Work together for better care

THE Malaysian healthcare system appears remarkably successful in delivering good health outcomes at a reasonable cost.

But despite these accolades from international bodies such as the World Health Organization (WHO), the chief problem in the Malaysian healthcare system which has yet to receive adequate attention from the Government is quality.

There is a tendency among Malaysian patients to complain about long waits, lack of consultation or “informed consent” procedures, and poor physical facilities not only in public facilities but also in the private sector (all of these topics are frequently discussed in the media).

More fundamental areas of concern are weaknesses in professional standards, inadequate continuation of medical education, and lack of quality control especially in the private sector despite the many laws and regulations governing them.

Within this context, a successful healthcare system has three attributes: healthy people, meaning a population that attains the highest level of health possible; superior care, meaning care that is effective, safe, timely, patient-centred, equitable and efficient; and fairness, meaning that treatment is applied without discrimination or disparities to all individuals and families regardless of age, group identity, or place, and that the system is fair to the health professionals, institutions and businesses supporting and delivering care.

A sustainable health system also has three key attributes: affordability, for patients and families, employers, and the Government (recognising that employers and the Government ultimately rely on individuals as consumers, employees and taxpayers for their resources); acceptability to key constituents, including patients and health professionals; and adaptability, because health and healthcare needs are not static (a health system must respond adaptively to new diseases, changing demographics, scientific discoveries, and dynamic technologies in order to remain viable).

In many health systems around the globe, primary care physicians (general practitioners or GPs) play a central role as gatekeepers to the rest of the system.

In Malaysia, GPs work mainly in private practice, receiving fee-for-service payments. The majority of Malaysian GPs derive a substantial proportion of their income from dispensing medications to their patients and they are at present hampering the implementation of dispensing separation between a GP clinic and a community pharmacist.

Malaysians are currently not linked to any particular private provider or group of providers through registration. This fragmented system needs to be reformed to improve efficiency and safety.

We are living in a time when consumers and patients want to know more about the food they consume and the drugs they take, and their appetite for information is growing. Yet our nation is facing a communication gap which will have serious implications for public health.

This gap begins at the stage where patients want to know about their medicines. Evidence from local and international studies suggests that inadequate communication about drugs is one of the principal reasons why 30% to 55% of patients deviate from their medical regimens. Patients’ misunderstanding of the proper use of medications is also an underlying cause for many adverse drug reactions.

I believe that in this present environment, bridging the information gap is a matter of high priority for consumers and providers, and counselling of patients by appropriate trained personnel is an important obligation.

The expansion of the pharmacist’s obligation to inform patients has been acknowledged in the pharmacists’ code of ethics. So far, however, economic considerations and constraints on physicians’ time have hampered efforts to ensure that patients receive such counselling.

There are relatively few barriers to a healthcare provider outlining to patients the risks of prescribed drugs. The question therefore is not one of principle but of implementation.

Physicians and not untrained dispensers in their practice need to weigh the amount of information they must give personally to their patients and the way to deliver it. GPs also need to acknowledge that pharmacists should have a larger role in educating patients about their medication and advising them to expect counselling when they fill their prescriptions.

Although the cooperation of many groups is important, the pivotal role – and the primary responsibility for the proper use of drugs – is in the hands of physicians and pharmacists. Their involvement will determine whether a renewed patient-education campaign will actually make a difference in the health of the public.

PROF DR MOHAMED AZMI AHMAD HASSALI

Professor of Social and Administrative Pharmacy

School of Pharmaceutical Sciences

Universiti Sains Malaysia