Ernest Dole, Pharm.D., PhC, BCPS, FASHP, a pharmacist clinician at the Pain Consultation and Treatment Center of the University of New Mexico Hospitals in Albuquerque, has been writing prescriptions since 1996.
Three years earlier, his
state became the first in the nation to grant a subset of highly trained clinical pharmacists prescriptive authority, contingent on collaborative practice agreements with supervising physicians.
On a typical day, Dole
writes prescriptions for NSAIDS, opiates, muscle relaxants, anti-seizure agents, and antidepressants.
Ernest Dole, Pharm.D., PhC, BCPS, FASHP
"As a pharmacist clinician, I am more directly responsible for patients and provide more direct input into their care, which I believe has resulted in better outcomes," said Dole
broad freedom in making treatment decisions, as defined in the collaborative practice protocol he
operates under, frees up his
physician colleagues to see more patients and perform more epidural injections, whose revenues significantly offset the cost of his
That is key to the success of pharmacist prescribing because Medicare does not recognize charges for pharmacist services-nor do most private insurers.
is part of a larger national conversation happening within the pharmacy profession regarding the need to improve patient outcomes as part of collaborative, team-based care.
The environment in which the conversation is happening is also changing.
Current and future shortages of general practice physicians, physician assistants and nurses and potential reductions in federal spending for Medicare and Medicaid may be laying a groundwork for more widespread recognition of credentialed pharmacists as prescribers.
But, according to Dole
, physicians are usually supportive once they understand that the arrangement is symbiotic and capitalizes on each profession's strengths.
That is especially true in primary care, where the number of physicians continues to dwindle, leaving large swaths of the population medically underserved and the workforce strained to the breaking point.
"In those situations, you can have a physician diagnosing and then turning over medication management to an advanced practice pharmacist, whose expertise lies not in diagnosis but in medication management," he
"Reimbursement is the issue," added Dole