Separation of dispensing

In recent months there has been a resurgence in media publicity about the issue of Separation of dispensing in Malaysia. An example is this recent article in FMT which deals with the pros and cons of the situation as it pertains to Malaysia. The biggest advantage of a system whereby the doctor prescribes and the pharmacist dispenses is the concept of medication safety. That I think we can all agree as this is the ideal setting:

Furthermore, having two healthcare professionals counter-checking on each other (doctors diagnose and prescribe whereas pharmacists counter-check and dispense) is of paramount importance in order to minimise prescription errors. Many drugs used have multiple actions hence resulting in multiple contra?indications. Thus the public should not compromise their own safety for the sake of convenience as some errors might be fatal or even cause life?long complications.

There are however some obstacles in Malaysia as the FMT article points out:

– Rural areas still lack pharmacists acutely should continue to have doctors dispensing until sufficient pharmacists are available.
– In pharmacies, however, dispensing of medications can only be carried out by pharmacists or by pharmacy assistants under the immediate personal supervision or presence of a pharmacist in the pharmacy. Not doing so is blatantly offending the law (Section 18(1)(b) Poisons Act 1952)**. Refilling prescription?only drugs without a doctor’s prescription is also a liability in court (Section 21(1)(c) Poisons Act 1952)**. Therefore patients requiring a refill are required to consult a doctor and obtain a prescription prior to getting their prescriptions refilled.
– Pharmacies currently carry very little of prescription drugs because rarely do any patients turn prescriptions in to be filled. This may be a problem for patients bringing prescriptions in to a pharmacy not carrying the drugs required.

Are Malaysians ready for separation of dispensing? As it stands, the situation in the country is frankly pretty much under-regulated. As a pharmacist commentator to that FMT article admitted

No doubt the system should change one day. As a pharmacist myself who spent a long time working in hospital previously, I have to say that the quality of pharmacists in Malaysia is lacking profesionalism. I can walk into any retail pharmacy and buy any drugs if I can spell its name. I don’t get any advice nor check of allergy. There is no doubt that it is still better than being dispensed by a clerk in a clinic but we really have to do better with the profesionalism and training of pharmacists.

Malaysian consumers I suspect won’t take this too well as it takes away their choice of where to get their medicines from. This response in an article in Yahoo news may be typical of many consumers:

“Going to a clinic and getting medication at a pharmacy does not go well with people like me. I work for a company and the employees usually go to the company”s clinic if they or their family members become ill.
“At the clinic, the employee does not pay a single cent for treatment, as everything will be absorbed by his employer. If I need to go to a pharmacy to get medicine, then it will be difficult, as I have to pay for it”.

At the heart of it all is the payment. This is the central argument I find missing in all the articles calling for or against separation of dispensing in the country. I have said it before and I say it again, there needs to be a National healthcare funding system. How separation of dispensing works in the UK and Australia is because not only is there better professionalism on the part of pharmacists and doctors in respecting the prescription (not to mention stricter enforcement), it’s because the consumer gets reimbursement for their medication. If anyone expects consumers who are paying for medication out of their own pocket or reimbursement only from their panel clinics to travel the extra distance to get their prescriptions filled, I can say that definitely will not go well with the public. It is unrealistic to force separation of dispensing on consumers until and unless there is the incentive of financial reimbursement for their medication in place.