'Not ready for Pharmacy Bill'

Kota Kinabalu: Malaysia or Sabah in particular is not ready for the new Pharmacy Bill in favour of a “doctors diagnose and prescribe, pharmacists dispense” system.

Voicing their protest at a press conference, Tuesday, non-governmental organisations (NGOs) and concerned individuals called on the Government through the Ministry of Health to conduct a referendum in Sabah on the controversial issue of dispensing separation (DS) in private primary care clinics, a scenario where doctors only prescribe and pharmacists dispense.

Earlier, for starters, representatives from Sabah Family Planning Association (SFPA), Inner Wheel Club of Kota Kinabalu, Kinabalu Pink Ribbon, Palliative Care Association of Kota Kinabalu (PCAKK), Sabah Nurses Association, Lions Club in Kota Kinabalu and concerned members of the public had come together for a meeting to discuss the pros and cons of DS and to voice their grievances.

Many concerns and issues were raised at the press conference chaired by Datuk Patrick Sindu in his capacity as a layman, an anti-dispensing separation activist and concerned citizen. Lions Club member Peter Liau was the event coordinator.

Sindu said Sabah’s rural setting with communication problems is not conducive to implementing the proposed DS system, adding there is no public engagement on the Pharmacy Bill to seek the people’s views.

“Sabah is certainly not ready for dispensing separation as it will increase financial and transportation expenses on the part of patients and consumers. It will cost more because you have to visit two different health professionals – doctor and pharmacist, each charging a fee for their service. Given the anticipated increase in healthcare costs, its implementation will only burden the people.

“From my visits to rural districts in the State, it is clear that DS will cause confusion and grave inconvenience to the masses as there may not be sufficient or any pharmacy at all in those places and likewise suburban areas,” Sindu said. “The kampong people in particular are worried because pharmacies in urban centres do not open 24 hours.”

Speaking as a consumer and Vice-President of Sabah Family Planning Association (SFPA), Mary Lim advocated a referendum as a platform for stakeholders to air their concerns and views.

“We (the general public) have not been consulted on this issue at all. There was never any public forum to get feedback from the people who will be directly affected by the implementation of dispensing separation.

“We believe a large segment of the population are not aware of this issue because they have no access to information, let alone know how DS is going to benefit them,” she pointed out. “So, it appears like a unilateral decision without any consideration for the potential difficulties to be faced by the people.”

On the public forum being held in the Peninsula for doctors and pharmacists, Lim, a qualified nurse, said the Sabah people are waiting for one to be held in the State. “Hopefully, for a bigger voice, all the NGOs and general public will be invited to participate in the forum, and not just the doctors and pharmacists. Parliament can’t simply pass the Bill without consultation with all the stakeholders.”

Noting that the Malaysian Pharmaceutical Society (MPS) is pushing for the new Pharmacy Bill to be passed by Parliament, Lim said : “If the Bill is endorsed by Parliament, there will be a lot of confusion, doubts and uncertainties as to how the DS system works.”

While conceding that the system may work in some developed countries, she is aware that others like Singapore are not adopting it “because the one-stop centre is the best solution, no fuss, no hassle.” She agreed that DS works well in some countries because they have a national healthcare system with top-notch, well-developed infrastructure such that pharmacies are found in almost every nook and corner unlike the prevailing situation in Malaysia.

Lim predicted that there will be layoffs and unemployment if private sector clinics are no longer allowed to dispense medication while patients and consumers will suffer additional costs and extra hassle.

From another perspective, she stressed that waiting time should be minimal as “very sick” patients just cannot afford to be pushed here and there for two to three hours after the doctor’s consultation.

“I don’t see how the concept of minimal waiting time can work in the separation of roles. Say there are 20 patients and you have to queue up for one to two hours before getting to see the doctor at the private clinic. Then you need to locate the nearest pharmacy.

“What if the nearest pharmacy does not carry the medicine prescribed by the doctor? Which means you will have to look for the next pharmacy to get the medicine,” she reasoned. “We can foresee this kind of problem.”

A doubtful Lim also questioned whether pharmacies can provide holistic, quality services as claimed in terms of patient’s health education to create awareness, advice on exercise and nutrition, counselling and the like.

“With 20 patients waiting at your doorstep, would you have the patience and time to do so? You would quickly give the prescribed medicine and ask the patient to go.

“For quality services to be in place, you need a special place to ensure privacy for counselling, among other needs.

Some of the pharmacies in super or hypermarkets are mere ‘pigeon-holes’ and unless these are upgraded, how do you expect them to provide quality services?” she asked.

Having said all that, Lim went on to suggest a DS pilot project in populated places in both urban and rural areas, adding “this could be the best move.”

For QEH retired Matron, Beant Kaur Auluck, her biggest concern as a consumer is a situation where the prescription medicine is not available and the pharmacist recommends another drug for the patient without consulting the doctor.

“A pharmacy has to have the right drug for the patient. But the pharmacist may think it’s all right to have an alternative drug. In such case, I have to trust the pharmacist although I don’t know the difference between the two types of drugs. This is something we should all think about. I feel very strongly about this,” she said while supporting the idea of a referendum on the Pharmacy Bill.

Kaur insisted that a one-stop solution for prescription and dispensation is convenient for the people because it is under the same roof “but with separation, medication will cost twice as you have to visit a second place (that is, a pharmacy) and this can be time-consuming and very inconvenient to people who are suffering from illness.”

Rokiah Yaacob, who represented the Palliative Care Association of Kota Kinabalu (PCAKK), expressed concern for the wellbeing of cancer patients in rural areas as medication will then not be readily available if it has to be obtained only from pharmacies should DS be implemented by the Government. “It’s not the right time yet for implementation. I hope the Government will defer it for the sake of the people.”

Concerned citizen Bernard Lee called for a comprehensive study on locations in Sabah, given its vast rural areas. He argued that what is considered very efficient in certain countries does not mean it is going to be a good system for Sabah.

“They are talking about Sabah being the second poorest state, so how is the implementation of dispensing separation going to impact the majority? That’s one big issue, not forgetting that city folks have their own problems as well.

“Any system has its pros and cons. For implementation in any country or state, the Government must conduct a comprehensive study. The Government needs to provide more information – let the people know the potential problems and benefits. And do get feedback from NGOs and the public,” he said.

Lee also concurred with the President of Kinabalu Pink Ribbon (KPR), Hjh Natrah Datuk Arif on privacy issues as certain stigmas are attached to certain diseases and some people are more sensitive to lack of privacy.

Earlier, Natrah dwelled on the aspect of confidentiality, saying by going to the pharmacy, another person will get to know the disease or ailment suffered by the patient.

“And inconvenience aside in having to hunt for the nearest pharmacy after seeing the doctor if I happen to fall sick at night, what happens if a particular drug (prescribed by the doctor) is not available? The pharmacist will recommend an alternative drug which may cost more. Sometimes the pharmacist is not even present at the station, and only the assistant is available,” she shared.

Saying we are living in a democratic world, President of the Lions Club of Tanjung Aru, Andrew Sim Yee Sheng said consumers or patients should be given the choice whether to get their prescription from the private doctor’s clinic or pharmacy.

“Allow them to make their own decision – this is not a big issue. What is important is we know what we want. I believe everyone can make their choice wisely by choosing whatever is most suitable for them. All we want is to save time and the expected hassle,” he said.

On another note, Sim opined that it is difficult for pharmacists to ensure that their services are in the best interest of patients. “Pharmacists might be pushing for certain drug use which might not suit the patients because when they do business, they are generally concerned about their own profits as well, and not just the patients’ benefit.

However, I am not saying that every pharmacy will take this approach.”

The Health Ministry’s Pharmaceutical Services Division proposed the new Pharmacy Bill in 2012 (with a view to safeguarding public interest) to replace the pre-independence legislations, namely the Registration of Pharmacists Act 1951, Poisons Act 1952, Sale of Drugs Act 1952, and Medicines (Advertisement and Sale) Act 1956.

Pharmacists insist that dispensing separation is to ensure best care for patients and error-free prescription by the doctor, not to mention that it is already in place in the public sector (government hospitals and health clinics).

Source Article from http://www.dailyexpress.com.my/news.cfm?NewsID=98331
'Not ready for Pharmacy Bill'
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