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Should Only Phamacists Dispense Medicines By Datuk Nancy

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Should Only Phamacists Dispense Medicines By Datuk Nancy Ho President Malaysian Pharmaceutical Society at Healthcare Symposium Organized by MMA Selangor – PowerPoint PPT presentation

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Title: Should Only Phamacists Dispense Medicines By Datuk Nancy


1
Should Only Phamacists Dispense Medicines
By
Datuk Nancy Ho
President Malaysian Pharmaceutical Society
at
Healthcare Symposium Organized by MMA Selangor
Future Challenges for Healthcare in Malaysia
Sunday, 18th January 2009 Sunway Resort Hotel
Spa
2
HEALTH
is defined by World Health Organization as a
state of complete physical, mental and social
well being and not merely the absence of disease
and infirmly
..it is a fundamental right
3
PHAMACISTS
are concerned with promoting total wellness to
individuals, covering the correct use of safe and
efficacious drugs, as well as an understanding in
healthy lifestyle to maintain good health and
wellness
4
EVOLUTION OF THE PHARMACY PROFESSION
No longer is the history of pharmacy simply that
of drugs. It now includes the history of
physical natural sciences, medical principles
and techniques and instruments as well as the
people who had to choose prepare the medicines,
their relationship with the public, the related
professions, the economy of a particular period
and country and history in general
5
Changes In Global Scene
Domestication Revolution
Agricultural Revolution
Industrial Revolution
Information Revolution
Wellness Revolution
6
Characteristics of global lifestyle
  • Dynamic, competitive and free market
  • Strong tendencies to save and invest
  • Strong family ties and social support systems
  • Ageing and affluent population
  • Relative trust / dependency on government
  • Experiment with attractive healthcare system and
    Rise of herbal medicines usage

7
GLOBALISATION
Old World New World
PEOPLE Isolated
Mobile
ECONOMY Isolated
Borderless
POLITICS Isolated
International
CULTURE Isolated
Globalised
INTERNET
e-commerce, telemedicine
8
  • Changes in Global Trends

Helping Model
Medical Model
9
Baby Boom (1946-1964)
Wellness Revolution
10
Sickness Industry
Wellness Industry
Cure
Prevention
11
Economic Reasons
Individual higher disposable income 3 GDP
expenditure on health is expected to increase to
7 in 2020
12
Roles of Pharmacists TODAY increased to-
a) Health Promoters
b) Lifestyle Counsellors
c) Primary Health Screening Providers
d) Total Health Education Trainers
13
Community Healthcare and the Role of Pharmacists
C
A
E
R
Based on
Pharmaceutical Care
  • The responsible provision of drug therapy for the
    purpose of achieving definite outcomes which
    improves the patients quality of life.

14
Four Pillars ofGood Pharmacy Practice
  • Promotion of Good Health
  • Supply and Use of Medicine
  • Pomotion of Patients Self Care
  • Improving the Use of Medicine including Enhancing
    Patient Compliance

15
Future Challenges
  • 1. Improve cost-effectiveness
  • 2. Healthcare development linked to economic
    development
  • 3. Investment in public health leading to GNP
    growth
  • 4. Increased healthcare spending
  • 2006-RM8 billion
  • 2007-RM10 billion
  • 2008-RM12.9 billion
  • 2009-RM14.3 billion
  • 5. Over prescribling and poly pharmacy leading to
    drug resistence
  • Hence EDUCATION and INFORMATION required

16
SHOULD ONLY PHAMACISTS DISPENSE ?
YES !
Except where there is no pharmacy within a 3-km
radius of the nearest clinic
17
DEFINITIONS
  • Dispensing - an act of preparation and giving out
    medicine and also the provision of drugs or
    medicines as set out properly on a lawful
    prescription (from Medical dictionary)
  • Dispensed medicine a medicine supplied by a
    registered medical practitioner, registered
    dentist, veterinary surgeon under and in
    accordance with section 19 or supplied, for the
    purpose of the medical, dental or animal
    treatment, of a particular individual by a
    licensed pharmacist on the premises specified in
    his licence.
  • ( Section 2, Poison Act 1952)
  • Dispensing Separation (DS) - division of labour
    where a doctor will focus on the diagnosis of a
    patients sickness and prescribe an appropriate
    treatment, including a drug therapy for him,
    while a pharmacist will audit the prescription
    and dispense the drugs with adequate medication
    counselling

18
BACKGROUND
  • In most jurisdictions (such as the United
    States), pharmacists are regulated separately
    from doctors. Specifically, the legislation
    stipulates that the practice of prescribing must
    be separate from the practice of dispensing.
  • These jurisdictions also usually specify that
    only pharmacists may supply scheduled
    pharmaceuticals to the public, and that
    pharmacists cannot form business partnerships
    with physicians.

19
BACKGROUND
  • It is common for a medical clinic and a pharmacy
    to be located together and for the ownership in
    both enterprises to be common, but licensed
    separately.
  • A campaign for separation has begun in many
    countries and has already been successful like in
    Taiwan on 1997 and Korea on 2000.
  • As many of the remaining nations move towards
    separation, resistance and lobbying from
    dispensing doctors who have pecuniary interests
    may prove a major stumbling block like in
    Malaysia.

20
EARLY OF DISPENSING SEPARATION
HISTORY
  • Back in 1271 in France, doctors and pharmacists
    were reported to have feuded over dispensing and
    has continued to this day
  • In 1240, German Emperor Frederick II initiated
    separation of occupations. This development
    became possible due to urbanization whereby
    markets had become large enough to allow for
    specialization
  • The fact that doctors could generate income from
    diagnosing and prescribing while pharmacists from
    dispensing alone is fundamental to the separation
    of both practices
  • These principles were accepted by Parliament in
    UK in 1912 and by National Health Insurance in
    1964
  • In Asia, dispensing split became legal in
    Indonesia (1964), Philippines (1969), India
    (1988), Taiwan (1997) and South Korea (2000)
  • But in South East Asia, dispensing separation is
    yet to be seen in Malaysia, Singapore and
    Brunei.

1240
1912
1271
1964
1988
1964
2000
1997
21
EARLY HISTORY OF DISPENSING SEPARATION IN MALAYSIA
  • In 1985 Malaysian Medical Association had
    officially agreed to a signed Memorandum Of
    Understanding (MOU) with Malaysian Pharmaceutical
    Society (representing the pharmacists) that
    dispensing of medicines is the professional
    role of the pharmacist.
  • At present, private practitioners are still
    dispensing drugs to their patients 20 years after
    the MOU.
  • Currently, dispensing separation is still an
    issue between doctors and pharmacists (consumers
    as well)

22
CURRENT ISSUES
  • ASIAN COUNTRY
  • Common to find 24-hour pharmacies in these
    countries (Philippines, India, Korea Indonesia)
  • Ratio of pharmacists to patient in Philippines
    and India is 11447 and 11666 respectively
  • Doctors income loss to be compensated with raise
    of consultation fees, overuse and misuse of
    medication (South Korea) and doctors resort to
    acquiring own pharmacy and reduced pharmacists
    role to following orders of the owner
    (Indonesia).
  • However, there has been improved therapeutic
    compliance in Philippines as result of the
    separation

NST, April 23rd 2008
23
Taiwans Experience
  • A study on Dispensing separation has conducted in
    Taiwan (year 2003)
  • (Health Policy and Planning 18(3),HEALTH POLICY
    AND PLANNING 18(3) 316329)
  • Background
  • Separation policy started at in Taipei and
    Kaohsung in march 1997, and expanded to Chia-Yi
    and Tai Chung in March 1998.
  • This Study compared the differences between
    drug prescription rate, Drug expenditure per
    visit and health expenditure per visit.
  • Conclusion
  • This study has concluded that, separation policy
    in Taiwan not only has positive effect on
    reducing drug prescription behaviour but also
    significantly reduced drug expenditure in total.

24
CURRENT ISSUES
  • MALAYSIA
  • Detailed Study called Pharmacy and clinic
    Mapping have been conducted and still in
    progress
  • Various issues ranging from welfare of patients,
    facilities available and capability of pharmacies
    to meet the demand are being taken into account.

NST, MARCH 29th 2008
25
STATISTICS
  • Until year 2002, ratio is of one pharmacy to 3
    private clinics. (Malaysian Community
    Pharmacists)
  • This ratio has improved even more in the
    pharmacists favor because there were about 600
    new pharmacists and 850 new doctors entering the
    working force in the last few years.
  • There were 3927 registered pharmacists in 2004
    with only 1540 retail pharmacies.

26
STATISTICs
  • Currently in the year 2008 there are 6500
    registered pharmacists for public and private
    sector with 1600 retail pharmacies nationwide
  • The ratio of pharmacist to population is 14700
    and projected to be 13600 in 2010. In 2020 it
    will be 1 1600
  • This would indicate in the near future there
    would be enough pharmacy to cover major towns,
    rural and remote areas
  • In the coming September 2009, the first batch of
    pharmacists who complete their government service
    will further improve the figures of pharmacists
    in private sector and thereby improve pharmacists
    to population ratio

27
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28
PHARMACISTS MANPOWER GROWTH TREND IN MALAYSIA
  • 1970 1975 1980 1985 1990 1995 2000 2005 2010
  • 235 265 434 893 1325 2100 3168 4793
    7008
  • Increase 30 169 459 432 775 1068
    1625 2215

29
Ratio Distribution of communityPharmacies Vs
CLINICSin Private SECTOR
30
TOTAL PHARMACISTS GRADUATES FOR THE YEAR
2008/2009
Not included overseas graduates
31
REASONS FOR DISPENSING SEPARATION
  • High risk of a conflict of interest by doctors.
  • Some doctors may have financial self-interest in
    diagnosing and in exaggerating their
    seriousness and prescribing unwarranted
    medication.
  • Such self-interest directly conflicts with the
    patient's interest in obtaining cost-effective
    medication.
  • Doctors spend limited time in counselling to
    patients and do not provide detailed information
    on medication
  • Source www.mcp.org.my

32
REASONS FOR DISPENSING SEPARATION
  • POSITIVE IMPACT ON PHARMACISTS
  • Pharmacists can now fully utilize their knowledge
    and skills acquired in their years of
    professional training in providing pharmaceutical
    care
  • Motivation for pharmacists to keep abreast with
    Continuing Professional Development program
  • To implement the effective Medicines Management
    Program that has already been designed
  • To enhance the professional role of pharmacists
    and promote better recognition by the community

33
REASONS FOR DISPENSING SEPARATION
  • POSITIVE BENEFITS FOR THE DOCTORS
  • Offload the doctors from the process of drug
    procurement and inventory management
  • Provides more quality time for medical care to
    patients which includes diagnosing, treatment and
    monitoring

34
REASONS FOR DISPENSING SEPARATION
  • POSITIVE BENEFITS TO CONSUMERS
  • Check and balance to healthcare program to ensure
    better patient medication safety
  • Accessibility to pharmacist counseling and
    follow-up
  • Provision for better drug information from
    pharmacists
  • Provision of wider choice of cost-effective
    medication to consumers
  • Improved transparency in costing through itemized
    billing

35
Reasons For Dispensing Separation
Positive Impact to the Ministry of Health
  • Potential to reduce drug bill
  • Can incorporate National Medicines Policy as well
    as 9MP
  • Enhance further primary healthcare
  • Savings in manpower to check clinics for Good
    Storage Practice

36
Reasons for Dispensing Separation
Positive impact to the countrys social Economic
Development
  • Develop local manufacturers - Buy Malaysian
  • Bigger market for local manufacturers and prepare
    them for the global market
  • Facilitate closer rapport among Healthcare
    professionals forwards cost-effective management
    and patient care

37
MEASURES TAKEN TO FACILITATE DISPENSING SEPARATION
  • Geo-mapping
  • Benchmarking
  • Standard Operating Procedures (SOP) inplemented
  • 24-hours pharmacy set up
  • Compulsory CPD programme
  • Price control
  • Information networking

38
Pilot project for DispensingSeparation
recommended in
  • 1. Johor Bharu
  • 2. Klang Valley
  • 3. Kota Bharu
  • 4. Kota Kinabalu
  • 5. Kuching
  • 6. Penang Island

39
Date Proposedfor Pilot Projects
January 2009
40
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41
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42
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