[AF] Pharmacist Prescribing: What Are the Next Steps?

[Eduardo Satue]

Preguntas claves del artículo que menciona Pedro:

En un sistema sanitario que tiene una amplio abanico de prescriptores, ¿qué valor añadido ofrece que el farmacéutico prescriba?
¿Cómo resolver los conflictos de interés que se pueden derivar de un farmacéutico prescriptor y dispensador?

Pensemos que este artículo se escribe como una ejercicio meramente teórico sino varios años después de que los farmacéuticos sean prescriptores 
en varios países anglosajones.


También se describen hasta 8 modelos diferentes de prescripción farmacéutica.


        Table 1. Authority or Responsibilities of Pharmacists Under International Pharmacist Prescribing Models^5

Model   Recognize Symptoms or Diagnose  Select Therapy  Supply and Administer Therapy   Initiate Therapy        Monitor and Modify Therapy      Start 
Therapy         Continue Therapy        Discontinue Therapy     Supervise Therapy
Independent prescribing         Full    Full    No      Full    Full    Full    Full    Full    Independently
Collaborative prescribing       Diagnosis, initial treatment decision by medical practitioner   Yes     No      Yes     Yes     Yes     Yes     Yes     Collaboratively by 
nominated individual independent prescriber
Supplementary prescribing       Diagnosis, initial treatment decision by medical practitioner   Per agreed patient-specific management plan     No      Per 
agreed patient-specific management plan         Per agreed patient-specific management plan     Per agreed patient-specific management plan     Per agreed 
patient-specific management plan        Per agreed patient-specific management plan     By nominated individual independent prescriber
Patient referral        Diagnosis, initial treatment decision by medical practitioner   Diagnosis, initial treatment decision by medical 
practitioner    No      Diagnosis, initial treatment decision by medical practitioner   Management of specific therapy or therapeutic outcome 
Management of specific therapy or therapeutic outcome   Management of specific therapy or therapeutic outcome   Management of specific therapy or 
therapeutic outcome     Delegated by nominated individual independent prescriber
Formulary       Per list of approved treatable symptoms         Per preapproved formulary according to symptoms         No      Indirectly per preapproved formulary 
Criteria for referral   Duration as per preapproved formulary   Duration as per preapproved formulary   Duration as per preapproved formulary 
Indirectly according to preapproved formulary
Protocol        Per list of approved treatable symptoms         Preapproved medication according to symptoms    Yes     Per protocol-driven symptoms    According to 
preapproved protocol    According to preapproved protocol       According to preapproved protocol       According to preapproved protocol       Prescribing 
delegated by independent prescriber
Patient group direction         Per list of approved treatable symptoms         Written direction under preapproved protocols   Supply and administration 
written direction under preapproved protocols   No      No      Yes     No      No      Delegated under preapproved conditions and protocols
Repeat prescribing (continuance)        Diagnosis, initial treatment decision by medical practitioner   Diagnosis, initial treatment decision by 
medical practitioner    Only supply sufficient medication until next appointment        No      No      No      Previously prescribed medication only; no 
modification    No      Delegated under preapproved conditions
Administration  Per list of approved treatable symptoms         Per preapproved formulary according to symptoms         Only administer for immediate 
treatment       No      No      According to preapproved protocol       No      No      Delegated under preapproved conditions and protocols