believe allowing pharmacists to prescribe will give patients increased access to the medications they need. It will allow them to benefit more fully from the pharmacists' expertise regarding medications.”

Although many of the details (like accepted standards of practice) have yet to be ironed out, the regulatory change will allow pharmacists to alter the dose, formulation and regimen of a drug; renew prescriptions; substitute another drug for a prescribed Schedule 1 drug; administer flu and travel vaccines; and assess patients and prescribe without necessarily obtaining physician authorization.

Essentially, pharmacists will be allowed to initiate new prescriptions under 3 circumstances: if they deem it appropriate after conducting a”patient assessment,” if they've received a recommendation from an authorized health professional that drug therapy is warranted, or if, in consultation with a health professional, it is determined that a Schedule 1 drug or blood product is appropriate.

A pharmacist's capacity to prescribe will be conditional on compliance with standards and a code of ethics established by the ACP, completion of an orientation course and proof of $2-million in personal professional malpractice insurance.

Cooney knows of no other jurisdiction where pharmacists have taken on a primary prescribing role although British pharmacists ”sponsored” by a physician can prescribe certain drugs.

The move worries the Alberta Medical Association. President Dr. Tzu-Kuang Lee says concerns include patient safety, proper diagnosis, liability and conflict-of-interest. Doctors, he notes, are forbidden to both dispense and prescribe drugs.”Who would be responsible if there were side effects from any prescription, especially if that resulted in admission to hospital? And who has access to the patients' medical records to document the changes?”

A prescribing pharmacist would have to perform physical exams, as a diagnosis cannot be made from a patient's history alone, Lee adds. “You can't prescribe in isolation — prescribing is part of a total package of caring for a patient.”

The Alberta chapter of the Consumers' Association of Canada has also weighed in with concerns that the change will inevitably result in accrued costs to consumers; increased fragmentation of care and decreased confidentiality. 

“We seriously question a number of assumptions about the benefits of enhanced prescribing powers and anticipated uses,” said spokesperson Wendy Armstrong.