Alberta pharmacist scope widened, may prescribe drugs and vaccines.

New regulations will enable Alberta pharmacists to prescribe certain drugs and administer some injections. At the same time, the Canadian and Alberta Medical Associations have raised questions. Nevertheless, the government plans to have the new rules in operation before the end of the year.

Pharmacists who receive additional training and are on the clinical registry of the Alberta College of Pharmacists will be permitted to prescribe many Schedule 1 drugs and blood products, as well as administer some injections, such as flu shots and travelers vaccines. However, they will be prohibited from prescribing narcotics and controlled drugs such as barbiturates and anabolic steroids.

They will be empowered to:

* adapt an existing prescription,

* address an immediate need for drug therapy if it is not reasonably possible for the patient to see a health professional to obtain the prescription.

Adapting a prescription includes altering the dosage, substituting a drug that is expected to deliver a therapeutic effect similar to the prescribed drug, substituting a generic drug for the prescribed drug, or renewing a prescription to ensure continuity of care.

The Pharmacist Association of Alberta says the landmark move validates the expanding role pharmacists have increasingly found themselves taking on.

"We're not talking about diagnosing," said President Susan Haunholter in 2004. "We're talking about just doing assessments and then telling physicians about what we've done for their patients. It's a total 2-way conversation that we're hoping for."

The Alberta Medical Association has raised questions about patient safety, quality of care and potential conflicts of interest by people who will prescribe and sell drugs. They also point to problems of payment for pharmacist services, which are not covered by medicare. The Alberta chapter of the Consumers' Association of Canada expressed concerns that the change will result in higher costs to consumers; greater fragmentation of care and decreased confidentiality.

Pharmacists will be allowed to initiate new prescriptions under these conditions:

* if they deem it appropriate after conducting a "patient assessment";

* if they've received a recommendation from an authorized health professional that drug therapy is warranted; or

* if, in consultation with a health professional, they deem that a Schedule 1 drug or blood product is appropriate.

In much of Europe, a pharmacist's ability to diagnose and treat is greater than their colleagues in Canada. They serve as first-aid providers. British pharmacists "sponsored" by a physician can prescribe certain drugs. The change gives the Alberta's 3500 pharmacists the broadest scope of practice in Canada and one of the broadest in the developed world. Each pharmacist prescribing drug treatment will be required to carry $2-million of insurance.

www.albertapharmacy.ca