Pharmacists and pharmacy chains have proposed expanding pharmacists' roles to allow them to prescribe certain routine medications for common illnesses. This would create a new category of "nonprescription drugs" that pharmacists could dispense without a doctor's prescription. Supporters argue this would increase access to healthcare, especially for underserved patients. However, medical associations oppose the proposal and argue that pharmacists lack sufficient medical training to safely prescribe drugs. The FDA is considering the proposal but acknowledges more evidence is needed regarding which drugs could safely be prescribed without a doctor. The future relationship between pharmacists and doctors remains unclear if pharmacists' prescribing roles expand.
A systematic review on paediatric medication errors by parents or caregivers ...Javier González de Dios
El objetivo del proyecto “FARMAVIZOR, uso más seguro de la medicación en pacientes pediátricos en el hogar” es desarrollar y evaluar una intervención online dirigida a padres-madres para incrementar la seguridad en el uso de los medicamentos pediátricos en el hogar. Esta intervención incluye un programa de educación sanitaria para fomentar un uso seguro del medicamento en el hogar, junto con la puesta en marcha de un sistema de notificación de incidentes en el hogar para padres-madres donde compartir experiencias con otros progenitores, aprender y mejorar a aplicar adecuadamente los tratamientos pediátricos en casa. Toda esta información se puede encontrar en la web del proyecto que hemos titulado como “Mi cuaderno pediátrico seguro seguro”.
Y como parte de este proyecto se han derivado algunos proyectos de investigación que van viendo la luz en las revistas biomédicas, en este caso el artículo “A systematic review on pediatric medication errors by parents or caregivers at home” publicado en la revista Expert Opin Drug Saf. (IF 4,250, Q2).
A systematic review on paediatric medication errors by parents or caregivers ...Javier González de Dios
El objetivo del proyecto “FARMAVIZOR, uso más seguro de la medicación en pacientes pediátricos en el hogar” es desarrollar y evaluar una intervención online dirigida a padres-madres para incrementar la seguridad en el uso de los medicamentos pediátricos en el hogar. Esta intervención incluye un programa de educación sanitaria para fomentar un uso seguro del medicamento en el hogar, junto con la puesta en marcha de un sistema de notificación de incidentes en el hogar para padres-madres donde compartir experiencias con otros progenitores, aprender y mejorar a aplicar adecuadamente los tratamientos pediátricos en casa. Toda esta información se puede encontrar en la web del proyecto que hemos titulado como “Mi cuaderno pediátrico seguro seguro”.
Y como parte de este proyecto se han derivado algunos proyectos de investigación que van viendo la luz en las revistas biomédicas, en este caso el artículo “A systematic review on pediatric medication errors by parents or caregivers at home” publicado en la revista Expert Opin Drug Saf. (IF 4,250, Q2).
Initial progress on the journey toward an open source potential drug-drug int...Richard Boyce, PhD
Presentation given at the 33rd VistA Community Meeting - George Mason University focusing on progress towards and open source potential drug interaction knowledge base
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
The slides from the keynote given by Dr. Dan Malone RPh, PhD at the First International Drug-Drug Interaction Knowledge Representation Workshop on October 6th 2014 (http://icbo14.com/sessions/drug-drug-interaction-knowledge-representation-workshop/). Posted with his permission.
Special Challenges in Clinical Trials: Case Study: the Dying child and the ...Michael Swit
A review of a case study involving whether it would be proper to authorize the use of a drug whose approval had been withdrawn when it is believed to be the only hope for a dying child.
The
new england journal
of
medicine
n engl j med
351;19
www.nejm.org november
4, 2004
2008
sounding board
The Limits of Conscientious Objection — May Pharmacists
Refuse to Fill Prescriptions for Emergency Contraception?
Julie Cantor, J.D., and Ken Baum, M.D., J.D.
Health policy decisions are often controversial,
and the recent determination by the Food and Drug
Administration (FDA) not to grant over-the-coun-
ter status to the emergency contraceptive Plan B
was no exception. Some physicians decried the de-
cision as a troubling clash of science, politics, and
morality.
1
Other practitioners, citing safety, herald-
ed the agency’s prudence.
2
Public sentiment mir-
rored both views. Regardless, the decision preserved
a major barrier to the acquisition of emergency con-
traception — the need to obtain and fill a prescrip-
tion within a narrow window of efficacy. Six states
have lowered that hurdle by allowing pharmacists
to dispense emergency contraception without a
prescription.
3-8
In those states, patients can sim-
ply bypass physicians. But the FDA’s decision means
that patients cannot avoid pharmacists. Because
emergency contraception remains behind the coun-
ter, pharmacists can block access to it. And some
have done just that.
Across the country, some pharmacists have re-
fused to honor valid prescriptions for emergency
contraception. In Texas, a pharmacist, citing per-
sonal moral grounds, rejected a rape survivor’s pre-
scription for emergency contraception.
9
A pharma-
cist in rural Missouri also refused to sell such a
drug,
10
and in Ohio, Kmart fired a pharmacist for
obstructing access to emergency and other birth
control.
11
This fall, a New Hampshire pharmacist
refused to fill a prescription for emergency contra-
ception or to direct the patron elsewhere for help.
Instead, he berated the 21-year-old single mother,
who then, in her words, “pulled the car over in the
parking lot and just cried.”
12
Although the total
number of incidents is unknown, reports of phar-
macists who refused to dispense emergency con-
traception date back to 1991
13
and show no sign of
abating.
Though nearly all states offer some level of le-
gal protection for health care professionals who
refuse to provide certain reproductive services, only
Arkansas, Mississippi, and South Dakota explicit-
ly protect pharmacists who refuse to dispense emer-
gency and other contraception.
14
But that list may
grow. In past years, legislators from nearly two doz-
en states have taken “conscientious objection” —
an idea that grew out of wartime tension between re-
ligious freedom and national obligation
15
and was
co-opted into the reproductive-rights debate of the
1970s
16
— and applied it to pharmacists. One pro-
posed law offers pharmacists immunity from civil
lawsuits, criminal liability, professional sanctions,
and employment repercussions.
17
Another bill,
which was not pass ...
Initial progress on the journey toward an open source potential drug-drug int...Richard Boyce, PhD
Presentation given at the 33rd VistA Community Meeting - George Mason University focusing on progress towards and open source potential drug interaction knowledge base
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
The slides from the keynote given by Dr. Dan Malone RPh, PhD at the First International Drug-Drug Interaction Knowledge Representation Workshop on October 6th 2014 (http://icbo14.com/sessions/drug-drug-interaction-knowledge-representation-workshop/). Posted with his permission.
Special Challenges in Clinical Trials: Case Study: the Dying child and the ...Michael Swit
A review of a case study involving whether it would be proper to authorize the use of a drug whose approval had been withdrawn when it is believed to be the only hope for a dying child.
The
new england journal
of
medicine
n engl j med
351;19
www.nejm.org november
4, 2004
2008
sounding board
The Limits of Conscientious Objection — May Pharmacists
Refuse to Fill Prescriptions for Emergency Contraception?
Julie Cantor, J.D., and Ken Baum, M.D., J.D.
Health policy decisions are often controversial,
and the recent determination by the Food and Drug
Administration (FDA) not to grant over-the-coun-
ter status to the emergency contraceptive Plan B
was no exception. Some physicians decried the de-
cision as a troubling clash of science, politics, and
morality.
1
Other practitioners, citing safety, herald-
ed the agency’s prudence.
2
Public sentiment mir-
rored both views. Regardless, the decision preserved
a major barrier to the acquisition of emergency con-
traception — the need to obtain and fill a prescrip-
tion within a narrow window of efficacy. Six states
have lowered that hurdle by allowing pharmacists
to dispense emergency contraception without a
prescription.
3-8
In those states, patients can sim-
ply bypass physicians. But the FDA’s decision means
that patients cannot avoid pharmacists. Because
emergency contraception remains behind the coun-
ter, pharmacists can block access to it. And some
have done just that.
Across the country, some pharmacists have re-
fused to honor valid prescriptions for emergency
contraception. In Texas, a pharmacist, citing per-
sonal moral grounds, rejected a rape survivor’s pre-
scription for emergency contraception.
9
A pharma-
cist in rural Missouri also refused to sell such a
drug,
10
and in Ohio, Kmart fired a pharmacist for
obstructing access to emergency and other birth
control.
11
This fall, a New Hampshire pharmacist
refused to fill a prescription for emergency contra-
ception or to direct the patron elsewhere for help.
Instead, he berated the 21-year-old single mother,
who then, in her words, “pulled the car over in the
parking lot and just cried.”
12
Although the total
number of incidents is unknown, reports of phar-
macists who refused to dispense emergency con-
traception date back to 1991
13
and show no sign of
abating.
Though nearly all states offer some level of le-
gal protection for health care professionals who
refuse to provide certain reproductive services, only
Arkansas, Mississippi, and South Dakota explicit-
ly protect pharmacists who refuse to dispense emer-
gency and other contraception.
14
But that list may
grow. In past years, legislators from nearly two doz-
en states have taken “conscientious objection” —
an idea that grew out of wartime tension between re-
ligious freedom and national obligation
15
and was
co-opted into the reproductive-rights debate of the
1970s
16
— and applied it to pharmacists. One pro-
posed law offers pharmacists immunity from civil
lawsuits, criminal liability, professional sanctions,
and employment repercussions.
17
Another bill,
which was not pass ...
DaniaRole of Advanced Practice NursingAccording to the FlorOllieShoresna
Dania
Role of Advanced Practice Nursing
According to the Florida Board of Nursing, advanced registered nurse practitioners (ARNPs) can prescribe patients with controlled substances that are listed in the schedule II, III and IV which are well described in s. 893.03 Florida Statutes. Before doing so, they are to participate in three-hour training sessions which would help them implement the right strategies (Florida Board of Nursing, 2016). For APRNs to provide the right prescriptions to their patients they are necessitate to analyze and describe patient’s health problems. They are also required to fill their patients with enough knowledge regarding the drugs side effects and how they are supposed to take them (Pigman et al., 2016). As well-known medical practitioners should ensure that after a patient receives a drug, its use is well achieved. As stated by the state requirements an APRN should also do the same to make sure that the drug given achieves the goal it it supposed to achieve (Kooienga and Wilkinson, 2017).
There are numerous barriers that inhibit APRN practitioners from carrying out their prescriptions roles as required. First, there are various programs that may be directed towards the deliverance of health care services that are of high quality. But the problem comes in when the leaders of these programs fail to equip APRNs with advanced skills for dealing with them. Lack of enough knowledge and negative perceptions towards the same may inhibit them from performing their prescription roles. Secondly, state license restrictions may limit APRNs from fully participating in their practices as required because most boards only allow they to take part in one nursing practice role depending on the concerted agreement (Reynolds et al., 2021).
When prescribing medication to patients ARNPs have a great role and responsibility. Their role depends on state laws which are associated with the prescriptive authority provided to them (Florida Board of Nursing, 2016). After and before prescribing APRNs have the role of ensuring that all the drugs are taken at the right time and that the patients know of their side effects. To be on the safer side all APRNs must be responsible while prescribing drugs as this is in all of the patients benefit.
To add on that every practitioner who needs to prescribe medication must be registered by the United States drug enforcement administration. They should also have an experience of two years in terms of the drugs they purchase, distribute, administer and dispense (Florida Board of Nursing, 2016).
References
Reynolds, A. M., Reynolds, C. J., & Craig-Rodriguez, A. (2021). APRNs' controlled substance prescribing and readiness following Florida legislative changes. The Nurse Practitioner, 46(6), 48-55.
Pigman, Campbell, and others. (2016). HB 423 – Access to Health Care Services. Retrieved from https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424
Florida Board of Nursing. (2016, April). Impo ...
Consumer health: time for a regulatory re-think? is a report by RB in association with PAGB, written by the Economist Intelligence Unit. It looks at the changing healthcare environment and the role self-care plays and efforts at regulatory harmonisation, the barriers they have encountered, and prospects for the future.
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Bác sĩ xem phương pháp tra liều thuốc của EduVET để tận dụng hết công hiệu của cuốn sách này
link cách tra liều thuốc: https://www.facebook.com/groups/448168926123166/
Unethical Practices in Pharma - Interesting Study from Pakistan Anup Soans
This study clarifies the current pharmaceutical drug promotion and prescribing practices in Pakistan. The majority of prescribers and national pharmaceutical firms and to some extent the multinational pharmaceuticals are involved in unethical practices in drug promotion and prescribing. Alarming policies governing the drug promotion and prescribing are required to be implemented by the concerned regulatory authorities to avoid unnecessary harm to the patient’s life and pocket through the unethical drug promotion. The prescribers should not accept any incentives, gifts of financial value from any pharmaceutical companies in return for an increase in prescribing selected brand. On the other hand, pharmaceutical companies must compete in the market on the basis of the drug quality and do not offer any valuable gift and incentives to the prescribers. The interaction between doctors and phar- maceutical firms should be restricted within acceptable boundaries and the authorities must be prepared to play an active role. Strengthening the regulatory machinery and formulating policies in this regard in neces- sary. It is essential that a health care professional such as a pharmacist can play an important role in this process since he/she is an expert in the pharmaceutical field as well as more aware of the outcomes of unethical drug prescribing practices such as polypharmacy and adverse drug reactions.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Pharmacist Prescription Drug Extension_Citations_edited_2015_05_07
1. 1
Pharmacists May Soon Be Allowed to Prescribe Certain Drugs, Competing with Licensed
Practitioners
April 7th
, 2015
In 2012, the State and National Board of Pharmacists, and several retail pharmacy chains, have
pushed to create a third category (“A New Paradigm”) within the Federal Drug Administration’s
(FDA) Register that redefines certain “prescription drugs” for common illnesses, to
“nonprescription drugs”, under a pharmacist’s discretion.
If the proposal passes, in three years, medical practitioners may see a pharmacist’s role expand to
become a different type of practitioner who can prescribe certain routine medications to patients
who walk through their doors. Doctors will be forced to work with pharmacists to coordinate a
level of care to ensure the safety of their patients. National pharmacy chains like Walgreens are
already heading in this direction by moving their pharmacists from behind the counter, to front
and center where they can educate and consult with their customers. (Link:
http://my.chicagotribune.com/#section/-1/article/p2p-81524140/ Accessed 5/7/2015)
The rationale for this new proposal, according to the 2012 FDA Register (Link:
http://www.gpo.gov/fdsys/pkg/FR-2012-02-28/pdf/2012-4597.pdf) ultimately stems from the
concern that many people with chronic medical conditions, such as asthma, migraine headaches,
high blood pressure, and high cholesterol, are currently being under-treated. These people walk
into pharmacies everyday asking their pharmacists for advice. The State Board of Pharmacists
feel that pharmacists should be allowed to dispense medications to treat these prevalent
conditions, since many people place a significant level of trust in their pharmacist, especially
patients with limited access to medical care.
Currently, all prescription medication must be prescribed by a licensed practitioner, which is
defined as a medical doctor, nurse practitioner, physician’s assistant, and other types of
practitioners. Under section 503(b)(1)(A) of the FD&C Act (21 U.S.C. 353(b)(1)(A)), a drug
must be dispensed by prescription if, ‘‘because of its toxicity or other potentiality for harmful
effect, or the method of its use, or the collateral measures necessary to its use, [it] is not safe for
use except under the supervision of a practitioner licensed by law to administer such a drug,”
according to the FDA Register.
At this time, pharmacists are able to dispense prescription drugs, evaluate whether there are any
dangerous or fatal drug interactions, identify any incorrect dosages written on the prescription,
and provide consultation on how to administer a particular medication. They also have the
ability to give advice on which over-the-counter medication to take for a particular ailment.
This is one of the arguments pharmacists and drug chains have given the FDA in supporting their
mission to change the law.
2. 2
The current argument by both the pharmacist boards and drug chains is that certain treatments
for ailments like high cholesterol, high blood pressure and triglycerides, are routine enough that a
pharmacist (who has some medical training) should be able to make an assessment based on
blood test results to prescribe the appropriate medication. This decreases the time and effort it
takes to get a prescription from a doctor and would benefit all the under-treated patients who do
not have the time to visit the doctor for something as minor as obtaining a prescription. For
example, “a pharmacist could make a recommendation regarding an appropriate drug therapy,
based on results of testing for cholesterol or triglycerides,” explained Dr. Robert Glatter, Forbes
magazine contributor. (Link: http://www.forbes.com/sites/robertglatter/2012/05/11/should-
pharmacists-prescribe-prescription-medications)
As a medical doctor, Glatter has similar concerns as his colleagues in the medical field. “I can
certainly appreciate a pharmacist prescribing an inhaler to an asthma patient who is in acute
distress in a pharmacy, or an Epipen auto injector to a person with an acute life threatening
allergic reaction standing in line at a pharmacy counter. However, I agree that the practice of
allowing pharmacists to routinely prescribe certain classes of drugs has the potential to create an
unsafe practice in certain subgroups of patients with multiple medical problems.”
The FDA, however, views this proposal as an opportunity to provide a larger population of
patients better access to basic health care, especially with the enactment of the Affordable Care
Act. Now more patients have access to health care and there are not enough general practitioners
to treat them all, states the FDA Register. The advantage of allowing a pharmacist to see
patients and prescribe drugs for common illnesses, directly contributes to reducing health care
costs. If a patient can visit their pharmacist for routine treatment, rather than visit a doctor who
bills at a higher rate, then the FDA has contributed to decreasing health care costs.
The FDA has also found that “some patients who obtain an initial prescription do not continue on
necessary medication because they would need to make additional visits to a health care
practitioner for a prescription refill.” Other patients need to visit their doctor for routine blood
tests before a doctor will write a new prescription or authorize more refills. The FDA feels this
is unnecessary and utilizing a pharmacist as an intermediary for these situations under a safe
environment would eliminate some of these issues.
By allowing pharmacists to handle basic health care needs, this practice would relieve the burden
of urgent care providers, emergency doctors, and medical practitioners, allowing them to focus
on more serious cases, the FDA believes. The medical field, however, disagrees.
Both the American Medical Association (AMA) and the American Academy of Family
Physicians (AAFP) wrote a letters of opposition to this “New Paradigm”. As far as the medical
community is concerned, there are significant risks allowing pharmacists to play a bigger role in
the medical field. The AMA argued that pharmacists do not have the training to correctly
prescribe a medication that is currently listed as a prescription drug under the FDA Register and
by redefining certain medications to nonprescription under this third category, could become
harmful to the patient.
3. 3
“The proposed practice of allowing pharmacists to prescribe so called ‘routine medications’
under this proposal, has the net effect of blurring the lines in the traditional relationship between
patients, medical providers, and pharmacists,” expressed Glatter.
During the FDA’s March 22, 2012 public hearing Using Innovative Technologies and other
Conditions of Safe Use to Expand Which Drug Products Can Be Considered Nonprescription,
individuals from both sides spoke in favor or against this potential change in the FDA rules.
Beverly Schaefer, RPh, who represented the National Community of Pharmacists Association,
spoke at the public hearing and claimed, “Pharmacists have demonstrated over the years, their
ability to provide increased access to health care with implementing mass vaccination campaigns
throughout the nation. During the 2009/2010 H1N1 influenza season, nearly one third of all
immunizations were administered in [a] pharmacy.”
(Link: http://www.fda.gov/downloads/Drugs/NewsEvents/UCM301937.pdf, FDA public hearing
transcripts)
Both the State and National Boards of Pharmacists and all pharmacist associations agreed;
pharmacists who are allowed to prescribe certain routine medications will be able to streamline
the system and provide medication to a greater population of those in need of health care. The
FDA is also considering certain routine medications to be defined as both prescription and
nonprescription. “Dual availability could help ensure greater access to needed medications by
making obtaining them more flexible,” explained the FDA Register.
A few medical practitioners attended the FDA public hearing on expanding non prescription
drugs and voice their concern and opposition to the addition of a third category proposed in the
FDA Register. One such practitioner, Dr. Sandra Adamson Fryhofer, an internist, voiced her
opinion, “Well, one of the concerns I have, and you mentioned doses of medications, as an
internist, I take care of adults of all ages, [from] adolescents [to the elderly]. My oldest patient is
94 and I hope she lives to be 104, and if I have anything to do with it, she will (there was a clap
in the audience). So, I’m very concerned about doses of medication and that’s a big source of
confusion, especially for my elderly patients.”
Dr. Fryhofer, continued by explaining that what seems to be a small dosage change can be a
detrimental to a patient’s health. “The difference between some of my patients taking 10
milligrams of a blood pressure medicine and five milligrams of a blood pressure medicine can be
the difference between them being able to walk to the restroom or falling right out of bed and
having a hip fracture.” Several medial professionals felt that if a pharmacist is going to take on
some of the responsibilities of a medical practitioner, then maybe they should be going to
medical school.
"Only licensed doctors of medicine, osteopathy, dentistry, and podiatry have the statutory
authority to prescribe drugs," says Goertz. "Allowing the pharmacist authority to dispense
medication without consulting with the patient's physician first, could seriously compromise the
physician's ability to coordinate the care of multiple problems of many patients,” explained
AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas in AAFP letter to the FDA
opposing the proposal.
4. 4
Even though the AMA and the AAFP wrote letters of opposition, there were very few
individuals from the medical community who were present at the public hearing. There were a
significant number of individuals representing the pharmacists and drug chains that supported the
proposal under discussion at the FDA public hearing in 2012.
The good news is that the FDA has discussed seeking input into evidence that would deem
certain prescription drugs to be redefined as nonprescription and administered under safe use.
“We anticipate that, depending upon the situation, applications for approval of nonprescription
products with conditions of safe use may need to include patient studies (e.g., self- selection
studies, label comprehension studies, and actual use studies) to demonstrate that the drug would
be safe and effective under the specified conditions,” stated the FDA in their Federal Registry.
So what will the future look like in the health care system if pharmacists are aloud to administer
certain medications that used to be categorized as a prescription drug? How will medical
providers and pharmacists coordinate together in this new system? At this time there is no
answer. Nobody has come up with any good solutions.
In less than three years, pharmacists may join the rankings of licensed practitioners in a limited
capacity to not only test patients before prescribing them, but to use their best judgment on what
types of medications, previously deemed prescription drugs, to prescribe to treat common
illnesses. General practitioners and urgent care doctors will need to find a way to coordinate
with pharmacists in their area to minimize the health risks to their patients. One possible
solution is to require pharmacists to consult with a patient’s doctor before prescribing a certain
medication, especially if there is any question or concern.