Andy Gray
In an oft-quoted, if apocryphal statement, our Minister is reputed to have said "Doctors must doctor, nurses must nurse, and pharmacists must …". Well, we all know where that one is headed. The message though was clear - – professionals should stick to their core business and not trespass on one another’s turf. It was this construct which informed the wording of sections 31 and 33 of the SAMMDRA Act. While this might have brought relief in some areas, it goes counter to some major trends in health care. In the US, the Pew Health Professions Commission has clearly shown the need for "multiskilling" or transdisciplinary practice. In the UK, a Crown Review on prescribing, supply and administration of medicines suggested the recognition of "independent" and "dependent" prescribers. The latter would prescribe, but only within "a specified assessment and treatment plan". Many American State legislatures have recently recognised the ability of pharmacists to "prescribe" within specified protocols. Under such "co-operative management" arrangements, medical practitioners make the initial diagnosis and drug selection, but the continued management of the patients is delegated to a pharmacist for a specified time. Early examples have involved pharmacists making dosage adjustments in anticoagulant and epilepsy clinics, based on kinetic or dynamic data. Similar approaches could be used in other chronic diseases such as hypertension and diabetes. There are many pharmacists practising in organised healthcare settings in this country who could immediately fill such a role. They are already active in Therapeutic Drug Monitoring services or in specialist clinics where they advise prescribers and patients on drug therapy. There are also many such opportunities in managed care settings and in pharmacy benefit management. It will thus be important to keep the door open for such practice, while still ensuring that legal efforts to rid medicine supply of perverse incentives are successfully implemented.
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