THE PRACTICE OF PHARMACY MUST CHANGE
I’m the king of the castle
and you’re the dirty rascal,
I’m the king of the castle
get down you dirty rascal.
The castle, of course, is the provision of health care for the people of Ontario, and the king of the castle is the doctor. Whether in private practice, in government or in the hospital, the medical doctor has the last word. The practice of medicine, with new scientific discoveries and technologies, has changed in the last 100 years adding more and more jobs to the medical profession but hardly ever taking simpler jobs from the profession and giving them to other health care givers, well trained, who can do the job as well or better, but at less cost. The province of Ontario now cannot afford to pay the doctors for jobs that can be done for less money. If I were a nurse I would write about “nurse practitioners” who also have a part to play, but as I graduated in Pharmacy and with many years of experience,I intend to talk about my profession.
For as long as I can remember the busy pharmacy has had a helper, usually a person who counts the tablets, answers the phone, and puts back the bottles of tablets on the shelf. But all the filled prescriptions MUST be checked by the pharmacist for accuracy and signed. The bulk bottle of drugs has to be checked by the pharmacist .The helper or assistant had no official status with the Ontario College of Pharmacists and learned by experience. With an amendment passed by the Ontario Legislature, a new professional group has been constituted .This group, legally referred to as “Registered Pharmacy Technicians” can fill prescriptions without the direct supervision of a pharmacist. Pharmacists under their scopes of practice are responsible for the therapeutic or clinical portions of the prescription. In essence, they are responsible for the patient. They are accountable for ensuring the medication prescribed or the therapy the patient is being treated for is appropriate. This responsibility extends to both a refill and new prescription and the pharmacist must sign off that this has been checked and approved. Technicians are accountable for the technical portions of filling the prescription, i.e. the drug, strength, quantity, directions and any other technical aspects of filling that prescription and signing off on that portion. Simply put, on any prescription, the pharmacist is responsible for the patient and the technician is responsible for the prescription, i.e. accuracy of dispensing.
The dispensing of medication to a patient is NO LONGER the sole responsibility of the pharmacist when a registered technician is part of the process. It is a shared responsibility.
I believe the Ontario Government through the ministry of health has thought long and hard about this development because it allows the pharmacist the leeway and time to act as a professional advisor to the prescriber, the medical doctor and to do some of the jobs given to doctors, at a lower cost. The big question is how long it will take the politicians to take the next step and allow the Pharmacist to do the job and be paid for same. The medical profession is well-funded and not to be taken lightly. I intend to outline where there is room for improvement.
The government is very worried about the cost of medication for the seniors of Ontario. This is a legitimate problem which I know about first hand, as a senior myself and a retired pharmacist. From my experience filling prescriptions, seniors are on too many drugs and the drugs are not monitored carefully. Many side effects occur, and it takes a lot of time to correct. Doctors are paid by the visit, and too long with one patient is not cost effective. Drugs are the specialty of pharmacists and they can remedy the situation in a shorter time period taking into consideration the senior may also be taking over-the counter drugs of which the doctor is unaware.
Brand name drug companies are always searching for new and better drugs. This is the way the system works. They always find new drugs but not necessarily better drugs and when doctors are influenced to use them, at a much higher cost, the pharmacist can advise the doctor if the change is in the best interest of the patient and not just a move to make money for the drug company.
Pharmacists should legally be allowed to prescribe and administer by injection pharmaceuticals under controlled conditions. Today the public visits the pharmacist much more than any other health professional. Injections by the pharmacist can be allowed for influenza vaccines and for palliative home care patients. Pharmacists can prescribe, to treat minor conditions, adjust dosage, provide emergency supplies and allow substitution of another drug that can have a similar therapeutic effect but be cost effective.
Drug therapy is constantly changing and the pharmacist is in the position, or should be, to be aware of all the changes. The pharmacist is the drug therapy expert, the physician is and remains, the diagnostician
