Recognizing the importance of utilizing pharmacy services to improve the state's health and under the urging of Obamacare to utilize each health-care provider to the maximum of their skill levels, California has become the fourth state, after New Mexico, Montana, and North Carolina, to allow pharmacists to initiate drug therapy.
Beginning in 2015 SB 493 officially declares pharmacists "healthcare providers who have the authority to provide health-care services." The bill calls for the inclusion of pharmacists into the multidisciplinary care of patients, giving them increased access to health-care records and participation in the multidisciplinary review of patient progress.
Moving our healthcare system from a focus on "sick care" to a focus on "health care" requires far more emphasis on managing patients with chronic diseases. The law states the pharmacists' role is "providing consultation, training and education to patients about drug therapy, disease management and prevention."
The new category of pharmacists in California will be the Advanced Practice Pharmacist ((APP). Pharmacists who meet the necessary criteria for APP recognition will have unique authorities. These will include the ability to perform patient assessments, refer patients to other providers, and operate as a collaborative drug-therapy-management pharmacist outside hospital walls. Hospitals, clinics and health plans will be able to engage pharmacists in managing patients with chronic diseases. APPs may order and interpret drug-therapy-related tests and initiate, adjust or discontinue drug therapy in collaboration with other health-care providers.
Existing law already allows a pharmacist to furnish emergency contraception. SB 493 expands a pharmacists' authority to now allow for the furnishing of self-administered hormonal contraception at a patients' request.
Prescription nicotine-replacement products may also be prescribed as well as travel medication not requiring a diagnosis but recommended by the CDC for individuals traveling outside of the United States.
One of the central tenets of the bill is the communication between members of the health-care team. It is based on collaboration not fragmentation. The bill states that the PPA shall notify the patient's primary care provider of any drugs or devices furnished to the patient by entering the appropriate information into the patient's electronic health record shared with the primary care provider. If the patient does not have a primary care provider the pharmacist shall provide the patient with a written record and advise the patient to consult a physician of his or her choice.
A PPA shall ensure when ordering drug-related tests that it is done in coordination with the patient's primary care provider as appropriate, including promptly transmitting written notification to the patient's diagnosing health professional.
All of the new authorities granted in SB 493 come with certain requirements. In order to furnish a nicotine-replacement product, for example, a PPA must be certified in smoking cessation by an organization recognized by the California Board of Pharmacy and must compete one hour of CPE focused on smoking cessation biennially, among other requirements.
California law currently allows pharmacists to provide immunizations pursuant to immunization protocol. Now SB 493 still allows pharmacists to provide them but under a different structure. The legislation creates a uniform state-wide protocol that all pharmacists seeking to provide immunizations would be required to follow. The protocol consists of an immunization program training-requirement certification in basic life support and compliance with all state and federal recordkeeping requirements, including entering the information into the patient's electronic health record.
The Pharmacy Education at a minimum includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. The pharmacist shall be certified in basic life support and this training shall be maintained by continuing-education classes.
A pharmacist administering immunizations may also initiate and administer epinephrine or diphenhydramine by injection for the treatment of a severe allergic reaction to the vaccine.
On a fundamental level the law provides hospitals, clinics, affordable-care organizations, and other health-care systems new tools to add to their efforts to improve care and reduce costs. Yet it will likely take time for the authorities, the public, and the system to fully realize the enormous potential of the new law. All in good time. All in good time.