Your Pharmacist Could Soon Prescribe Your Kidney Medications—Here's What Patients Think

Dialysis patients and healthcare providers are largely supportive of allowing pharmacists to prescribe kidney medications directly, according to new research from Toronto General Hospital. The study found that both groups see potential benefits in expanding pharmacists' roles beyond their current advisory capacity, particularly in busy dialysis centers where medication management is complex.

Researchers conducted detailed interviews with 11 dialysis patients and 11 healthcare professionals, including six nephrologists, two pharmacists, two dietitians, and one nurse practitioner, during June and July 2025. The goal was to understand how people felt about the idea of pharmacists having prescribing authority in outpatient hemodialysis units.

What Problems Do Current Prescribing Methods Create?

The current system has some significant challenges that both patients and clinicians experience regularly. Communication gaps and delays in care were the most commonly reported issues, creating frustration for patients who need timely medication adjustments.

Consider the typical dialysis patient's situation: they undergo four-hour treatments three times per week and take an average of 12 medications daily. These medications often require specific timing around dialysis sessions and frequent adjustments based on blood work results. When prescription changes are needed, patients currently must wait for a nephrologist's availability, which can create delays in their care.

Why Are Healthcare Teams Embracing This Change?

The research revealed several anticipated benefits that made both patients and clinicians optimistic about pharmacist prescribing. Healthcare professionals recognized pharmacists as valuable care team members due to their expertise in medication management and strong rapport with patients.

The expected advantages of allowing pharmacists to prescribe include:

• Improved Medication Optimization: Pharmacists' deep knowledge of drug interactions and dosing could lead to better-tailored treatment plans for each patient's unique needs
• Enhanced Workflow Efficiency: Reducing bottlenecks in the prescribing process could streamline care delivery and reduce waiting times for patients
• More Timely Care: Patients could receive necessary medication adjustments more quickly, potentially preventing complications or hospitalizations
• Pharmaco-economic Savings: Better medication management could reduce overall healthcare costs through optimized therapy and prevention of adverse events

However, the study also identified some barriers that would need addressing. Limited prescribing knowledge among some pharmacists was noted as a potential challenge that would require additional training and education.

What Would Safe Implementation Look Like?

Both patients and clinicians emphasized that any expansion of pharmacist prescribing authority should come with careful safeguards. The research identified several key considerations for successful implementation.

A collaborative approach with maintained physician oversight emerged as a critical requirement. Rather than replacing nephrologists, pharmacists would work alongside them, with prescribing authority restricted to specific clinical areas where their expertise is strongest. Participants suggested a phased rollout approach, ensuring adequate resources and clearly defined roles and communication protocols.

The study's findings provide important groundwork for healthcare systems considering similar expansions of pharmacist roles. In Canada, nearly 30,000 people were receiving chronic dialysis in 2023, with more than 75% receiving hemodialysis in hospital-based settings. This represents a substantial patient population that could potentially benefit from more streamlined medication management.

The research suggests that structured frameworks should be developed to clearly define scope of practice, support interdisciplinary communication, and ensure sufficient training and resources. This collaborative prescribing model could reduce physician workload while maintaining continuity of care, ultimately benefiting the entire healthcare system.