Transforming and Supporting Patient Care - Health Professions ...

177Chapter 7 – Professions of Chiropody and PodiatryOral AntifungalsThe proponents state that topical antifungals may not penetrate far enoughinto deep toenail infections to eradicate the infection and that oralantifungals are necessary to effectively treat this type of infection. Theprescribing of oral antifungals reflects best practices of the profession,provides better outcomes for patients and can avoid a referral to aphysician for a needed prescription.HPRAC agrees that chiropodists and podiatrists should have access to oralantifungals to treat infections of the foot. This will enable practitioners totreat infections more effectively, will benefit the patient, and possibly limitcomplications and unnecessary visits to physicians.Cytoprotective Agents and Corticosteroids to Treat GoutProponents are also seeking cytoprotective agents and corticosteroids totreat gout.Cytoprotective agents can carry serious toxicities. HPRAC is also concernedthat gout that does not respond to diet, NSAIDs and/or corticosteroidsshould be referred to a rheumatologist. Further discussion of this issue isrequired, and may be revisited as part of the upcoming scope of practicereview.ViscosupplementationChiropodists are seeking viscosupplementation to treat the smaller joints ofthe foot.HPRAC feels that further consideration is required regarding the use ofviscosupplementation agents. HPRAC learned during its pharmacologicalreview that viscosupplementation is a new type of treatment that is usuallyused in larger joints such as the knee or shoulder. More information isneeded on the effectiveness of this treatment and further study is requiredto determine if this practice is within the scope of practice of theprofession. This issue will therefore be revisited as part of the upcomingscope of practice review.5. Authority to Order Laboratory TestsThe CCO is asking that chiropodists and podiatrists be granted theauthority to order laboratory tests that are consistent with standards ofpractice and authorized acts. HPRAC will be considering this request aspart of the scope of practice review.ConclusionsHPRAC recognizes the importance of foot care in Ontario, and theimportant role that chiropodists and podiatrists play in foot care. Providingchiropodists and podiatrists with the authority to administer substances byinhalation, with appropriate competencies, education and standards ofHPRAC Critical Links January 2009