Specialization in pharmacy: looking to the future of practice
At the recent Malaysian Community Pharmacy Business Forum (MyCPBF), a discussion forum was held on the subject of “Transcending Primary Healthcare Services: The Future of Specialized Pharmacy Services and Pharmacy Specialization”. Panelists included Tuan Haji Amrahi Buang, president of the Malaysian Pharmaceutical Society (MPS); Sarah Abdullah, supreme council member of the Malaysian Community Pharmacy Guild (MCPG); and Syireen Alwi, bursar of the Malaysian Academy of Pharmacy (MAP), with MPS treasurer Jack Shen as moderator. The following is an edited account of the forum’s proceedings.
Jack Shen (JS): Why should community pharmacy bother with specialization?
Amrahi Buang (AB): Community pharmacists must embrace the principle given by WHO on the real meaning of community pharmacy practice … There are 4,000 community pharmacies at the moment. The community sees [them] based on five images. Is it based on products, discount store, health and wellness, professional services, or all of the above? How do the community and government perceive us?
JS: There is a price war going on and the public want cheaper medicines. Are we ready for specialization?
Sarah Abdullah (SA): As a community pharmacist, it is extremely challenging to run a business if we depend solely on the sale of medications and products. This type of environment, where pharmacists are racing to sell the cheapest medications … is not a good path to go down. Eventually we will be overtaken by health technologists from other countries.
Specialization is important because it enables you to identify your business and yourself, as a pharmacist, from the rest of the pack. How are community pharmacies different from other logistic companies for pharmacy? Those companies do not provide services. Community pharmacists should be engaged with the community and know the patients in the surrounding community … specialization can eliminate the price war because pharmacists [would] take care of their respective communities based on their specialization in different diseases.
JS: Looking at the statistics, we have 71 board-certified pharmacotherapy specialists (BCPS) among 13,151 practicing pharmacists, which is equivalent to 0.53%. What is academia doing to look into this issue?
Syireen Alwi (SY): At the moment, BCPS is an international accreditation for pharmacotherapy, usually for hospital pharmacists … We do have people sitting for the BCPS, at least one to two every year. The certification lasts only for 7 years so they have to be recertified. However, not every pharmacist is fortunate enough to be able to sit for the BCPS because it costs approximately USD 600; recertification costs approximately USD 300.
The MAP does have other plans or modules. For example, for smoking cessation, there are three levels, smoking cessation provider, OSCE skills and specialist for smoking cessation … To be certified, you can visit the MAP or MPS websites to find out when are the courses and OSCE. They are available everywhere, including Sabah and Sarawak. Once you are a certified provider, your name will be listed in the database, and general practitioners can refer their patients to you.
We are hoping for the same mechanism for medication therapy adherence clinics (MTACs), whether for diabetes, asthma, COPD, warfarin, wound or neurology, that will [apply] not only to [pharmacist in] the hospital but also the clinics. We are hoping that people will come in and spare their time to listen to the talk, do the online modules and get themselves attached at accredited clinics to be certified.
JS: The problem with pharmacists are the ‘behind-the-counter’ syndrome… What can the MPS do to encourage the pharmacists [to step out]?
AB: Hard work. Getting the government to recognize our mQuit providers to be equal to the doctor was a difficult task; we managed to do that. We literally convinced government that we provide adequate training and accreditation. Pharmacists who provide mQuit counselling for the patients must be given same fees as the nurses and doctors.
JS: Specialist doctors can collect X times more fees than general practitioners. Pharmacists do not charge fees; how do we convince the community to support us?
SA: We do not charge fees for our specialized consultation at the moment; this is the [current] reality of being a pharmacist. I would like every student aspiring to be a pharmacist [to believe] we are the generation of change … We do not charge any fees because we want to inculcate a certain type of behaviour and passion in our pharmacists to show off our knowledge for the profession and for the sake of the patients. Once we are more visible to the community and the community recognizes our value, they will not hesitate to pay us our worth.
JS: What future development plans does MAP have to increase pharmacist participation in training and public recognition of certification?
SY: The challenge is to get government recognition. We met with the Director-General and mentioned our hope that the government will recognize what MAP and MPS has provided. For academic institutions, public tertiary education institutions do not offer postgraduate certificate courses whereas [private ones] might be able to take up certification courses. We have reviewers for our modules; the MAP will provide short certification courses.
Under MPS, there are CMEd programs and pharmacist programs. Under MAP, there are MTACs and requests from pharmacists to run a medication review certification process so that they can [recruit] patients for the service.
There was research 3 years ago on why pharmacists do not go for courses or online modules. The thing is that once [pharmacists] begin work, their priority shifts. We need to make the courses more accessible; we will do online courses where pharmacists only need to come for attachment and OSCE, and we will try to have them all over Malaysia.
JS: Managing a community pharmacy, we have a lot of operational problems, strategic problems, technological problems, etc. How can we convince business owners to do specialisation in community pharmacy?
SA: Community pharmacists are in charge of operations of the whole pharmacy; the business owner expects us to do all the jobs. In term of convincing the business owner on specialisation, we need to break out of this cycle and get an assistant who can do all these [basic] roles. We need to show them a good business proposal and what kind of return of investment the business could enjoy.
It is important to do market research, know the demography and their needs and the service that best suits the community. For example, in Kelantan, pharmacists are very much into medication home review. In urban areas, patient come to the community pharmacy mostly for chronic medication and nutrition.
I have been a compounding pharmacist since I finished PRP for more than 10 years. In my opinion, looking at the trends [of] specialization in medicine, compounding is going to be our best friend in the future. Compounding means preparing treatments that are individualized or personalised to one patient … It solves the problem of dispensing separation because compounding medication needs a prescription from doctor [but a pharmacist to compound]. This is the future of pharmacy and we have to work towards it.