Some state laws also establish a formula of medications that PAs cannot prescribe. For example, Florida Admin. Code R. 64B8-30.008 establishes several provisions relating to the prescribing capabilities of PA. [6] The Florida formula does not allow PAs to prescribe general anesthetics or psychiatric medications to patients under 18 years of age. Other states with restricted drug formulas include Georgia, New Mexico, Ohio, Oklahoma, and West Virginia. Overall, the scope of laws on the practice of PA is expanding, with prescriptive restrictions being lifted over time. [7] National protocols are issued by a state agency or agency that authorizes pharmacists to prescribe a drug or class of drugs under a protocol. According to statewide protocols, all state licensed pharmacists who meet the requirements of the protocol, such as: Completion of a continuing education program, authorized to prescribe certain drugs under the authority granted by the state by laws and regulations. Collaborative Practice Agreements (CPAs) are voluntary agreements that create a formal practice relationship between a pharmacist and a prescribing physician, whereby the prescribing physician delegates certain functions to the pharmacist, often undertakes, modifies and discontinues drug therapy, and orders laboratory tests in accordance with the terms of the agreement.
The prescribing physician is primarily a physician, although an increasing number of states allow CPAs between pharmacists and other prescribing physicians such as nurses. The agreement specifies the functions that may be delegated to the pharmacist by the cooperating prescribing physician beyond his or her usual field of activity. The terms used and the characteristics pharmacists can provide as part of a CPA vary from state to state. Regardless of the specific prescribing patterns of different types of providers, all providers must focus on patient-centered care. The growing professions of PAs and NPs are critical to alleviating the burden of a physician shortage, particularly in primary care. [14] In addition, the use of advanced practice providers is a cost-effective means of providing comparable health services to the public. [15] The Affordable Care Act has resulted in an increase in patient workload and demand for primary care, necessitating the full use of advanced practice providers. The expansion of the normative powers of PAs and NPs is a mechanism to mitigate the increased health needs of the public. In particular, the adoption of legislation allowing for greater normative power is not synonymous with the adoption by providers of advanced practices. For example, in 2001, Washington State passed legislation allowing NPs to prescribe Schedule II-IV drugs as part of a joint practice agreement with a physician. However, NPs had to turn to the DEA for the expanded prescribing power.
Surprisingly, only 60% of NPs submitted Schedule II-IV drug requests after the implementation of the new legislation. [9] Reasons for low acceptance of expanded prescribing powers included concerns about knowledge, questions about discipline by regulators, and concerns about working with patients with drug-seeking behaviour. NPs have the normative authority to prescribe controlled substances in all fifty states. However, NPs cannot prescribe Schedule II drugs in Georgia, Oklahoma, South Carolina, and West Virginia. [4] In addition, the laws of the states of Arkansas and Missouri limit NPs to prescribe only Schedule II combinations of hydrocodone. In particular, surveys have shown that many NPs have used strategies to prescribe controlled substances that were not strictly legal. These strategies included using pre-signed prescription pads, signing the prescription by a physician without consultation, and prescribing planned medications without the physician`s involvement. [8] Notarization and privilege are additional methods to enhance the authority of pharmacists in the delivery of patient care services. These programs were introduced by the Joint Commission to establish a process that allows healthcare facilities to expand provider practice powers within their organization, independent of federal and state laws, while maintaining a high level of quality and safety.
The registration process reviews and assesses an individual`s qualifications to provide services, and the privilege process consists of organizations authorizing an individual to perform a specific area of care in that facility. Certification in the pharmacy profession provides a comprehensive overview of the current environment. States have adopted various strategies to facilitate access to clinical services provided by pharmacists by expanding the scope of pharmacists` activities to accommodate pharmacists` education and training. “The continuum of pharmacist prescribive authority” (Adams AJ, Weaver KK) describes how these strategies fit into a continuum that refers to the ease with which pharmacists can prescribe medications to patients. Cooperation agreements require a voluntary agreement between pharmacists and providers and may be the most cumbersome to implement, while stand-alone prescribing models give the pharmacist at the state level the authority to prescribe certain drugs or classes of drugs. State legislation on prescriptive authority for advanced practice providers continues to change and expand. Given current trends, it is likely that advanced practice providers will have increasing normative power over time. Therefore, creating a dialogue between physician groups and progressive practice provider organizations can improve understanding of attitudes toward greater autonomy.
Such discussions have shown that physicians and NPs have similar beliefs regarding increasing prescribing power. [16] Both physicians and NPs were concerned about patient safety, and both agreed that most NPs understand when it is necessary to refer patients to a specialist. Interprofessional communication between different supplier groups can improve team performance while reducing polarizing beliefs. Pharmacists are trained to optimize medication use and improve public health outcomes. When pharmacists are part of the healthcare team, they can help improve medication use and adherence, expand access to care, and reduce health care costs.