1. 1 1 Rajashri Ojha (Founder & Director, Raaj GPRAC) www.rajgprac.com rajashrio@gmail.com raajgprac@gmail.com +91 9819488208 ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.''

2. Disclaimer Contents of this presentation are the presenters personal views and do not necessarily represent any companies policies and position. Some images are taken freely available from the internet for a diagrammatic representation of the content and the source is acknowledged. 2 ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 3. Aims towards, The implementation of prescription rights for registered pharmacists in India. Purpose ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 4. Prescribing by pharmacists differs from what is currently understood as prescribing by other health professions. Pharmacist prescribing describes a wide range of activities. It includes: prescribing drugs to treat minor, self-diagnosed or self-limiting disease conditions; adjusting dosages and dosage forms; monitoring and refilling prescriptions to ensure appropriate and effective care; providing emergency supplies of previously prescribed medication; providing comprehensive drug therapy management where the pharmacist, working with other health professionals, takes full responsibility for establishing and maintaining a patients chronic drug therapy; and ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' What is pharmacist prescribing? 5. 5 Substituting another drug that is expected to have a similar therapeutic effect. Pharmacists will assess and triage each patient as required. If the pharmacist has the competencies and appropriate information to initiate drug therapy for minor, self-limiting or self- diagnosed conditions, he or she may initiate treatment. Alternatively, the pharmacist may refer the patient to another part of the health system. What is pharmacist prescribing? ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 6. Prescribing activities can be grouped into three general categories: 1] Initial access prescribingprescribing when a patient chooses a pharmacist for advice about and treatment of minor, self-limiting or self-diagnosed conditions, about wellness programs, or in urgent or emergency situations. 2]prescription modificationmodifying a prescription written by another prescriber to alter dosage, formulation, regimen or duration of the prescribed drug, or provide a therapeutic alternative to improve drug therapy or provide continuity of therapy What kinds of prescribing can pharmacists do? ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 7. 7 3] Comprehensive drug therapy managementinitiating, maintaining, modifying or changing drug therapy based on referral from another health provider who has made the diagnosis or upon the request of the patient upon receiving a diagnosis. Comprehensive drug therapy management will occur only in a collaborative health team environment wherein sufficient information is available to the pharmacist for him or her to make a recommendation for drug therapy. What kinds of prescribing can pharmacists do? ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 8. This system has already been pioneered on the international level for the better. Such practices can be projected to validate- i. Ample benefits for healthcare provision and organization. ii. Patient convenience iii. Patient safety iv. Harmony with clinical management plans v. Proficiency in general practice and hospitals vi. Professional gratification for pharmacists. Why is this in aid of? ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 9. Prescribing necessitates deep acquaintance of doses, drug-drug and drug-food interactions, adverse effects, ideal routes of administration, pharmacokinetics, pharmacodynamics and observation of effects. Pharmacists are all already alive with the knowledge of the above mentioned details. Their prior involvement in the prescribing process may help enhance the use of medicines. Why is this in aid of?....continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 10. Involvement in medication management, encompassing monitoring of therapy are well accepted in the hospital background. Broadening of the same by adding the permit to prescribe early therapy and to adjust long-lasting therapy is relatively a small step With the overall approval of prescription by pharmacist on the international stage, its high time that such an approach in India be implemented. Why is this in aid of?....continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 11. Only registered physicians have been prescribing the prescriptions in India so far As yet, this is restricted in the context of pharmacists If truth be told and as said earlier, prescribing requires having subtle information of drugs and pharmacists are full of such fine details. That is why, there is a real need of the introduction of prescription by pharmacist in India, though at a small level in the beginning to lessen the workload in the healthcare system. Findings ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 12. 1. Reliant prescribing by proper agreement defined for it. Such type of prescribing encompasses more restrictions on prescription activities by dint of formularies and/or protocols. Is a written guideline, a clear and much detailed document that delineates the activities that pharmacists might perform in their prescriptive boundaries. Methodologies ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 13. The content of an agreement shall cover The procedures, decision criteria or plan that the pharmacist must follow while prescribing Disease types, drug-drug categories that pharmacists may prescribe within, for instance, anticoagulants, antiemetics, analgesics etc The time limit for the agreement Methodologies.continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 14. The responsibilities of each person involved Documentation and feedback methods to the authorizing prescriber Strategies for review and revision of the agreement etc Methodologies.continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 15. 2. Reliant prescribing: Auxiliary prescribing. Auxiliary prescribing- Is a voluntary companionship between the independent [doctors]and auxiliary[pharmacist] prescriber Fulfills already decided patient restricted plan of clinical management with the agreement of patient. The independent prescriber shall undertake the preliminary assessment The auxiliary prescriber can then write prescriptions at public expense, working to a care management approach that has been granted by the physician. Methodologies.continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 16. Here the role of pharmacist will be inclusive of contributing to clinical management plan screening. swapping the medicines Finally bringing up to the independent prescriber where applicable Detailing clinically significant facts. Methodologies.continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 17. 3. Mutual prescribing This requires a cooperative practice association linking a pharmacist and a physician with a legal authority to prescribe medicines. The physician first analyses and makes treatment decisions for the patients The pharmacist further picks, commences, screens, alters and continues or discontinues pharmacotherapy as suitable to achieve the agreed patient results. The physician and pharmacist both share the risks and responsibilities for the patient consequences. Methodologies.continued ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 18. Responsibilities ought to be taken for the whole process of diagnosis, prescribing and follow ups including the cognizance of boundaries of know- how. Surprisingly, every pharmacist might not desire to accept such sort of liabilities. Pharmacists are able to handle those for minor ailments but on the contrary, expanding those responsibilities to prescription medicines may have an introduction of new quality assurance concerns. Some shortcomings ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 19. o Episodic evaluation of pharmacists prescribing practices. o This would serve as a method for maintaining standards and ensuring best patient outcomes. o Having regular audits is a much fruitful solution to examine the adherence or compliance to prescribing rules etc o Proper upholding of patient records. Conquering the shortcomings ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 20. All registered pharmacists in India must accept all the intrinsic accountabilities relating to prescribing. They need to prove their competence to do so. However, there are also various professional, technological, educational and legal matters that need to be come to a decision before pharmacists can start to prescribe. captivatingly, the induction of mutual and/or auxiliary prescribing methods in India would be the appropriate steps in the best interest of patients. Conclusion ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 21. Emmerton, L., Marriot, J., Bessell, T., Dean, L., (Aug 2005), pharmacist and prescribing rights: Review of international developments. J Pharm pharmaceut., Vol 8{2}, page no 217- 225. Alberta College of Phamacists About ACPFor The PublicComplaints ResolutionNews & EventsRegistration & LicensureContinuing CompetencePractice ResourcesPrescriber ListsContact UsFeature LinksSearchQuickpoll ArchiveQuickpoll Archive References ''Copyright(C) Raaj GPRAC,Mumbai 2011-2012. All rights reserved.'' 22. Thank you.. and open for discussion !