Independent pharmacist prescribers can improve patient pharmacy care

We read with great interest the recent study conducted by Turner et al,¹ which analysed the prescribing errors made by independent pharmacist prescribers and medical prescribers. The results illustrated that independent pharmacist prescribers made significantly fewer prescribing errors than doctors. Based on these findings, we believe that independent pharmacists should be granted new responsibilities as part of efforts to improve doctor–patient relationships and patient pharmacy care.

Our institution is a tertiary general hospital in China that fills 1200 prescriptions per day in its outpatient pharmacy. The introduction of an electronic prescription system and an automatic drug delivery machine in 2014 led to considerable time and labour savings. However, patient satisfaction with the outpatient hospital pharmacy has not consistently increased according to a neutral third-party report.

After carefully analysing the third-party report, we identified three potential explanations for the findings.

First, our hospital has an extremely high workload because doctors usually treat dozens of patients in the outpatient department on a daily basis. Medical prescribers can sometimes make prescribing errors, especially with increasing numbers of patients seeking treatment. Because of prescribing errors, outpatient pharmacists sometimes refuse to fill prescriptions. Consequently, patients may feel that their time has been wasted, further straining the doctor–patient relationship.

Second, to avoid prescribing errors, electronic prescription system training is needed, especially for new physicians, but access to training is confined by time and space. We created an official WeChat account to resolve this problem because this application does not have time limits and it is suitable for maintaining confidentiality. However, older doctors are unfamiliar with using WeChat for training.

Finally, older adults represent a vulnerable and growing segment of the population with a high burden of comorbidities. According to the Prescription Administrative Policy of China, prescriptions should not exceed 7 days in duration and, thus, the workload required to prescribe medications to older patients is high in our hospital.

In most large-scale general hospitals in China, outpatients with various diseases are usually treated in different clinical departments. Our outpatient pharmacy only has three full-time clinical pharmacists. Therefore, it is impractical to expect these pharmacists to care for all patients with various diseases. Aiezza et al ² reported that prescriptions written by independent pharmacist prescribers were associated with reduced potentially inappropriate medication usage and adverse drug reactions, increased safety in older patients and reduced numbers of drugs prescribed. Thus, pharmacists with the same prescribing privileges as medical doctors are urgently needed, especially those focusing on chronic diseases or discipline-specific illnesses.

Increasing numbers of elderly patients with chronic diseases purchase prescription drugs at set intervals. Despite being medical experts, doctors may not carefully examine each order because of low staffing and large workloads. In addition, they often have less specific information about drugs than specialist pharmacists. The inspiring outcomes from the study by Turner et al ¹ strongly encourage policies that grant prescribing responsibilities to independent pharmacists. Although the establishment of independent pharmacists is not described in the existing policy of China, we agree wholeheartedly with the authors’ conclusion that specialist pharmacists make significantly fewer prescribing errors than doctors. Therefore, granting independent pharmacists additional integrated roles in the multidisciplinary team is recommended. These findings represent a good reference for improving patient satisfaction in our hospital.

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