The expanding scope of pharmacists' practice: implications for physicians.

have supported a broadening of the scope of pharmacists’ practice across Canada. Under the authority of these new regulations, hospitaland community-based pharmacists are able to renew, refuse to fill, adjust or substitute prescriptions. Pharmacists may also initiate drug therapy for certain selflimiting conditions, order and interpret laboratory tests, and administer injections and vaccines. Each province and territory has its own body for registering and regulating pharmacy practice, thus the scope of changes varies accordingly. Table 1 summarizes the activities that havebeen approved or are pending legislation in each province and territory as of January 2013. A growing recognition that patients’ health care demands are exceeding physicians’ capacity to address them has contributed in part to the evolution of pharmacists’ practice. Increasingly, physicians are managing a higher prevalence of chronic disease and multimorbidity in their patients. In 2003, the Canadian Medical Association issued a joint statement endorsed by the Canadian Pharmacists Association and the Canadian Nurses Association on the determination of shared scopes of practice for allied health professionals. The statement reinforced that policy decisions taken to expand the scope of practice for health professionals must put patients first and reflect physicians’ commitment to professionalism, lifelong learning and patient safety. Subsequent regulatory changes across Canada have defined the areas where these changes can occur. Internationally, pharmacists are increasingly involved in providing joint patient care. The United Kingdom, New Zealand and the United States have all moved toward various forms of independent or collaborative prescribing. Countries in which pharmacists can be trained and certified to administer vaccines include the US, the UK, Ireland and Portugal. Whereas patients will likely benefit from increased pharmacist care, a number of concerns may arise. How will pharmacists communicate with physicians when medication adjustments occur? What are the liability issues for physicians when such changes occur? Will there be a loss in quality of care or physician income with these changes? This analysis reviews the opportunities and evidence for an expansion in the scope of pharmacists’ practice. The ethical, liability and fi nancial implications for physicians will be addressed. Future considerations include integration of interprofessional education for physicians as well as for medicine and pharmacy students at the graduate and postgraduate levels to improve the working relationship between physicians and pharmacists in real-world settings.