2023-09-24 03:10:00
the essentials Spokesperson for professionals in Aude and P.-O. as far as Occitania, the Catalan Bruno Galan, president of the Regional Council of the Order of Pharmacists, is a happy apothecary. In accordance with an ancestral request, he and his colleagues become prescribers of vaccines and soon antibiotics for patients suffering from cystitis or angina. Even if he understands the fierce opposition of doctors, he hopes instead for effective collaboration.
Bruno Galan, let’s start with vaccines, you already had the capacity to administer those for influenza and Covid-19, today you can also inject the 12 others recommended, and above all prescribe them: why such a sudden advance?
The Covid-19 period proved that we were capable. We tested, vaccinated, renewed prescriptions… and everything went very well. Hence the idea of expanding our missions in a context where the shortage of private doctors is glaring.
To alleviate them, you will now be able to prescribe vaccines and inject them to everyone?
The decree of August 8, 2023 gives us the prescription of the 14 obligatory or recommended vaccines in France, two of which we had already administered. The goal is to simplify access to care. Until now, we needed a doctor’s prescription for tetanus. From now on, people will be able to come and do it directly with us from the age of 11, without a prescription since we will be the ones to write it, after having conducted the questioning on the person’s state of health.
Do you follow training to perform injections?
A needle is a needle, we’re used to it. But indeed, we have compulsory training of 10:30 hours for the procedure and the prescription. It is a reminder of vaccination practice, schedule and recommendations. However, in my opinion, what is most important in the act is the monitoring of the vaccinated and the traceability of the product.
On the medication side, you had the only prescription for the morning-after pill, is your scope of action widening there too?
We are moving step by step towards pharmaceutical prescription for everyday ailments. The profession has been asking for it for a long time. We managed to do this as part of the coordinated exercise for pharmacists who belong to a multidisciplinary health center. But this was far from the majority, resulting in inequality between pharmacists and confusion in the minds of patients. They thought that all pharmacies could prescribe.
By January 2024, you will in principle be able to deliver antibiotics against cystitis and tonsillitis. However, antibiotics were not systematic, would we put them back?
Antibiotics will remain non-automatic. Contrary to what our doctor friends say, we are not going to give it away. The bill, which is part of the 2024 social security financing plan, provides that at the start of 2024 patients who are in the acute phase of cystitis or angina during the day, in the evening, on weekends or on holidays can be relieved without going to the emergency room.
Concretely, what will be your role as pharmacist?
Today, the general practitioner prescribes the TROD, a rapid diagnostic test, the patient goes to the pharmacy with his prescription, we carry out the test and if it is positive we send him back to his treating practitioner so that he can brand of antibiotics. Tomorrow, no more back and forth. We do not yet know the precise conditions of the new provision, but we know that for angina, we will do a TROD, or a sample from the throat with a swab, then we will analyze it in order to determine if the pathology is caused. bacterial or viral origin. In the first case, we will prescribe antibiotics directly, in the second we will deliver a powerful painkiller and an anti-inflammatory. For cystitis, the test will be done on a urine strip. We are awaiting the official protocol from the High Authority of Health (HAS).
In fact, you will act as a doctor?
We will compensate for the lack of private doctors. On each shift, we have several attacks of cystitis in the middle of the night. The pain is violent, it can be associated with fever, the infection can spread to the kidneys and the patient risks pyelonephritis. Currently our only recourse is to send the person to the Emergency Department which is saturated. The system is failing, it is collapsing. If we do not simplify access to care and if we, pharmacists, who guarantee increased safety, are not involved in the health plan, we are heading for disaster.
Does starting by prescribing antibiotics open the door to pharmaceutical prescriptions for more numerous pathologies?
We do not yet have the complete list of medications that can be dispensed, but look at how Switzerland, England, and Canada work… There, pharmacies prescribe everything except opioids, from the moment the attending physician is informed. So yes, it is planned, the list of products that we can prescribe should grow. But, they will always be subject to TROD.
Which infections should be targeted?
Gastrointestinal illnesses like other common benign illnesses, those which overload our emergency rooms and practices. An experiment has just been carried out in Brittany where six pathologies were concerned for the delivery of medicines to the pharmacy without going through the doctor. The study turned out to be very conclusive. We could consider developing pharmaceutical prescriptions for rhinitis, pharyngeal pain, lower back pain, headaches, conjunctivitis, tick bites, simple wounds, or even first-degree burns.
Will pharmacies need to benefit from new private spaces to receive and treat patients?
Since covid, we already have a confidentiality zone for tests and vaccinations but it is obvious that there will be an adaptation to be made and that is so much the better.
Who will pay ? Social security, mutual insurance, the patient, the pharmacist…
Reimbursement is the unknown of the reform. Obviously, tests, vaccines, medications and our consultation will be covered, but to what extent? For the moment, in a nursing home, it’s a gas factory. A price of 25 euros is shared between the doctor and the pharmacist, but the patient without a prescription pays unless the test is positive. At the same time, a TROD is worth around 7 euros.
What demands are you putting on the table?
We ask to be paid €25. These actions will take us time, we cannot carry them out for free.
Aren’t you afraid of pitting health professions against each other?
No. The evolution will work, I am sure, and this is only the beginning of the change in our profession. Doctors remain predominant, we continue to be the specialists in medicine and side effects. Collaboration is essential.
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