Battle erupts over Alberta plan to let pharmacists prescribe drugs

[Abrad]

www.theglobeandmail.com
CALGARY -- A war of words has erupted between pharmacists and doctors who are battling to win patients' trust as Alberta moves toward becoming the first province to allow pharmacists to prescribe some medications.

The new regulations, which could come into effect this fall, would allow some patients to bypass their family doctors by permitting pharmacists to prescribe some basic medication, order drug refills, and inject vaccines.

Provincial Health and Wellness Minister Iris Evans has said this arrangement will mean better access to basic drug treatments and prescription refills, which now require a doctor's appointment.

But the plan, which pharmacists have talked about for a decade, has some physicians worried about patient safety. Other doctors have suggested it will create a conflict of interest because pharmacists could benefit commercially from the medications they prescribe.

"It's somewhat unprecedented for the leadership of one profession to call into question the qualifications or intentions of another profession. It's surprising," said Barry Cavanaugh, head of the Alberta Pharmacists' Association, a professional organization that represents about 2,600 of the province's 3,600 pharmacists.

Newspaper editorials have lauded the idea, calling it a cost saver for the health-care system and a way to eliminate frustration for patients. Letter writers have also been busy.

Isabelle Vonder Muhll, a professor at the University of Alberta medical school, recently wrote that the notion that pharmacists can or ought to replicate the role of doctors in prescribing medication is "unproven and unsafe."

In the past few days, the Alberta Medical Association and the College of Physicians and Surgeons of Alberta have issued letters to its members outlining its concerns about the government's plan.

Tzu-Kuang Lee, president of the AMA, issued a letter outlining doctors' concerns, such as proper diagnosis, liability, interference and conflict of interest.

"These physicians are, however, seriously concerned about the prospect of a primary prescribing role for pharmacists -- not from a scope of practice perspective, but from the impact it may have on patient care," he wrote.

The College of Physicians and Surgeons, which has long complained about a lack of transparency in making this regulatory change, is still waiting to see evidence about pharmacist training that would ensure patient safety before it will give its endorsement, according to spokeswoman Kelly Eby.

In a recent letter to the profession, college registrar Trevor Theman said that it was not clear what medical conditions pharmacists would be able to manage, but assured members that any new diagnosis would be referred to a physician.

The Alberta College of Pharmacists is working on a training program that would be a requirement for those interested in prescribing medication. It is also establishing guidelines on what conditions pharmacists are competent to assess.

Drugs such as narcotics, barbiturates and anabolic steroids, which are federally controlled and outside of provincial regulation, would not be among those pharmacists could prescribe. The regulations could allow pharmacists to order refills of medications for long-standing conditions such as asthma, or inject flu or travel vaccinations.

Mr. Cavanaugh, who is not a pharmacist, said it is disappointing that any doctor would think pharmacists want to make money from the change.

"We just want to bring our expertise as drug therapists to the team," he said. "I don't know how this is objectionable."

The province's Ministry of Health and Wellness, which has received only a couple of phone calls from the public on the issue, said it hopes to have the new rules in place this fall, but it may be a quite a while before pharmacists will actually be prescribing medications.

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