Management of Drug Therapy: A Reality for Home Care R.Ph.S?

By Snyder, Karyn | Drug Topics, July 24, 1995 | Go to article overview

Management of Drug Therapy: A Reality for Home Care R.Ph.S?


Snyder, Karyn, Drug Topics


Though home care pharmacists may work closely with patients, they are often powerless to make any changes to improve drug therapy. While prescriptive authority continues to grow for R.Ph.s working in hospitals, clinics, long-term care facilities, health maintenance organizations, and even retail stores, that power is often not extended to the home care R.Ph. Many groups representing physicians remain opposed to granting R.Ph.s such power in what they view as an unsupervised setting.

"There's the perception that there isn't as much possibility of oversight by other folks [in the home care setting]. In reality ... the home care setting is probably one in which this is occurring more than in other settings. What actually does happen is that in many cases physicians will allow the pharmacist to adjust therapy [and approve] it after the fact, but organized medicine is very opposed to that idea," said Teresa Ann Miller, Pharm.D., executive v.p.-California Society of HealthSystems Pharmacists (CSHP).

Such was the case in California, where a recent bill was amended to appease the California Medical Association. Although the CSHP and the California Pharmacists Association were seeing an expansion of drug therapy management to a variety of outpatient settings, including HMOs, clinics, and home care, they had to drop the home care language to get the bill passed. "The California Medical Association was going to try to kill [the bill] unless we amended [the home care references] out of the bill," Miller said.

Currently, 10 states have granted R.Ph.s varying degrees of prescriptive authority, bringing pharmacy another step into the future. Such authority helps pharmacists become more than mere drug dispensers and helps them establish themselves as integral members of the health-care team. States that have granted prescriptive authority to R.Ph.s include California, Florida, Mississippi, Nevada, North Dakota, New Mexico, Oregon, South Dakota, Texas, and Washington.

Prescriptive authority varies widely from state to state. Florida has granted pharmacists independent prescriptive authority, while such authority in most states is dependent upon protocol or physician approval. While some states allow R.Ph.s to initiate drug therapy, others allow them only to modify it. A few states allow R.Ph.s to order lab tests and administer injections, as well.

The practice setting in which R.Ph.s may exert their prescriptive authority also differs from state to state. …

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