YH connected the various articles that appeared recently:
The Berita MMA publication over the present MMA President first 100 days http://202.144.202.76/mps/newsmaster.cfm?&menuid=37&action=view&retrieveid=3053
NST report on “Unfair for hospitals to open feeder clinics” http://202.144.202.76/mps/newsmaster.cfm?&menuid=36&action=view&retrieveid=3052
What the MMA’s president wrote about us and …. ? In simple words, the answer is, he does not know the difference between chicken and egg, I mean between pharmacist as professional and pharmacy as a profession. Which means, he cannot differentiate between the practitioners, the practice and the territory of pharmacy. When he answered “NO” to separation between dispensing and prescribing citing about the public naïve about the role of pharmacist, this should also include doctor’s naïve about our role and standard of pharmacy practice, what it means by the gold standard in pharmaceutical care.
I have come across many serious incidents in Malaysia, including serious injuries and death, when the doctors denied responsibility for patients who suffered severe side effects from the drugs. We all know that pharmaceutical care advocates the pharmacist to be responsible for the provision of drug therapy for improving the patients quality of life, which means taking responsibility for the decision to supply medicines to the patient including all consequences that can happen to the patients, while to the doctors it is because the drugs that decide to harm the patients, not them.
That is why the MMA’s president simply wrote, while fee splitting is unethical to medical practice, but not pharmaceutical fees. To him pharmaceutical services is no different from the business of selling fruits, that is the reason why the price should be left to the market forces.
Now the GPs are meeting with their own unfortunate fate when the business owners of the private hospitals start downstream to outreach walk-in patients at their own outpatients clinics. They start preaching professional issues like doctors in the clinics are paid to refer patients to their own hospitals, affecting the livelihood of the GPs operating without specialist support and by professional standard the GPs are suppose to act like gatekeepers to keep the patients right to choose hospitals without considering the issue of inconvenience.
Because of this, the GPs incomes have to be reduced by undercutting each other in order to remain competitive. Does this sounds familiar with our won issue with the GPs, when the retail pharmacies have to undercut each other without the support of a system that separates prescribing from dispensing?
Next time, when MPS or pharmacy programs run awareness campaign, the first target group should be the doctors.
Thursday, November 5, 2009
Implications of Up- or Down- Scheduling of Scheduled Products
The Malaysian Group C schedule items is a blessing to the community pharmacists, with such a wide range of products that can be sold with almost no restrictions.
The only concern is that such products too require diligence when dispensed out. They cannot just be given out without proper and adequate counseling. They are in Group C because they are effective for the approved indications and are relatively safe but at the same time with significantly greater side-effects / precautions require as compare to one that is non-schedule, generally speaking.
Hence if the licence holder were to request for down-scheduling of the products what does this mean? It could be that that they feel that there is a bigger market outside the pharmacy. It could also mean that they want to advertise in the newspaper but due to it being a Schedule Poison, it cannot be done. After down-scheduling the licence holder could either continue to make the product available to pharmacy only or they can now distribute it to the open market to generate more sales.
For Pharmacy Only item, pharmacist has to show that they are doing a good job in handling the product. If indeed it is so safe, so be it that it be down-schedule. But if not, intervention by pharmacist would be the best option for the patient. Intervention here means proper counseling, assessing the patient to determine the best available medication to recommend taking consideration various factors (concomitant medication / drug interactions etc )
This scenario of re-scheduling is not faced by pharmacist locally alone. For example recently the Australian TGA plan to up-schedule the cold and cough medicines for children to be available on Prescription only. But the Pharmaceutical Society of Australia National President voiced that there is no reason to act in this way and such a move would make the job of pharmacists more difficult. Indeed it would be best to up-schedule up to Pharmacist Only to allow pharmacist to assess the appropriate symptomatic relief. (Source: e-news Pharmacy 27th Oct 2009)
Meanwhile Nov 1st SUN carried an article headlined as “Painkiller Abuse Alert”. It reported that their reporters went to 4 pharmacies to test-buy tramadol. Only 1 refused to sell, whereas the reporter had no problem with the other 3. They contacted the Addiction Medicine Association of Malaysia (AMAN - President Dr Steven Chow is Chairman) who proposed to make tramadol a ‘controlled drug” so that medical practitioners would exercise caution when dispensing it. (meaning to make it to be controlled like psychotropic).
If one were to talk to other medical practitioners along the conference room corridors in-between meetings there were also mutterings among the GPs that they want to make oral antidiabetic agents to be Group B item. But there were no formal request and there are not enough good reasons. However one need to note that all the newer OAD are Group B items
Earlier last year, the Malaysian Dermatological Society made a proposal to the Poison Board to up-schedule topical corticosteroids to Group B / Group A (unrealistically) but eventually this medicine group finally remain status quo.
There was also a report in Utusan Melayu about the ease of obtaining OC by transvertites and this lead to a call to up-schedule this to Group B.
On the other hand some products were down-schedule, like clotrimzaole dermatological from Group C to non-schedule.
Whether up-schedule or down-schedule, if pharmacy are not intervening to ensure proper drug usage, one will see more such proposals. While MPS is always consulted before such a move, the activity of defending such a move is non-productive and it should not happen in the first place.
The only concern is that such products too require diligence when dispensed out. They cannot just be given out without proper and adequate counseling. They are in Group C because they are effective for the approved indications and are relatively safe but at the same time with significantly greater side-effects / precautions require as compare to one that is non-schedule, generally speaking.
Hence if the licence holder were to request for down-scheduling of the products what does this mean? It could be that that they feel that there is a bigger market outside the pharmacy. It could also mean that they want to advertise in the newspaper but due to it being a Schedule Poison, it cannot be done. After down-scheduling the licence holder could either continue to make the product available to pharmacy only or they can now distribute it to the open market to generate more sales.
For Pharmacy Only item, pharmacist has to show that they are doing a good job in handling the product. If indeed it is so safe, so be it that it be down-schedule. But if not, intervention by pharmacist would be the best option for the patient. Intervention here means proper counseling, assessing the patient to determine the best available medication to recommend taking consideration various factors (concomitant medication / drug interactions etc )
This scenario of re-scheduling is not faced by pharmacist locally alone. For example recently the Australian TGA plan to up-schedule the cold and cough medicines for children to be available on Prescription only. But the Pharmaceutical Society of Australia National President voiced that there is no reason to act in this way and such a move would make the job of pharmacists more difficult. Indeed it would be best to up-schedule up to Pharmacist Only to allow pharmacist to assess the appropriate symptomatic relief. (Source: e-news Pharmacy 27th Oct 2009)
Meanwhile Nov 1st SUN carried an article headlined as “Painkiller Abuse Alert”. It reported that their reporters went to 4 pharmacies to test-buy tramadol. Only 1 refused to sell, whereas the reporter had no problem with the other 3. They contacted the Addiction Medicine Association of Malaysia (AMAN - President Dr Steven Chow is Chairman) who proposed to make tramadol a ‘controlled drug” so that medical practitioners would exercise caution when dispensing it. (meaning to make it to be controlled like psychotropic).
If one were to talk to other medical practitioners along the conference room corridors in-between meetings there were also mutterings among the GPs that they want to make oral antidiabetic agents to be Group B item. But there were no formal request and there are not enough good reasons. However one need to note that all the newer OAD are Group B items
Earlier last year, the Malaysian Dermatological Society made a proposal to the Poison Board to up-schedule topical corticosteroids to Group B / Group A (unrealistically) but eventually this medicine group finally remain status quo.
There was also a report in Utusan Melayu about the ease of obtaining OC by transvertites and this lead to a call to up-schedule this to Group B.
On the other hand some products were down-schedule, like clotrimzaole dermatological from Group C to non-schedule.
Whether up-schedule or down-schedule, if pharmacy are not intervening to ensure proper drug usage, one will see more such proposals. While MPS is always consulted before such a move, the activity of defending such a move is non-productive and it should not happen in the first place.
A survey with the primary objective of studying the perception of the general public towards the dispensing doctors’ practice as carried out in Penang recently. Below is the response to various questions
In the table below, SA = Strongly Agree; AG = Agree; DS = Disagree; SD = Strongly Disagree.
Table is courtesy of the authors - see below
An important opinion is that only 26.8% of the respondents said “yes” to the question about whether they agree to the implementation of dispensing separation in Penang. The remaining 73.2% said no. Also only 54.3% of the respondents thought that a pharmacist is more reliable than a doctor in explaining the uses and side effects of medicines and drugs.
Source: Hassali MA, Shafie A A, Palaian S, Awaisu A. (Corresponding author email: azmihassali@usm.my)
Public Opinion on Dispensing Doctors in Malaysia. Journal of Clinical and Diagnostic Research 2009 Oct (3): 1776-1778
What Does Patient Want to Know About Medicines
According to a survey conducted recently in UK, patients are more likely to use the internet to learn about a medical condition and its treatment than they are to ask a pharmacist or consult a patient information leaflet (PIL).
6.5% of those questioned would always ask a pharmacist
12.7% would always consult a PIL
30.1% of patients would always look online
32.9% would always ask a doctor
Nearly 18% of respondents said they never ask a pharmacist to learn about a condition and its associated treatment.
Over 43%of those surveyed said that they had previously failed to complete a full course of prescription medicines.
However the survey results on internet usage may not be true for Malaysians, but one should look at the following survey results when a doctor prescribes a medicine for them:
47% of patients said they were very interested in learning about the side effects of the medicine,
27% were very interested in how the medicine worked and
62.4%were very interested in how and when to take the medicine.
Imparting knowledge about medicine is pharmacist job and there is indeed an interest. Pharmacist should not have difficulty in finding patients to listen to them about medicines. But does the pharmacist here have the time or the interest to provide the information. No doubt some do, but what about the others ?
Tell us what is your experience here.
Source: Patient Engagement Research
http://www.kyp.com/ikyp/files/3e/3eaf17dc-56a7-47ac-a253-7ce21db08151.pdf
6.5% of those questioned would always ask a pharmacist
12.7% would always consult a PIL
30.1% of patients would always look online
32.9% would always ask a doctor
Nearly 18% of respondents said they never ask a pharmacist to learn about a condition and its associated treatment.
Over 43%of those surveyed said that they had previously failed to complete a full course of prescription medicines.
However the survey results on internet usage may not be true for Malaysians, but one should look at the following survey results when a doctor prescribes a medicine for them:
47% of patients said they were very interested in learning about the side effects of the medicine,
27% were very interested in how the medicine worked and
62.4%were very interested in how and when to take the medicine.
Imparting knowledge about medicine is pharmacist job and there is indeed an interest. Pharmacist should not have difficulty in finding patients to listen to them about medicines. But does the pharmacist here have the time or the interest to provide the information. No doubt some do, but what about the others ?
Tell us what is your experience here.
Source: Patient Engagement Research
http://www.kyp.com/ikyp/files/3e/3eaf17dc-56a7-47ac-a253-7ce21db08151.pdf
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