An Associate Professor Shares How the Role of the Pharmacist Has Evolved Over the Years

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR WONG PEI SE
School of Pharmacy
International Medical University (IMU)

This year, the theme of the World Pharmacists’ Day is Pharmacy strengthening health systems. In light of this, we’re pleased to have Dr Wong Pei Se joining us to share her thoughts on the role of community pharmacists in our healthcare system.

MALAYSIANS ARE CONSULTING PHARMACISTS MORE THEN EVER

In 2015, the National Survey on the Use of Medicines (NSUM) found that only 5% of the respondents would consult a pharmacist on health problems.

Just 6 years later, in 2021, it was reported that Malaysians on average visited community pharmacies 31 times a year. This is comparable to the average in developed countries such as Australia, the US, and the UK!

This could be spurred by the growing awareness of the role of a pharmacist as a result of the COVID-19 pandemic. That was when people began to rely more on their pharmacist for information and guidance on the use of medications, sanitizers, masks, and more to stay safe and healthy during the pandemic.

Even then, many Malaysians may still overlook how the pharmacist behind the counter can be a reliable first stop for medical and general health advice, beyond the scope of the pandemic.

GUIDANCE & EDUCATION ON GENERAL MINOR AILMENTS

“Community pharmacists can help manage minor ailments, give advice and help to educate the public on different aspects of ailments and treatments available,” says Dr Wong Pei Se.

She adds, “Pharmacists are also able to guide customers onto the right medical path – when you are not sure whether you need to see a doctor, or even which doctor you need to see.”

THE BIGGEST ROLE OF A PHARMACIST

No, it’s not to sell medications and over-the-counter products!

The biggest role a pharmacist can play in their community is to support healthy living and self-care in that particular community. They are in an optimal position to help members of the community prevent or reduce their risk of illnesses as well as to stay healthy through basic health advice on exercise regimes, good nutrition, and health supplements.

Dr Wong explains further: “We want to intervene before people get a heart attack, before a stroke, before diabetes leads to kidney problems. These are things that we can manage at the community level so that people don’t end up going to the hospital.”

To that end, many pharmacies provide screening and monitoring services for blood pressure, sugar and cholesterol levels.

Although there are many devices that can be used at home, this service is an alternative for those who are not willing to invest in a device or who are just not comfortable self-administering these tests.

The availability of these services is convenient for people that are unable or unwilling to make a trip to a hospital or clinic.

People also don’t have to delay their monitoring for months as they wait for their follow-up appointments at a clinic or hospital.

CONVENIENCE & ACCESS

Ultimately, people find pharmacies easily accessible and hence very convenient. After all, as Dr Wong shares, there were over 3,000 pharmacies in Malaysia—you can find 1 every 5 to 10 km in urban areas.

Furthermore, there is hardly any need to for registrations or making an appointment in advance.

“The consultation is free when you just need to ask a few questions, or if you are unsure of the medical severity of your condition; these are factors that make a big difference,” says Dr Wong.

As an example, Dr Wong brings up that many people with skin problems such as acne are more likely to visit a pharmacy first. In such a situation, the pharmacist can guide these people through the many options of skincare available and also advise them to visit a doctor if the situation warranted it.

“Pharmacists have become a very accessible primary care service provider,” says Dr Wong. “When clinics are overcrowded and when there is an unexpected burden on the system, pharmacies can help to optimize a healthcare system.”

SO, WHAT’S IN THE FUTURE FOR PHARMACISTS IN MALAYSIA?

In the past few years, digital platforms have been pushed to the fore by the pandemic and pharmacies have not been left out of this technological leap.

“During the lockdowns, pharmacies started doing deliveries and digital health platforms became a very common communication method,” says Dr Wong.

During the pandemic, it was common for long-time customers of a pharmacy to send messages over WhatsApp to ask for advice as well as to place orders products ahead of time for convenient pick-ups or deliveries. This trend continues beyond COVID-19 and has contributed further to the convenience of the consumer.

On a bigger scale, personalized medicine and pharmacogenomics are trends that are moving the industry forward.

Personalized medicine allows for a patient’s treatment to be tailored to their unique genetic makeup, lifestyles and health conditions. Therefore, such treatment is optimized to be most effective and appropriate for them as each individual.

Pharmacogenomics looks into how one’s individual genetics affect the effectiveness of medicine. “It studies how our different genetics will affect how and when you should take a particular medicine, how it is absorbed into your body, how it interacts with your body, the side effects that you may have,” explains Dr Wong.

However, pharmacogenomics is not something that can be done across the board, as pharmacogenomic tests are costly and are available only for certain treatments, for example cancer.

CHALLENGES IN THE WAY INTO THE FUTURE

The perception of certain members of the public can be a significant hurdle that pharmacists will need to overcome.

“The pharmacy is seen as a business. There is a perception that pharmacists only want to sell their products: People feel that the more I talk to you, the more you will want to sell me things,” Dr Wong explains as a reason as to why some people still remain reluctant to engage a pharmacist.

Privacy is also a big issue. Unlike at the clinic, a pharmacy doesn’t have private consultation rooms. This could hinder people from asking more personal issues. “If you have a very private question and you see ten people ahead of you, you probably wouldn’t want to ask it,” muses Dr Wong.

Nonetheless, Dr Wong reiterates that the community pharmacist still holds a unique position of being part of the community. Being privy to certain lifestyles and habits of the neighbourhood, the pharmacist has unique insight on the community as well as the opportunity to build relationships and walk together with their customers not just through sickness, but in health.

IMU Professor Shares How Evolving Role of Pharmacists Can Lead to Better Medicine Safety

WORDS PROFESSOR ONG CHIN ENG

FEATURED EXPERT
PROFESSOR ONG CHIN ENG
Dean of School of Pharmacy
International Medical University (IMU)
UNSAFE MEDICATION PRACTICES AND MEDICATION ERRORS A LEADING CAUSE OF INJURY AND AVOIDABLE HARM 

Globally, the cost associated with medication errors has been estimated at USD42 billion every year.

Furthermore, throughout the world each year, adverse drug events—harm resulting from medication use —cause billions of visits to hospital emergency departments.

LEARNING ABOUT MEDICATION SAFETY CAN REDUCE AND EVEN PREVENT THE RISK OF HARM FOR YOU AND YOUR LOVED ONES

Errors can occur at different stages of the medication use process. These include but not limited to patient receipt of the incorrect prescription (such as receiving the wrong drug or the correct drug but at the wrong dosage), harmful drug-to-drug interactions, errors in the drug preparation or delivery, and inappropriate or overprescribing of certain drug groups such as opioids.

Medication errors can also occur as a result of weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages. These issues can affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.

ENSURING THE SAFE PRESCRIBING AND DISPENSING OF MEDICATION TO PATIENTS

In conjunction with World Pharmacist Day on 25 September, it is a timely reminder to the pivotal role of this healthcare provider in safeguarding the proper and safe use of medicines.

Pharmacists ensure that patients not only get the correct medication and dosing, but that they have the guidance they need to use the medication safely and effectively.

However, as healthcare providers with expertise and focus on medications, there is an opportunity for the pharmacists to expand their role as patient safety leaders, working with patients and other providers to improve patient care outcomes and prevent medication errors.

While traditionally pharmacists have been perceived as ‘behind the glass’ dispensing medications, in the changing healthcare landscape they are increasingly seen as critical partners in the multi-disciplinary care team addressing complex patient needs.

Particularly in response to the recent COVID-19 pandemic, there are some clear opportunities for hospital and community pharmacists to assume a greater role in pressing patient safety issues, access to medications, medication adherence, readmission reductions, and medication safety.

Pharmacists have a unique expertise and knowledge base that can support improvements in medication error rates and play a critical role in the reporting process, such as providing appropriate feedback to providers. This may result in improved prescribing practices and greater teamwork as well as improving pharmacist confidence and feeling of self-worth in the care team.

ANTIMICROBIAL STEWARDSHIP (AMS) PROGRAMMES

Antimicrobial resistance is a growing public health threat and inappropriate use of antimicrobials (including antibiotics, antivirals, and antifungals), has further aggravated the resistance.

Pharmacists have an important role within AMS programmes, including developing and managing antimicrobial guidelines; reviewing individual patient regimens to optimize therapy; educating healthcare staff on the appropriate use of antimicrobials; and monitoring and auditing outcomes.

Pharmacists are central to the delivery of education on stewardship to healthcare professionals, patients and members of the public. Pharmacists are also key healthcare educators in the community, as they are often the first point of contact for the public and have a responsibility to be a source of information and education on antimicrobial use and resistance.

AMS programmes have been proven effective at improving clinical outcomes, reducing adverse events, and reducing resistance. Given the success of the AMS model, pharmacist role in other medication stewardship programmes may increase.

PHARMACISTS OFFER UNIQUE SKILLSETS TO ADVANCE PAIN AND OPIOID STEWARDSHIP PROGRAMMES

Other therapeutic areas, such as glycaemic control and thrombotics, may also be suitable targets for future programmes.

As evidence continues to demonstrate the success of stewardship programs, medication stewardship could become a central aspect of the pharmacists’ role in ensuring patient safety.

COUNSELING SERVICES AND COMMUNICATION ON POTENTIALLY UNSAFE MEDICATION COMBINATIONS

Increasing medication reconciliation by the community pharmacist following hospital discharge has the potential to reduce adverse events, reduce patient hospital readmissions, and even reduce the risk of death.

PROVISION OF LONG-TERM CARE

From a healthcare policy and care delivery standpoint, there is an ever-increasing focus on providing long-term care as a means of increasing the quality and safety of care. As patient care delivery evolves from episodic to longitudinal, organizations will restructure to care for patients across the continuum.

This evolution will reinforce the need for team-based care to ensure care coordination, patient safety, and optimal patient outcomes. Pharmacists play a great role in supporting a transition to longitudinal patient care and can serve to enhance pharmacist patient safety services.

Central to this longitudinal care is the home medication review (HMR) process. The intent of the HMR is to support the quality use of medicines and assist minimizing adverse drug events by helping patients to better understand and manage their medicines through a medication review conducted by a pharmacist in the home.

An HMR is a collaborative process between the referring doctor (referrer), pharmacist, patient, and where appropriate, a carer.

Currently, there are 3 HMR services provided by Malaysian government hospitals and health clinics, namely neurology/stroke, psychiatry, and geriatrics.

During the HMR interview process, the pharmacist will aim to improve the patient’s understanding of the medicines.

After the initial interview, the pharmacist will produce a HMR report that outlines the findings. This report aims to improve the referrer’s understanding of how the patient is using the medicines and provide recommendations that will assist the referrer and patient in developing a medication management plan.

If clinically indicated, up to two follow-up services can be conducted, with a focus on the resolution of medication-related problems identified at the initial interview.

DIGITAL HEALTH & TELEPHARMACY

Digital health and telepharmacy have gained increasing importance in the delivery of health care, largely due to COVID-19 pandemic.

There are some innovative models of telepharmacy services aimed at optimizing and improving access to pharmacy care, resulting in improved patient safety and outcomes.

Such innovative technology improves access and affordability for consumers, breaks down geographical barriers to accessing pharmacy services and medicines, and empowers pharmacists to manage medication risks for consumers.

The use of digital health records, electronic prescriptions, and real-time prescription monitoring, for example, provides ample opportunities for pharmacists to ensure the safe and quality use of medicines.

THE FUTURE

As the topic of medication error is continually pushed to the forefront of patient safety initiatives, the role of pharmacists will continue to evolve. This will broaden the opportunities pharmacists have to become integral change makers in the reduction of adverse events and improvement of healthcare safety.

Alpro Prestige Scholarship Worth RM600K Is Open for Application!

WORDS LIM TECK CHOON

Alpro Pharmacy has announced the first dedicated scholarship for pharmacy students in the country called the Alpro Prestige Scholarship.

SCHOLARSHIP DETAILS
  • It offers up to RM600,000 per year,
  • Each recipient will receive RM20,000 financial support. The amount is divided into RM10,000 each year for their third and fourth year of studies.
  • Upon graduation, there will be a guaranteed placement for Pre-Registration Pharmacist (PRP) training followed by a job offer as a professional community pharmacist with exclusive remuneration package.
WHO CAN APPLY

The scholarship is open to third-year pharmacy degree students in Malaysia.

INTERESTED IN APPLYING?

For more information, visit https://www.alpropharmacy.com/alpro-prestige-scholarship (link opens in a new tab).

Application is opened until 15 June 2023.

Empowering Pharmacists to Better Serve The Nation

WORDS LIM EN NI

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

For the longest time, the role of a pharmacist has been seen by many, even among those in the profession, as retailer of supplements and other healthcare products. However, due to the COVID-19 pandemic, the general public have come to recognize the values community pharmacists bring.

MEDICATION SAFETY

Very often, patients with multiple non-communicable diseases (NCDs) were prescribed with medications by different doctors, they might not be aware of possible medical contradictions. They brought these medications to community pharmacists like me, and we helped them review and explain the dosage and possible side effects of each medicine. Most importantly, pharmacists ensure the safety of patients from medication errors.

ACCESSIBILITY

Pharmacies are usually open for long hours and pharmacists offer informal, appointment-free consultation. At the height of the pandemic when clinics and hospitals required COVID-19 screening prior to consultation with doctors and patients avoided going to high-risk places, community pharmacists filled the gap by offering advice on COVID-19 and other health related matters including basic health screening and re-filling much needed chronic prescriptions through collaboration with telemedicine providers.

SOLUTION-BASED SERVICES

In recent years, many product-based retail pharmacists have transited to community pharmacists with solution-based services, such as wound-care, smoking cessation service, and diabetic-care.

THUS, COMMUNITY PHARMACIES INFLUENCE NATIONAL HEALTH CARE PROGRESSION IN POSITIVE WAYS

It is high time for the Government to endorse community pharmacists as an integral part of community health and wellness by allocating funding for programmes in support of the Government’s efforts in creating a smoke-free generation, battling against NCDs and providing preventive care for the ageing population.

The inclusion of community pharmacists in the Government’s outreach plan will benefit the country as a whole, as it will ultimately reduce medical costs, improve population health, increase the quality of healthcare in Malaysia and contribute to the country’s GDP.

This year, The International Pharmaceutical Federation announced the theme of World Pharmacist Day 2022 as “Pharmacy United in Action for a Healthier World”. This theme invites comrades from all sectors of the pharmacy profession to take part in the campaign. Regardless of culture or point of view, the core duty of every pharmacist remains—to safeguard medication safety for everyone.

Reflections of a Pharmacist on Solidarity, Price Wars & Public Service

WORDS LIM KELVIN

FEATURED EXPERT
LIM KELVIN
Pharmacist

The views and opinions expressed in this article are the author’s own. They do not reflect the opinions of his colleagues, associates, employer, and organizations he is affiliated with.

THE 25TH OF SEPTEMBER IS WORLD PHARMACISTS DAY

The official theme of the year is ‘Pharmacy united in action for a healthier world’.

The aim of this theme is to showcase the positive impact of pharmacists on health around the world and to further strengthen solidarity among the profession.

The keywords here are ‘united’ and ‘positive impact’.

THE POSITIVE IMPACT OF PHARMACISTS

In today’s healthcare landscape, pharmacists find themselves playing a new role, bestowed upon them by the public: they are the fact checkers and encyclopaedia for members of the public when it comes to everything and anything related to health. In other words, pharmacists are the new Alexa or Siri whenever someone has a question about health!

Pharmacists didn’t necessarily ask for or want this role, but it is one thrust upon us by a public that not only view us as the most accessible healthcare professionals in our society—members of the public also develop a trust in our knowledge after forming a rapport with us.

Our clients usually just walk into our outlet and obtain valuable health advice easily, with low or no cost at all.

With the advent of social media, we tend to become THE go-to person they talk to whenever they want to verify a health claim or ask about the latest health fad.

How pharmacists can step up for this role

To perform this role well, pharmacists need to be competent in their core field of pharmacotherapy, as well as to know a bit of everything in the realm of healthcare.

This is not a small feat to achieve, but it’s one that we need, to be able to guide our clients, or at least point them to the correct direction when there is no direct answer to their queries.

Having good research and analytical skills and keeping up with current updates are the 2 main paths for a pharmacist to become a good source of information.

Apart from pharmacists taking the initiative to do the necessary, our universities play a big role in instilling these skills in our pharmacy undergraduates, to enable them to cope with this new demand. So perhaps our fellow academicians can put more emphasis in this aspect.

Does it make a difference though, if we play this new role well?

Yes. Immensely.

In this world of information overload (or rather the age of misinformation), any Tom, Dick, and Harry can broadcast ‘health advice’ on social media.

As a result, members of the public are bombarded with equal amounts of information and misinformation.

Not everyone will be able to separate fact from fiction, even after googling for the answers, perhaps due to a lack of understanding of the information they found or to use the information to make an informed conclusion.

Pharmacists with years of training and experience will be in a better position to help members of the public digest complex terms and ideas into simple statements that they can more readily absorb. Even more so for the elderly and uneducated.

So, being a trusted point of reference is of utmost importance for our society right now. Apart from carrying out our core duties of being the custodians of medications, this new role positions us to impact the health of the world most significantly, positively.

PHARMACISTS IN SOLIDARITY

Then we arrive at the other key aspect of this year’s theme: unity.

Unity is not something we commonly see among retail or community pharmacies. The supposed fellowship and camaraderie had eroded more substantially in the recent years, mainly due to the intense competition between big pharmacy chains as well as price wars.

Competition was originally thought to be a positive force in keeping market prices low for the benefit of the consumer. However, when competition goes too far, it becomes unhealthy to both the profession and the consumer.

‘Tribal war’ among pharmacists?

Pharmacists have become more and more hostile to their counterparts from another ‘tribe’, due to the aforementioned competition.

They view each other as adversaries or even enemies, instead of colleagues.

This hinders cooperation between pharmacy groups. Even in times of medication shortage, a pharmacist is less likely to seek cooperation/help from other ‘tribes’, which in turn negatively impacts their clients’ welfare and the image of our profession.

Furthermore, smaller pharmacies not belonging to any big ‘tribes’ sometimes face unnecessary hostility from bigger tribes when these tribes migrate and open next to them en masse.

Almost in every town you can see 4 to 5 different pharmacies opening in the same stretch of shop-houses, and price wars inevitably make it near impossible for a stand-alone pharmacists to practice their trade professionally.

Still, price wars are good for the consumer… right?

Unfortunately, this is not always true.

With drug prices being sold at cost or below cost, businesses have to to obtain profits through alternate channels. These channels can be additional sales of legitimate products or from some other less-ideal methods.

Either way, the interest of the client is not going to be the main focus anymore. Instead, sales, incentives, and targets take precedence over the client’s genuine needs.

This is NOT what most pharmacists want, but the nature of the industry is forcing more and more of them to sing to this tune. Furthermore, the end game for many price wars is monopolistic in nature, where absurd profits are to be reaped after a dominant force appears.

But what can pharmacists do about this? How do we unite?

Needless to say, it is going to be a gargantuan task, but we have to start somewhere.

Stay professional. Always be a pharmacist first, retailer or businessman second. I’m not asking you to go on strike or forego profits. Just be sure to put our client’s needs first in our every consideration.

From here, build bonds with your fellow pharmacists. Meet more pharmacists outside your workplace, so that you can find solutions to each other’s weaknesses. Cooperation not only benefits our customers in the long run; it also changes our views on competition.

Maintain mutual respect and keep competition healthy. Compete with each other to be the better pharmacist, to see who elevates our healthcare to a higher level. Don’t just compete in terms of profit and loss.

It’s up to us to create the future we want to live in. I always say I don’t want to grow old one day and have to doubt the advice given by my pharmacist for the fear of being ripped off or being coerced into buying something.

Talk to your management. Voice out what you feel is right or wrong whenever you have the opportunity. This doesn’t have to be confrontational, if we do it the right way. Only when there are enough voices saying the same thing, will things start to change.

Lastly, do actively support our professional body.With enough support and the right mindset, our profession can be more united to under this body, and we can all serve the public better.

A LAST NOTE: TO OUR CLIENTS

Cherish and support any pharmacist that gives you more value for your health rather than your wallet.

Granted, price is a big deciding factor when making any purchase, but as long as the difference is not too big, always support the one that truly cares for your health.

Hopefully with changes in the mindsets of both pharmacists and clients, the big divide caused by price and competition will slowly narrow and allow pharmacists can be more united in serving the public positively.