As the Podiatry Accreditation Committee homes in on finalising accreditation standards, some universities are preparing curricula to train students and practising podiatrists to gain endorsement for scheduled medicines. The number of podiatrists with endorsement is therefore likely to rise, perhaps swiftly, over the next decade.
What endorsement acknowledges
Endorsement of registration with the Podiatry Board of Australia for scheduled medicines acknowledges that a practitioner has the relevant skills and training to administer, obtain, possess, prescribe, sell, supply and use Schedule 2, 3, 4 or 8 medicines on the national formulary. While the regulations as to what practitioners are allowed to do still rests with each state, most states green light the full range of medicines on the formulary.
The process for prescribing
The recommended process for prescribing has been well-described and follows four stages.
- Information gathering
- Clinical decision-making
- Communicating the decision, and;
- Monitoring and review
These stages are clearly not specific to prescribing and indeed would be used by most clinicians no matter who they are consulting and what they are implementing.
A word of caution
With prescribing in your armamentarium, there is however a need to be ultra-vigilant with history taking, as to avoid providing a patient with a medicine that interacts with something that they currently take or that may not be suitable with an underlying condition. If you do determine that a medicine could be useful, you must then consider whether the benefit(s) of the medicine outweigh the potential harm(s). This is something that you and the patient both need to consider.
Medical side effects on impact and the foot and ankle
One of the most insightful aspects of the endorsement training was understanding how many medicines have adverse effects that may manifest as foot/ankle complaints. Over 200 medicines used in Australia have adverse effects including arthralgia, myalgia, myopathy, onycholysis, paraesthesia, paronychia, peripheral neuropathy, synovitis and tendinopathy. Many are repeat offenders. One may even cause plantar fibromatoses!
The beauty of using medicines for treatment is that medicines undergo rigorous testing even before they get to clinical trials, their usefulness and potential for adverse effects are well documented and constantly updated. The scale of the research (and ongoing safety and effectiveness data) used for these therapies is almost unlike any other treatment a podiatrist can provide.
An investigative process
Given scheduled medicines are so heavily tested, and given the standardisation of the drug components, you can determine the actual therapeutic effect of the medicine, and tease out what is likely due to placebo, natural history or other non-intervention related mechanisms. The use of scheduled medicines in our undergraduate and postgraduate student clinics is rewarding for both the student and patient. The resolution of either an infected ingrown toenail with a short course of antibiotics, or relief of a painful joint with a corticosteroid can be quick, cheap, and satisfying.
Up to you
If you have an interest in broadening your scope of practice using regulated and proven therapies, then endorsement for scheduled medicines may be something to consider. An accredited university can provide undergraduate and postgraduate students with the resources required to successfully complete Pathway A - some may be able to offer this as early as 2022.