Table 1.
The Alberta Prescribing Model and Clinical Scenarios Presented to Study Participants
| Model Category | Emergency Prescribing | Adapting a Prescription* | Additional Prescribing† | |
|---|---|---|---|---|
| Definition | Fulfill immediate need for drug therapy | Alter dose, formulation, or regimen | Issue prescription for continuity of care | Prescribe schedule 1 drugs‡ |
| Criteria | Deemed unreasonable to see another prescriber | Must be initial (new) prescription, not ongoing therapy | Provision of a reasonable supply until patient can see original prescriber | Pharmacist must have ability to assess the patient, knowledge of the disease area, and ability to collaborate with other care providers |
| Example | Remote community, patient with asthma needing salbutamol | Adjustment of antibiotic for renal dysfunction | Provision of short-term supply of antihypertensive until physician can be seen | Initiation or adjustment of anti-hypertensive to achieve and maintain target blood pressure |
| Pharmacists who can perform | All with licence on ACP’s clinical registry | All with licence on ACP’s clinical registry | All with licence on ACP’s clinical registry | Restricted to those who have applied and been successful, as deemed by ACP |
| Specific example and scenario presented | Tom, a 19-year-old man with a history of sports-induced asthma comes into the pharmacy after a game of soccer (the field is across the street from the pharmacy, and it is a late evening game), with shortness of breath. He did not realize he was so low on his salbutamol and shows you an empty inhaler (with no refills) and asks if you can provide him with another. You determine, based on your detailed assessment, that it is clinically appropriate for him to get another salbutamol inhaler, so you proceed to … | Elaine, an 86-year-old woman with newly diagnosed atrial fibrillation, comes in with a new prescription for rivaroxaban 20 mg daily with food. You note that she is elderly, and proceed to check her renal function. You identify that her CrCl is 40 mL/min (and has been so for the past 6 months), and hence you determine she should be taking rivaroxaban 15 mg daily with a meal. As such, you proceed to... | Katelin, a healthy 22-year-old woman, comes in during her lunch hour requesting her last refill of her birth control pills. You pull up her file in your computer system and find she has no remaining refills. She tells you that she was only able to get an appointment with her doctor in 2 weeks. She took her last pill yesterday and requests a new box for continuation of therapy. You determine that it would be appropriate for her to continue, and proceed to… | John, a regular patient of yours, comes into the pharmacy for his salbutamol refill. You’ve known John for many years and he is an otherwise healthy 33-year-old man with chronic asthma. You notice that John has been going through his salbutamol inhalers very quickly. After a full assessment, you decide it would be appropriate for John to start an inhaled corticosteroid, like ciclesonide (Alvesco) 100 mcg daily. As such, you proceed to… |
ACP = Alberta College of Pharmacists (provincial regulatory body), CrCl = creatinine clearance.
*
Also includes ability to substitute a drug within the same therapeutic class for patient-specific reasons.
†
The scenario for additional prescribing authorization was initial-access prescribing for a chronic disease.
‡
Schedule 1 drugs are those regulated by the province, available only by prescription. Federally regulated drugs (e.g., narcotics, barbiturates, and benzodiazepines) are excluded.