In several recent letters to the editor, readers have complained about difficulties in getting prescriptions renewed. While several factors are involved, the principal issue is that many British Columbians still cannot find a family physician.
The result is a tour around local walk-in clinics, looking for an available general practitioner. This often means hours of waiting.
We have several suggestions to offer, but from the outset, let’s be clear. The shortage of family physicians is not going to change any time soon. As it is, the capacity of our medical schools is barely sufficient to keep up with GPs retiring.
That means we need new approaches to the process of prescribing and dispensing drugs.
First then, extend the maximum prescription duration beyond the present limit of 12 months. This could only be done for medications that are well tolerated, and only for patients in stable health.
But there are several drugs that treat chronic conditions, such as statins, asthma inhalers and some anti-hypertensives, which may be taken for years. It should be possible, with minimum risk to the patient, to relax the 12-month limit in such cases.
Second, encourage physicians to renew prescriptions by telephone or email. Again, this is viable only in certain situations.
If a patient’s health is declining, or the condition being treated requires ongoing monitoring, an office visit is essential. It’s up to the family doctor to make this determination.
But as things stand, more use should be made of this option.
Third, permit pharmacists to extend prescriptions beyond their expiry date. They already have authority to add extra refills before the date of expiration.
There’s no reason this policy can’t be broadened, so long as the patient’s physician is notified in advance, in case there are reasons not to proceed.
Lastly, allow pharmacists to prescribe drugs on their own authority, within certain limits. Pharmacists in Alberta are allowed to prescribe most medications, with the exception of “controlled” substances such as narcotics. Several U.S. states follow this practice, Oregon and California among them.
Two years ago, the B.C. College of Pharmacists examined this option and found overwhelming support among its members.
Notably, however, they also encountered “strong resistance” from physicians.
And here we come to the heart of the matter.
Each of the healthcare professions who have a role in prescribing and dispensing drugs jealously guards its territory. This in itself has been a major barrier to progress.
So how do we proceed?
First, some of these options will require a change in billing practices. Physicians who issue prescriptions by phone or email should be compensated at the same rate as an office visit.
And extending the duration of prescriptions beyond the 12-month expiry point will require a change under the Health Professions Act.
This will be contentious.
There will likely be concerns about threats to patient safety if this option is chosen.
But the broader reality is this.
The prescribing arrangements currently in place assume a state of affairs that does not exist and will not exist any time soon, namely ready and timely access to a family physician.
That being so, the needs of patients should take priority. The present system is entirely provider-centred, designed by providers, overseen by providers and fortified by provider groups each with its own vested interests.
This has to change. There is no point citing all the difficulties involved. The difficulties will argue themselves.
What’s needed is a complete overhaul, by all means safeguarding patients, but also recognizing that as things stand, patient wellbeing is not safeguarded.
An expert panel should be set up to examine the options, and go into the details in depth. The provincial Health Ministry will have to lead this process. It will not occur spontaneously.
And yes, any meaningful program of reform will have to be collaborative.
But collaboration is only feasible if the will exists. Does it?