Pharmacist prescribing

I was interested in the discussion about pharmacist prescribing at the Canadian Medical Association's most recent annual meeting.1 Every day, pharmacists help patients deal with drug-related problems, such as drug prescriptions with no clear indications, medical conditions for which the patient needs a prescription drug but has not yet received it, drug side effects, drug–drug or drug–food interactions, suboptimal dosing and poor drug selection. Once the problems have been assessed, the pharmacist formulates a plan to resolve them, usually by initiating, stopping or changing the drug therapy or changing the dosing.

In most settings, we need to contact the patient's physician to complete this aspect of patient care. Canadian community pharmacists can alter drug therapy independently for nonprescription drugs (called counter prescribing in Britain), but in hospitals we cannot even start a patient on acetylsalicylic acid for a headache without going through his or her physician. How can this be good for patient care?

British pharmacists have been prescribing since 2003; they complete an accredited training program that includes a physician -supervised practicum. Concerns that pharmacists would prescribe drugs inappropriately have proven to be unfounded. Although British pharmacists can legally prescribe most drugs, in practice they only prescribe drugs within their area of expertise and according to their level of competence, just like physicians. The top 5 drugs prescribed by pharmacists in Britain are ramipril, bendroflumethiazide, simvastatin, amlodipine and acetylsalicylic acid (for antiplatelet therapy).2 Let us go beyond the fear of the unknown and seize this opportunity to optimize our use of health care resources for the benefit of patients.