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Physician Assistantsassistants an Update

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Physician Assistantsassistants an Update ONTARIO’SONTARIO’S PHYSICIANPHYSICIAN ASSISTANTSASSISTANTS AN UPDATE 30 ANY CONTROLLED In 2006, the Ministry of Health and Long-Term Care announced a demon- ACT ASSIGNED TO THE stration project to evaluate the role of Physician !ssistants (P!s) in the provin- PHYSICIAN ASSISTANT cial healthcare system. Since the launch MUST BE DELEGATED BY of the P! demonstration project, P!s have been successfully integrated into THE PHYSICIAN EITHER interprofessional teams "ithin specialized THROUGH A DIRECT ORDER hospital services (internal medicine, orthopedics, surgery, etc.), community (VERBAL OR WRITTEN) OR health centres, ambulatory, diabetes and long-term care settings, and more THROUGH THE USE OF A recently family health teams (FHTs) MEDICAL DIRECTIVE. and emergency departments. There are currently approximately 250 P!s "orking "ithin these practice settings across Ontario.1 HISTORY !ND EDUC!TION P!s have practiced in the United States since the 1960s and "ith almost 90,000 practicing members, they have estab- lished their role as a safe and effective part of the U.S. healthcare system.2 Similar to the U.S., the Canadian P! is rooted in the Canadian Forces as a class of clinicians introduced to provide medical care to the men and "omen of the Canadian Forces both at home and abroad. Ho"ever, it "asn’t until the 1990s that the concept of the P! "ithin Canada’s civilian healthcare system began to take shape. Today, in addition to training under the Canadian Forces Health Services Program, three Canadian Universities offer degree programs in Physician !ssistant Studies; McMaster University (Hamilton), University of Manitoba and the University of Toronto. PH!RM!CY CONNECTION ~ F!LL 2014 ~ P!GE 31 PHYSICI!N !SSIST!NTS REGUL!TION !ND SCOPE • Conducting patient intervie"s and F!QS OF PR!CTICE taking medical histories • Performing physical examinations Ho! do I kno! that a P" has been Despite P! practice advances in • Counseling on preventative given authority to prescribe pursu- Ontario, an application (January healthcare ant to physician delegation? 2012) by the Canadian !sso- • Performing certain controlled ciation of Physician !ssistants acts delegated by the physician ! prescription generated by a P! (C!P!) to the Health Professions (including prescribing) pursuant to delegation (direct order Regulatory !dvisory Council or medical directive) should include: (HPR!C) for regulation of the Physician !ssistant profession in DELEG!TION • Reference to the fact that the Ontario "as not approved. This prescription "as generated via decision "as centred on HPR!C’s !ny controlled act assigned to delegated authority assessment that public safety and the P! must be delegated by • Name and contact information of quality of care are sufficiently the physician either through a authorizing physician upheld through the delegation direct order (verbal or "ritten) • Name, designation, signature, and model under the supervision of or through the use of a medical contact information of the P! a licensed physician. Therefore, directive. %hen a physician issuing the prescription P!s remain unregulated under delegates to a P!, they must do so the Regulated Health Professions in accordance "ith the College of See the example of a prescription !ct (RHP!), and, as such, do not Physicians and Surgeons of Ontario generated under a medical directive have the independent authority to (CPSO) policy on Delegation of on page 33. preform controlled acts. Controlled !cts: http://""".cpso. on.ca/policies-publications/policy/ ! consistent format including all %ithout the independent authority delegation-of-controlled-acts. of the above information allo"s to perform controlled acts, the care the pharmacy team to identify a P! provides under the supervi- !lthough P!s are not authorized to prescriptions that have been sion and delegated authority of a independently prescribe medication, authorized through delegation. registered physician; "hich must a P! acting under the authority of a Pharmacists and pharmacy take place "ithin the physician- physician may evaluate patients and technicians are encouraged to patient relationship. The specific prescribe medication as established collaborate "ith P!s practicing duties of a P! "ill vary according by his or her delegated authority. in their communities to establish to individual P! competencies, the Ultimately, the supervising physician best practices "ith respect to P! physician’s area of practice, and remains responsible for the quality generated prescriptions. the "ork the physician chooses to of care that the P! provides to assign, but may include: patients. P!GE 32 ~ F!LL 2014 ~ PH!RM!CY CONNECTION PHYSICI!N !SSIST!NTS Can P"s prescribe narcotics and other controlled substances under delegation? EX!MPLE OF ! P! ISSUED PRESCRIPTION "RITTEN UNDER DELEG!TED !UTHORITY No, Health Canada, responsible for !ND PURSU!NT TO !N EST!BLISHED administering the Controlled Drugs and Substances !ct (CDS!) does not permit MEDIC!L DIRECTIVE. medical directives to be used to imple- ment orders for prescriptions for narcotics, controlled drugs, and benzodiazepine/ other targeted substances. #ho should I contact for clarification/ confirmation of P" prescriptions? If there are questions about the prescrip- tion, the pharmacist should contact the P! directly. If the questions cannot be resolved, the physician should be contacted for further clarification. #ho is recorded as the “prescriber” on the pharmacy generated label and dispensing record? The physician is recorded as the prescriber for the purposes of a pharmacy’s prescrip- tion records. !ll communication "ith both the P! and physician should be documented "ithin the patient record. #here can I find more information? Canadian !ssociation of Physician !ssistants: http://capa-acam.ca Canadian Medical !ssociation (CM!) – Physician !ssistant Toolkit: https://""". cma.ca/!ssets/assets-library/document/ en/advocacy/P!-Toolkit-e.pdf OCP practice consultants often receive questions from members seeking guidance with respect to other Ontario's Physician !ssistant Initia- healthcare professionals’ scope of practice (nurses, tive (Health Force Ontario): http:// optometrists, naturopathic doctors, etc.). OCP practice """.healthforceontario.ca/en/M4/ consultants cannot provide details related to another Ontario%27s_Physician_!ssistant_Initia- practitioners’ legal authority. As such, members are tive encouraged to discuss their questions/concerns with the practitioner directly and (or) contact the appropriate OCP Practice Tools - Interprofessional regulatory body for guidance (e.g. College of Nurses of Collaboration & Team"ork: http://""". Ontario for nurse practitioner (NP) related questions). ocpinfo.com/practice-education/practice- tools/collection/ipc-team/ Links to Ontario’s health regulatory colleges can be found on the Federation of Health Regulatory Colleges of Ontario (FHRCO) website: 1. http://capa-acam.ca/about-pas/pa-fact-sheet/ http://www.regulatedhealthprofessions.on.ca 2. http://capa-acam.ca/about-pas/history/ PH!RM!CY CONNECTION ~ F!LL 2014 ~ P!GE 33.
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