Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

The determination by the National Drugs and Poisons Scheduling Committee (NDPSC) to recommend that emergency hormonal contraception (EHC) become a "Pharmacist Only" item opens up an area of debate that has often been discussed before- "Prescribing by health professionals other than medical practitioners".
The area of prescribing EHC has many models to learn from in other countries including England and Canada.
The Pharmaceutical Society of Australia has been evaluating the overseas data as well as consulting with other organisations to develop a protocol and guidelines for pharmacists to use in their pharmacies when 'prescribing' EHC.
Once the decision recommended by the NDPSC is ratified the guidelines will be disseminated to Australian Pharmacists.

"Pharmacist Only" products are a domain that pharmacists are able to use wisely and effectively to reinforce their ability to prescribe in limited situations.
The NDSPC has recommended two other products move to the "pharmacist only" area of the market- diflucan and orlistat- which will require careful evaluation and counseling by the pharmacist before these products are given to the consumer.

The 'Pharmacist Only" are of community pharmacy is an area of practice that pharmacists need to use wisely and ensure that they have the therapeutic knowledge and skills to perform this role.
Recent studies do not show that we deliver this role in a consistent and therapeutically effective manner. We are very critical of other practitioners trying to move in on our domain area of dispensing and counseling but if we are not careful the same arguments that we are using to ensure we do not lose our dispensing role to others will be used against us.
The area of nurse practitioners is one such case of concern to pharmacists but do we have a right to be critical?

In many states in Australia there has been legislation enacted to allow for the practice of nurse practitioners to be established.
The original intent for nurse practitioners was for them to deliver services in rural, remote and isolated settings.
In some states the legislation for nurse practitioners allows for the practitioner to prescribe, dispense and administer medication in a range of settings including aged care facilities, hospitals and community and primary care settings.
The fact that the same nurse practitioner is able to perform all three roles lessens the chance for a review by an independent person.
In current practice the medical practitioner prescribes, the pharmacist dispenses and the nurse/carer/patient administers and there are 'check' mechanisms in place during this process to minimize the chance of errors.

The nurse practitioners will have performed post graduate study to undertake this role but it will not be as comprehensive in the areas of pharmacology and therapeutics as undertaken by pharmacists.
I have no problem with their role of prescribing in specific situations e.g. sexual health clinics, aged care facilities, but apart from rural and remote settings I do not see the need for the nurse practitioner to be the dispenser of the medication as well.
Australia has an excellent medicines policy that ensures the most effective delivery of medication in an affordable, safe and timely manner and the move to allow nurse practitioners to undertake all three roles for the same patient requires some evaluation and consideration.

There have been other models suggested previously such as pharmacists being able to prescribe continuing medication for residents in residential aged care facilities with timely reviews by the medical practitioner.
There is a chronic shortage of all health professionals and we must ensure we utilize all of our available resources to maximum benefit but not at the cost of patient safety and therapeutic effectiveness.