Pharmacies to dispense medicines if proposal accepted

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PETALING JAYA: Instead of getting their medicine from private clinics, patients will have to obtain it from pharmacies if the Health Ministry accepts the proposed “Doc­tors diagnose, pharmacists dispense” system.

While the system may cause some inconvenience to patients, pharmacists say it will help bring down the prices of medicine and give doctors access to many more drugs to prescribe.

It is learnt that doctors and pharmacists have held several discussions on the issue over the last year and they plan to meet the Health Minister soon.

They are represented by the Malaysian Medical Association (MMA), Medical Practitioners Coalition Association of Ma­­lay­­sia, Islamic Medical Association of Ma­­­laysia, Malaysian Pharmaceutical So­­ciety (MPS) and Malaysian Community Phar­­macy Guild (MCPG).

According to MCPG president Wong Sie Sing, the five organisations had, at their last meeting on Nov 8, agreed in principle that dispensing be left to pharmacists.

Representatives of pharmacists later met Health Ministry director-general Datuk Dr Noor Hisham Abdul­lah on Nov 26.

He said the two professions met to work out a timeframe to introduce the new system, adding: “I hope we can implement it by April.” Debate on the issue has been going on from as far back as 2008.

“If pharmacists are allowed to dispense, doctors would have access to 10 times more drugs to prescribe than what they have in stock. This will benefit the patients,” Wong said.

MCPG represents more than 2,000 community pharmacies employing some 2,500 pharmacists.

MPS president Datuk Nancy Ho said patients would receive further counselling from another group of well-trained healthcare professionals if pharmacists were to dis­­pense medication.

“The check-and-balance reduces prescription and dispensing errors. Dispensing separation is about professional medication management and only pharmacists are trained in this specialised practice. We know everything about a drug’s healing value and possible harm,” she said.

MMA president Dr H. Krishna Kumar confirmed that the associations had met on the proposed new system but said nothing had been agreed on yet.

Dr Noor Hisham confirmed meeting representatives of pharmacists, and said they discussed about integrating and consolidating the Pharmacy Act cialis generika ohne rezept.

Stating that nothing had been decided on, he stressed that the ministry’s main priority was to ensure quality and safety.

Universiti Sains Malaysia (School of Phar­maceutical Sciences) Assoc Prof Mohamed Azmi Ahmad Hasalli said a 2013 study of 40 clinics and 100 pharmacies in Penang found that doctors dispensed more medicine and antibiotics and charged more than pharmacists.

Many willing to pay ‘price of convenience

PETALING JAYA: For the sake of convenience, many patients would rather pay more to get their medicine immediately from their doctor than go to pharmacies which usually charge less.

Housewife Selina Pheng, 38, said she did not mind paying the “price of convenience”. She was recently charged RM20 for cough syrup at a clinic although the price is only RM15 at a pharmacy.

She prefers the “one-stop” system here to the practice in the United States where her family used to live.

“In the US, it’s very inconve­nient. After seeing the doctor, you have to go to a pharmacy for me­dication,” she said.

Pheng said doctors’ consultation fees here are much lower than in the United States but medication is cheaper there.

“Here consultation is cheap but doctors tend to prescribe a lot of medication because that’s probably how they earn more.”

A 40-year-old manager who only wanted to be known as Tan agreed.

“Doctors here usually prescribe many types of medication, even for the common flu. There are different drugs for morning and night, additional medication for sore throat and phlegm, Vitamin C and antibiotics that cost between RM45 and RM60 per visit,” said the mother-of-two who now gets annual flu jabs instead.

New mother Rodziah Hassan, 32, said she paid RM90 to see a doctor for her son’s cough.

“I found out the medicine only costs RM27 at the pharmacy. But I didn’t mind because I just wanted him to get well. Plus, it’s more convenient to get the medicine from the clinic rather than carry a crying toddler around town looking for a pharmacy,” she said.

Kathy Arokiasami, 26, said she paid RM10 for an antiseptic cream at a clinic but later discovered that a pharmacy was selling it for half the price.

Despite the experience, the bank teller still chose to get her drugs from the clinic because “doctors are certified”.

Published: Sunday February 15, 2015 MYT 12:00:00 AM

Don’t change what has stood the test of time (Letter to Star)

I REFER to the report “Pharmacies to dispense medicines if proposal is accepted” (Sunday Star, Feb 15).

The headline is misleading. It gives the impression that pharmacies have not been allowed to dispense medicines. Nothing is further from the truth. Pharmacies have always been allowed to dispense.

What the writer is trying to highlight is the coming of the Pharmacy Act which proposes to stop doctors from dispensing, so that pharmacists only can dispense, something we call “Dispensing Separation”.

Yes, this debate had been on for the last 30 years or more. It was the wisdom of the many previous health ministers that prevented it (Dispensing Separation) from being made into law.

I sincerely hope that the present Health Minister will also do likewise and not try and change a system that has stood the test of time.

Of course, there are advantages and disadvantages if doctors only can dispense, and advantages and disadvantages if pharmacists only can dispense.

If pharmacists dispensing has so many advantages, example price advantage, drug range advantage and safety advantage, then surely the smart patients will know where to go for their medication.

However, if the smart patient wishes to get his/her medication from his/her doctor, why stop him/her? Patient’s right to choose must not be taken away by laws.

Under the current system, both can dispense, so that the patient has the choice and the right, where to get their medications from. The best of both worlds!

The current system is good for Malaysia. Why change it and make the system worse for patients, removing their right to choose?

We, however, welcome the move by pharmacies to offer a wider range of drugs than doctors. This is a step in the right direction. They can do so even now. Why later?

It is also highly contentious and disputable to say that a pharmacist knows all about drugs and has a monopoly to knowledge about drugs. It smacks of arrogance. We have seen many examples of pharmacist errors.

It is a shame to see the Governments make laws just to protect some businesses and businessmen.

It is for good and capable businesses and businessmen to fight the headwinds, seize the opportunities and overcome the business threats and bring success to their business.

Not by working with their “friends in Government”, behind the backs of other stakeholders, to make laws to favour them. This is an abuse of the process.


Doctors’ right to dispense drugs

THE Health Ministry (MOH) is considering implementing sole dispensing rights to pharmacists. This will cause a lot of problems as Malaysia is not ready for this.

Doctors and patients feel that the present method of doctors dispensing medicines for their patients should continue.

This system has served the patients and doctors well. For the patient it is convenient, economical and entails a lower risk of mistakes, as doctors usually prescribe drugs they are familiar with and thus keep sufficient stock.

Supplying the medicines is part of the total care of the patient. It provides convenience and care continuity expected by the patient.

Doctors being responsible for diagnosis would be more knowledgeable about the most appropriate medication and their method of use in tailoring the treatment regime. During follow-up, doctors will also be aware if the patient is taking the medicines as directed.

Treatment includes giving the appropriate medicine. Therefore, doctors have every right to dispense medicines if they choose to do so.

On the other hand, pharmacists are not qualified to diagnose and treat. They can only supply scheduled drugs with a doctor’s prescription.

It is important that pharmacists working in private pharmacies be ethical and willing to work with and not against or compete with doctors.

There have been many complaints that some pharmacists have been practising like doctors. They not only take blood pressure readings and do blood glucose and cholesterol tests, but also give advise on treatment to their clients.

Some pharmacists even sell scheduled medicines such as antibiotics and those for diabetes, hypertension and high cholesterol, without a doctor’s prescription.

Pharmacists must also not give repeats without the approval of the prescribing physician.

Regular follow-up by the doctor is very important to ensure that his patient’s illness is under control without any complications, including side effects, from the medication taken.

Those who try to save by not seeing a doctor usually end up spending more when they develop medical problems due to poor control of their medical condition. Having to be admitted into a private hospital will cost them even more.

At the moment, there are too few pharmacies in the country and most are concentrated in cities and town areas.

In Malaysia, we have a good system that is convenient for the patients and should be maintained.

If dispensing is to be done by pharmacists it will be very impractical. After seeing a doctor, the patient will have to search for a pharmacy to buy the medicine.

This will be difficult in rural areas and if the patient needs the medicines urgently. Traffic jams and parking problems will add to this inconvenience.

Healthcare costs will also increase drastically if the MOH implements this plan.

Doctors will then have to charge a higher consultation fee to be able to maintain their clinics.

Presently, most general practitioners (GP) are charging a lower consultation fee than they are entitled to.

Buying medicine from pharmacists will also cost much more since pharmacists will have to make profit from their sales.

Usually, doctors charge less than pharmacies for medicine, though I agree that there are some unscrupulous doctors who are charging more for medicines. But this is an exception rather than the rule.

Pharmacists may not have the drugs the doctor has prescribed which may cause more delay and inconvenience to the patient.

Every doctor has his favourite medicines, which they use more often because they are more familiar with them and have faith in them.

The doctor’s dispensary will definitely have in stock the medicine the doctor uses and is familiar with.

If the pharmacist does not have certain medications prescribed, the patient will have to go back to the doctor for a change of prescription or will have to go hunting for another pharmacy that has the medicines.

Furthermore, the brand of the particular medicine the pharmacist has in stock may not be acceptable to the doctor who prescribes it. He may doubt its potency, efficacy and reliability.

Before the dispensing rights can be taken from doctors, all salient points raised must be closely looked into and corrected if necessary or the public will lose out.

The time is definitely not right for the pharmacists to take over completely the dispensing of medicines.

However, I agree that sooner or later this may happen, but only when patients can benefit from such an arrangement. It is still a long way off judging from the present scenario. It should not be politically motivated.

The increase in the number of laws against the private healthcare sector such as the Private Health Care Bill has already made it difficult for family doctors and with rising costs of hiring clinic assistants and rental, GPs are already finding it difficult to run clinics and serve the public efficiently.

The role of GPs as healthcare providers is very important and with all these obstacles they are facing, they are finding it difficult to make ends meet.

Soon family doctors will be obsolete and Malaysians will have to go straight to hospitals and specialists which will make healthcare costs even higher and unaffordable.

General practice plays a very important role in any healthcare system and the authorities shouldpromote it.

DATUK DR LEE YAN SAN  ( 17/02/2015)

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