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forgotten, expired, absent. What if the pharmacist could prescribe?

Oct122022

Paola Brusa, professor at the University of Turin, suggests the possibility of a professional who could also prescribe, recommend and renew old prescriptions.

The repeatable prescription that the patient presents to the pharmacy for the delivery of drugs is often at the center of criticality when, for example. for various reasons, either it does not have it, or it is expired, creating difficulties for the pharmacist. Paola Brusa, professor at the Department of Medicine Science and Technology of the University of Turin, suggests the possibility of a professional who could also prescribe, recommend and renew old prescriptions, in a contribution published by Puntoeffe (n. 12- 2022).

The reproducible recipe, valid for six months, dispensing 10 boxes of medicine

“The repeatable prescription is a prescription that must be presented to the pharmacist for the latter to dispense the drugs listed in Table 4 FU. It is valid for 6 months and allows the delivery of 10 boxes of medication. With regard to medicines containing narcotic and psychotropic substances in section E of the Table of Medicines, the prescription is valid for 30 days and allows up to three blisters to be issued. This is what we teach students on the course each year. of Pharmaceutical Law. me. my colleagues, however, it is different. The repeatable prescription is that prescription that the client almost never has, that “the doctor didn’t give me the medicine because I have to pay for it”. The repeatable prescription is that prescription that has expired for years folded in the wallet or that prescription filled by the doctor (with original stamp and signature) sent via WhatsApp to the patient, who prints it and claims that it is valid as an origin ale. The repeatable prescription is that prescription that “I don’t have it, but the doctor is sure that the doctor told me to. Do you think you are taking drug X without being prescribed it? ‘ The repeatable prescription is prescribed orally over the phone by the doctor. The repeatable recipe is this document necessary to distribute Oki and Tachipirina 1000: “But doctor really? No one ever asked me.’

Brusa: meeting the patient without breaking the rules

Since it can be corrected and sometimes necessary to meet the needs and health needs of patients, I think it often leads to excess. On the one hand, there are clients/patients who (frequently) expect us to “sell” them what they want: sometimes they have really forgotten the prescription at home; sometimes they actually left the box of blood pressure medication at sea; sometimes it was really the doctor who, questioned on Sunday morning, answered via WhatsApp with the indication of the medicine to be taken. Other times, however, the person claims to be buying the same medicine the cousin is taking or the doctor prescribed ten years earlier for a similar symptom. Added to this are the doctors: sometimes they are really overwhelmed and with such tasks that they are unable to visit or contact all the patients; at other times, however, they still make little use of the electronic reproducible recipe and send photos of recipes whose copy cannot legally be used for distribution. Then there are the pharmacists who often try to understand the client/patient’s situation by meeting the health needs, but sometimes they “sell” the medicine without the presence of a prescription because they know that if the client goes to the nearby pharmacy he will find a colleague who will sell it to you. In short: a dog that bites its own tail.

The modern pharmacist has the skills to renew the prescription of a chronic patient

In all this, it should not be forgotten that the delivery of medicines without a medical prescription, if any, violates the code of ethics in various articles, for example article 28 stipulates: “The delivery of medicines subject to medical prescription is subject verification by the pharmacist of the formal and substantial requirements of the prescription, to guarantee the protection of the patient’s health”. Finally, remember that, in practice, the method of registration of drugs is sometimes misleading: the same active ingredient at the same dosage provides in some cases a prescriptive regimen, in others not, depending on the period of marketing . permission has been granted. What is the solution? I don’t know and I don’t think the reason lies on one side only. I think it is right, however, especially at the end of the state of emergency due to the pandemic, that the territorial health model be redesigned also with regard to the repeatable prescription sent to the pharmacy: after five years of university studies, updating, acquired experience and the confidential relationship with the user, we are sure that the pharmacist of the 21st century does not have the skills to recommend sachets of ketoprofen, one gram of paracetamol or, why not, renew the prescription of an antihypertensive drug in a chronically ill patient? “.

Paula Brusa
Department of Medicine Science and Technology, University of Turin

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