Creating the "Pharmacist Prescriber" Model of Practice

A new model of practice with pharmacists as medication therapy management experts is on the horizon.

The American Society of Health-Systems Pharmacists (ASHP) recently published a survey focusing on the prescribing abilities of pharmacists and the progress the profession has made towards a new model of prescribing.

“In light of ongoing shortages of general-practice physicians and nurses, likely reductions in federal spending for Medicare and Medicaid may be the opportunity that leads to specific recognition of the credentialed pharmacist as another less expensive provider,” said C. Richard Talley, editor of the American Journal of Health-System Pharmacy.

The most notable arguments for pharmacists expanding their current role come from an article entitled Pharmacist Prescribing: What Are the Next Steps?, a commentary by Lisa Nissen, BSPharm, PhD, FSHP, FHKPA, associate professor and deputy-director for the Centre for Safe and Effective Prescribing, School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland.

Dr. Nissen notes that the role of the pharmacist may need to change in response to the funding of medication therapy management services outlined in Medicare Part D programs. As the role of the pharmacist grows, there will be additional challenges in “work force supply, training and credentialing remuneration for services, access to and sharing of medical records, local and national legislation, expansion of professional roles, and provision of continuity of care,” according to Dr. Nissen.  The following are the key points of her paper.

Overall Shortage of Prescribers
o   Advanced information technology could expand the reach of pharmacist prescribers, as there is an international shortage of medical practitioners and prescribing “arrangements” do not currently meet community needs.
o   Pharmacists should look to the nursing profession as an example that has been successful in expanding its practice responsibilities.

Pharmacists as Prescribers
o   Pharmacists would need to follow these steps to prescribe:
   1. Gather information (take medication history).    3. Communicate prescribing information (to other health care professionals and the patient).
   4. Monitor and follow-up (ask, “is the treatment working?”).
o   Clinical decision-making is the most complex step facing pharmacists.
o   Pharmacists have skills that are underused: health promotion, disease management, medication review, in-depth training in pharmacology, clinical therapeutics,
and patient care skills.
o   Extending prescribing authority to pharmacists has the potential to “help optimize medication management and improve the continuity of patient care and patient access to medications."

Future Developments
o   Pharmacists can already prescribe medication in the current areas: the United Kingdom, New Zealand, Canada, and those certified for collaborative clinical practice in New Mexico and North Carolina.
o   Although pharmacists need to recognize there is more to prescribing than just issues of therapeutics, they should know they do add value through their knowledge of medications.
o   Those best prepared for a prescribing role are pharmacists who target their skills to particular areas of practice, specifically those that require complex medical treatments (Eg, HIV, cancer, diabetes, and pain management).

Although physicians, and the public, will likely need time to adjust to the idea of pharmacists in a prescribing role, pharmacists are already providing prescribing advice in some settings. It is “likely that specialist practitioners (pharmacists with advanced training) will become the pharmacist prescribers of tomorrow,” according to Dr. Nissen.