Home' Australian Pharmacist : Australian Pharmacist March 2012 Contents 240 Australian Pharmacist March 2012 I ©Pharmaceutical Society of Australia Ltd.
Recent evidence on the efficacy of OTC
combination analgesics containing
codeine suggests that the benefits
of these products may have been
overestimated. In light of ever-increasing
reports of serious morbidity and mortality
associated with these products, the
benefits of having them readily available
OTC may no longer outweigh the risks
of harm. Pharmacists have a role to play
in ensuring consumers are fully aware
of the benefits and risks associated with
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Steps along the way to
By Andrew Daniels
Pharmacists must not assume they can
become prescribers just because they
know about drug therapies according to
a commentary published in the American
Journal of Health-System Pharmacy.1
It observes that internationally
pharmacists have been prescribing an
increasing range of medicines over the
past 20 years. In the UK, the US, Canada
and New Zealand pharmacists can legally
prescribe a range of medicines previously
only prescribed by medical practitioners.
However, it warns that in spite of a wide
range of pharmacist prescribing models
having been developed around the world,
a lack of evidence of the overall impact
of these models on clinical practice and
on patient outcomes is a stumbling block
The commentary's author, Associate
Professor Lisa Nissen from the University
of Queensland, writes that around
the world countries with developed
economies have crises in their health care
systems -- key issues being the increased
cost of new pharmaceuticals and other
evolving technologies, the growing
needs of ageing populations, the impact
of chronic diseases, and a significant
She says that while there are no easy
solutions, 'what is clear internationally
is that pharmacists can be key
participants through their contribution
to the informed and appropriate use of
medications in the community.'
Dr Nissen goes on to say that it is clear
that current prescribing arrangements
do not fully meet community needs for
timely, cost effective and convenient
access to prescription medicines. She
writes that it is also clear, 'that medicines
should be provided to consumers by
making the best use of professional
expertise and scarce health resources.'
It is this assertion, she says, that has
driven the expansion of prescribing to
nurse practitioners, physician assistants,
optometrists, physiotherapists and
pharmacists, to name a few. Further,
pharmacists can learn from nurses as their
broad scope of practice, long history of
advanced practice models and specialised
practice have allowed them to provide a
viable option to governments 'struggling
under the stress of overstretched health
Dr Nissen outlined a number of critical
issues that need to be addressed before
pharmacist prescribing can move forward,
including: work force capacity issues,
training and credentialing, remuneration,
professional indemnity, legislation, and
access to and sharing of medical records.
She pointed to the issue of conflict of
interest as being of particular importance
for pharmacist prescribers. Pharmacists
play a pivotal role in being the first or
second check on prescribing by other
health care practitioners so pharmacist
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