Are nurses qualified to provide the general public with information about medicines?

Pharmacy consultant Ron Batagol doesn’t think so. He’s hopping mad that a nurse will be at the other end of the line for those calling the National Prescribing Service’s Medicines Line.

He writes:

“With the all-pervasive and very effective influence of the nursing lobbies in the highest echelons of health system decision-making, why are we so surprised that a national therapeutic advisory organization for consumers (the National Prescribing Service) chooses to use nurses instead of pharmacists to provide drug information to consumers?

After all, the “powers-that be” decided long ago that nurses, after some extra post-graduate study, are qualified to diagnose and also prescribe medications to patients to save them having to find a doctor.

Never mind that doctors spend years of dedicated study, under expert medical tutelage in both the art and science of differential diagnosis, and that pharmacists are acknowledged as experts in the therapeutic use of medications, having spent 5 years, plus post-graduate practice, studying and interpreting the chemistry, applied pharmacology and pharmacokinetics of drugs.

But, then again – if it’s OK for clinical consultations, why not go a step further and set nurses up to perform the role of a drug information pharmacist!

Now, don’t you just love the throwaway lines of the NPS justifying the new arrangements? “Registered nurses will answer calls in line with national nursing standards. More complex medicines-related questions will be triaged and referred to a health professional or an NPS medicines-information pharmacist.”

And even better:  “Many questions to medicines lines are about what the information on a label or medicine pack means and things that can be answered by reading the consumer medicine information leaflet.”

In reality, of course, it is ludicrous to think that you can “triage” these sorts of issues to a nurse or anyone else who does not have a pharmacist’s professionally-acquired understanding of how drugs work, and knowledge of the potential interactions, side-effects and optimum usage requirements. I’m also intrigued as to how “ being “in line with national nursing standards” is relevant in this context!

Indeed, as one who had, at various times, over a period of 30 years, been involved in setting up, and running Drug Information Centres for professional clients and consumers, as well as chairing professional specialty practice committees and seminars on drug information, let me say that it is the initial discussions with the caller that, if effectively handled, elicit the most valuable and, for the client, the most useful, exchange of information, that will set the framework for more detailed consideration and problem solving of specific medication-related issues.

And as to suggesting that “many questions related to “reading the consumer medicine information leaflet”, it is precisely the attempted decoding and deciphering of the convoluted gobbledygook of the consumer medicines information that brings many a consumer to phone a medicines advice line for expert advice and interpretation from a pharmacist.

Quite frankly, it’s a nonsense, and an insult to everyone’s intelligence to see the NPS using nothing more than clever spin to justify the dumbing down of a valuable national medication information line for consumers.”

• This post is also being published at the internet discussion group for pharmacists, AusPharmList.

Croakey wonder what others think about these matters?

(I must admit to having a wry smile about pharmacists aligning with doctors on this issue; I could have sworn they were at loggerheads just a moment ago… )

Meanwhile, the NPS website tells us that it collaborates with healthdirect Australia to deliver the Medicines Line, a telephone service providing consumers with information on prescription, over-the-counter and complementary (herbal/’natural’/vitamin/mineral) medicines.

It says: “When you call 1300 MEDICINE you will speak with an experienced registered nurse. Your question may be answered on the spot, or you may be referred to your GP or pharmacist, or to another health professional. If you have a complex enquiry you may be put through to a NPS pharmacist. In addition to receiving information, callers will be encouraged to discuss the information with their own doctor or pharmacist, who are be best placed to help interpret the medicines information. This telephone service is not for emergencies, medical advice or second opinions. Information provided by Medicines Line does not replace advice from a doctor or pharmacist.”

I will also seek a direct response from the NPS; will keep you posted…

Update, 9  July. Here is the response from the NPS  acting CEO, Karen Kaye:

“We are concerned the facts of this issue have become clouded: pharmacists are still pivotal in providing information to consumers who call Medicines Line.

Our decision to use healthdirect Australia to triage calls through to Medicines Line was based on giving consumers the best possible access to medicine information. Under the previous model, calls to Medicines Line could not be answered outside business hours.

With the new model, questions which can be appropriately handled by the experienced registered nurse answering the call will be answered on the spot. If the query falls outside their strict remit, the call will be triaged to an NPS medicine information pharmacist or the caller will be advised to contact their local pharmacist or doctor.

Registered nurses have an important role in managing a range of triage services which currently support health functions in this country, and providing health-related information in communities.

Pharmacists remain a critical element to the Medicines Line model and the new model does not in any way undermine their expertise. Rather, it provides further opportunities for referral to pharmacists where appropriate.

We encourage anyone who has questions about the new model to contact us directly or their professional organisation.”

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