Scope of Practice


In Los Angeles, How Pharmacists Are Improving Patients’ Health

Dr. Sarah Ma goes over medications and dosages with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)

Sarah Ma, a pharmacist with USC, goes over medications with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)

By Laurie Udesky, CHCF Center for Health Reporting

Jose Navarro regularly trekked to the drugstore after being diagnosed as a diabetic seven years ago. In a sign of transformation in the local fight against diabetes, the pharmacist is now coming to him.

On a recent day Sarah Ma, a 28-year-old USC clinical pharmacist, set up shop at Navarro’s kitchen table in Santa Ana.

She checked Navarro’s blood pressure and blood sugar, examined his feet for cuts or infection, and refilled his monthly pill box. On previous visits she had changed the hour he took some medications, altered some doses, and discontinued others.

She inspected the refrigerator. “I see carrots, eggs, beets, cheese and yogurt that I haven’t seen before,” she said, delighted.

It wasn’t all great news. Navarro, 78, had told Ma that the pastry he had at breakfast was tiny. Actually, it engulfed half the plate Ma brought with her to illustrate what portions to eat of different food groups. Continue reading

California Pharmacists Providing More Direct Care to Patients

Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)

Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)

Anna Gorman, Kaiser Health News

Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.

“I was freaking out,” said Freedman, 55. “You get very emotional when you think you could drop dead at any moment.”

Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on — her pharmacist.

“We are the most overeducated and underutilized healthcare professional in the U.S.”   

“It was Diana who figured out what the problem was,” said Freedman, referring to her longtime pharmacist Diana Arouchanova. “Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.”

Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman’s medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman’s blood pressure daily. Soon, it began to drop. Continue reading

Midwifery, Physical Therapy, Pharmacist Bills Move to Governor’s Desk

(Getty Images)

(Getty Images)

California’s legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These “scope-of-practice” bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown’s desk.

Here’s a recap of some of the bills and where they stand now:

Midwifery Bill (AB 1308) — headed to governor’s desk

The Center for Health Reporting writes that the bill passed unanimously Thursday night and is now on the governor’s desk. From the Center:

(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.

The bill removes the requirement for licensed midwives to be supervised by a physician.

“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”

Physical Therapy (AB 1000) — headed to governor’s desk Continue reading

Debate Over Role of Nurse Practitioners in Primary Care Responsibilities

Pediatric Nurse Practitioner examines toddler. (Chris Richard/KQED)

A pediatric nurse practitioner examines a toddler. (Chris Richard/KQED)

An estimated 6 million Californians will be eligible for insurance under Obamacare — about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.

Yet, just 16 of California’s 58 counties have enough primary care doctors right now. To try to improve access, California legislators are moving bills to expand “scope of practice” for such midlevel health providers as pharmacists and nurse practitioners. In general, such bills would allow certain health providers to practice more independently. Right now, in many cases, they must be overseen by physicians. More autonomy could open access for underserved groups.

But some of those ideas are being hotly debated in Sacramento.

The toughest scope-of-practice sell right now seems to be nurse practitioners. Earlier this week, SB 491, which would expand nurse practitioner duties, failed to get out of committee. It will be up for a vote again next week. State Sen. Ed Hernandez (D-West Covina), an optometrist himself, joined KQED Forum Friday to discuss the bill. He said California needs to “utilize providers within their training” to help ease this “huge access problem in primary care.” Continue reading