By Prof. Datuk Dr. Allan Mathews
Dean, Faculty of Pharmacy, Quest International University, Ipoh, Perak.
I view with concern regarding the role of Community Pharmacists and Community Pharmacy Practice in Malaysia. Undoubtedly, the separation of dispensing and prescribing roles has not yet been implemented in the private clinics and community pharmacy sectors and this has contributed much to the confusion among the general public of what is actually done by the Community Pharmacist.
Regretfully, there are also sometimes doubts that Community Pharmacists are not competent enough to manage patients. This perception is outdated and far from the truth.
The World Health Organization (WHO) outlines the roles of the Community Pharmacists as ensuring quality of medicines, processing of prescriptions, care of patients (Clinical Pharmacy), monitoring of drug utilisation, extemporaneous preparations and health promotion.
In other words, the focus has shifted. Instead of a Community Pharmacist being a provider or seller of products, they are now providers of care.
Worldwide, the move is towards the utilisation of the Community Pharmacist in managing patients. 98 percent of vaccinations in the UK are carried out by Community Pharmacists and the government actively encourages patients to seek the services of the Community Pharmacist. Health centres have both a Medical Doctor and a Pharmacist in attendance. The Pharmacist is there not to dispense prescriptions but to manage medication-related issues. In fact, UK Pharmacists can now by law prescribe medicines to the same level as Medical Doctors.
In their 2013 policy statement, the British Medical Association noted that in recent years, the direction of travel for community pharmacy has transitioned from a business model that relies predominantly on dispensing services, to one that is more heavily reliant on providing clinical services.
As of 2019, Pharmacists in the UK are empowered to alter the strength, quantity and type of drug as long as they have a similar effect. Nearby in Thailand, Community Pharmacists are empowered to manage patients on long term treatment without having to have repeat prescriptions. They can also carry out generic substitutions to keep down the cost of healthcare.
In Canada, Pharmacists administer medicines including injections, and in the USA, the utilisation of the Pharmacist has resulted in improved patient care, decreased hospital admissions and reduction in cost. In Australia as well, Community Pharmacists are remunerated for the clinical services provided.
What we can see is that in these countries, the Community Pharmacist has achieved the due recognition that they deserve – commensurate with their 5 years of training to be a Registered Pharmacist.
The Malaysian Registered Pharmacist undergoes training in all aspects of medicines, including therapeutic outcome management. The course covers Medical Sciences (e.g. anatomy, pathology etc.), Disease States, Dosage Forms, Pharmacology (the use of drugs) and Clinical Pharmacy (direct patient clinical service) – which includes laboratory results interpretation.
The Pharmacist of today is more than competent enough to manage patients. Malaysian law empowers the Community Pharmacist to prescribe Group C Controlled Medicines for Medication Management and for responding to symptoms. Pharmacists are also trained to know when to refer a patient to a Medical Doctor.
I am of the opinion that the time has come to optimise utilising the expertise of the Community Pharmacist. Studies worldwide have shown that there is an improvement in patient care as well as overall healthcare savings for the state.
Patients with chronic diseases e.g. diabetes and hypertension can be managed by Community Pharmacists once they have been diagnosed and prescribed medications. There is a need for the dispensing function—which is the fundamental role of Pharmacists—to be solely carried out by Community Pharmacists, as this ensures safety, quality and proper use of medicines.
By separating the functions, the patient will get the most appropriate medication and care for their condition. There is also the emerging role of Community Pharmacists in Primary Healthcare e.g. in weight management, smoking cessation and in the early detection of life-style diseases.