Pills medicine medication treatment 370 (R).
(photo credit: Srdjan Zivulovic / Reuters)
Most members of the Knesset Labor, Social Affairs and Health Committee present at a session on Wednesday voiced support for a government-initiated law passed in 2010 that would give pharmacists significant involvement in prescriptions and advice to patients. This worries the Israel Medical Association, which fears physicians will be consulted less and pharmacists will take over some of their traditional roles.
The committee is due soon to hold a final vote on regulations, leading to implementation. In the meantime, the IMA is still lobbying against it, the Health and Finance Ministries favor it and the pharmacists are divided because they will not get special pay for their extra work.
The IMA claims that the law, which was part of the Treasury’s Arrangements Law of 2010, will “harm public health, create a situation endangering safety and efficacy in medical care and unreasonably risk the privacy of patients.”
According to the law and regulations, a patient with a chronic condition may go to a licensed pharmacist and ask for a repeat prescription without going to a physician. This, of course, will reduce visits to doctors and save health funds’ quarterly, per-patient doctors’ fees.
In addition, any patient can receive a prescription for a one-time medication for a skin infection or other acute problem; this, says the IMA, will lead to primary or continued care without the doctor seeing the patient. The pharmacist will be able to give a prescription for up to six months after the doctor’s original prescription expired. Only pharmacists with at least five years of experience will be able to prescribe drugs on their own. The IMA, which represents most physicians working in the public medical system, charged that patients coming into pharmacies will not have privacy and that customers will be privy to their personal medical situation.
Dr. Eyal Schwartzberg, an experienced clinical pharmacist who worked at hospital in the north before moving to the Health Ministry to head its pharmaceutical branch, told The Jerusalem Post that many health fund pharmacies, if not private ones, have already set up consultation rooms for patients. Thus he denied that patients’ privacy would be compromised.
Schwartzberg, who favors the Health Ministry initiative, insisted that the arrangement would not be compulsory for either the doctor or patient and that it would be carried out voluntarily, without payment being made to the pharmacist or his organization. They will do this to provide better care for the patient as a public service, he said, adding that pharmacists will not sell more expensive medications as for chronic conditions, it will be the same medication they had and for acute conditions, there is a limited number of products. “It will make life easier for patients, especially in the periphery, where there are fewer pharmacies,” he said. He doesn’t envision private pharmacies joining the arrangement unless the public health funds sign contracts with them on giving counseling on medications, Schartzberg said.
The ministry “honors doctors as primary prescribers. We are thinking of giving other medical professionals room to expand their responsibilities as well, gtiven the fact that in 10 years there won’t be enough family physicians and the population is aging.”
Howard Rice, a veteran but retired pharmacist who used to head the Israel Pharmacists Association (of private pharmacists), said he favors the reform in principle but insists that it won’t work unless pharmacists are paid for this extra work. “It would take an average of 20 minutes for each consultation. I believe that the doctors have brought this on themselves. since so many have their secretaries write the repeated prescriptions anyway. “
Rice, who owned a private pharmacy in a prime Tel Aviv neighborhood, closed it down a few years ago because he “sold only medications and not cosmetics. There was no way to earn a decent living, so I closed it and rented out the premises. Now I am involved in research and consultancy,” he said. “Many others have followed suit.” There are some 850 private pharmacists and a total of 700 in all health fund pharmacies.
He noted that the IMA’s claims that pharmacists lack the training to advise patients are wrong. Many pharmacists have more clinical pharmacology training than physicians. But “the true name of this governmental move is how the heath funds can save more money to waste on services and treatments that they could and should have avoided in the first place. Most physicians in Israel receive poor payment for the enormous responsibility and time they provide to patients. Pharmacists are in the same position, as indeed are most health care professionals in Israel. The Health Ministry has proven to be lame in solving this problem, either because officials are too scared to have a confrontation with the insurers.”
Rice added that “the doctor is not always available and the patient (usually on Fridays or the eve of festivals) finds himself without medication. What should he do?. Go to any doctor? Go to the emergency room at as hospital? To do his job properly the pharmacist must know the medical profile of the patient, even the foods he eats and non-prescription things he takes.”
The veteran pharmacists concluded: “It is high time that the Health Ministry took the bull by the horns and insisted on what is called in the more advanced countries of the Western Collaborative Care. The physicians should work hand in hand with the pharmacist and both work hand in hand with all healthcare professionals for the benefit of the patient. In England and Scotland, for example, this already occurs, and in the latter, when one patronizes a new pharmacy, one has to formally register with it and the file goes with him.