Wednesday, 2 July 2014

A case for separation of roles

WE refer to the letter “Docs’ right to dispense medicine” (The Star, June 27) with interest and would like to point out certain conflicting statements made by the writer.

From the time of apothecary, dispensing of medicines was considered as a professional obligation of the pharmacists.

The Arabs, for instance, separated the art of apothecary and physicians in the eighth century and the Europeans followed suit through Frederick II of Hohenstaufen edict in 1240.

Thus, for many centuries, in most countries, health professionals other than pharmacists were not allowed to dispense medication.

In Malaysia in1985, the Malaysian Medical Association (MMA) and the Malaysian Pharmaceutical Society (MPS) had a formal Memorandum of Understanding (MOU) to recognise dispensing as the professional role of pharmacists.

However, because of the severe shortage of pharmacists, the doctors were legally allowed to dispense medications.

Now, with about 1,000 new pharmacy graduates entering the workforce annually, pharmacists in this country are more than ready to do what they have been trained for.

Furthermore, the practice of dispensing medicine has now evolved into more than the mere act of giving out medicines. Dispensing now involves intricate knowledge and skills in pharmacology, clinical pharmacy, pharmacoeconomic, pharmaceutical technology, physio­logy and forensic pharmacy in order to ensure the right medicine is given to the right patient at the right time.

Certain quarters have asked: Why change something that seems to have worked well for many years?

In considering the merits of a separation of roles, three issues need to be addressed:

> Convenience: A separation of the services will entail going to two places – first to see the doctor and then to collect medications from the pharmacist. While it might appear this will inconvenience the patient, this might not necessarily be so.

Take, for example, a general hospital. One can receive the treatment in one room and still cross over to another block to collect the medications. By the same token, pharmacies which are located close to a clinic will serve just as well.

> Cost: It is well-known that clinics have a limited range of medications. There are instances where prescriptions have to be written out by doctors for patients to purchase them from a pharmacy. Pharmacies would not only have a wider range of inventory but in most instances would be cheaper than the local GP.

> Safety: With medication error rate in primary care as high as 40% (Malaysian Institute of Health Service Research), a professional trained at detecting such errors could significantly reduce its serious and fatal consequences.

At present in the majority of private GP clinics, dispensing is usually done by unqualified persons. This will expose the patient to a higher rate of medication errors.

Any discussion on the dispensing separation policy should consider the issues above.

Further, in order to successfully implement dispensing separation, the following factors need to be looked into:

a) The need for rescheduling of the current Malaysian poison list. Currently, some of the medicines such as those listed for the treatment of diabetes e.g. Daonil® and Diamicron® are being categorised as group “C” poisons which can be sold by pharmacists without a doctor’s prescription.

With the implementation of dispensing separation, it is imperative that more drugs from group “C” are moved to group “B” poisons which can only be dispensed with a doctor’s prescription. This move will help the doctors monitor their patient’s health regularly as the patients need to see them for their prescriptions.

The Pharmaceutical Services Division proposed a new Pharmacy Bill since 2012 to replace the pre-independence legislations, namely the Registration of Pharmacists Act 1951, Poisons Act 1952, Sale of Drugs Act 1952, and Medicines (Advertisement and Sale) Act 1956.

These legislations were outdated to meet the current challenges and it was hoped the new bill would shape a new paradigm in drug scheduling in the country.

b) Establish the need for a pharmacist-physician patient referral system. Related authorities should establish a pharmacist-patient referral system to the GPs.

Currently, doctors only receive referrals from their medical peers. According to recent recommendations by the World Health Organisation (WHO) and the International Federation of Pharmacy (FIP), establishing such a system would help overcome the problems of “under-diagnosed” ailments in the community as some of the findings from initial screening tests that can be performed by pharmacists will be evaluated further by a medical doctor.

We believe there is room for implementation of dispensing separation in Malaysia. At most institutions across the world and Malaysia, medical specialists are also intensely involved in teaching clinical aspects of disease management to pharmacy students during their clinical years.

Therefore, mutual insight into each other’s professional roles is needed and any personal conflict should be avoided as it will mar the professional images of both professions.


Universiti Sains Malaysia


Tags / Keywords: dispensing of medicines


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