14 November 2019
Public hospitals in Hong Kong could do with more clinical pharmacists, in an expanded role, observers say. Photo: Reuters
Public hospitals in Hong Kong could do with more clinical pharmacists, in an expanded role, observers say. Photo: Reuters

Why we need more community-based pharmacist services

With increasingly high demand for public health care, I have often appealed to authorities that they should develop primary care services so as to reduce the pressure on the already overloaded government hospital system.

For instance, by expanding the roles for pharmacists, they can enhance the quality and safety of care in terms of managing and following up on patients’ medications.

The 2017/2018 policy address has marked a good start as the chief executive proposed recruiting additional pharmacists and enhancing pharmacy services.

The scope of services of pharmacists is extensive. Not only do they provide dispensing service, they can also assist in clinical pharmacy. Clinical pharmacists can conduct drug inspections along with doctors in hospital wards, ensuring that the medicines prescribed to patients are suitable, and monitoring and assisting patients’ recovery.

At present, the United States and many European countries have separated medical treatment and the dispensing of medicines, with the latter function assigned to the clinical pharmacists. By law, each hospital ward should have a clinical pharmacist who can advise patients about medicines, including how to take them, what reactions may occur, and answer patients’ questions. They would also have to conduct inspections and examine in-patients’ condition.

In Hong Kong, few hospitals have clinical pharmacists. And even if they have such staff, the persons often have to be in charge of more than one unit, such as pediatric, general and intensive care units, at the same time.

In order to fully implement clinical pharmacy service, authorities should hire more clinical pharmacists who can specifically examine, review and follow up on patients’ prescriptions, from admission till discharge from the hospital. As the pharmacists shoulder the workload, it will result in additional time available for medical practitioners to conduct more thorough consultations.

A lot of people with chronic illnesses at specialist outpatient clinics sometimes only receive hasty consultation every six months, meaning they would be taking home four or six months of medicine. And the doctors may not have the time to follow up on whether the drugs are taken properly.

It is estimated that up to 30 percent of patients do not take medicine according to instructions, due to worries about side effects. That is a huge waste, which eventually puts more pressure on the medical system.

According to a report by the Sha Tin District Council and the Pharmaceutical Society Charitable Foundation, 42 percent of elderly people surveyed said they have to take at least seven or more drugs. And many among the seniors are not able to follow the instructions strictly as they have to handle too many pills at one time. That is a reason why are witnessing increasing hospital admission rates of the elderly.

Given the situation, I would suggest implementing a public-private-partnership under which specialist outpatients in stable condition can not only get their prescriptions during medical consultations at government clinics, they can also receive professional pharmacy service at 600 assigned pharmacists or the pharmacies already in the community.

This article appeared in the Hong Kong Economic Journal on June 5

Translation by John Chui

[Chinese version 中文版]

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Legislative councilor and head of nursing and health studies in the Open University of Hong Kong