"If
you love something, set it free. If it comes back to you, it's yours; if
it doesn't, it never was."
FAQ on SPD for patients and doctors
"If
you love something, set it free. If it comes back to you, it's yours; if
it doesn't, it never was."
FAQ on SPD for patients and doctors
What are "SPD" and "MIP" ?
MIP is the shortform of Mandatory Issuing of Prescription
What
are the meaning and implications of SPD or MIP?
SPD has been in practice in most western
countries for decades.It is an important part of the health
care system with consistency and efficiency. SPD means the medical practitioners
prescribe medicine but do not dispense medicine; and the pharmacists dispense
medicine but do not prescribe medicine. The belief behind such system is
that medical practitioners are trained professionally in diagnosing and
prescibing but not dispensing; and the pharmacists are trained professionally
in dispensing. These two different disciplines are depending on each other
and monitoring at the same time. They cannot be "mixed together" to avoid
any conflict of interest. It is the common goal of therapy for doctor and
pharmacist to utilize their professional skills in patient care.
More importantly, this set up allows a two ways monitoring system for both pharmacist and medical practitioner to ensure patients are not receiving unnecessary or inapproiate or incorrect medication. The patients are allowed to have the prescription dispensed in any retail pharmacy and to have the medication dispensed according to the necessity or financial constraints. In case of any mistakes or misunderstanding in the prescription, the pharmacist can contact the doctor immediately on the phone, and amend the item by endorsement or have the doctor countersigned later,or refer the patient back to his or her doctor if necessary. Moreover, professional advices on how the medication should be taken are given by the pharmacist while handing out the dispensed medicine. The patients can revisit the pharmacy and ask for the pharmacist for advice without an appointment and it is free.
However, SPD needs time to be implemented. Therefore, we are proposing a flexible-SPD with (5 years) stepwise implementation for infrastructure and capacity building, and adaptation by the public and doctors and pharmacists; so that constant reviews and refinements can take place to set up a good system. Under the flexible SPD, we propose the Mandatory Issuing of Prescription. Under the MIP, the patient will have to pay the consultation fee during the registration in the clinic. The doctor will issue a prescription to the patient after consultation and the patients can decide where the prescription is to be dispensed. If the patient chooses the prescription to be dispensed in the clinic, the patient has to pay again for the dispensed medicine. If the patient chooses the prescription to be dispensed by a retail pharmacy, the patient is free to leave. Consequently, under MIP, a patient can choose when, where and how many medicines are dispensed, and the prices of the medicines are clearly stated on the receipt.
For those doctors who are used to overprescribing
or giving medication inappropriately or not prescribing according to the
standard protocols, they ¥ßhave to think again before the prescription
is written. There may be "second opinions" to comment on their prescribing
habits and the "evidence" is being retained. For those pharmacists who
do not dispense properly or fail to control the prescription medicine,
they have to work harder, for many doctors and patients are looking at
the quality of their service.
Is it cheaper to have the medicine dispensed in pharmacy than in the clinic?
No definite answer! There is no proper research data available for the situation in HK. However, in a recent survey conducted by the Next magazine1, the drug fees are around 25 to 60% of the overall charge per patient visit. The drug fees involved ranged from 200% to 700% of the actual wholesale cost of the medications. On the other hand, under current retail pharmacy practice, the minimal charge per tablet or capsule is around 50c to 1 dollar for common generic medicines, and 15%-50% add up cost for expensive branded medications. Besides, no dispensing fee is added.
It is well established that dispensing doctors prescribe more items than non-dispensing doctors2, 3. (That is one of the common experience that we are receiving much more items in HK than in western countries where SPD is being enforced). If fewer items were being prescribed, the overall dispensing cost that charge the patient would also be reduced.
Moreover, we should not focus on the cost alone, your safety, the efficacy of the medicine and your freedom of choice are our main concern.
The Freedom of Choice
Yes! If SPD is implemented in Hong Kong, medicine will no longer be stocked and dispensed in the clinics
However, Prescribing and Dispensing are two different professional disciplines. If the pharmacist demands a prescribing right, and claims that it is more convenient to the patient (we don't ask for consultation fee and no appointment is required!) and it is the patient's right to get the prescription from the pharmacist. Would it be a "conflict of interest"?! In SPD, the freedom to opt for clinic's dispensary may be limited, but you can surly able to choose from the 300 plus retail pharmcy to dispense your medicine. Moreover it is a system to safeguard your interest in proper prescribing and dispensing.
The Safety and Efficacy
In the doctor's dispensary, the safety of the dispensing which are done by the nurses (trained, mostly untrained, and not even RN or EN) is questionable. Some doctors claimed that they are the one who are responsible for the dispensing, not the nurses. How can the doctor monitor the drive of a double-desker bus on the top desk while letting the nurse do the driving? Even medical doctors are not trained in dispensing! Having studied several units in pharmacology isn't enough for dispensing at all, even a PhD in pharmacology isn't qualified for registration to be a dispenser in HK! Moreover, the nurses could not answer your questions on therapeutic effects, side effects, and drug interactions, they could not even identify the ingredients in a medication properly. For historic reasons, it may be acceptable for the doctors to do the dispensing themselves, but it could not be found by experience.
MIP
At the moment, we are not demanding a complete separation of prescribing and dispensing. We are not "powerful enough" to take away the doctor's right to do dispensing. We are just demanding the Mandatory Issuing of Prescription and let the patients choose. We are, in fact, working on the same direction in promoting patient's right with the doctors.
Yes! It is a matter about Patient's Right and Right or Wrong.
"If you love something, set it free. If it
comes back to you, it's yours; if it doesn't, it never was."
The press and many doctors have suggested th retail pharmacies are selling prescription medicine without prescription, and without proper labeling and advice. How can I trust them and allow my patient to have the prescription dispensed in retail pharmacy?
First of all, it is their legal rights for the patients to choose. Neither the patients nor the prescriptions are the "properties" of the medical doctors. You can surly advise the patients how to choose, but the patients should not have to ask for any permission to choose.
We admit that not all pharmacy practices are up to the standard, but we must be aware of the types of malpractice, which are not done by the pharmacists. One must also distinguish that there are two major retail medicine shops in HK: medicine shop (without a pharmacist on duty) and pharmacy/ dispensary (with a pharmacist on duty). Please don't confuse the malpractice by those medicine shops with the pharmacies. The pharmacist is in charge of the dispensary; it is almost impossible to control the medicine "businessmen" if they are obtaining medicines from parallel products or illegal sources or if they are selling medicines outside the pharmacist hours of service.
There were around 3000 test-buy operations by the pharmaceutical inspectors in the pharmacies last year, but none had been done in doctor clinics. We are not going to discuss about the fairness of such operations. If the pharmacies are not good enough, no matter how poor others are doing, we have to correct it!
Yes! That is exactly why we need such a separation to improve the retail pharmaceutical services in Hong Kong. Firstly, if they sell prescription medicines they can sell them anyway with or without such a separation (you can see the example of pirated CD). Secondly, we must stress that SPD is a "mutual" (Two ways) monitoring system that means the doctors can also monitor the quality of the prescriptions that are dispensed. The patient's safety and the quality of service can be guaranteed in SPD.
Thirdly, we recognize a SPD system would require time for the infrastructures and dispensing regulations to be developed. If a SPD system is being established, we demand the ownership of a retail pharmacy must be controlled, that would ensure the ethics and the professionalism are being enforced at all time.
In the mean time, we understand we are not
"powerful enough" or we have not gained enough trust among the public to
take away the doctor's right to do dispensing. Therefore, we are only demanding
mandatory issuing of prescription and let the patients decide. Let the
patients find the quality service provided in retail pharmacies or in the
clinics' dispensaries.
By labeling our medicine or have the prescription dispensed outside, my patient can easily read the label and buy medicine/ OTC* without proper prescription forms!
It is an issue of patient's right to know, rather than SPD!
Labeling medicine is a worldwide standard in dispensing practice. That could safeguard the patient's right to know and to identify the name and the amount of medicines in drug poisoning cases.
The health authorities, the doctors and the pharmacists are ethically required to educate the patients about the improper uses of medications. Besides, medical information can be easily obtained from the Internet or media, the patients have every right to self-medicate about their own minor illnesses.
*If it is an OTC (Over the Counter) medicine, it is legal to purchase for self-administration without a prescription.
Can I have the prescription dispensed from the doctor's clinic after SPD?
Yes and No!
Yes
It is the basic idea of SPD to avoid conflict of interest. If a complete SPD is being enforced, the doctors can still dispense under exceptional circumstances, such as operating under a not for profit requirement, emergency, or vaccination.
No
Off-hours, Sundays, and holidays are not exceptional circumstances because a system of rota will be in place. Pharmacy with long service hours may flourish like the 7/11 convenient shops if there is an existed market.
MIP
But under the present proposal of Mandatory
Issuing of Prescription, medicine can still be dispensed in the clinics.
We believe in our service, we want our patient to experience the advantages
of SPD, and decide whether a mandatory SPD is necessary in the coming years.
It also allows the infrastructures, regulations, patients and pharmacist
preparations to be fine-tuned.
The doctor said the patients already have the "Right of Choice" to ask for a prescription. What is my "Right of Choice"?
If it is our "right", why do we have to ask for it?
A survey done by the South China Morning Post showed that more than one-third of 20 private clinics refused to issue prescriptions for patients to buy drugs at pharmacies5.
Although the Medical Council claims the patients has the "Right of Choice" for a prescription for the last 20 years, the result from the above survey showed otherwise:
.....................
"Among the 7 clinics turned down a request to issue prescriptions for drugs, most said it was "very rare" for patients not to have drugs dispensed at their clinics.
A nurse in a Tsz Wan Shan clinic said: "Our $200 consultation fee already includes the drugs cost.
"We give out six or seven kinds of pills and one syrup to patients suffering from colds. The drugs are too complicated. You can't get them outside."
A Sheung Wan doctor was annoyed by such an "unusual request". "The separation of dispensing and medical practice hasn't come into effect in Hong Kong. If you want to buy drugs at pharmacies, go to other doctors," he said.
Another nurse in Ho Man Tin said: "It's difficult to get our specialist drugs at pharmacies."
Lilian Lau Sau-han, spokeswoman for the Hong Kong Patients' Rights Association, said some doctors were denying patients the right of choice. "Most Hong Kong patients do not even know they have the right to ask for a prescription, but definitely it is their right to do so. Some patients did ask, the doctors refused but gave no reason.""
......................
Some doctors even have their own brand medicines, with a different color, shape, and name, to avoid the medicine being identified and dispensed outside or at other doctors' clinics. That is why a Mandatory Issuing of Prescription and generic (common) names prescription writing is essential.
What are the advantages for my prescription to be dispensed by pharmacist?
Do I have to wait longer or do more traveling for my prescription to be dispensed in the retail pharmacy?
It is no trouble at all. But under the current
proposal, if you find the waiting time or distance is unacceptable, you
can stay at the clinics to have the prescription dispensed.It is up to
the patient to decide the service they want.
SPD in western world has been legally carried
out for more than 50 years. All patient groups support such a separation.
In Britain, only remote rural area without a dispensary is allowed to have
a dispensing doctor. Hong Kong is a highly densed place. You can easily
locate a pharmacy near the clinic or work place or near home, to have the
prescription dispensed. Moreover, if there is a dispensing market, more
pharmacies could be opened within months, and more dispensing staffs would
be empolyed in each pharmcy, waiting time would be definitely reduced.The
dispening service is not only compete on price, buy also the quaily, the
time. Short dispensing time is almost guaranteed in such a free market.
After all, better the service means more time is spent on the patients. Please don't be scared by the preceived difficulty, you can certainly decide whether ease and convenience or safety and cost are more important.
Many countries are working towards electronic
prescribing and dispensing. The prescription can be transmitted through
the Internet or simply by fax, your prescription can be ready to be picked
up when you arrive at the chosen pharmacies, if such a system is implemented.
That would never be realized without a SPD.
Are there enough pharmacists to allow a SPD now?
Hong Kong has 1264 pharmacists at the moment and about 320 pharmacies. By deducing those who are working in the Hospital Authority , the Health department and retail pharmacies, we still have around 600 pharmacists. Maririty are working at non-pharmacy related occupation or as dispensers. They can engage in the retail dispensing service if the market is available. That would allow a 300% increase from the present pharmacy number. The CUHK produces around 30 pharmacists each years locally; and the student quota can be increased if the SPD has been finalised. Moreover, oversea pharmacy graduates can return to work in Hong Kong if the job prospect is good. The number of pharmacist available for the market will keep growing.
To implement a complete SPD, the Taiwanese
health department has spent about 8 years to prepare such a separation.
Likewise, the mandatory issuing of prescription we are proposing now is
the first step towards a complete SPD in Hong Kong. If the patients find
that there are not enough pharmacies, or the waiting time is too long,
they can surely have the prescriptions dispensed in the clinic. After 3
to 4 years, the system can be reexamined to assess the possibility to implement
a complete SPD.
I bought prescription medicine from the "pharmacy", but I don't know who is the pharmacist and couldn't find the "Rx" sign!
That means you did not obtain the medicine from the "pharmacy". Many news reports and even some doctors have confused about the terms "pharmacy or dispensary" with "medicine shop".
According to the Pharmacy and Poisons Regulations, dispensing can only be performed in the "pharmacy". The pharmacy must have a full-time pharmacist on duty and the "Rx" sign must display in the Pharmacy. The pharmacy can stock a wide range of medicinal products, including prescription medicines and non-prescription medicines. The dispensing of the prescription medicine must be supervised by pharmacist according to the prescription. Medicine shops, unlike the pharmacy, can only stock a limited range of medicines, and the "Rx" can not be displayed.
The medicine shop is illegal to stock or sell prescription medicine. But like pirated CD, if there is somebody looking for it, there will be someone to sell. It is a matter of legal enforcement.
Please make sure that you are looking at
the right place!
I heard that one pharmacist can register to several pharmacies. How can I ensure my prescription is being promptly dispensed by the pharmacist?
Wrong in most cases.
Under current regulations, a pharmacist can ONLY register to ONE pharmacy, and the pharmacist must be on duty during the listed working hours. However, under exceptional circumstances, a pharmacist can work most of his hours in one shop and also covers odd hours at another shop, e.g. Watson's shop. The pharmacist must prove that his duty at the other shop will not interfere or adversely affect his duty at the primary location, in addition, special approval is required from Pharmacy and Poisons Board.
How can I ensure my prescription is properly dispensed in the retail pharmacy?
Always take notice of the pharmacist's working hours and the license of the pharmacist, which must be posted outside the dispensary. Always ask for the pharmacist to have your prescription dispensed and only receive advice from the pharmacist, not any other sale person.
Please inform your pharmacist about
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