I'm not a doctor, but I play
one in the pharmacy

Pharmacists in Alberta seek the right not just to
fill prescriptions, but write them too

By Marguerite Crooks Slyfield

Sixty-year-old Belinda Levinson was sitting at home one Saturday night, when she felt the familiar symptoms of yet another UTI coming on. She groaned, remembering that her prescription for ciprofloxacin had run out. She didn't particularly feel like waiting in the overcrowded emergency room, but where else would she find a doctor at midnight to get her the pills?

Belinda's dilemma might soon be a thing of the past — at least in Alberta. The Alberta College of Pharmacists (ACP) has submitted a proposal to the Health Professions Advisory Board that would allow pharmacists to prescribe Schedule 1 drugs and to administer vaccines and other medications by injections. The idea gets mixed reactions from doctors. "I don't feel comfortable with pharmacists prescribing Schedule 1 drugs without the necessary medical training," says Dr David Yue, a family physician in Edmonton. "But for immunizations and vaccine injections, I don't have too much of a problem."

As for the pharmacists, they argue that patients don't always get sick at a convenient time to see a doctor, and so don't get the immediate help they need. They think doctors are reluctant to share this control. Dr Yue isn't so sure. "Access to medical clinics from 9am to 10pm isn't a major problem since there are quite a few walk-in clinics in major cities," he says. "And if patients need assistance after 10pm, most pharmacies are closed anyway."

Pharmacists may bristle at any suggestion that their knowledge of medications is not up to par but the Canadian Medical Association (CMA) is sceptical too. After all, prescribing is only one aspect of overall patient care.

In a report prepared for the ACP titled Pharmacists Prescribing in Alberta: An Examination of the Literature and Pharmacist Practices, Rosemary Bacovsky lays out new roles for pharmacists. She stresses that what's attractive is that pharmacists can be more accessible than doctors and anyway they're already providing drugs to patients in emergency situations.

Susan Haunholter, President of the Pharmacists Association of Alberta, admits that there are still some outstanding questions to be addressed. One is the need for pharmacists to obtain increased liability insurance. These costs certainly complicate the situation. Dr Yue agrees. "I'm not sure if pharmacists are aware that with these prescribing privileges, they will be exposed to more litigations," he says.

From a global perspective, it's clear that the role of pharmacists is changing. In the UK, pharmacists and nurses have recently been given supplemental prescribing authority. This gives them the power to prescribe in partnership with doctors. In the US, more than half of all states now have some similar forms of cooperation.

In Canada, pharmacists are now recognized as 'medical practitioners' by the federal government. This allows pharmacists to issue tax receipts for professional services. Roy Romanow's federal commission on the future of healthcare in Canada came down off the fence and urged increased responsibilities for pharmacists.

Ms Bacovsky feels momentum is inevitable. "The evolution of pharmacists prescribing will be primarily dependent upon health system design, acceptance by the public, acceptance by physicians, reimbursement, and acceptance by pharmacists," she writes. She stresses that, "it will vary with the practice environments. These include structured multi-disciplinary healthcare environments like hospitals, continuing care facilities, and primary care clinics."

For now, Belinda and her fellow patients can only sit back and watch the show.