ALBERTA, CANADA
COUNCIL MEETING OUTCOMES
The Council of the College of Physicians & Surgeons of Alberta (College) met in Edmonton on Sept. 12, 2008. Significant outcomes of the meeting included:
Registrar's Report
Dr. Trevor Theman updated the Council regarding labor mobility and concerns about physician distribution. Recently, Canadian premiers agreed to loosen restrictions across the country, which could mean that a physician licensed in one jurisdiction would be able to move freely and work in another jurisdiction. The College has concerns, such mobility might leave rural, remote and under-serviced areas, such as northern Alberta, without adequate physician resources. These concerns were raised in discussions with Alberta Health & Wellness and the issue will be considered as this agreement moves forward.
Substantial Equivalency
The Council discussed the registration requirements and equivalencies that will be used to determine a candidate's competence for independent medical practice under the Health Professions Act. Council agreed the College's current requirements are acceptable; however, directed a committee be created to examine what level of experience/training/education would be considered to be ‘substantially equivalent' to these requirements for an international medical graduate applying for a medical license. The committee will bring its recommendations to Council at a future meeting.
2009 Operating Budget
The Council approved the Finance and Audit Committee's proposed operating budget for 2009. Implementation of the budget required several bylaw changes, including setting the annual fee at $1,600. The development and enhancement of new or existing programs, enhanced focus on physician prescribing practices and the sustainability and cost of doing business were the main drivers for this year's budget.
Financial Benefits for Physicians Who Co-locate With Other Businesses
In responding to inquiries about physicians accepting a financial inducement to co-locate with another business, Council considered its policies governing the ethical conduct of members. Council resolved it would not be considered improper for a physician to receive a financial benefit from a business that may benefit from co-location with a medical practice if the:
physician's fiduciary obligation to patients is not compromised,
physician does not influence a patient's choice of location of services, and
physician adheres to the College's policies and guidelines governing conflicts of interest, principles of ownership and practice-in-association.
Disruptive Physicians
The Disruptive Physician initiative was developed to deal with disruptive physician behavior in the health care work-place. A multi-stakeholder working group was formed to develop strategies to address this issue, and produced a draft document the Council accepted in principle. The document will now be circulated to stakeholders for feedback. The document also contained a Code of Conduct that will be revised and considered for adoption as a Standard of Practice. More information will be provided in the future.
Continuous Professional Development
Council passed a resolution regarding Continuous Professional Development whereby:
Physicians on the College's general register or tele-medicine register with an active practice license must be continuously enrolled and in good standing with the MAINPRO program of the College of Family Physicians of Canada or the MOC/CPD program of the Royal College of Physicians and Surgeons of Canada after December 2009.
Physicians who do not comply with the above must make an application to the Registrar and provide satisfactory evidence to support an exemption or deferral of the requirement.
Reprinted from the College of Physicians and Surgeons Alberta website.
E-PRESCRIBING IN ALBERTA
Recent media reports referred to an e-prescribing approach that some Alberta practitioners are pursuing. As there is some confusion about e-prescribing in Alberta, the College offers this clarification.
Unacceptable
E-mail prescriptions. An unsecured e-mail transmission does not provide authentication of the e-mail sender (to confirm he or she is an authorized prescriber) nor protect the information sent in the e-mail. Pharmacists cannot accept e-mail prescriptions.
Prescriptions produced by computer but not signed by a physician, or with an electronic signature that is not hand-initialed by the physician.
Acceptable
Prescriptions produced by computer, then hand-signed by a physician or with an electronic signature that is hand-initialed by the physician, given to a patient to take to a pharmacy.
Prescriptions produced by computer then hand-signed by a physician or with an electronic signature that is hand-initialed by the physician, faxed to a pharmacy of the patient's choice.
Hand-written and signed prescriptions faxed to the pharmacy of a patient's choice, following College guidelines.
Please note that it is the pharmacist's professional responsibility to ensure the validity of a prescription before filling that prescription.
The College supports the concept of e-prescribing, provided suitable infrastructure exists to protect the privacy of patient information and ensure the authenticity of prescribers. Alberta Health and Wellness has started a new initiative to develop e-prescribing capabilities for Alberta and the College is involved. More details will follow when available.
For best practices in communicating prescriptions, refer to Ensuring Safe & Efficient Communication of Medication Prescriptions on the College website at www.cpsa.ab.ca/publicationsresources/policies.asp.
Reprinted from the online version of issue 145 of The Messenger, published by the College of Physicians and Surgeons of Alberta.
BRITISH COLUMBIA, CANADA
PHARMACISTS' EXPANDED SCOPE OF PRACTICE
As a result of legislative amendments passed by government this spring, pharmacists in British Columbia will have a new expanded scope of practice effective Jan. 1, 2009. The new professional activities to be granted to pharmacists (termed “renewing or adapting” a prescription) include:
Changing the dose, formulation or regimen of a new prescription (including a new prescription for ongoing therapy)
Renewing a previously filled prescription
Making a therapeutic drug substitution within the same therapeutic class for a new prescription
The new scope of practice granted by government to pharmacists is similar to scope of practice changes introduced by other provincial governments, including Ontario and Alberta. The experience in Alberta, where pharmacists are also allowed to independently prescribe, is that only one percent of community pharmacists are adapting or issuing new prescriptions. In British Columbia, legislation does not allow pharmacists to initiate a new prescription.
The College of Physicians & Surgeons of British Columbia (College) has carefully weighed the potential benefits, such as greater public access to health professionals, against the risks to patient safety inherent in broadening the scope of practice and responsibilities of pharmacists. The College was not consulted by government prior to the introduction of legislation enabling the scope of practice changes.
In May 2008, the College did have an opportunity to convey its concerns arising from the new scope of practice for pharmacists at a forum held by the Ministry of Health that included other regulatory colleges and professional associations. The letter provided by the College to the forum attendees, which expressed our opinions and concerns, is available on the College website at www.cpsbc.ca.
At the forum, the College of Pharmacists presented a document titled Medication Management – a professional practice protocol which pharmacists must adhere to if they choose to renew or adapt a prescription. The College of Pharmacists is providing orientation sessions this fall for pharmacists who wish to provide prescription renewals or adaptations. All pharmacists must be familiar with the Medication Management policy prior to acting within the new scope of practice allowances.
While some of the patient safety and public protection concerns raised by the College have been addressed in the College of Pharmacists' Medication Management policy, we continue to have some concerns. The following information is provided to College registrants to assist them in the management of patients who require pharmacotherapy that may be subject to pharmacist-initiated prescription renewal or adaptation.
Physicians should inform patients of the new professional activities granted to pharmacists with respect to renewals and ensure they understand when it is necessary to see their physician for an assessment if they are receiving medications for chronic conditions/indications. A pharmacist's renewal of medication is not a substitute for a physician assessment, particularly if the patient requires follow-up examination, further investigation, or health maintenance tests. Original prescriptions may be renewed for the duration of the original prescription, which is currently one year, except for prescriptions for oral contraceptives, which may be renewed for two years. Pharmacists will not be allowed to renew or adapt prescriptions for narcotics.
If an extended prescription of medication for a chronic condition/indication is clinically warranted, it would be preferable for physicians to indicate on the original prescription the appropriate number of refills they are prepared to authorize.
Physicians generally use the opportunity to have the patient return to the office for a prescription renewal as a method for improving patient compliance or as an opportunity for reassessment. If a physician's professional opinion is that a pharmacist-initiated renewal would be clinically inappropriate, he/she can indicate that on the original prescription by uniquely adding the phrase “Do Not Renew”. As with instructions not to dispense generic substitutions, a physician must not use a stamp or a pre-printed prescription to indicate “Do Not Renew”.
The College has significant concerns with a pharmacist being able to unilaterally change the dose, formulation, or regimen of a new prescription or to make a therapeutic drug substitution from the same therapeutic class for a new prescription. It is the position of the College that changes, substitutions and adaptations are most appropriately done if there has been collaboration between the physician and the pharmacist in advance of the dispensing of the prescription. It is in the patient's best interest the pharmacist and physician communicate prior to any alteration of the original prescription.
To facilitate timely communication between pharmacists and physicians, the College encourages all physicians to ensure that prescriptions written for community dispensing include contact information for the physician. This is particularly important if the prescription is written on a hospital prescription form at time of discharge from the hospital or the emergency department. If physicians work in more than one office, it would be helpful to have all contact information listed on the prescription.
The College has advised the Ministry of Health that in the patients' interests, physicians must have the authority to write a prescription order which explicitly states “Do Not Adapt” or “Do Not Alter”, when professionally appropriate to do so and where pharmacist initiated changes would be inappropriate. As with renewals, physicians must indicate Do Not Adapt or Do Not Alter on the prescription uniquely, and not have their prescription pad pre-printed or stamped with this directive.
It is the position of the College that community pharmacists who renew or adapt prescriptions must communicate with the prescribing physician in writing, and within 24 hours. The College has provided input to the College of Pharmacists on a Prescription Adaptation and Notification form template that will be used by pharmacists to notify physicians of prescription renewals or adaptations. This will allow for inclusion of this information in the patient's medical record. Copies of the Medication Management policy and the Prescription Adaptation and Notification form can be viewed and downloaded from the College of Pharmacists' website at www.bcpharmacists.org.
The College is supportive of pharmacists renewing prescriptions under limited circumstances. The expanded scope of practice for pharmacists must not adversely impact the management of chronic medical conditions or health maintenance activities. The College is not supportive of pharmacists adapting new prescriptions without prior collaboration with the physician. The College will continue to work with other regulatory Colleges and professional associations to ensure patient safety and public protection are paramount as the new professional activities granted to pharmacists are implemented and evaluated.
Reprinted from the online version issue 61 of College Quarterly, published by the College of Physicians and Surgeons of British Columbia.
LONDON, ENGLAND
GMC TAKES ACTION ON EQUALITY AND DIVERSITY ISSUES
The General Medical Council (GMC) is working in partnership with the Economic and Social Research Council to fund a research program that aims to find answers to long-standing questions about medical regulation. The research has been commissioned to help provide a greater understanding of equality and diversity issues and support the development of the GMC's regulatory activities.
As part of this initiative, and building on the success of a roundtable meeting last year, the GMC has established an independently chaired forum. The Equality and Diversity Research Forum met for the first time Sept. 10, 2008 and was chaired by Baroness Amos.
The forum heard from researchers who are leading work into a wide range of topics including:
Why international medical graduates are over-represented throughout all stages of the GMC's fitness to practice procedures
The experiences of United Kingdom, European Union and non-European Union medical graduates making the transition to the United Kingdom work-place
How non-United Kingdom qualified doctors and doctors from a variety of cultural backgrounds understand the ethics of medical practice in the United Kingdom
Comparing systems of medical regulation between the United Kingdom and other countries
“I'm delighted to chair this forum, and support the GMC's efforts to better understand the experiences and circumstances of doctors who've qualified from outside the United Kingdom or are from a minority ethnic background,” Amos said. “I hope that working with other organizations in this way will lay the foundations on which to build our understanding of how equality and diversity issues impact on health care regulation.”
The forum plans to meet again in six months.
UPDATED ETHICAL GUIDANCE
The GMC has updated the guidance it gives on prescribing, conflicts of interests and reporting criminal and regulatory proceedings.
The guidance has been revised and updated in light of issues that have been raised with us by doctors, employers, patients and others and is part of our rolling review of all our ethical guidance to make sure it is up to date and fit for purpose.
The main changes to reporting criminal and regulatory proceedings within and outside the United Kingdom clarify doctors' obligations to tell us about fixed penalty notices for offences such as shoplifting, criminal damage and threatening behavior. There also is a new duty on doctors to tell us if they receive a warning for the possession of cannabis or an anti-social behavior order.
We have amended the guidance on good practice in prescribing medicines to address concerns raised about the inappropriate supply and administration of Botox® and other medicines, particularly when this is done in the absence of a doctor, but whose GMC number might be used to obtain the medicines or who might prescribe or direct administration.
Finally, we have made a number of changes to the advice in conflicts of interest in response to doctors' and various public and medical bodies' requests for additional guidance on a number of issues, including Practice Based Commissioning, doctors' relationships with the pharmaceutical industry and target payments for preventative health measures and health monitoring.
Reprinted from the General Medical Council website.
- Copyright 2008 Federation of State Medical Boards. All Rights Reserved.
