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EVOLVING SCOPE OF PRACTICE IN THE PHARMACY PROFESSIONNerkeza Andjelic Christina MacNeil
Leila Bonakdar Dan Zhou
TOPICS COVERED IN THE PRESENTATION INCLUDE:
Background of the Pharmacy profession Regulation of Pharmacists and Pharmacies Evolving Scope of Practice Positive & Normative Analysis Controversies voiced by other health
professionals What UK pharmacists are proposing Winners & Losers Further Suggestions
EXPERTS IN DRUG THERAPY…
Pharmacists Pharmacist’s practice is patient – focused.
PHARMACISTS …Have Training in …. Drug therapy How medications work Side effects of drugs Interactions between
medications How to minimize side
effects with drugs Delivery method to
increase efficacy
Perform … Compounding, preparing
and dispensing of medications from a prescription
Providing natural health products and non-prescription medications
Taking medication history.
Providing guidance and advice.
Delivering convalescent aids, medical appliances and equipment.
CANADIAN PHARMACISTS* PRACTICE IN…
Community Pharmacies “retail”
HospitalsPharmaceutical
IndustryRegulatory & AdvisoryInsuranceAcademia Federal & Provincial
Gov’tOther
22,373 71%
5,128 14.5%3,872 13%
* Vacancy of 10% especially in rural areas
PHARMACISTS AND PHARMACIES ARE REGULATED AND LICENSED BY …
Self- regulatory body - the College of Pharmacists of British Columbia
The provincial government defines the College role by…
Provincial Legislation: Health Professions Act (HPA – 2009) Pharmacy Operations and Drug Scheduling Act
(PODSA) Framework Professional Practice (FPP) Professional Practice Policies Other pieces of legislation such as ….
PHARMACISTS AND PHARMACIES ARE REGULATED AND LICENSED BY …
Federal Legislation: Food & Drugs Act and Regulations Controlled Drug and Substances Act (CDSA)
Narcotic Control Regulations Benzodiazepines and Other Targeted Substance
Regulations Precursor Control Regulations
PHARMACISTS AND PHARMACIES ARE REPRESENTED BY …. The Canadian Pharmacists Association
(CPhA) National Association of Pharmacy Regulatory
Authorities (NAPRA) Canadian Association of Chain Drug Stores
(CACDS) Canadian Society of Hospital Pharmacies The International Pharmaceutical Federation The Canadian International Pharmacy
Association (CIPA) Pharmacy Examining Board (PEBS) of Canada
PHARMACY TECHNICIANS ….
At this time are not in a regulated profession; pharmacists assume their liability
Training and qualifications vary from “on the job” training to certificates in school or distance education
Move is to regulate the profession under the College of Pharmacists
Motivation is coming from the Pharmacists
PHARMACISTS ARE SEEKING AND GETTING APPROVAL TO INDEPENDENTLY … Adapt prescriptions (dose and substitutions
on some medications) Renew some types of prescriptions Prescribe certain types of drugs Administer drugs by injection or inhalation Screen for the diseases, order tests, monitor Education/advice/support of patients and
caregivers (home visit and palliative care)
HOW DID THE “SCOPE OF PRACTICE” EVOLVE? Governments created a superstructure
legislation setting out uniform provisions governing all health professionals and their activities
The special content required for each specific profession is by Schedules or Regulations
Health professionals no longer own their skills and must obtain the right from the government to engage in risk-related activities
Governments reserves the right to make future changes
NORMATIVE ANALYSIS
Economic Efficiency Increased access for people Decreased cost to taxpayer for service Increased productivity of professional
workforce Increase supply of pharmacists
Fairness and Equity Increased access for people Principles of natural justice observed
Paternalism – Protecting the Public Information asymmetry
POSITIVE ANALYSIS
Effective lobbying by pharmacy associations & NAPRA
Public … the voters
A VIDEO : YOUR LOCAL PHARMACY http://www.youtube.com/watch?v=JOzODvpjBbQ
WINNERS WITH CHANGES IN SCOPE OF PRACTICE
Government (Health Authorities) Decrease cost Increase healthcare efficiency Gain popularity amongst interests group
WINNERS WITH CHANGES IN SCOPE OF PRACTICE Pharmacists
More power and influence1) Prescribe medication or at least participate in
drug selection2) Involved in direct patient care
Financial benefits1) Purchase decisions2) In the future, prescription fee?
WINNERS WITH CHANGES IN SCOPE OF PRACTICE
Pharmacies Pharmaceutical Industry
Both are in business to sell drugs and generate a profit
WINNERS WITH CHANGES IN SCOPE OF PRACTICE
Patients More convenient to access medications Time saving Get more medication therapy information
LOSERS WITH CHANGES IN SCOPE OF PRACTICE
Patients If pharmacists can prescribe independently,
are patients really safe? Could pharmacists be influenced by drug
companies?
LOSERS WITH CHANGES IN SCOPE OF PRACTICE
Physicians Lose occupational power An ability to maintain role-task boundaries by
establishing legal control over certain occupational tasks.
Leader position is changing in new healthcare model.
LOSERS WITH CHANGES IN SCOPE OF PRACTICE
Insurance Companies (in the short term)
Well documented in UK that more claims for prescriptions and increase payments …
Eventually insurance companies charge a co-payment resulting in less prescriptions and more visits to physicians (substitute) … which has effect to creates more losers ….
patients, pharmacists, pharmaceutical industry and a winner .. physician
FURTHER SUGGESTIONS ….
All pharmacy technicians need to be regulated before any expanded scope of practice for pharmacists can occur
Being “Regulated” implies a lot of factors to safeguard the public which don’t currently exist
The plan is for technicians to perform additional duties currently performed by pharmacists
There should not be any “grandfathering” of existing technicians because of the substantial changes in duties
FURTHER SUGGESTIONS ….
Investment, enhancement and access to medication management system The publics medication profiles need to be
uploaded into a Pharmacare system for the province
Physicians and pharmacists need access to a sophisticated drug management software and incentives for maintaining
While waiting for e-health … drug software can add lab results and summary of health conditions and known allergies
promote inter-disciplinary teamwork between physicians and pharmacists
FURTHER SUGGESTIONS ….
Drugs on formularies need to be tendered and contracted nationally by the government Cannot leave drug prices up to the Pharmacies –
it is a conflict of interest (It works very well in Australia and New Zealand )
Pharmacies are first businesses; their objective is to increase their profits
Government oversight on how pharmacies are performing and adhering to policies
FURTHER SUGGESTIONS ….
Regulations for Pharmacies & Associations 70% of pharmacies are chains … are the chains
directing Canada’s health policies? Stop Internet-based pharmacies from exporting
drugs Monitor ownership of pharmacies Ensure that pharmacies providing health care
services does not conflict with NAFTA Prevent pharmacies from advertising and self-
promotion. Physicians are not allowed Prevent pharmacy associations from including
Pharmaceutical Industry as members Stop pharmacists receiving “gifts” from Industry
FURTHER SUGGESTIONS ….
Governments need to get the incentives right … To encourage pharmacists to consult with
physicians and not create another silo To encourage physicians to consult with other
health professionals To encourage other forms of treatment To manage people medications more effectively
especially the elderly To promote input and referral to drug information
management systems To promote physicians to manage and monitor
chronic diseases