What collaborative prescribing could look like for pharmacists

collaborative prescribing

PSA CEO Dr Shane Jackson has backed the likelihood of pharmacists being able to prescribe under a collaborative framework by the end of next year.

Speaking at PSA19, Dr Jackson said pharmacist collaborative prescribing is ‘absolutely achievable by 2020’.

‘There is significant overlap between the prescribing competencies that have been endorsed by NPS MedicineWise and current competency standards for pharmacists in our country.

‘The reasons it needs to be implemented without delay is because whilst our country ranks well for healthcare outcomes, it does rank poorly in a couple of areas, especially around equity and access.’

Dr Jackson referenced the growing body of evidence, particularly out of the UK and Canada, around the benefits of pharmacist prescribing.

‘The evidence has supported pharmacist prescribing delivering three main outcomes: access and efficiency, improved patient safety and more focused, person-centred care,’ he said.

‘If we had resident pharmacists in aged care facilities working in partnership with general practitioners, I don’t think we would have the level of inappropriate prescribing that we have for antimicrobials, antipsychotics, opioids and medicines that cause falls that we currently have. 

‘As a profession it will be more difficult for us to take ownership of medicine safety if we don’t have the opportunity to prescribe. Prescribing goes hand in hand with the ability to be able to address medicine safety concerns.’

Dr Jackson said an essential first step was having a clearly articulated framework for collaborative prescribing, specifically for community pharmacy.

‘Community pharmacy will improve access to healthcare from a prescribing perspective,’ he said. 

‘It shouldn’t be limited to pharmacists outside of community pharmacy. We need to see prescribing broadly, across settings.’

Dr Jackson described three key planks of collaborative prescribing:

  • initiation of a medicine after a diagnosis has been made
  • dose modification of an existing medication
  • cessation or initiation to reach treatment goals.

‘Collaborative prescribing is where you would enter a relationship with a medical practitioner – that practitioner might in a hospital, in aged care, in general practice, or it might be through a community pharmacy – and that agreement sets the frame for that collaborative prescribing.’

He said an individual collaborative prescribing framework could be as broad as a pharmacist partnering with a prescriber in an aged care setting and prescribing for chronic disease and geriatric conditions, or as narrow as working in a community pharmacy and being able to adjust the dose of a prescribed antihypertensive if the patient is outside the previously agreed parameters.

‘When I talk to health professionals other than doctors, they are asking “Why aren’t we [pharmacists] prescribing?”,’ Dr Jackson said.

‘A lot of pharmacists are teaching prescribing to nurses or podiatrists. We have the best medicines knowledge and expertise and we’re not prescribing – it just doesn’t make sense.

‘Non-medical professionals are very supportive but doctors are a little different. They are seeing prescribing solely through a community pharmacy lens, and through a perceived conflict of interest, which you can minimise through different programs of work, but they’re not seeing the opportunity.’

For more, see our Australian Pharmacist feature on pharmacist prescribing.