Academy Chapters Use AAFP Resource to Fight Pharmacist-administered Inoculations Legislation

A growing movement in state legislatures to give pharmacists broad authority to administer inoculations without physician supervision has resulted in an informational brief from the AAFP to its constituent chapters that compares and contrasts the educational levels and backgrounds of pharmacists and family physicians and highlights the dangers of this type of legislation.

Most states allow pharmacists to administer influenza immunizations without physician supervision, but several state legislatures now are either considering or have approved measures permitting pharmacists to prescribe and administer vaccinations, essentially allowing pharmacists in some states to act in the same capacity as physicians when administering inoculations, according to several AFP chapter officials.

In North Carolina, for example, two bills pending in the state legislature, H.B. 444 (3-page PDF; About PDFs) and S.B. 246, would allow pharmacists to administer immunizations to anyone 14 years and older without physician oversight. If enacted, the legislation would treat inoculations as an OTC drug, thus eliminating patient counseling and the ability to monitor and catch adverse reactions, said Gregory Griggs, EVP of the North Carolina AFP.

"We don't believe that counseling can be done in a retail setting," said Griggs. "Patient safety is also an issue in a retail setting. Are pharmacists really going to catch reactions and contraindications?"

The AAFP informational brief underscores the differences between pharmacist and family physician training by analyzing the disparate educational and degree requirements for each profession, concluding that "pharmacists are not trained to prescribe drugs independently and are not prepared to collect and assess subjective and objective clinical patient information as a means to initiate drug therapy or to monitor therapeutic progress."

For example, according to the brief, "between 1928 and 1959, the bachelor's degree of pharmacy, a four-year program of study, was the minimum degree required for pharmacist licensure."

"From 1960 to 2000, this requirement changed to a five-year bachelor's degree program," the brief says. "Not until 2000 was doctoral education in pharmacy (PharmD) required for a pharmacist license."

As a result, the highest degree for more than 71 percent of pharmacists in 2004 was a bachelor's degree, according to the National Pharmacist Workforce Study.

By contrast, family physicians complete a four-year bachelor's degree program and a four-year medical education program. Moreover, medical students spend nearly 9,000 hours in lectures, clinical study, lab and direct patient care, which includes examining how pharmacotherapy integrates into all branches of medicine. Medical school graduates then are required to start full clinical training in a residency program designed to expand knowledge and skills through many direct patient care experiences, including pharmacotherapy, the brief says.

The informational brief is designed to give AAFP constituent chapters a tool to help educate lawmakers about the divergent educational requirements for pharmacists and physicians. It shows a difference of as many as 14,900 total education and clinical hours between the two professions.

"It at least gives (lawmakers) one more piece of information to consider," says Griggs. "Whether it changes their mind completely, I don't know. But it gives them one more thing to think about and consider before making a policy decision without complete information or data."

Pennsylvania FPs are also facing challenges from pharmacists. The state legislature is considering two measures, H.B. 817 and S.B. 254, that would allow pharmacists to inoculate patients younger than age 18 years.

Supporters of the legislation have framed the measures as an access-to-care issue, saying the legislation would expand access to inoculations among the state's youth. But the Pennsylvania AFP dismisses that argument, saying any child in Pennsylvania who needs a vaccination has access either through his or her primary care physician if the child has insurance or through a federally funded program that provides inoculations for low-income children and those without insurance, said Andy Sandusky, deputy EVP for the Pennsylvania AFP.

Sandusky said the measures giving pharmacists broad inoculation authority are "contrary in many ways to the patient-centered medical home (or PCMH), which is to have primary care inoculations as well as primary care medications delivered within the primary care physician's office."

"The proposed legislation takes the patient out of the PCMH and severs the connection between immunizations and well visits," says a policy brief distributed by the PAFP. "This undermines the goal of health care reform -- to provide affordable, high-quality health care and prevent rising health care costs through preventative care."

In Louisiana, pharmacists can give influenza inoculations without physician supervision, but a bill introduced in the state Senate would have greatly expanded the menu of pharmacist-administered inoculations without requiring physician oversight. If enacted, the measure would have "carved the physician out of the process completely," according to James Taylor, M.D., legislative chair of the Louisiana AFP.

Although the bill passed the Louisiana Senate, it died in the House Health and Welfare Committee, thanks, in large part, to a relentless lobbying campaign conducted by the LAFP. The chapter's lobbyist spoke out against the bill on a regular basis at the state legislature, and family physicians, at the behest of the LAFP, contacted their representatives on the Health and Welfare Committee and urged them to vote against the measure, Taylor said.

"This victory proves that family medicine can be effective in the legislative arena," he added.