Pharmacy is a specialised field which dates back several hundred years ago, with its unique, deep-rooted traditions and practices. The sector is so specialised that it almost segregates itself from the rest of the healthcare ecosystem. This is especially true for community pharmacy, which generally stands alone and does not have much interaction with the rest of the healthcare community.

Such phenomenon does not bode well for community pharmacists when the healthcare sector at large is moving towards the value-driven system. (For instance, pharmacy practice in Malaysia particularly has been always one-step behind compared to other countries.)

Not only does the country reject dispensing separation that forms the very core principle of safe medication practice, the profession itself seems to stay stagnant when its members are not given the opportunity to be formally recognised as specialists in their own field.

The misfit of community pharmacies

The current modus operandi of community pharmacies is very product-oriented – the focus is on selling the largest amount of products at the maximum profit margin. Most of the time, these products are health supplements, where some have little evidence to support their efficacy. The core product, medicine, is under strict regulatory control – and rightly so under most circumstances.

However, the lack of dispensing separation limits the full functionality of community pharmacists in ensuring patients can receive the right medicine at the right dose and at the right time. Although the regulation permits pharmacists to dispense medicine based on prescriptions – in reality, such practice only constitutes a relatively small portion of the workload and can rarely sustain the business in its entirety. The profession, to some extent, is marginalised on its very core duty: to ensure safe and efficacious use of medicine among the local community.

Many may argue that focusing on health supplements is another niche specialty, a so-called "Blue Ocean Strategy". However, we have to be cautious that many products do not have sufficient evidence to support their health claims.

We should bear in mind that, against the backdrop of value-driven healthcare practice, a lack of efficacy evidence implies a misfit with the healthcare model. If Malaysia were to move forward and adopt a value-oriented healthcare model, the current community pharmacy practice must undergo significant transformations or risk further marginalisation.

What is value-driven healthcare?

A value-driven or value-oriented healthcare sector is a highly sophisticated field. As there are multiple stakeholders in healthcare, it is often challenging to reach a consensus on what constitutes "value" in the sector. It may feature access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness and satisfaction as discussed by Porter in his NEJM article.

However, it is commonly understood that “value” in healthcare should always revolve around patients and their well-being. In other words, improving the health outcome per dollar (or ringgit) spent should be the principal objective.

Many developed nations are already gearing up their healthcare sector towards a value-driven system – where healthcare professionals or institutions are reimbursed financially based on how much their services have improved patient outcomes. The traditional product-oriented model is considered outdated, as it does not focus on delivering quality service – rather, it encourages pharmacies to sell more products at a lower cost.

However, such progress towards a value-driven system may bring catastrophe to the existing community pharmacy network in the country. As argued by Trygstad, the value-driven network requires the entire healthcare sector to come together, and provide a higher quality service via the synergistic effect from different professions.

Community pharmacy, however, appears to be rather isolated from this network of care. Some may think of it as an independent profession capable of surviving on its own, others view it as a stubborn dinosaur refusing to admit its time has come.

No quick answer

It is inevitable that community pharmacists ask how long they can survive while the whole industry is moving towards better integration. However, a drastic change within the industry in near future is unlikely, as inertia and myopia prevail in the current environment. Eventually, only a favourable legislation change may provide the much-needed room for community pharmacies to thrive, once again. MIMS

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Community pharmacies: 4 tips to ensure that the audit goes smoothly
"Highly competitive market" causing Malaysian community pharmacists to barely stay afloat