Prescribing rights to pharmacists for minor ailments
AMONG many advanced pharmacy services, pharmacists prescribing for minor ailments are very much into consideration based on the proven potential to improve the efficiency of healthcare system.
Minor ailments are described as conditions which are self-limiting that fall within the scope of the pharmacists’ knowledge and training and can be managed by them without physician’s intervention.
These commonly include cough, cold, fever, acne, musculoskeletal pain, headache, indigestion, vomiting, etc.
In Canada, the United Kingdom, the United States and Australia, community pharmacists have been offering partial or independent prescribing services. Similar efforts are being made in other developed and developing nations.
Pakistan has not yet endorsed pharmacist prescribing for minor ailments despite an overburdened healthcare system.
This piece is intended to invite the attention of healthcare policy makers in Pakistan towards the importance of pharmacist prescribing for minor ailments, as its approval seems beneficial in a number of ways.
First, pharmacist prescribing for minor ailments hold potential to minimize burden on the healthcare system whilst not compromising quality of services.
Despite consistent efforts of the Pakistani government, the demand for healthcare services continues to rise due to the growing burden of diseases.
Besides chronic diseases, minor ailments account for a great proportion of visits to emergency departments, thereby resulting in health facility occupancy, and inefficient use of healthcare resources.
Second, pharmacists prescribing for minor ailments is required due to a number of patient-specific reasons.
In 2019, the International Pharmaceutical Federation and the Global Self-Care Federation articulated that one of the goals of the pharmacy profession is to develop self-care as a “pillar of sustainable health systems”.
There is evidence that the Pakistani population least practice self-care predominantly due to poor health literacy and financial limitations.
Additionally, limited access to healthcare facilities and physicians further discourage the patients to seek healthcare consultation.
Consequently, the majority of the population, especially residing in rural areas, seeks guidance and purchase low cost risk-prone medication from quacks.
Even in urban settings, general public refrain from visiting healthcare settings due to their poor financial status, busy work schedule and/or negative health beliefs.
Moreover, excessive self-medication in the case of minor ailments, especially antibiotics, is very common in Pakistan.
The risk-prone behaviour exposes the Pakistani population to adverse drug reactions, medication errors and the spread of antibiotic resistance.
Besides, those patients who visit healthcare facilities encounter poor quality of consulting due to overburdened healthcare workforce.
Evidence from Pakistan revealed that the average consultation time was much less (i.e., 1-2 minutes) than the proposed optimal norm (ie, =10 minutes).
Given the aforementioned facts and the drug retail outlets being the easiest and first point of contact for patients in Pakistan, the pharmacist prescribing for a minor ailment seems a much-needed and value-added initiative.
The integration of prescriber pharmacists for the minor ailments may appear to be easy due to availability of pharmacy workforce having Doctor of Pharmacy (Pharm-D) qualification.
However, canvassing this concept requires a clear roadmap. The establishment of advance community pharmacy services in Pakistan has been historically thwarted by a number of interlinked governmental, academic, pharmacists and proprietor-related factors.
Specifically, the elephant in the room is up-skilling of pharmacists to “prescribe pharmacist” status.
On a short-term basis, this warrants residency training and evaluation of Pharm-D graduates under the supervision of physicians.
On long-term basis, the revision of Pharm-D course alongside the inclusion of one-year residency training seems most promising to instil holistic patient-centred skills in prospective pharmacy graduates.
In addition to improvements in background knowledge and skills, poor remuneration offered to community pharmacists could be one of the major barriers linked to prescribing role of pharmacists.
In the current scenario, the proprietors of drug retail outlets do not prefer to employ pharmacists because of their justified claim of very low profit margins.
Proprietors further claim that their monthly profit is not enough to meet the regulatory requirements and adequate salary of pharmacists.
Considering the fact that most of the poor people visit the drug retail outlets for self-medication and/or seeking free advice for minor ailments from non-qualified sales staff, the government should address the issue of who will incur the costs related to prescriber pharmacists.
Apart from all pharmacists and system related challenges, authorization of pharmacists to share prescribing authority with physicians is expected to face censure by physicians.
In this context, neutral support of the government will be of paramount importance to spread awareness among physicians and convince the Pakistan Medical Commission about noteworthy benefits of prescriber pharmacists.
After implementation of the scheme, promoting harmonious physician-pharmacist relationship and ensuring effective supervision of physicians during training will be the next challenge.
Altogether, implementation of pharmacist prescribing for minor ailments is expected to set the foundation for service sustainability and improved medication safety in the Pakistan.
However, if authorization of pharmacist prescribing for minor ailments is to occur, utmost attention should be given to up-skilling of pharmacists and strict implementation of existing rules of mandatory availability of pharmacists at drug retail outlets.
In this regard, collaborative efforts of the Pharmacy Council of Pakistan and the Drug Regulatory Authority of Pakistan are required to arrange training programs for pharmacists, financial support for proprietors and reasonable remuneration model for prescriber pharmacists and trainer physicians.
—The writer is Professor of Pharmacy Practice and Chairman of the Department at the Islamia University of Bahawalpur, Pakistan.