Expanding Health Professionals’ Scopes of Practice Pertaining to Pharmacist Prescribing (Mar 2011)

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Title: Expanding Health Professionals’ Scopes of Practice: A Case Study of Health Policy Pertaining to Pharmacist Prescribing
Principal Applicant Title(s) Institutional Affiliation Funding Amount Anticipated Completion Date
Dr. Linda MacKeigan Associate Professor Leslie Dan Faculty of Pharmacy at University of Toronto $15,480 March 2011
Co-Applicant(s) Titles(s) Institutional Affiliation(s)
Mr. Nedzad Pojskic 3rd year PhD Student Graduate Department of Pharmaceutical Science at University of Toronto
Dr. Heather Boon Associate Professor and Acting Associate Dean Graduate Education, Leslie Dan Faculty of Pharmacy at University of Toronto
Dr. Jillian Kohler Assistant Professor Leslie Dan Faculty of Pharmacy at University of Toronto

 NedzadBiography of Principal Investigator: Mr. Nedzad Pojskic is a PhD Candidate in the Department of Pharmaceutical Sciences at the University of Toronto.

His research focus is on expanding health professional scopes of practice, with a particular focus on the pharmacy profession.

He recently completed the Collaborative Program in Health Services and Policy Research. Nedzad also holds a Masters Degree in Pharmaceutical Sciences and an Honours Bachelor of Science degree in Psychology.

Abstract

In recent years, there has been increasing recognition, both in Canada and internationally, that pharmacists are an underutilized resource in the health care system. Since 2006, all Canadian provinces and territories, except for Yukon, Nunavut and Newfoundland, have expanded pharmacists' scopes of practice to include drug prescribing authority. The extent of the authority and the degree of implementation vary provincially with Alberta at the forefront in both aspects. In the UK, pharmacists have been permitted to prescribe as supplementary prescribers since 2003 and as independent prescribers since 2006.

In Ontario, the recently passed Bill 179, Regulated Health Professions Statute Law Amendment Act grants pharmacists limited prescribing authority. The process of developing the policy began with the Health Minister's 2007 request to the Health Professions Regulatory Advisory Council (HPRAC) to recommend ways to facilitate interprofessional collaboration and examine the authority given to non-physician health professions to prescribe drugs. After a 1‐year consultation process, HPRAC recommended that pharmacists be granted the authority to independently adapt, modify and extend prescriptions and initiate drug therapy for smoking cessation. These recommendations formed the basis for the changes in pharmacists' scope of practice outlined in Bill 179. While pharmacy professional organizations welcomed these regulatory changes, medical organizations, and in particular the Ontario Medical Association, strongly opposed them on the grounds that they could compromise patient safety.

For its part, the Liberal government contended that changes outlined in this Act (which included changes in the scopes of practice of 10 health professions) will enable health professionals to work to their full scope of practice, increase access to care for patients, and lead to greater interprofessional collaboration among the health professions. However, there is no scientific evidence to support the connection between expanded scopes of practice and either interprofessional collaboration or access to care. Therefore, the Liberal government may have had other undeclared objectives in pursuing this policy initiative.

The main goal of this research project is to develop a better understanding of the public policy process by which health professions' scopes of practice change, by examining the case of pharmacist prescriptive authority in Ontario. The secondary goal is to ascertain the confluence of factors that promoted expanded scopes of practice onto the government's agenda, while the tertiary goal is to identify and understand the strategies that pharmacy and medicine used in order to advance their interests with respect to scopes of practice.

This qualitative study will analyze policy documents and interviews with key informants form the Ontario government, and pharmacy and medical professional organizations. Anticipated learnings include the relative influence of problems versus politics in driving a government agenda with respect to scopes of practice and the relative power of government versus the health professions in setting the government's agenda and shaping the final policy.

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