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Pharmacists Not Qualified to Initiate Drug Therapy

ACP-ASIM Policy Would Prohibit Independent Prescribing Authority

(Washington, DC): Patients can benefit from pharmacists assuming a greater role in patient care through collaboration with physicians, although pharmacists lack the training and experience necessary to diagnose and treat patients, according to the American College of Physicians - American Society of Internal Medicine (ACP-ASIM). The College outlined its concerns about granting pharmacists independent prescribing authority in a policy paper "Pharmacist Scope of Practice" published in the Annals of Internal Medicine on January 1, 2002.

"As technology speeds the process of dispensing medications, we see an expanded role for pharmacists in educating patients and physicians about drug safety, drug interactions and cost-savings, " stated William Hall, MD, president of the ACP-ASIM. "The Institute of Medicine has documented medication errors as an area needing significant improvements and we have no doubt that greater collaboration between physicians and pharmacists will improve patient results."

As many as 24 states have passed legislation expanding the role of pharmacists to include authority to issue refills, initiate medication regimens or to change a patient's medication. ACP-ASIM opposes pharmacists obtaining independent prescribing privileges and initiating drug therapies.

"We have seen evidence that a collaborative relationship between physicians and pharmacists works well in a hospital setting, where information sharing and physician supervision are part of the daily routine," said Dr. Hall. " Our concern is in the private practice setting, where pharmacists do not have access to medical histories and communications between pharmacists and physicians are more limited."

In an effort to improve patient safety and reduce medical errors, ACP-ASIM supports physician-directed pharmacist/physician collaborative practice agreements limited to pharmacist involvement in patient education and hospital rounds. ACP-ASIM recommends research evaluating the effects of pharmacist and physician collaboration on physicians' time with patients. The College also recommends studies examining the developing role of the pharmacist as education is increased and drug dispensing moves to an automated system.

According to the policy, collaborative drug therapy (CDT) in a hospital setting is one of the best examples of how pharmacists work with physicians. CDT is designed to maximize the patient's health-related quality of life, reduce the frequency of avoidable drug-related problems, and improve the societal benefits of medicines. It includes basic dispensing functions, drug information services, solving patient- and medication-related problems, and making decisions regarding drug prescribing, monitoring and drug regimen adjustments.

"Physicians are qualified to diagnose and treat patients, while pharmacist expertise lies with pharmaceuticals," said Dr Hall. "Decisions about the most appropriate drug for a patient's condition are often subtle and require a level of experience and training that is not required of pharmacists. Physician training entails numerous years of practical, supervised 'hands on' training because of the subtleties of diagnosis and therapeutics involved with patient care."

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership encompasses more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America.

Note to Editors: The full text of "Pharmacist Scope Of Practice" is available online at www.acponline.org/advocacy.

Jennifer Whalen, (202) 261-4575
Jack Pope, (202) 261-4556

Page updated: 11-04-03

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