Abstract
CPhA's Centennial Celebration Could Not Come at a Better time. Across the country, the landscape of pharmacy practice is changing, marked not by small steps, but by giant strides. In Ontario, with the unveiling of the Pharmacy Council and commitment to fund professional services, the government appears intent on sustaining a drug program with pharmacists playing a lead role in shaping policy. 1 In Alberta, new legislation gives pharmacists the power to independently prescribe under a defined framework. 2,3 These changes are seismic steps forward for the profession. But more than any other significant achievement this past year, future generations will reflect back on the attainment of prescribing powers by Alberta pharmacists as a watershed moment. Already the ripple effect is being felt as other provinces move toward prescribing rights. 4 Slowly but surely pharmacists can do away with the traditional stereotypes of the profession. The ingredients are in place for a tectonic shift in pharmacy practice.
With legislation that allows for restricted independent pharmacist prescribing, Alberta has taken a giant leap for the profession. While the Alberta College of Pharmacists must still finalize the formal standards for prescribing, Alberta pharmacists have plowed a path that the rest of the country should follow. The reason is clear and sensible: Before the names Romanow and Kirby fade from the national consciousness, pharmacists should seize on the opportunity to prove the assertion that they are one of the most underutilized resources in the health care system. A system so strained by physician shortages and long line-ups in emergency rooms requires — demands — that every conceivable solution be explored, that an alternative to the current practice model be tested. Prescribing authority, even if limited, is one of several key steps to moving toward an environment where the medication experts will be used to their fullest potential. Pharmacists will have the authority to make immediate and meaningful decisions for the benefit of patients that any professional with our training and expertise should be able to make within our scope of practice. Whether it be initial prescribing or prescription modification, prescribing power is a logical extension to some of our duties and our current role as one of the most accessible health care providers. The potential societal and economic benefits for the system are arguably greater than any potential downside.
Of course, the profession of pharmacy does not exist in a vacuum. How we practise affects not only patients, but other disciplines as well. The lack of unequivocal endorsement by the medical community for pharmacist prescribing should not be a deterrent to moving forward. It is not wrong for physicians to insist that pharmacists meet certain standards before prescribing. (No one has ever claimed that prescribing is a trivial matter.) On the contrary, the public and allied health professionals need to be confident in the judgment of pharmacists and be assured that we have the training to prescribe safely. Individuals who prescribe should meet the most stringent standards. It is therefore reassuring that prescribing will be limited to pharmacists who have attained the required credentials, and then only to those who wish to assume the added responsibility. But pharmacists would be naive if we were to wait for unanimous support from physicians. If a recent survey is any indication of a broader philosophical outlook, it is unreasonable to think that the medical ethos would ever allow physicians to voluntarily cede much responsibility for patient care to other disciplines. 5 Whether by design or by circumstance, medical curricula seem to instill in graduates the mentality that physicians alone should bear the entire burden of providing health care. It is important for pharmacists to continue to engage physicians in this debate, but we should also be prepared to move forward alone if necessary. In the current climate, no one profession can presume to hold the patent on patient care. Physicians who are truly committed to professional collaboration (those who are willing to help close some of the gaps in a strained system and not merely pay lip-service to the lexicon) will come onboard.
The move toward an expanded scope of practice comes at an opportune time in our history — just as pharmacy schools throughout the country inch ever closer to the inevitability of an entry-level PharmD program. As an engaging commentary in this journal stated: “Recent legislative opportunities in several provinces, recognizing pharmacists' advancing roles, illustrate the issues for which timing-sensitive response is critical.” 6 An expanded role for pharmacists, including prescribing rights, should be ample justification for an entry-level PharmD program. Eventually, the academics entrusted with teaching future pharmacists will reach consensus as the following questions become resolved: What good is bestowing a title if it does not confer any real power or responsibility? What good is enduring additional years of scholastic labour and clinical training if the end result is practising the status quo? In the new environment, graduates with the PharmD designation will embrace the challenges that accompany additional responsibilities to enhance pharmacy practice. Pharmacy faculties need only envision the following scenario: A PharmD graduate with clinical expertise, authority to prescribe, and compensation for providing cognitive services. Will there ever be a better time and impetus for curricular change than now?
Prescribing rights or professional collaboration — call it what you will — an expanded scope of practice is essential to move the profession forward. By coincidence, the implementation of prescribing rights in Alberta and payment for professional services in Ontario is set to come into effect by April 1, 2007. 1,2 For pharmacists and for the profession, this date will signal an evolutionary era in practice. In some instances, pharmacists will have the legal authority to provide care and improve outcomes for patients where, in the past, our hands have been tied. Patients can only benefit from the greater accessibility and efficiency in health service. The goal is to optimize the role of pharmacists, and the result will be to redefine the practice of pharmacy. Just as important, our critics will no longer myopically see us as mere dispensers of drugs. And that will be no April Fool's Day joke.