Testimony Before the House Health Care Licensing Committee

July 12, 2024
Avinash Mantha, MD - IAFP Board of Directors

Thank you, Chairman Morgan and Vice-Chairwoman Mah for holding this subject matter hearing on pharmacists’ scope of practice. I’m Avinash Mantha, a family physician and member of the Illinois Academy of Family Physicians Board of Directors.

As the leader of a patient’s care team, family physicians diagnose and treat illnesses, provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and personalized counseling on maintaining a healthy lifestyle. Our training to diagnose before we treat is fundamental in identifying early interventions to effectively manage and treat the disease.

The safety and efficacy of any medical treatment depends on an accurate diagnosis of the patient’s condition and within the context of the patient’s overall health. Many adults who have multiple chronic conditions are already taking several prescribed medications. Working without a patient’s full medical record and medications list puts those with some preexisting illnesses at risk for serious complications. Not knowing if someone has kidney disease, liver disease, etc. impacts the type of medication chosen and the appropriate dose. An isolated lab test in a pharmacy is not enough to determine a course of treatment unless the patient’s overall health is taken into account.

For example, people with chronic respiratory conditions like asthma and COPD can present in very similar ways to common viral and bacterial illness like those identified in the omnibus bill. They may experience increased distress of their chronic conditions as a result of the acute illness. However, only treating these patients for their Covid or Strep with anti-infectious disease agents would not be sufficient if they are also having flare ups of their asthma or COPD. These patients require a doctor’s assessment of their vital signs like oxygenation status and respiratory rate, which may include adding or changing inhalers, and prescribing other medications like oral steroids. Patients with other comorbidities like diabetes or high blood pressure may also have these conditions worsen because of an acute illness, requiring adjustment of these medications as well. Some patients with influenza or COVID will have symptoms severe enough to warrant hospitalization. Who will clinically assess these patients at the Point Of Care to determine if additional treatment (or no treatment) is appropriate?

It’s impossible for lab results to be accurate 100% of the time: Some labs are better at detecting disease, while others are better at confirming that a person does not have a disease. Please allow me to walk through this scenario: What if the patient tests negative? Not every person who tests positive for Covid or influenza automatically needs prescribed medication treatments. Likewise, if a person tests positive, how will a pharmacist be able to determine if a treatment is still viable, depending on how long the patient has been experiencing symptoms? A positive test does not necessarily mean a treatment is still needed, leading to wasted treatments and unnecessary health care costs. Moreover, many young adults testing positive for flu and COVID do not need treatment as they have very low risk of serious complications and over treatment can lead to adverse effects and diminish supplies for patients who truly need treatment.

Finally, there are also false-negative and false-positive possibilities for all point-of-care tests. If pharmacists independently prescribe a treatment solely based on a positive test result, will they include counseling around red flag symptoms, plans of care should the medications not work, and when to seek culture or other diagnostic follow-up which is available to properly trained physicians?

These are the very reasons a primary care physician is essential to a patient’s care first and foremost. On behalf of the family physicians in Illinois, thank you for hearing our concerns. I’m happy to answer any questions.