Following the publishing of the Report of the Director of Audit on the Accounts of the HKSAR by the Audit Commission November 2016, the Hong Kong government is currently in discussions with pharmacist groups on the possibility of introducing a Public Private Partnership (PPP) on drug dispensing to reduce drug waste. Amongst the aims of this partnership include enabling patients to collect their regular, repeating prescription medicines directly from community pharmacies.

The report contained heavy criticism on Hospital Authority's existing drug management processes, said to lead to a substantial amount of unused medicines.

Shortening prescription durations


Chronic disease patients in public hospitals often need to wait a long time before their next return visit, thus doctors will usually need to prescribe medications in advance to ensure their supply is sufficient. As such, prescription durations can be for a few months or even up to half a year.

The Report of the Director of Audit on the Accounts of the HKSAR by the Audit Commission criticised Hospital Authority's existing drug management processes. (Photo credit: Oriental Daily News)
The Report of the Director of Audit on the Accounts of the HKSAR by the Audit Commission criticised Hospital Authority's existing drug management processes. (Photo credit: Oriental Daily News)

In addition to drug wastage, pharmacist groups have commented that patients with multiple co-morbidities, thus having to take a large number of different drugs with different indications, face high risk of becoming confused about the various dosages and directions of use.

Worse yet, when faced with unpleasant side effects, patients might discontinue the medications without a doctor's consent, and this would very likely negatively affect their treatment outcomes. Emergency situations could result in an emergency department visit or hospitalisation, further posing a burden on the healthcare system.

Pharmacist groups thus suggest that the prescription durations be shortened to one month, following which patients would bring their prescriptions to community pharmacies or dispensing centres for follow-up.

Strengthening the role of community pharmacists


Besides the dispensing of medications, community pharmacists can also handle roles like integrating information about the patient’s drug history, and clarifying the patient’s understanding of the intended dosage regimen and method of administration. The hope to strengthen the role of community pharmacists, empowering them to provide essential advice to the prescriber.

"Community pharmacists can schedule a monthly consultation with patients to monitor and evaluate the therapeutic response. They can also offer guidance to the patients. This includes advising the patients on how and when to take the medications, such as whether the patients should take the drugs at night or during the daytime," said Professor Chun-Ming Chui, President of the Society of Hospital Pharmacists of Hong Kong.

Hiring more pharmacists in community pharmacies


While patient groups welcome the suggestion, they are concerned as to whether community pharmacies have sufficient manpower to uphold the service quality, including ensuring a sufficient supply of appropriate products. Community pharmacies have responded to say that extra pharmacists will be hired if the government is willing to provide subsidies, and it is also expected that 70% to 80% of community pharmacies will join the program.

"It is meaningless to ask the pharmacists to hold vigil for 12 hours a day at the pharmacy because we do not receive any prescriptions at night. However, if there are more prescriptions because of this partnership, we can ask the pharmacists to work overtime. Alternatively, we can also hire extra pharmacists to take shifts," explained Mr Oi-Kwok Lau, Vice-Chairman of the Hong Kong General Chamber of Pharmacy Limited.

"We will prefer to purchase the medications by using our own autonomy if the partnership is successfully implemented. To encourage more community pharmacies to join up, we also hope that the government will subsidise the cost of medications," he added. MIMS

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Source:
http://news.tvb.com/local/58a80f546db28c5d23aa85cc/
http://news.mingpao.com/pns/dailynews/web_tc/article/20160816/s00002/1471284251699
http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.2.html#Jh2995e.1.6.2