Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

On the 21st November 2002,the British Health Minister launched a new health package allowing appropriately trained pharmacists and nurses to prescribe medicines by the summer of 2003. This announcement has caused a flurry of activity at the National Health Service, education facilities and the professional bodies, as structures are developed to be able to deliver these 'appropriately trained' health professionals in the time line provided.

The education and accreditation process to be able to perform medication reviews is a good example of the depth of 'extra' training that would form a base for this increased role. As in the British model, how are we going to deliver 'pharmacist prescribing' as a consistent package across Australia? If only a percentage of pharmacists undertake this new role will the Department of health and Ageing be willing to be the major financial backer to this project? In Britain it is expected that only a small number of pharmacists will undertake the training and become a 'supplementary prescriber' in the early months to years-how will the health consumer cope with this inequality across pharmacy practice?

In Australia, pharmacists have a large area of product that they are able to 'pescribe- the scheduled 2 and 3 sections. As more products move from prescription only to this area pharmacists are being given better products to utilise in their everyday pharmacy practice. But in reality are we using this area of our practice to its full advantage-the data from many areas of pharmacy practice tells us that we are not consistent in our delivery of professional service in this area. It is very hard then to use this data to convince government and other legislative and professional bodies that 'pharmacist prescribing' should occur.

Queensland health is currently undergoing a complete review of their "Primary Clinical Care Manual" and the question has been asked whether pharmacists would be able to deliver some of the health Management Protocols (HMP's) described in this manual in rural and remote locations. To deliver this service competency upskilling would need to occur for these pharmacists eg basic observations: - pulse rate, blood pressure, respiratory rate, temperature and oxygen saturation. Pharmacists receive undergraduate training in these observations however they do not generally, routinely make these observations in clinical practice. Pharmacists do routinely ask patients about presenting concerns, past medical history, allergies and medications and make general appearance observations e.g. skin, hydration, oedema - however these are limited by the surrounds a public place - a pharmacy or hospital ward

Pharmacists do not make hands-on observations of GI system, respiratory
system or CNS or use instruments in the assessment of ear, nose or throat or insert cannulas for IV administration and these areas would need significant education to occur.

In the British model it is proposed to place the 'supplementary prescribing' pharmacists into a medical practice for 'work experience' to occur. This would involve the mentor Doctor teaching the pharmacist how to take a medical history, theory of diagnosis and how to apply their clinical skills in prescribing to the diagnosis. Under this model, the outline states that at the end of their training the prescribing pharmacist should be able to:

· Develop effective relationships with independent prescribers and patients
· Communicate and consult effectively with patients and carers
· Conduct a relevant physical examination pf patients whose conditions for which they may prescribe
· Monitor response to therapy and modify treatment or refer the patient as appropriate
· Assess patients' needs for medicines, taking account of their wishes and values in prescribing decisions
· Prescribe safely, appropriately, clinically and cost effectively
· Identify and use sources of information, advice and decision support and use them in prescribing practice
· Develop and document a clinical management plan within the context pf a prescribing partnership
· Apply the legal and professional framework for accountability and professional responsibility
· Adopt a reflective approach to continuing professional development of prescribing practice

As in Britain, in Australia this will require a substantial change in the curriculum at post and undergraduate level to encompass the competencies needed to fulfil this role. It is a challenge that the Australian pharmacy schools have already made significant moves towards with the increase in areas of communication skills, evidence based medicine practice, evaluation of clinical data, and the incorporation of integrated health team models. My major concern is how are we going to prove to government that we are able to fulfil this role with professional competency when we have not excelled in delivering a superior and consistent model at the S2 and S3 level.