Magazine article Drug Topics

Docs at Odds

Magazine article Drug Topics

Docs at Odds

Article excerpt

AMA AAFP, and ACOG question R.Ph.s' capability to counsel

Three physician associations have told federal officials that there is little evidence that retail pharmacists routinely counsel patients about prescription drugs or are "capable"' of doing so. They also suggested that pharmaceutical care is an effort by R.Ph.s to supplant physicians as the primary Rx counselors.

The comments by the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians & Gynecologists (ACOG) are contained in a 137-page "action plan" that nearly three dozen private organizations crafted as a voluntary alternative to the Food & Drug Administration's proposed regulation on patient information known as MedGuide. The plan was submitted to Health & Human Services (HHS) secretary Donna Shalala on Dec. 4. Pharmacy groups on the panel included the American Pharmaceutical Association (APhA), ASHP, National Association of Chain Drug Stores (NACDS), and National Community Pharmacists Association (NCPA).

"The pharmacy organizations have made a strong effort to use the action plan to legitimize one of their chief legislative and regulatory goals, which is to gain reimbursement for pharmacists' 'cognitive services,"' the physician groups told Shalala. "There is little evidence that retail pharmacists are routinely providing cognitive [patient counseling] services or, in fact, are capable of providing these services. Expecting patients and third-party payers to reimburse for these activities will increase the overall costs of health care and encourage the inappropriate practice of medicine by pharmacists who might otherwise not go beyond the limits of their competence."

The AMA, AAFP, and ACOG also took direct aim at pharmaceutical care, which APhA cited in its push to have the plan focus more heavily on oral counseling than just on written patient information leaflets. "Some pharmacy organizations have taken advantage of this situation to promote an agenda that they call 'pharmaceutical care,' " the physician groups said. "These organ-izations have attempted to use the action plan as a mechanism to legitimize the role of the pharmacist as a primary counselor of patients about prescription medicines.

"It is the unwavering view of the physician organizations," they continued, "that this is inappropriate, as it distorts the reality of actual practice. While pharmacists can help improve medication use by reinforcing to the patient the instructions of the prescribing physician, they clearly are not the primary counselors."

In interviews, the pharmacy associations represented on the steering committee reacted differently to the physicians' comments. "The first thing that we want to avoid is a big battle in the media," Susan Winkler, APhA's director of practice affairs, told Drug Topics. Winkler said APhA, which has had an ongoing dialogue with the AMA on pharmaceutical care and other issues, will continue its discussions "CEO to CEO, board to board, staff to staff."

"It is clear from what they wrote in their comment letter," she continued, "that their concept of what pharmaceutical care is and why organized pharmacy is moving in that direction is different from what we're speaking of. There are certainly some discrepancies and really a clear misunderstanding about what organized pharmacy is trying to do and the threat that medicine is perceiving from that. …

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