Other Health Care Providers (Part II) Holly L. Mason, R.Ph., Ph.D. PHRM 831
Objectives for lecture: 1. Identify prescribers and limited prescribers and explain the limitations on their prescriptive authority. 2. Recognize the professional designations used by various health care professionals.
Objectives 3. Identify the role and functions of each health care professional discussed. 4. Recognize the meaning of the terms protocols, and certification/credentialing.
Prescribers: Have full rights in their area of expertise (but not outside of that expertise--defined by their license to practice)
Physicians (MD) Responsible for the health of the whole body Physicians who are licensed may prescribe any product for any condition Medical specialties (27; residency required)
Primary Care Physicians (about 33% of MDs) Family Practice generalist / Primary Care MD Internal Medicine generalist / Primary Care MD Pediatrics - Children / Primary care MD General Practitioners / non-specialist, Primary Care MD
Board Certifications Examples include: F.A.A.F.P., A.B.F.M., A.C.P., F.A.C.S. Certification designation will follow M.D. So-> M.D., F.A.A.F.P. Certified pharmacists also use designations (e.g. BCPS, BCNP)
Osteopaths (DO) Stress the importance of the musculoskeletal system in health and disease Take a holistic approach to patient Same board exams and prescribing rights as MD physicians
Dentists (DDS) Responsible for the health of teeth and related structures Dental Specialties (8 areas; residency required)
Podiatrists (DPM) Treat diseases of the feet and supporting structures Frequently prescribe analgesics, antibiotics, antifungals
Veterinarians (DVM) Treat and prevent disease in animals, including dispensing of most meds Pharmacists in rural areas dispense some veterinary prescriptions
Limited Prescribers / Mid- Level Practitioners There are a group of practitioners that prescribe using formularies, under limitations of protocols, and/or as defined by their certification/credentialing
Terms: Formulary Formulary: A list of drug products that may (or may not) be prescribed or dispensed in given circumstances. There is a lot of variation among state Medicaid and insurance program formularies in terms of how they are used and structured. All managed care organizations and hospitals use formularies
Terms: Protocols Protocol: written guidelines that outline circumstances under which an activity may occur as well as the specific nature of that activity
Terms: Certification Certification (credentialed): completion of specified educational or examination requirements. --Applies to pharmacists in some situations for disease management or prescribing
Pharmacist Certification Immunizations (all states, most require certification) MTM programs for insurance companies and states Focused disease state management programs Collaborative or independent prescribing
Terms: Collaborative Prescribing Arrangements between two licensed practitioners (one typically a physician) to allow limited or midlevel prescribers to prescribe, adjust, monitor, or manage a patient s drug therapy. This is almost always done under a written protocol
Pharmacists (R.Ph.) Independent prescribing authority is not generally seen as a goal for the practice of pharmacy, but has some advocates in U.S. (UK, Australia, Canada is more widespread) Protocols and/or credentialing are typically involved for collaborative or independent prescribing Indiana recently expanded prescribing to out-patient practice via protocol
Nurse Practitioners (NP / APRN) Registered nurses with additional certification or credentials to perform expanded functions; usually requiring a M.S. degree or clinical degree equivalent (e.g., DNP); often have collaborative or independent prescribing authority
Physician Assistants (PA) Similar to NPs / APRNs, but under physician supervision Many have prescribing authority within their practice environment Post-BS education is typically concentrated over <2 years (M.S.) Number of programs more than doubled from 97 in 1997 to 230 now
Optometrists (OD) Examine the eyes to determine the presence of vision problems Typically has prescribing rights, but some states restrict controlled substances or utilize formulary
Number of States Allowing Limited Prescribing Pharmacists -- 40 Physician Assistants -- 44 Nurse Midwives -- 32 Optometrists 46 Nurse Practitioners 38 Chiropractors -- 0
Chiropractors (D.C.) Spinal Manipulation / Adjustments Education 2+4 May not prescribe under any circumstances Providing OTC products by DC prescription is not prescribing
Dieticians Nutrition for individuals and, more frequently, groups Institution focus (e.g., hospitals, long term care facilities) Education 4-5 yrs.
Nutritionists Food utilization by body Individual care focus (hospitalized patients, nutrition disorders) Education 4-6 yrs.
50 Best Jobs 2016* 1. Software Engineer 2. College Professor 3. Financial Advisor 5. Physician Assistant 9. Pharmacist *based on job opportunities, salary, stress, physical demands and working conditions
Best Jobs -- Continued 12. Physical Therapist 14. Chiropractor 15. Medical Scientist 22. Optometrist 28. Health Services Manager 30. Physician/Surgeon 32. Occupational Therapist 33. Mental Health Counselor
Best Jobs -- Continued 38. Speech Pathologist 40. Dietitian / Nutritionist 43. Dentist 47. Registered nurse 49. Veterinarian
Divorce Rates -- 2016 Nurses 33% Health Care Executives 30.9% Lawyers 26.9% Dentists 25.2% Physicians 24.3% Pharmacists 22.9%
Questions?