Clearing misconceptions on pharmacy practices — Gan Ber Zin See more at:
http://www.themalaymailonline.com/what-you...h.TsMjaLiT.dpufMARCH 20 — Kindly allow us to refer to the column “Pharmacists vs doctors: The ongoing debate” published in Malay Mail Online on March 11, 2015. We too agree with the writer that all parties should be working together towards the betterment of healthcare for the rakyat.
Nonetheless given so many letters and articles by doctors associations to the media with several misleading statements and comments, we have little choice but to respond as we need to correct the many misconceptions about the profession.
The allegation by some doctors that dispensing in government hospitals and clinics is not carried out by pharmacists reflects ignorance of the real situation. Since the 1980s, government pharmacy practices have made tremendous progress and have been providing pharmaceutical care to the rakyat. Such allegations are not doing justice to the government pharmacists who have diligently been providing the best pharmaceutical care to the rakyat.
Perhaps these doctors are confused and are referring to some of the 1 Malaysia Clinics where the assistant doctors (medical assistants) prescribe and the assistant pharmacists (dispenser) dispense. Incidentally, both qualified pharmacists and doctors advocate these 1 Malaysia Clinics to be served by qualified professionals.
In government hospitals, pharmacists screen all prescriptions taking into consideration the patient’s individual condition like their health status, lifestyle, and food habits before handing it over for packing by trained pharmacy assistants with diplomas in pharmacy. The packed medicines are then counterchecked and dispensed by another pharmacist.
All new patients are counselled at the Pharmacy Drug Counselling Room and patients who opted for the Medicine by Post programme are provided with follow-up consultation through phone calls by pharmacists.
In the ward pharmacies, medication to in-patients are now packed in the unit-of- use packs and sent to the wards ready to be served by the nurses. Special formulations like Total Parenteral Nutrition and all Cytotoxic drugs for cancer treatment are constituted by pharmacists. Doctors or nurses may ADMINISTER the medicines to the patients but there is a marked distinction between administering the medicines versus dispensing.
Administration of medicines by doctors, nurses or by the caregivers is NOT DISPENSING of medications. Similarly the DELIVERY of medications by post or courier is NOT DISPENSING medications. It is very sad to see doctors that cannot differentiate dispensing from administering or delivery.
Pharmacists have been assigned to the wards since the 1980s and these pharmacists carry out pharmacy ward rounds, check on the medication and provide bedside medication counselling to patients. Pharmacists take part in the Consultant Ward rounds where they are accepted as part and parcel of the health team which also include other healthcare professionals. It is only those doctors who quit government service to set up private practice that suddenly feel that the pharmacist’s services are no longer of use to them or to their patients!
The Drug Information Service (DIS) in the hospital is one of the busiest units within the pharmacy. The clients who are using this DIS are mostly doctors who require all sorts of information related to the use of medicines.
Over the past decades, Medication Therapy Adherence Clinics (MTAC) manned by pharmacists had been set up in most government hospitals. These MTACs operate side by side with the doctors clinics in the hospitals. At these clinics, patients who are on long term medication therapy are referred to the pharmacists manning the MTACs by doctors for the required medication counselling. The MTSCs are very much in demand as the doctors want the pharmacist’s intervention to see better compliance to medications. Better compliance to medication leads to better outcomes.
The government has the facts and figures on the number of fatal prescribing errors like wrong dosages, inappropriate or irrational, excessive prescribing, drug interactions etc. The numbers of the pharmacist’s intervention on these errors prior to dispensing are also documented. These data are collected from all outpatient and inpatient pharmacies as part and parcel of the MOH’s Quality Control Programme to ensure medication safety to patients. These data can only be collected in settings where there are dispensing separation.
Another misconception that some private practitioners would like us to believe is that ALL medicines require a doctor’s prescription and some have accused pharmacists of selling medicines without prescriptions from doctors. To set the record straight, medicines are classified into Groups B, C and others. All Group C medicines like medication for flu and cold, eye-drops, dermatological preparations and several medications for other diseases like diabetes, asthma are dispensed under Group C classification, which is the legal responsibility of pharmacists and these medicines can be dispensed without a doctor’s prescription.
Putting aside the qualification of GPs to dispense, there are two key issues which are related to the quality of the community healthcare that should be improved. Firstly most of the time, the dispensing jobs in GP clinics are not done by the doctors themselves but by unqualified personnel who are not trained in screening prescriptions and are dispensing medication without proper counselling. According to a MOH survey on the use of medicines by Malaysian consumers in 2012, 73 per cent agreed that counselling is necessary to help them in taking their medications.
Secondly, again not questioning the qualification of GPs in this case but outpatient healthcare system as a whole, there is lack of a check and balance mechanism in place to ensure the quality, safety and effective use of medicines. Dispensing should involve clinical review of medicine order. Solitaire in healthcare where the private doctors diagnose, prescribe and supply medications to patients rules out patient safety.
The age-old myth of not enough pharmacists or patient inconvenience are no longer true. There are many pharmacies within walking distance of clinics and 24-hour pharmacies will be available as soon as separation takes place on a “supply and demand” rationale. Increasingly more and more people are seeking the services of pharmacists, in both the government as well as in the community pharmacies.
Community pharmacies are the most accessible and affordable healthcare facilities to the rakyat. Any person can walk in to a pharmacy and see the pharmacist in attendance without the need for an appointment. Moreover, for all the professional services provided pharmacies do not charge or impose any consultation fee. Currently the pharmacists to population ration is 1:2250.
By 2017 we shall reach the WHO recommended norm of 1:2000 in the private sector. The data available in Health Facts 2014 also indicate that there are 6,801 registered private clinics as at December 31, 2013 and 2,800 registered community pharmacists who hold Type A licence as at December 31, 2014. Needless to say, we are not short of pharmacists to serve doctors on a 1:2.4 basis.
The accusation by doctors that pharmacists who conduct blood sugar or blood pressure screening with the home monitoring devices are acting like “doctors” again overlook the fact that many doctors all round the world are encouraging patients to monitor their own health parameters. Are those private practitioners also implying that the patients who are using these home monitoring devices to monitor their health parameters are guilty of "playing doctor"?
There is absolutely nothing wrong for pharmacists to conduct health screening using these home monitoring devices. The paramedical staff are conducting all these measurements in hospitals as part of their work to screen the patients before the patients see their doctor. The pathology lab has also not disallowed pharmacies to carry out such measurements with the home monitoring devices. Pharmacies should be encouraged to assist in the screening and detection of patients with potentially serious problems such as elevated blood sugar and blood pressure. These patients can then be referred to the doctors for management
Last but not least, some private practitioners asked why change when Malaysia has one of the best healthcare system in the world, often quoting a WHO report. The positive ranking that the World Health Organisation (WHO) has given Malaysia is due to our healthcare delivery system by the PUBLIC Sector and not the private sector. To equate this ranking to the doctor dispensing system in our country is indeed very misleading.
In any case, it has been reported that a large majority of the countries with rankings which are better than Malaysia have been practising dispensing separation for a long time. That WHO paper on Policy Perspectives on Medicines has categorically found that “prescribers who earn money from the sale of medicines prescribe more medicines and more expensive medicines, than prescribers who do not.” This report perhaps helps us to understand why so much objections have arisen from our medical practitioners against dispensing separation.
Another WHO report had stated that “Drugs cannot be viewed as ordinary commodities of commerce as they are not like most other commodities. Drugs are not chosen directly by the buyer (the patient), the buyer is not always the responsible payer, and the buyer often has no background or the necessary information to evaluate or make a choice which can have hazardous or even deadly consequences for the patient….”
In conclusion, we ask for clear thinking and open-mindedness in this consideration of dispensing separation. We trust the authorities to advocate best practices in medicines management by pharmacists to reduce medication errors and "over-prescribing" which could well lead to greater patient safety and cost saving.
* Gan Ber Zin is the former chief pharmacist of Hospital Tuanku Ja'afar, Seremban.
Feb 15 2015, 12:29 AM
So would the cert from Parkville be recognized by the Singapore Pharmacy Council then? >< Just want to know so that it'll help in my decision on whether I would want a credit transfer or not..
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