Doctors groups lobby to prevent pharmacists from dispensing first line ARV drugs to patients
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DURBAN - DOCTORS’ lobby groups are objecting to a proposal that seeks to allow pharmacists to dispense first-line antiretroviral medicine to patients.
The Unity of Forum of Family Practitioners (UFFP), the African Viral Society (AVCS) and the Independent Practitioner Association Foundation (Ipaf), are all trying lobbying to stop the implementation of the proposal.
Recently the Pharmacy Council gazetted the Pharmacist-Initiated Management of Antiretroviral Therapy (Pimart). It proposed that pharmacists should be allowed to manage patients for ARV treatment, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to increase the public’s access to health services.
Vincent Tlala, registrar and chief executive of the SA Pharmacy Council, said the introduction of Pimart by the council meant South Africans would now have increased access to HIV testing, first-line treatment and prevention, as more than 3 600 community pharmacies would become potential sites for access to testing and treatment.
The council said the role of pharmacists would be to provide first-line treatment in line with the Health Department’s approved primary health-care guidelines. Stakeholders were given 60 days to comment when the gazette was tabled in March.
Ipaf chief executive Dr Unben Pillay said the extension of pharmacists to dispense first-line ARV medicine was too simplistic an approach.
Pillay said the various bodies representing more than 8 500 general practitioners felt the gazette had been missed by them as they have been focusing on the country’s vaccine campaign to curb the Covid-19 pandemic.
“There are several factors associated with the proposal that we find deeply concerning for the safety and well being of patients.
“Although the regulator was not obligated to inform us, in fairness, it should have alerted doctors of the change. As much as I agree that as a country we have a high disease burden, and that more should be done to help all health workers and clinicians, it sets a bad precedent.
“What we are asking is that we be allowed to interrogate the proposal further and make our comments. We don’t want a legal process on Pimart being implemented, but we must always look at patient care first,” said Pillay.
Dr Muhangwi Mulaudzi, managing director of the AVCS, said pharmacists were not clinicians and a few weeks course would not make them such.
“Pharmacists are not trained at tertiary level the same as doctors, therefore this is tantamount to hijacking our profession, and we strongly object to such a move.”
Mulaudzi said the AVCS was there to support health-care professionals to manage viral infections, according to the most current guidelines, to allow for the individual care needs of their patients.
“The identification, confirmation and selection of optimal treatment and patient education on all aspects of treatment, requires the participation and co-operation of numerous stakeholders to achieve the optimal outcome.
“The caregivers range from social workers, nurses and pharmacists, to general practitioners and specialists, depending on the needs of the individual. The Pimart proposal and its conduct amount to a simplistic papering over the health issues it seeks to address, with the effect of putting patients' health at an unwarranted risk.
“Pharmacists are not primarily trained to treat patients and the Pimart proposal is therefore tantamount to the hijacking of the medical profession or practice for an objectionable purpose” said Mulaudzi.
He said the treatment of a viral infection had far-reaching ramifications as incorrect treatment can influence the long-term outcomes of the patient, and cause harm.
“We believe that each discipline should focus on their role as part of the treatment team, and that blurring the roles and responsibilities is not in the best interest of the patient.”
Dr Norman Mabasa, chairperson of the UFFP and former chairperson of the South African Medical Association, said the organisation had requested an urgent meeting with the health ministry about patients being able to receive, and initiate HIV medicines without a doctor’s script.
Mabasa said the family practitioners were deeply concerned about maintaining the standards of health care and what the Pimart changes would mean for patient care.