Ever since the election of Emmanuel Macron and the doctors had condemned as strong and as unanimous a reform regarding the health care system. The origin of this anger, the adoption by the deputies, on the 17th of October, in the committee on social affairs, an amendment to the draft law of financing social Security (PLFSS) for experiment under certain conditions the issuance without a prescription by pharmacists of medicines to medical prescription mandatory.
” It’s starting to be enough ! It does not transform the healthcare system by removing skills to doctors to give them to professionals who do not have in their scope or in their training ! There’s a moment where it has to be a stop ! “assure the World Patrick Bouet, president of the national Order of physicians, while the PLFSS is debated by mps in first reading until Friday 26 October. “Tired” and ” disappointed “, Mr Bouet denounces a ” surfeit of amendments proposing experiments that are not in a strategy of reforming the health system “.
The device adopted in the committee is perceived by physicians as an infringement of two of their prerogatives fundamental : the diagnosis and the prescription.
The amendment intends to allow from January 1, 2019, and for a period of three years, the pharmacists of the two regions to deliver drugs ” in the context of a medical protocol and cooperation agreement with the attending physician and the health communities of the coordinated structures “, in other words, a local agreement on a form of delegation of authority. To decide on an application for patients, pharmacists will be able to refer to a “decision tree” developed with doctors. The drugs involved will be defined by ministerial decree.
“Confusion of roles”
Among the pathologies that may give rise to such deliverances, the member Delphine Bagarry (LRM, Alpes-de-Haute-Provence), at the origin of the amendment, quoted cystitis (urinary tract infection), conjunctivitis, or eczema. “These are requests almost daily,” says Karen Wolf-Thal, the president of the College of pharmacists, in favour of such an initiative. “I understand the concern of physicians,” she says. The idea is not to do without them, but to secure what pharmacists can do. There was a time when you need to be pragmatic in relation to problems of access to care experienced by the French. “
” What do you do when a woman presents in the evening with the symptoms of cystitis ?, request Ms. Wolf-Thal. I’ve had this type of request when my guard last Sunday. It was 14 hours. I had to ask this woman to go to the er to do a test. She returned to 18 hours after waiting four hours in the hospital. But some colleagues, after having conscientiously interrogated the patient, deliver the bag of antibiotics without medical prescription. “
The doctors, who already had to resign themselves to seeing the licensed pharmacists to immunize adults against influenza – what they had fought at the time of the act health Marisol Touraine in 2015 –, today see in this experiment a new stage of the ” sellout of the profession “, according to the formula of MG France, the first union of general practitioners, who denounces a ” confusion of roles “.
“When we start to mix the roles and missions of each, it can only lead to errors of diagnosis and poor decision support,” says Jean-Paul Ortiz, president of CSMF, the first union in the physicians. “A cystitis, for example, can hide a beginning of infection to the kidney or a calculation landlocked,” he said.
” Stop trying to make change, the pharmacists of the business, if pharmacists want to be a doctor, they make medicine ! “says Jean-Paul Hamon, president of the Federation of doctors of France, also very “upset” against “this offensive constant that is intended to nibble on medical activities” to the doctors.
The measure, which was included in the recommendations of the report of the member of parliament (LRM, Charente) Thomas Mesnier to improve the access to care that is not programmed, has received a support net of the minister of health, Agnes Buzyn. “The experiment deserves always to be carried out, and widespread, if it turns out that we do not take risk to the population “, she told les Echos on 23 October. Doctors, them, ripen them on the counter attack and hope that the measure will be removed during the examination of the PLFSS in the Senate.
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