“I come here to consult a pharmacist on a regular basis but never buy any medicine. As I can use my Civil Servant Medical Rights, I have never spent a single Baht, on this drugstore,” Suda Mekhavipark, 78, says when being asked about frequency of her visits to this pharmacy. Suda was receiving blood pressure measuring service by Pharmacist Sunee Panyawuthikrai, who is also the owner of “Sunee Pharmacy”. Having hypertension and high cholesterol levels, Suda usually receives medicines from the hospital. “After receiving medicines from the hospital, I come to ask for advices from the pharmacist as to how I should take the medicines. Pharmacists at the hospital have no time to explain details to me due to long queues of patients. To spend a lot of time with me is impropriate.”
Thanks to the short distance between her house and the pharmacy, Suda regularly walks to the pharmacy to check her blood pressure. A small patient card is used for recording her blood pressure levels and the medicines she takes.
“Here, every patient has his or her own personal health card to keep track of medical records for the benefits of receiving advices,” Pharmacist Sunee explains.
Kittipong Kijlarppinitkul has been another regular visitor of this pharmacy, since its opening 35 years ago. Despite having diabetes, high blood pressure, and high cholesterol, he decided not to go to the hospital but to come to this pharmacy instead. “It takes a whole day waiting on a long queue at the hospital. It is a total waste of time as I have to earn money as a taxi driver.”
The taxi driver is among those who have chronic non-communicable diseases and are well-informed on how to take care of themselves in order to keep cholesterol, blood pressure and blood sugar to the safety levels. However, practically he cannot control his lifestyle behaviors to healthy limits. “The other day my blood sugar level was as high as 214, because I ate Fun-O (sandwich cookies filled with chocolate cream)”, he says with a laugh while revealing his personal health card. “But here, the figures are quite good because I did not eat desserts, nor the red bull (energy drink). I would like to show her that I can do it.”
Kittipong claims he can estimate his blood sugar and blood pressure levels before being measured because he is well aware of his eating habits and continuity in medication. “As a taxi driver, I am driving on the streets all day long. It is quite stressful sometimes and it is quite impossible to follow the strict healthy diets and lifestyle.”
During one and a half hour of observation at this pharmacy, the author had a good number of impressions. The “Friendly Community Pharmacy” signboards in front and inside of the pharmacy, undoubtedly speak a lot about the roles of this pharmacy.
Friendly Community Pharmacy
“Sunee Pharmacy” is among one of the 30 pharmacies taking part in the “Friendly Community Pharmacy” Project, initiated by the National Health Security Office (NHSO). On January 7, 2019 the NHSO Board agreed to broaden the scope of roles of modern medicine pharmacies (Khor.Yor.1) to cover additional services in accordance with the Section 3 of the National Health Security Act B.E.2545 (2002). The aim is for retail modern medicine pharmacies to act as healthcare units with additional responsibilities, including identifying risks of metabolic syndromes, providing health information, health care advices and proper uses of medicines. The participating pharmacies are required to team up with other interdisciplinary teams of professionals in delivering healthcare service to patients in communities. Implementing in 11 administrative areas of Bangkok, this healthcare service network is a pilot project, aiming to work closely with local healthcare units, family doctor clinics and pharmacies.
Retail pharmacies which are entitled to participate in the “Friendly Community Pharmacy” Project, must meet the prerequisites of Notification of the Ministry of Public Health B.E.2557 (2014) Re: Good Pharmacy Practices (GPP) regulations in the modern drug pharmacies under the Medicine Act B.E. 2557 (2014) and the Notification of the National Health Security Office (No.2) B.E. 2561 (2018) Re: Criteria of pharmacies as health service units. Also the participating pharmacies have to be opened at least eight hours a day, under supervision of pharmacists throughout the operating hours, and willing to participate as health service units.
One of the main reasons retail pharmacists are urged to be part of this healthcare service network to work together with local health units, is that there are a great number of people out there, like Kittipong, who opts for retail pharmacies, rather than hospital pharmacies. Around 20% of Thai people chooses to go to pharmacies instead of going to the hospital or clinics when they fall sick, according to a research cited by Dr. Jadej Thammatacharee, Deputy Secretary-General of the National Health Security Office.
Another study in 2017 by Kasikorn Research Center reveals that retail pharmacies are the first choice for patients with common illnesses and mild symptoms, at the ratio of 32%, as opposed to clinical and state or private hospital treatments. These people say “it is faster, more convenient and not too costly, compared to services in private hospitals, and they do not have to waste their time waiting in a long queue in the state hospitals.”
“This is why retail pharmacies are encouraged to assist in taking care of people’s health. The project has also broadened the roles of professional pharmacies,” says Dr. Jadej during an earlier interview at the launch of the Community Pharmacy Policy. (https://www.thaihealth.or.th/Content/49439-a.html)
The roles of Friendly Community Pharmacies include initial diagnosis and identification of illnesses. Are these roles beyond pharmacists’ ability? Or, today’s Thai pharmacists do not work to the best of their abilities? Recently, a complaint is made by the Medical Technology Council, viewing that a finger-prick blood test by a pharmacist is an infringement on professions of medical technologists.
Roles of Pharmacists in Health Security System
When it comes to pharmacists, we often conjure up an image of persons who are knowledgeable about medicinal drugs, professionally qualified to prepare and dispense medicinal drugs as prescribed by doctors, and provide advices on medicinal drug uses.
“Common people do not know that professional pharmacists can perform a lot of tasks. During the six-year university program, we learn about diseases, and anatomy in the first year, and focus on medicinal drugs for another three years. We have learned all the details of medicine’s journey through the body, from being taken by mouth, to being absorbed in the bloodstream, and where the medicines are distributed and excreted,” Pharmacist Sunee points out.
After conducting interviews with many pharmacists, it can be concluded that pharmacists, in particular those who attended the six-year program of the Faculty of Pharmacy, which takes the same duration as that of the Faculty of Medicine, believe that their abilities are not fully utilized to serve the public.
“This healthcare service system is narrowly designed, which does not match the scopes of practices in the universities. The curriculum of Faculty of Pharmacy was extended to six years, instead of five years, of learning. With longer periods of learning, the students are better trained. The problem is their roles are still limited. In other countries, pharmacists work closely and walk side by side with doctors, as they are doctors’ medicinal consultants. Doctors diagnose diseases while pharmacists dispense medicinal drugs,” explains Pharmacist Sunee.
Meanwhile, Pharmacist Jiraporn Limpananont, president of the Pharmacy Council views that the problem is not the limited roles of pharmacists but the government’s limited budget, which is a hindrance in hiring more state hospital pharmacists.
“At present, the scope of practices has been broadened. More and more pharmacists work closely with doctors to identify proper drugs. One of the issues in Thailand is that it is very difficult to hire more pharmacists, who work for the state hospitals due to lack of budget. In fact, in many places pharmacists has played wider roles,” the president of the Pharmacy Council argues.
The “Friendly Community Pharmacies” is a good solution to expand the scope of practices of pharmacists in order to serve the public in the healthcare system. Furthermore, thanks to the latest policy of the Ministry of Public Health, retail pharmacies will soon be able to dispense pills from behind the counter to outpatients of some diseases.
With Doctors’ Prescription from Hospital, You Can Now Get Pills from Drugstores Near You.
One of the responsibilities of pharmacists as described in the pharmacy law is to prepare and dispense drugs as prescribed by doctors. However, in the past your doctor’s prescriptions are handed only to pharmacists in the hospital or clinics and scarcely to pharmacists at drugstores. Since the drugstore opened 35 years ago, Pharmacist Sunee says she has received no more than 10 prescriptions from doctors.
Good news is that the latest policy of the Ministry of Public Health allows retail pharmacies — not only those participating in the Friendly Community Pharmacy Network but also any pharmacy that meets the required quality standards — to dispense pills to patients. The pharmacies are required to meet the Food and Drug Administration’s quality standards in structural aspects such as storage condition, cleanliness, and internal temperature and to be registered with the Minister of Public Health.
Public Health Minister Anutin Charnvirakul disclosed the following options for participating pharmacies:
- Hospitals prepare and send drugs to pharmacies to be dispensed to the patients.
- Hospitals reserve drugs at pharmacies and pharmacists in the pharmacies dispense them as prescribed by doctors.
- Pharmacies buy and store drugs using hospital’s expense.
To receive drugs at retail pharmacies without having to pay more, patients must be cardholders of the National Health Security Fund and suffer the following four chronic diseases: asthma, hypertension, diabetes, and psychiatric disorders. This pilot project takes effect on October 1, 2019 at 50 hospitals and around 500 pharmacies.
This project not only helps reduce congestion in the hospital but patients with chronic diseases also gain benefits from being closer and more often with pharmacists who can give them proper health advices. Generally, this group of patients are required to meet doctors once every four or six months and they receive enough pills before the next appointment. The problem is while some patients are managed to eat healthily, and be very well-disciplined on their drugs and diets, others, like Kittipong, may not act according to doctor’s advices but they know how to keep their blood pressure, blood sugar and cholesterol below the risky levels only shortly prior to seeing the doctor. To allow retail pharmacies to dispense pills to this group of patients means patients can get closer to medicinal experts more often, which is highly likely resulting in better health and well-being of the patients.
Additionally, this is a sensible solution to make the most use of healthcare resources. According to the Public Health Ministry, a survey found that massive amounts of drugs prescribed by doctors ends up unused, and the monetary loss is estimated at above two billion Baht a year. To reduce this hefty unnecessary loss means to save national budgets.
An increasing number of pharmacies and pharmacists have lately been encouraged to take significant health service roles to serve the public.
The “Friendly Community Pharmacies” is a good move forward in the national healthcare service system amid the environment of healthcare workforce and budget constraints.
Story : HRDO,
Photos : Phongnarin Hongthong