Pharmacist Prescribing: Has the Momentum Started?

Abstract

At a March 2012 session in Calgary on legal liability related to expanded scope of practice, numerous pharmacists vehemently criticized the Alberta government for implementing, on July 1, 2012, payment to pharmacists for renewing prescriptions. The pharmacists were not criticizing the amount of the fee but, rather, the fact that they would have to perform the activity (i.e., renew prescriptions) to keep any clients who might ask for this service and also the fact that pharmacists would have to comply with standards of practice for this activity. Imagine pharmacists prescribing and being paid, by the government, to do so! This scenario was unimaginable when I graduated in 1977. Both clinical pharmacy in general and pharmacists making recommendations for prescription changes were emerging concepts at that time. Pharmacist prescribing still seemed an impossible dream in the early 2000s when I and other pharmacists in Alberta strongly advocated for pharmacists to be given independent prescribing privileges through legislation. Pharmacists had been prescribing dependently for decades, both formally (e.g., through therapeutic substitution and other hospital-based policies) and informally (e.g., in the community, through agreements with physicians). I wrote background papers for the Alberta College of Pharmacists, participated in working groups, lobbied politicians and government officials, and spent most of my free time trying to convince fellow pharmacists that this expanded scope of practice was essential for the profession to grow, and even for the profession to survive. I did not think it would happen in my lifetime, but on April 1, 2007, Alberta pharmacists gained authorization to independently prescribe drugs. It has been over 5 years since that “miracle” occurred, yet the uptake of prescribing by pharmacists has been very limited, even with payment for services. In addition to having authorization to adapt prescriptions and prescribe in emergencies, Alberta pharmacists can also apply to the Alberta College of Pharmacists to obtain “additional prescribing authorization”, which allows them to initiate therapy. However, of the almost 4300 practising pharmacists registered with the Alberta College of Pharmacists as of February 29, 2012, only 155 had additional prescribing authori zation, most of them in community-based practices. I find this very disappointing, in terms of both the overall number of pharmacists and the relative dearth from hospital practice. This expanded scope of practice would have been extremely useful when I was in hospital practice, which is why I advocated for independent pharmacist prescribing. The current lack of interest shown by hospital pharmacists is not surprising to me, as only 2 of the 9 regional health authorities endorsed pharmacist prescribing before the 2008 merger that created the provincial agency, Alberta Health Services. Around that time, I talked with a hospital-based pharmacist whose clinical practice I admired. He was applying for the additional prescribing authorization, but only because his hospital had made it mandatory for his position. He greatly resented the application process as too much extra, unnecessary work, given that he had been doing drug therapy management for years, without this official recognition. What he failed to recognize was that the status quo would not be in compliance with the new legislation. Alberta Health Services supports pharmacist prescribing and has made additional prescribing authorization a requirement for many positions, and many pharmacists in primary care networks and family care clinics are now obtaining this authorization. When examining the acceptance of prescribing by pharmacists, I find it useful to compare pharmacists’ attitudes with those of nurse practitioners who have received prescriptive authority, often earlier than pharmacists. In most jurisdictions, nurse practitioners have a broader scope of practice as it pertains to prescribing drugs than do pharmacists. For example, they will soon be able to prescribe narcotics and controlled drugs. I have