Why Pharmacist is not allowed for Prescription drug, a thought

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Rajashri Ojha
(Founder & Director, Raaj GPRAC)
www.rajgprac.com
rajashrio@gmail.com
raajgprac@gmail.com
+91 9819488208
''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.''

Disclaimer
 Contents of this presentation are the presenters
personal views and do not necessarily represent
any companies policies and position.
 Some images are taken – freely available from the
internet for a diagrammatic representation of the
content and the source is acknowledged.
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Aims towards,
The implementation of
prescription rights for
registered pharmacists’
in India.
Purpose…

 Prescribing by pharmacists differs from what is currently
understood as prescribing by other health professions.
 Pharmacist prescribing describes a wide range of activities. It
includes:
 prescribing drugs to treat minor, self-diagnosed or self-limiting
disease conditions;
 adjusting dosages and dosage forms; monitoring and refilling
prescriptions to ensure appropriate and effective care;
 providing emergency supplies of previously prescribed medication;
 providing comprehensive drug therapy management where the
pharmacist, working with other health professionals, takes full
responsibility for establishing and maintaining a patient’s chronic
drug therapy; and
What is pharmacist prescribing?

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 Substituting another drug that is expected to have
a similar therapeutic effect.
 Pharmacists will assess and triage each patient
as required. If the pharmacist has the
competencies and appropriate information to
initiate drug therapy for minor, self-limiting or self-
diagnosed conditions, he or she may initiate
treatment.
 Alternatively, the pharmacist may refer the patient
to another part of the health system.
What is pharmacist prescribing?

Prescribing activities can be grouped into three general
categories:
1] Initial access prescribing—prescribing when a patient
chooses a pharmacist for advice about and treatment of
minor, self-limiting or self-diagnosed conditions, about
wellness programs, or in urgent or emergency situations.
2]prescription modification—modifying a prescription written
by another prescriber to alter dosage, formulation,
regimen or duration of the prescribed drug, or provide a
therapeutic alternative to improve drug therapy or provide
continuity of therapy
What kinds of prescribing can
pharmacists do?

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3] Comprehensive drug therapy management—initiating,
maintaining, modifying or changing drug therapy based
on referral from another health provider who has made
the diagnosis or upon the request of the patient upon
receiving a diagnosis.
Comprehensive drug therapy management will occur only
in a collaborative health team environment wherein
sufficient information is available to the pharmacist for him
or her to make a recommendation for drug therapy.
What kinds of prescribing can
pharmacists do?

 This system has already been pioneered on the
international level for the better.
 Such practices can be projected to validate-
i. Ample benefits for healthcare provision and
organization.
ii. Patient convenience
iii. Patient safety
iv. Harmony with clinical management plans
v. Proficiency in general practice and hospitals
vi. Professional gratification for pharmacists.
Why is this in aid of?

 Prescribing necessitates deep acquaintance of
doses, drug-drug and drug-food interactions,
adverse effects, ideal routes of administration,
pharmacokinetics, pharmacodynamics and
observation of effects.
 Pharmacists are all already alive with the
knowledge of the above mentioned details.
 Their prior involvement in the prescribing
process may help enhance the use of medicines.
Why is this in aid of?....continued…

 Involvement in medication management,
encompassing monitoring of therapy are well
accepted in the hospital background.
 Broadening of the same by adding the permit to
prescribe early therapy and to adjust long-lasting
therapy is relatively a small step
 With the overall approval of ‘prescription by
pharmacist’ on the international stage, its high
time that such an approach in India be
implemented.
Why is this in aid of?....continued…

 Only registered physicians have been prescribing
the prescriptions in India so far
 As yet, this is restricted in the context of
pharmacists
 If truth be told and as said earlier, prescribing
requires having subtle information of drugs and
pharmacists are full of such fine details.
 That is why, there is a real need of the introduction
of ‘prescription by pharmacist’ in India, though at a
small level in the beginning to lessen the workload
in the healthcare system.
Findings…

1. Reliant prescribing by proper agreement
defined for it.
 Such type of prescribing encompasses more
restrictions on prescription activities by dint of
formularies and/or protocols.
 Is a written guideline, a clear and much detailed
document that delineates the activities that
pharmacists’ might perform in their prescriptive
boundaries.
Methodologies…

The content of an agreement shall cover
The procedures, decision criteria or plan
that the pharmacist must follow while
prescribing
Disease types, drug-drug categories that
pharmacists may prescribe within,
for instance, anticoagulants, antiemetics,
analgesics etc…
The time limit for the agreement
Methodologies….continued…

The responsibilities of each person
involved
Documentation and feedback
methods to the authorizing prescriber
Strategies for review and revision of
the agreement etc…

2. Reliant prescribing: Auxiliary prescribing.
Auxiliary prescribing-
 Is a voluntary companionship between the independent
[doctors]and auxiliary[pharmacist] prescriber
 Fulfills already decided patient –restricted plan of clinical
management with the agreement of patient.
 The independent prescriber shall undertake the
preliminary assessment
 The auxiliary prescriber can then write prescriptions at
public expense, working to a care management approach
that has been granted by the physician.

Here the role of pharmacist will be
inclusive of contributing to clinical
management plan screening.
swapping the medicines
Finally bringing up to the independent
prescriber where applicable
Detailing clinically significant facts.

3. Mutual prescribing
This requires a cooperative practice association
linking a pharmacist and a physician with a legal
authority to prescribe medicines.
The physician first analyses and makes treatment
decisions for the patients
The pharmacist further picks, commences, screens,
alters and continues or discontinues
pharmacotherapy as suitable to achieve the agreed
patient results.
The physician and pharmacist both share the risks
and responsibilities for the patient consequences.

Responsibilities ought to be taken for the whole
process of diagnosis, prescribing and follow ups
including the cognizance of boundaries of know-
how.
Surprisingly, every pharmacist might not desire to
accept such sort of liabilities.
Pharmacists are able to handle those for minor
ailments but on the contrary, expanding those
responsibilities to prescription medicines may have
an introduction of new quality assurance concerns.
Some shortcomings…

o Episodic evaluation of pharmacists’
prescribing practices.
o This would serve as a method for
maintaining standards and ensuring best
patient outcomes.
o Having regular audits is a much fruitful
solution to examine the adherence or
compliance to prescribing rules etc…
o Proper upholding of patient records.
Conquering the shortcomings…

 All registered pharmacists in India must accept all
the intrinsic accountabilities relating to prescribing.
 They need to prove their competence to do so.
 However, there are also various professional,
technological, educational and legal matters that
need to be come to a decision before pharmacists
can start to prescribe.
 captivatingly, the induction of mutual and/or auxiliary
prescribing methods in India would be the
appropriate steps in the best interest of patients.
Conclusion…

 Emmerton, L., Marriot, J., Bessell, T., Dean,
L., (Aug 2005), ‘pharmacist and prescribing
rights: Review of international developments’.
J Pharm pharmaceut., Vol 8{2}, page no 217-
225.
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References…

Thank you…………..
…………and open for discussion !

Why Pharmacist is not allowed for Prescription drug, a thought

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