EDMONTON -Pharmacists in several provinces, wanting to do more than just count out pills, are pushing for the power to prescribe medications and play a more meaningful role in their patients' health care.
But some physicians' groups caution that allowing pharmacists to write prescriptions without consulting a doctor could harm those very patients.
In Alberta, the change will be allowed under legislation expected to take effect on April 1.
While they won't be allowed to write prescriptions for narcotics or steroids, Alberta pharmacists will be able to refill existing prescriptions and provide emergency supplies of previously prescribed medication.
Some will be able to prescribe for chronic diseases if they meet additional requirements that are being determined by regulators.
"I think job satisfaction is probably one of the biggest things, and being less restricted and being able to do our job much more easily," said pharmacist Will Leung, who owns the Strathcona Prescription Centre in Edmonton.
Widening the scope of practice is the buzz in the industry right now, said Jeff Poston of the Canadian Pharmacists Association, which is developing an action plan to prepare for the shifting role.
"You need to define new practice models, you need to look at legal and regulatory changes and liability issues, you need to look at education and training and financial viability and sustainability," Poston said from Ottawa.
"We're looking at the development of programs to really support pharmacists to change their practice in order that patients can get better outcomes from drug therapy, better access to patient care."
One argument pharmacists make is that the number of family physicians is dwindling and the shortage is much tougher in rural areas, where pharmacists may be one of the only health professionals in a community.
"The answer clearly is to train and license more family doctors, and there are measures underway to do that," said Dr. Colin McMillan, president of the Canadian Medical Association (CMA).
"But it won't change things overnight."
The association doesn't endorse the idea of pharmacists writing prescriptions.
But if they do get that power, McMillan said provincial officials will need to make sure that patients consent to it, that patient records are maintained and that pharmacists disclose any potential conflict of interest, since they also sell the medication they would be prescribing.
One of the problems doctors have with the idea is that pharmacists aren't trained in the critical art of diagnosing, said Dr. Trevor Theman, registrar of the Alberta College of Physicians and Surgeons.
"The piece here that's missing, as far as we know, for pharmacists is that they're not trained in clinical diagnosis, they're not trained to examine patients, they're not trained to integrate all that information," said Theman.
New Brunswick pharmacists have also announced that they want to be able to prescribe medications independently, arguing that their role in the health-care system is evolving as society's dependence on medication increases.
In Manitoba, the government recently passed legislation that would allow pharmacists to prescribe some medications and order and receive diagnostic tests.
Regulations that spell out the specifics are still in the works but could be implemented sometime in 2007.
Ronald Guse, registrar of the Manitoba Pharmaceutical Association, said some of his members are already pushing the envelope in some cases by extending existing prescriptions.
"What pharmacists are doing now to meet the need of the patient, under professional judgment, are stretching the law a bit," he admitted.
"As a licensing authority you don't want to have to put practitioners or pharmacists in a position to break the law to provide the care a patient needs. Under the new act, that will be the authority of the pharmacist."
Final approval of standards to qualify Alberta pharmacists to administer injections and manage drug therapies for chronic conditions is expected in early 2007, said Greg Eberhart, registrar of the Alberta College of Pharmacists.
Back at his pharmacy, Will Leung hopes eventually to offer flu vaccinations and inoculations for customers who are travelling overseas - something the medical clinic next door does for about $20 per patient.
"I think it's really going to provide patients with easier access to another health-care professional who might be able to help them a little more readily and a little more quickly," he said.
But expanding their practice isn't for everybody, said Barry Cavanaugh, chief executive officer of the Alberta Pharmacists Association.
"Some have said, for example, that there are some services they just don't want to try to provide because they just don't see how they could accommodate it within their existing patient load and the volume of their pharmacy."
