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The Advanced Practice Pharmacist (APh) designation in California was created via legislation 10 years ago. California pharmacists who meet certain criteria can be designated as an APh and unlock additional practice authority. Just 1065 pharmacists, or 2% of licensed California pharmacists, have obtained the APh designation through 2022. APhs did not report benefiting from the designation as it relates to expanded scope of practice. This experience of low uptake and minimal benefit mirrors the tiered licenses created by three other states. More recent legislation broadened the independent prescriptive authority of APhs, but this increased value proposition aligns with the practice authority adopted by other states who have imposed fewer barriers to entry. Given the track record observed to date, we doubt that tiered licensure will ever prove successful in the pharmacy profession. Instead, state policymakers and pharmacy advocates should consider adopting a "standard of care" regulatory approach to improve patient access to safe and beneficial pharmacist services.
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BACKGROUND: Recent legislative advances now permit pharmacists to prescribe tobacco cessation medications in 17 states. While national initiatives are underway to prepare the pharmacy profession for this expanded role, patient perceptions of this role have not been explored. OBJECTIVE: The objective of this study was to characterize patient perceptions, attitudes, and awareness of pharmacists prescribing for tobacco cessation medications. METHODS: A cross-sectional survey of English and Spanish-speaking patients was conducted at 12 locations of a federally-qualified health center in Northwest Indiana. Survey measures assessed sociodemographics, tobacco use history and interest in quitting, prior interactions with pharmacists and awareness of pharmacists' ability to prescribe tobacco cessation medications, and perceptions of pharmacists assisting with cessation. The Theory of Planned Behavior (TPB) served as a framework for item development. Multivariable logistic regression was used for modeling. RESULTS: A total of 2082 individuals (1878 English, 204 Spanish) completed the survey (42.4%). Among current users (n = 592; 28.4%), 46.2% had made a quit attempt in the past year, and 41.0% reported having used a tobacco cessation medication in the past. Over half (60.5%) of current users would be comfortable talking with a pharmacist about quitting, 31.9% intended to talk with a pharmacist about quitting, and 31.7% intended to ask a pharmacist to prescribe a medicine to help with quitting. In multivariable modeling, intention to (a) talk with a pharmacist about quitting and (b) ask a pharmacist to prescribe a medication were significantly associated with TPB constructs. Current tobacco users were receptive to pharmacist-facilitated assistance with quitting, including prescribing of tobacco cessation medications. CONCLUSIONS: Patients' attitudes, subjective norms, and perceived behavioral control, from the Theory of Planned Behavior, were important predictors of intention to engage with pharmacists for quitting and intention to ask a pharmacist to prescribe a cessation medication.
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Servicios Comunitarios de Farmacia , Cese del Uso de Tabaco , Humanos , Farmacéuticos , Estudios Transversales , Encuestas y CuestionariosRESUMEN
Pharmacist prescriptive authority continues to increase at the state level in the United States. Recently, the Idaho Board of Pharmacy (BOP) finalized regulations that expanded autonomous prescriptive authority in its state to a range of preventative care as well as acute and chronic conditions. This manuscript reviews the key decision points made by the BOP regarding drug categories included, education requirements, protocols, access to data, and use of standards of care. Overall, Idaho's approach closely reflects the medical model of regulation and may prove useful to other states and jurisdictions as they consider similar issues.
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OBJECTIVE: Explore the intersection of the Pharmacists' Patient Care Process (PPCP) and state laws in order to identify laws that may impede the delivery of optimal patient care. SUMMARY: A review of the PPCP identified six areas in which state laws can limit full pharmacist engagement: 1) ordering and interpreting laboratory tests; 2) participating in a collaborative practice agreement; 3) independently prescribing certain medications; 4) independently adapting medications; 5) administering medications; and 6) effective delegation. A framework is put forth to organize how these scope of practice matters are interrelated. CONCLUSION: For pharmacists to fully engage in the PPCP, state laws must enable full participation. By unleashing pharmacists to fully engage in the process, patient care delivery and outcomes can be improved, and total health care costs can be reduced.