Therapeutics

By Professor Geoffrey DobbThe AMA opposes the growing trend to grant prescribing rights to more non-medical health professionals, outside of a medically delegated environment.

In the interests of patient safety, any prescribing by non-medical practitioners should only be carried out within strict co-management regimes.

Unfortunately, under ‘continued dispensing’ legislation passed by Federal Parliament, pharmacists will be able to dispense medicines under the PBS without a prescription and without reference to the patient’s treating doctor, on the basis of a previous prescription. This represents a significant change in the professional role of pharmacists within a health care team.

Medical practitioners place a high value on the professional role of pharmacists, and work with them to improve the medication management of patients and their clinical outcomes.  However, continued dispensing will allow pharmacists to operate autonomously.

Initially, pharmacists will only be able to dispense ‘eligible’ medicines: the contraceptive pill and lipid modifying agents. However, we can expect strong lobbying by the pharmacy sector to expand that list over time.

The most recent draft guidelines for continued dispensing prepared by the Pharmaceutical Society of Australia (PSA), state that after dispensing an eligible medicine “pharmacists must provide written communication to … the most recent prescriber advising of the supply of the medicine to the consumer”.

However, unless a pharmacist checks with the treating doctor, he or she has no way of knowing whether the patient’s medical practitioner intended to continue the medication, to adjust it, or to cease that treatment. It is a concern that a professional organisation such as the PSA has seen fit to turn back the tide on collaborative care by guiding the pharmacist to inform the relevant medical practitioner after the event.

This arrangement will compromise medical practitioners’ care of their patients. Who will be responsible if something goes wrong after the pharmacist has given the patient more medication without review by the patient’s medical practitioner?

The guidelines state that the pharmacist must provide written advice to the patient’s medical practitioner within 24 hours of the supply of the medicine, together with information covering: the patient’s name and address; date medicine dispensed; medicine details such as the strength, form and instructions provided for use; and reason for continued dispensing. The information must also include a declaration co-signed by the consumer indicating their understanding of, and consent to, the supply.

I welcome your views and comments on how you see this working for you in practice. If you receive this information will you feel compelled to review the patient’s file and call the patient in for review?

Please forward your comments to ama@ama.com.au.

In the meantime, I encourage AMA members to maintain strong working relationships with local pharmacists. This is critical to ensuring patient safety and avoiding fragmentation of care.