Dispensing Separation: Are pharmacists actually ready for it?

Posted on Posted in SwipeRx Malaysia
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Author:

Dr. Sharon Lee, PharmD

Dispensing separation, also known as separation of prescribing and dispensing, is a medical and pharmacy practice where the prescribing physician provides the patient with a written or electronic prescription for the dispensing of the prescribed medication at a pharmacy. Historically, the lack of dispensing separation is attributed to a shortage of pharmacists in Malaysia in the early stages of development following independence in 1957, which inevitably led to regulations that gave physicians the right to dispense medications directly to the patients.1 Since then, the full separation of the professional responsibilities of physicians and pharmacists has been an ongoing heated debate in Malaysia for many years, and the reason for such controversy is largely due to the conflict of interests between prescribers and pharmacists.
The supporters of dispensing separation argue that this system will greatly improve patient care by reducing medication errors or inappropriate use, reduce overall treatment costs, and also eliminate the conflicts of interest for physicians who benefit financially from the medications they prescribe.1 As for the physicians who are against the separation of prescribing and dispensing, they reason that patient inconvenience would be an issue as they would have to visit two separate locations, medical consultation fees would have to be increased to cover for physicians’ losses in revenue from dispensing medications, and there may be insufficient pharmacy coverage in rural areas of Malaysia.1
Health Minister Dzulkefly Ahmad with director of Pharmaceutical Enforcement Department Tan Ann Ling (left) and director of the ministry’s Pharmaceutical Services Division, Dr Ramli Zainal at the recent townhall session with pharmacists. Photo courtesy of : Free Malaysia Today
During a press conference after Health Ministry Town Hall Session with pharmacists in August 2019, the Health Minister Datuk Seri Dzulkefly Ahmad mentioned that the Health Ministry is looking to include mandatory prescriptions upon requests as a provision under the Poisons Act 1952.3 Physicians are currently following the “mandatory upon request” policy, which means that prescriptions are only provided upon patient’s request. Pharmacists have argued that this practice is unsafe as it is up to the patients to make the decision on their own as most patients here have limited health literacy, and it is indisputable that this policy is unknown to many patients. In this case, the idea of “mandatory prescription upon request” seems like a compromise to the already flawed system rather than a policy designed around patient centered care.

In the midst of this decade-long debate of dispensing separation in Malaysia, the question of whether pharmacists in Malaysia are truly ready for the separation of prescribing and dispensing should also be raised. At this point in time, it is uncommon for pharmacists in Malaysia to question the prescribers’ decisions on any prescription. In other words, the lack of interprofessional communication is evident in this country’s healthcare practices. In this country, the practice of having pharmacists challenge the doctors’ prescriptions is unusual, and the reason behind that may be related to the public’s perception of the pharmacist’s profession as many still view pharmacists as “pill counters”. In addition, it is also important to think about whether Malaysian pharmacists are equipped with the skills to effectively carry out a Drug Utilization Review (DUR) with enough confidence to challenge the prescribers when appropriate. Only when the profession is recognized will the fight for separation of prescribing and dispensing be able to move forward.

References:

  1. Loo J, Lo E, Mai C, Gan P, Lee E, Tiong J. Separation of prescribing and dispensing in Malaysia: public perception of pharmacists’ roles and agreement towards a separation policy. Journal of Pharmacy Practice and Research. 2019. doi:10.1002/jppr.1542
  2. Vasantha Ganesan. Will Dispensing Separation Finally Become A Reality?.; 2019. https://www.theedgemarkets.com/article/will-dispensing-separation-finally-become-reality. Accessed November 23, 2019.
  3. Soo Wern Jun. Health Minister: Mandatory Prescriptions Upon Request To Be Included In Poisons Act.; 2019. https://www.malaymail.com/news/malaysia/2019/08/08/health-minister-mandatory-prescriptions-to-be-included-in-poisons-act/1778988. Accessed November 23, 2019.

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