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