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Patient safety has to be priority in widening prescribing pool

The AMA Therapeutics Committee has had a busy few months responding to several consultation opportunities regarding prescribing and medicine regulations. Health Workforce Australia is investigating a nationally consistent approach to expanding the prescribing of medicines by non-medical health practitioners registered under the National Law, and the Committee has made a submission in response to its consultation paper Health Professionals Prescribing Pathway (see www.ama.com.au/node/7989).

01 Jul 2012

The AMA Therapeutics Committee has had a busy few months responding to several consultation opportunities regarding prescribing and medicine regulations.

Health Workforce Australia is investigating a nationally consistent approach to expanding the prescribing of medicines by non-medical health practitioners registered under the National Law, and the Committee has made a submission in response to its consultation paper Health Professionals Prescribing Pathway (see www.ama.com.au/node/7989).

We welcome the development of a consistent platform from which registered non-medical health professionals can undertake prescribing, consistent with their scope of professional practice.

However, prescribing by non-medical health professionals should only occur within a consistent and sustainable medically delegated environment, where each member of a health professional team is collaborating with the other team members under clear and transparent arrangements.

AMA members have first hand experience of the wide range of arrangements under which non?medical health practitioners prescribe medications. AMA members see the inherent risks to patient safety that arise from the inconsistency of these arrangements and, consequently, the uncertainty of who is ultimately responsible for the management and care of the patient. Without collaboration and coordination, which should be through a patient’s general practitioner, the risks of duplication and drug interactions will increase exponentially with the number of prescribers.

On the theme of public safety, the Therapeutics Committee also assessed new draft guidelines on the evidence required before medicines can be listed. The guidelines, Evidence required to support indications for Listed Medicines, were released for comment in April, and are a considerable improvement. They give sponsors much clearer and more detailed instructions on the type and level of evidence required before medicines can be listed.

In its response, the Committee noted that strengthening regulations governing the listing of complementary medicines would help better protect the public. But it warned that until the TGA has the resources to undertake more audits of sponsor information, the system for listing evidence would still be open to fraud and abuse (see full letter at www.ama.com.au/node/7992).

The AMA was also invited to comment on a review being conducted by the Pharmaceutical Benefits Advisory Committee (PBAC) of the current Emergency Drug Supplies (Doctor’s Bag) section of the PBS. The review was prompted by recommendations made in an article published in the Australian Prescriber in February this year.

In its response, the Committee supported several recommended changes, including replacing diazepam with midazolam, replacing haloperidol and chlorpromazine with olanzapine, and withdrawing verapamil and terbutaline.

However, the experience of AMA members ‘in the field’ led us to disagree with some other recommendations, including the suggestion that frusemide 20 mg in 2 mL injections be replaced with glyceryl trinitrate 50 mg in 10 mL injections for intravenous infusion, because of the impracticalities of setting up an infusion in home settings.

PBAC will meet in July to consider the Doctor’s Bag review results and we will advise members of any subsequent changes.


Published: 01 Jul 2012