Health Ministry to test drive-through project at Penang Hospital soon

Star, 27th April 2008.

PETALING JAYA: Patients with chronic ailments may soon enjoy “drive through” facilities to collect their medication instead of having to wait at government hospital pharmacies.

Health Ministry director-general Tan Sri Dr Ismail Merican said a pilot project would begin at the Penang Hospital in three months to study its feasibility.

The service, which would also operate after hours, would be enjoyed by those who suffered from illnesses like diabetes and hypertension.

“They will not have to come on their work day. They can get their medication after office hours or on weekends,” he said.

Ismail said the move was to make pharmacies at the hospitals less congested.

He said patients would be able to make a telephone call or send an SMS to the pharmacy ahead of making the collection.

“Right now, we do not give medication out every three or six months anymore. It is now on a monthly basis and patients have complained that this is inconvenient,” he said.

Furthermore, he said patients with chronic ailments would not need to see the doctor if it was merely repeating one’s medication.

Dr Ismail said “e-prescribing” – the computerisation of medicine prescriptions – had seen a decrease of the number of prescription errors.

The programme has been implemented at the Putrajaya, Selayang and Sungai Buloh hospitals.

Teaching hospitals like Hospital Universiti Kebangsaan Malaysia and University Malaya Medical Centre have also recognised the benefits of computerisation and e-prescribing, he said.

Ismail said there were now more pharmacists in government hospitals particularly after September 2005 when compulsory service for them was introduced.

By the end of last year, 78% of vacancies for U41 pharmacists had been filled. He said there were 2,288 pharmacists in the public sector.

'Patients want their pills from clinics'

'Patients want their pills from clinics'

NST, 23rd April 2008

KUALA LUMPUR: The number of patients who visit private clinics may drop if doctors are not allowed to dispense medication, said the Dermatological Society of Malaysia.

Its president, Dr Allan K.C. Yee, said Malaysians usually see a doctor to get medicines.

"Malaysians generally do not believe in paying consultation fee for nothing, if they know they are not going to get medicines from the doctor," he said.

This is one of the reasons why the 70-plus member society is against the idea of separation of functions of doctors and pharmacists which would also apply to dermatologists, who are medical doctors by profession, said Yee.

He added that dermatologists are more qualified than pharmacists in advising patients in applying topical medicines which is frequently the common treatment for skin problems.
"Dermatologists are better qualified to show the patients how to apply the medicine to the affected skin, how much of the medicine to use and how to store them," he said.

The patients might also be shy to ask the pharmacists how to use the medicine in a pharmacy, especially if the problem is around the private parts, he said.

Yee admitted that dermatologists' profits will drop if the separation takes place but said the consultation rate will not change.

He also said the condition of the topical drugs is compromised when drugs are sold in bulk packaging and then repacked by pharmacists.

"Customers are the ones who lose out because they would not be able to keep the medicine for long as it would be either spoilt or become ineffective," he said.

How some Asian nations handled dispensing split

How some Asian nations handled dispensing split

By : Rina De Silva

NST, 23rd April 2008

KUALA LUMPUR: Dispensing of medicine by pharmacists and not doctors is not just a western practice. It is the norm in several Asian countries, including India, Korea, the Philippines and even Indonesia.

It became legal in Indonesia in 1964, the Philippines in 1969, India in 1988, and in South Korea in 2000.

It is common to find 24-hour pharmacies in these countries.

Besides 24-hour pharmacies, the Philippines' 72 public hospitals also render 24-hour pharmaceutical services, said Romeo L. Manalo, assistant secretary of the Office of Standard Pacific Affairs at the Philippines' Department of Health.

"The hospital pharmacies run on an eight-hour shift not only for the inpatients and outpatients but also for the general public," he said.
In Mumbai, India, there are at least twenty 24-hour pharmacies, said Subodh Priolkar, immediate past president of the Indian Pharmaceutical Association.

If the pharmacy is closed, the patients can purchase the prescribed medication from hospital pharmacies which are open 24 hours, he said.

There are about 1,000 government hospitals there, he added.

The only exception to the law is in the rural areas in India where clinics there would purchase medicines in bulk from pharmacies, he said.

The exception to the law is also allowed in rural areas in Indonesia, said Eka Suripto, the head of communications at the Indonesian Embassy here.

In big cities, where there are more than one pharmacy, each will take turns to operate 24 hours, he said.

Although the separation of functions is now a norm, the practice came with its share of problems initially in Indonesia and South Korea.

As doctors could not dispense their own medicine some started to acquire their own pharmacy and the pharmacists' role was reduced to merely following the orders of the owner, said Eka.

He said due to the increasing number of such cases, the government issued an additional regulation in 1988 which barred doctors and dentists from dispensing or preparing medicine, except injections.

In South Korea, the separation of functions was strongly opposed by physicians who were afraid of losing an income source, said Prof Dr Soonman Kwon, chairman of health policy and management department at the Seoul National University's School of Public Health.

"Following a wave of strikes, the government was forced to modify the reform package and to raise the doctor's consultation fees substantially to compensate for the physicians' income loss," he said.

Prior to the mandated separation of functions, both physicians and pharmacists were prescribing and dispensing medicine which resulted in the overuse and misuse of medicine, he added.

"After the separation of functions, pharmacists are not happier because they cannot prescribe anymore," he said.

In India, the separation of function made no difference to the doctors' consultation fee, said the spokesperson from the media division of the Indian High Commission here.

In private practice, the consultation fee of 50 to 200 rupees (about RM4.20 to RM16.50) remained the same.

Subodh said the separation of functions worked because only pharmacists have the knowledge and training to dispense medication and counsel patients on how to take the medication.

"In the event of possible effects of drug combination, pharmacists have the right to ask for a medical history," he said.

He added that doctors usually prescribe the best medication for the patient based on the patient's medical history.

There has been an improved therapeutic compliance in the Philippines as a result of the separation, said Manalo.

"Pharmacist as dispensers serve as the second technical person in contact with the public by providing the necessary information and counselling on drugs and other related matters," he said.

News Focus: Doctors or pharmacists?

News Focus: Doctors or pharmacists?

By : Annie Freeda Cruez

NST, 23rd April 2008

KUALA LUMPUR: Complement each other, not fight. This is the advice given by Health Minister Datuk Liow Tiong Lai to doctors and pharmacists who have been arguing over the right to dispense medicines.

"We are talking about two professional bodies. They should complement each other and not be competing with each other."

He said it could not be denied that both were specialised in their respective fields of work.

Right now, Liow said, the system was such that doctors handled all the functions.

On the issue of separation of duties in the dispensing of medicine, he said: "I had a meeting with the Malaysian Medical Council last week and I will be meeting representatives from the Malaysian Medical Association tomorrow. I will meet representatives from the pharmaceutical industry next week."
Liow said he would decide on the matter after the meetings.

For almost 20 years, pharmacists have been fighting for the return of their right to dispense medications but have been unsuccessful for various reasons.

The ministry had planned to conduct a pilot project on the separation of functions between clinics and pharmacies in selected major towns before implementing it nationwide.

However, even before the pilot project could kick off, there have been protests by doctors.

Long wait to see govt specialist

By YENG AI CHUN

IT was a long wait for more than 200 patients at the specialist clinic in the Seberang Jaya Hospital.

Patients who started to queue up as early as 7am found themselves waiting for more than four hours to see a medical specialist.

During a check on Monday, disgruntled marketing executive M. Gopinathan, 33, who was accompanying his father S. Mariasoosay, 62, to see the orthopaedic specialist, said they had been waiting since 7.45am.

“The queue is terrible. The waiting room is packed and people have to wait outside the corridors.

Crowded: The waiting room at the specialist clinic in Seberang Jaya Hospital is packed with patients and their family members.

“Today is especially bad and the doctor only saw my father after 12pm. Usually, it would only take two hours but today, I had to tell my employer that I could not report for work as I had to wait for my father’s medical appointment,” he said when met at the hospital.

Just last month, Health Minister Datuk Liow Tiong Lai announced that he hoped to shorten the waiting time at government hospitals to 30 minutes.

Housewife Mehbuba Yusou, 28, said it was normal to wait for a long time to see a doctor.

“Sometimes the doctor sees you on time. Sometimes not, it depends on your luck but many patients cannot wait long as they have to get back to work,” said Mehbuba, who had been waiting since 7.30am.

State health director Dr Teh Lei Choo said there were more patients than usual at the hospital that day.

She said the specialist clinic saw 290 patients that Monday compared to the usual of about 220 to 240.

“We would also like to see a shorter waiting period but it is not easy due to factors like patients arriving late and physical factors such as doctors sharing rooms to see patients,” she said, adding that Mondays were the among the busiest days.

Star, 18th April 2008.

Dispensing medicine: Patients should be given a choice

Dispensing medicine: Patients should be given a choice

By : DR HAFIZ LAW, President, Penang Medical Practitioners' Society

NST, 15th April 2008

THE Penang Medical Practitioners' Society (PMPS) would like to respond to the statements made in the media regarding the right of doctors to dispense medicine.

The PMPS views the statement attributed to the past president of the Malaysian Pharmaceutical Society with great regret and concern.

To say "a pharmacist spent four years acquiring knowledge about medicine compared with a doctor who has none" is irresponsible, uncalled for and bordering on absurdity.

Doctors are knowledgeable in clinical pharmacology, which is part of the medical undergraduate curriculum, and doctors spend a greater part of their working life treating patients with medicine.

All doctors are familiar with the usefulness, interactions and side-effects of drugs. If a patient develops adverse reactions from any medicine, he sees a doctor to diagnose and treat the side-effects not a pharmacist.
It is also not true that doctors only prescribe branded medicines. Most general practitioners and hospitals prescribe generic drugs if the patients choose the cheaper generic drugs.

Doctors are aware of the economics of healthcare and try to deliver effective and efficient care at affordable costs.

As a body of medical doctors, we believe the interests of the patient are of primary concern. Let the patients decide if they would like to collect medicine from the doctors or pharmacists.

In all government hospitals and many private hospitals, doctors do not dispense medicine. However, general practitioners should be allowed to dispense, maintaining the status quo allowed by the Poisons Act 1952.

Of course, patients should always be allowed to collect the prescribed medicine from their preferred pharmacists should they wish to do so.

Grads prefer to stay on overseas

By SIM LEOI LEOI

newsdesk@thestar.com.my

Star, 13th April 2008

PUTRAJAYA: More and more medical students sent abroad to study on government scholarships, many costing more than a million ringgit each, are breaking their 10-year bond by refusing to return and serve in public hospitals.

“This is a sore point with us. In 2006, 21 medical students in Britain did not return. Last year, the number was 63. For those studying in Ireland, three students did not come back in 2006 while last year, 27 did not return,” said Human Capital Development division director Datin Madinah Mohamad.

She said these students cost the Government up to RM1.1mil each in funding for the five-year course.

“The number has been steadily increasing each year since 2003. The excuse these undergraduates often give is that they want to do their two-year housemanship over there and continue with sub-specialisation courses.

“But when they do so, they may then get employed and become eligible for registration in Britain. With the pay they are getting there, it’s highly unlikely they will come back and serve here,” she said in an interview here yesterday.

Since 2003, 145 students from Britain and 85 from Ireland have not come back. However, only three from Russia, two from Jordan and one from Japan failed to return.

Another reason many students chose to stay back could have been due to PSD’s perceived lenient treatment of such students in the past and a paltry penalty of RM160,000 each before 2003, she said.

“It encouraged undergraduates, who have seen many of their seniors being let off, to follow suit,” she said.

Although the department had officers in Britain and Ireland to track down errant medical students, some in the last year of studies ignored notices and others did not bother to show up when called for interviews.

She said tougher measures were needed to make them come back and serve or pay their bond.

The department was now seriously considering suggestions to make errant students repay twice or thrice the sum of their scholarships as punishment.

“We need to study this recommendation,” she said, adding the department had also handed 30 such cases since 1989 to the Attorney-General’s Chambers for legal action and had even declared one former student bankrupt.

But legal action was slow and guarantors would be taken to court only as the last resort, she said.

Since PSD’s Overseas Scholarship Programme started in 2000, RM2.15bil in scholarships had been given to 10,485 students up to the end of last year.

Unrecognised medical graduates

Hope yet for med grads

Star, 10th April 2008

By AUDREY EDWARDS

PUTRAJAYA: Medical graduates from overseas universities not recognised by the Government now have the option of transferring their credits to recognised local establishments to pursue their goal of becoming doctors.
This option is being given on a one-off basis instead of them sitting for a competency examination.
Health Minister Datuk Liow Tiong Lai said yesterday that this was useful for those who had failed the examination for a maximum of three times.
He said the easing of the rule was until Dec 31 this year for graduates who completed their studies by Dec 31 last year.
“The Cabinet has agreed that graduates from unrecognised institutions, especially those who have exhausted all chances of sitting for the exam, be given the chance to continue their studies via credit transfer to recognised institutions,” he told reporters yesterday.
Under the Medical Act, only medical graduates from recognised institutions are allowed to register with the Malaysian Medical Council to practise legally.
Those who graduated from unrecognised institutions are required to pass a competency examination under the Medical (Setting Examination for Provisional Registration) Regulations before they can register.
He said that under the new arrangement they would have to undergo one year of pre-clinical studies and two years' clinical studies, adding that this period depended on courses they had taken previously.
Liow added that the students could transfer their credits to institutions like the Asian Institute of Medical Sciences and Technology.
A group of about 200 students, most of whom had sat for the examination three times, had recently appealed to him to be allowed such credit transfers, he said.
Once they are accepted for the credit transfer, the students will be absorbed into the recognised institutions, sit for examinations as usual and become housemen at hospitals.

National health financial scheme

Liow: Open forum to discuss health scheme

Star, 9th April 2008
By AUDREY EDWARDS

PUTRAJAYA: The Health Ministry is keen to have a public debate on the National Health Financing Scheme.
Minister Datuk Liow Tiong Lai said a public forum would be the “best way” to address issues and problems on the implementation of the scheme.
“I would like to have a public debate. Let us talk about it,” Liow said in an interview on Monday.
“This is something which will help the people and the Government have better health services in the country.”
When the idea was first mooted 25 years ago, certain parties raised concerns about how the scheme would be implemented.
The proposals included having it modelled after the EPF and Socso schemes where “eligible” employees make monthly payments through a deduction from their salary and both the scheme and the National Health Financing Authority overseeing it would be non-profit and not privatised.
Former Health Minister Datuk Seri Dr Chua Soi Lek announced in 2004 that Prime Minister Datuk Seri Abdullah Ahmad Badawi had given approval and the “general principles” had been agreed upon.
Consultants were also appointed to look into the details of the mechanism and there were even calls for a Royal Commission to be set up to get broad feedback before it was introduced.
Liow admitted that it was not going to be easy for the Government to have such a scheme because it might not be a popular decision.
However, he said the Government “did not have much choice” where the present system has left it subsidising almost 98% of healthcare in the country.
He, however, said it would take about three to four years before the scheme could be implemented.
A plus point of having the scheme was that the people would be able to get treatment either in the private or public sector where the Government would be able to use all existing doctors instead of the current system, he said.
“One way to solve this problem is to have an insurance scheme. It does not matter whether you go to the government or the private sector. The doctor will treat you and the insurance will pay,” he said.
A minus point, however, would be the risk of the government or insurance company going bankrupt because the public had developed a “buffet mentality”.
Asked who was likely to take charge of the scheme, he said it did not matter because the most important thing was for the people to enjoy the benefits.

Separation of doctor/pharmacist duties: 'Patients shouldn't suffer'

Separation of doctor/pharmacist duties: 'Patients shouldn't suffer'
By : Shuhada Elis

NST, 3rd April 2008

KUALA LUMPUR: The separation of duties between doctors and pharmacists would only be implemented if it does not burden the public.
Deputy Health Minister Datuk Dr Abdul Latif Ahmad gave this assurance yesterday and said the matter was still being studied."We are still conducting research on the matter but it is impractical if the people are adversely affected," he said.Last week, the New Straits Times had quoted the ministry's director-general Tan Sri Dr Ismail Merican as saying that the move to separate the duties of doctors and pharmacists was in the pipeline.Dr Ismail had said that the pilot project would be implemented in major towns where there were pharmacies located near clinics.
Dr Latif said although the separation of duties had been carried out in other countries, Malaysia might not be able to do the same as there were not enough pharmacists.The NST had reported that there were about 5,000 registered pharmacists practising in some 1,600 pharmacies in the country."Maybe you will not experience the inconvenience if you live in the Klang Valley because you can go to a pharmacy nearby. But in rural areas, like in my village, there's only one pharmacy serving a population of 1,000." He stressed that the public's welfare would always be the ministry's priority. He said at present, doctors were still allowed to prescribe and dispense medicine, adding only practitioners in Malaysia and Singapore did not separate the two functions.On another matter, Dr Latif said the ministry had seized seven herbal products from the market this year.He said the syndicates had deceived consumers by labelling their products as health products with herbal ingredients but checks found that they also contained harmful ingredients.He added that those found guilty could be fined up to RM5,000 or two years' jail or both

Separation of doctor/pharmacist duties: Diverse opinions on plan

Separation of doctor/pharmacist duties: Diverse opinions on plan
BERNAMA

NST, 3rd April 2008

KUALA LUMPUR: "You have tonsillitis. This is your prescription slip and you can obtain the medication at any pharmacy."
The conversation above may well be too familiar in the future if the Health Ministry decides to allow doctors to only issue the prescription with patients having to get the medication at pharmacies.According to a recent news report, the Health Ministry will soon launch a pilot project on the separation of functions between clinics and pharmacies, where, in the future, dispensing medications may be the exclusive rights of pharmacies."I think Malaysians are not ready for the separation of functions between clinics and pharmacie," said consumer activist Gurmukh Singh. Gurmukh said the Health Ministry should consider several factors.
"First, at the moment, I don't think there are pharmacies that open round-the-clock."If your child suddenly develops fever or diarrhoea in the wee hours of the morning and you rush him to a 24-hour clinic. "Imagine your annoyance when the doctor only gives you a prescription slip and asks you to get the medication from a pharmacy."After that, your blood pressure shoots up when you can't find a pharmacy or any which opens at that particular hour." Mother of three Zaidah Zainal, who stays in Green Valley Park near Rawang in Selangor, said there were not many pharmacies in her neighbourhood."In my area, there are five clinics, but only one pharmacy is in operation. "If the health authorities decide to separate the functions, then we should have more retail pharmacies around to cater for the expected higher demand." Contrary to what people may say, separating the functions can be costly to consumers, said social activist Fatimah Mansur."The doctor has to charge consultation fees. If you get your medication at the clinic, the total amount charged is definitely less than the whole amount charged for separate consultation fees and medication," she said.The Malaysian Medical Association (MMA) recommends a minimum fee of RM30 for a doctor's consultation, but most of the time private practitioners charge less than this amount.Fatimah said the public prefer to go to only one place, and at present, the clinic serves as a one-stop centre."You can get your medical check-up at the clinic. Your blood test can be done, as well as X-rays. "By the time the doctor has finished with them, the patients maybe too tired to go elsewhere to get their medication." And the move, if implemented, would be time-consuming and related costs would rise."Imagine after seeing your doctor, you have to drive around to look for a pharmacy. "You may find one, but then the medication required could be unavailable, and you have to look for other pharmacies." Thus, the actual cost is higher, as the public may have to spend more on petrol for their vehicles, she said.According to Health Ministry's statistics, there are about 1,600 pharmacies nationwide.Educationist Ikmail Ahmad Borhanodin said the public should allow the Health Ministry to conduct a study to determine whether the separation of functions is suitable for Malaysians."Allow the consumers to make their own choice, as at the moment they let the doctors dispense the medication. They have the choice on whether to get branded or generic drugs, so they can save money."Ikmail said there are some good points to such a move.He said doctors are only familiar with medicines that they often prescribe, while pharmacists are always in touch with the drugs industry."But, bear in mind that the doctors have the knowledge on medical problems as well as their causes. And they are familiar with the patients too". The priority is for the public to have good healthcare services, said Gurmukh."The pharmacies must improve their services. Sometimes when consumers walk into a pharmacy, the pharmacist is not around and nobody else can dispense the drugs. This is wasting the public's time." Gurmukh said for a start, the "pharmacist not in" syndrome should be discarded."In Malaysia, there are many clinics appointed by employers for the convenience of their sick workers. Employers want to make it easy for themselves and their workers." Under this concept, employers will foot the medical bills of their sick workers. Usually the employers would pay the panel clinics monthly, after receiving the respective invoices."Do we need to have panel pharmacies later?" asked Gurmukh. -

Dispensing medicine: Address the central issue

Dispensing medicine: Address the central issue

By : DR MILTON LUM, Petaling Jaya

NST, 1st April 2008

I REFER to the reports on the issue of dispensing medicine ("Doctors to be disallowed from dispensing medicine" - NST, March 29 and "A need for 24-hour pharmacies" - NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).

Among his claims were:

- With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.

- Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.

- The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.

Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate's training and continues throughout the medical course.

Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.

On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.

There is also confusion between prescribing and dispensing.

Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.

A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.

Dispensing refers to the preparation and supply of drugs prescribed by doctors.

Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.

The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.

Drug interactions can be minimised when there is knowledge of the patient's medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.

Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.

Many doctors are already prescribing and dispensing generic drugs.

When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.

Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.

The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.

Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.

The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient's right to make his own choice? The MPS president's advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.