ORIGINAL ARTICLE

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PROFESSIONAL TRAINING AND ROLES OF COMMUNITY PHARMACISTS IN MALAYSIA: VIEWS FROM GENERAL MEDICAL PRACTITIONERS

Table 2. General practitioners’ perceptions about community pharmacists’ training and roles

SA = strongly agree; A = agree; N = neutral; DA = disagree; SD = strongly disagree; Gen = gender; and Y. Ex = years of experience as a general practitioner
*Fisher’s exact test was used to determine the p-values

DISCUSSION

In the current study, nearly half of the respondents agreed that GPs should accept community pharmacists’ recommendations whenever there is any problem with the prescription given by them. The mission of pharmacy practice according to International Pharmaceutical Federation (FIP) is to provide medications, other health care products and services and to help people and society to make the best use of them.¹⁷ Furthermore, the World Health Organization (WHO) has long thought that pharmacists could make a greater contribution to the provision of health care.² Pharmacists are viewed as being well-placed to advise on the management of common symptoms and long-term conditions, and to participate in health education and promotion. In order to uphold all these tasks, the WHO has clearly defined the roles and responsibilities of community pharmacists. In addition to the dispensing of prescription medications, other professional roles of community pharmacists include processing of prescriptions, care of patients or clinical pharmacy, monitoring of drug utilization, extemporaneous preparation and small-scale manufacture of medicines, traditional and alternative medicines, responding to symptoms of minor ailments, informing health care professionals and public, health promotion, domiciliary services, agricultural and veterinary practice.²

This study showed that the majority of the GPs were well informed about pharmacists’ core duties in identifying drug-related problems among patients. In recent years, the term “pharmaceutical care” has established itself as a philosophy of practice, with the patient and the community as the primary beneficiaries of the pharmacist’s actions.¹⁷ GPs were comfortable if community pharmacists referred patients to them for further medical evaluations. In line with the FIP/WHO recommendations to facilitate continuity of care among patients by referral, this will create an opportunity for collaborative patient care.¹⁹ The Crown Report from the UK had highlighted the need of greater collaboration between the two professions, and if barriers exist, these must be overcome before comprehensive inter-professional working can be realised.⁸ Moreover, the respondents were aware that pharmacy profession had changed tremendously from being one concerned with the distribution of drug products to one centred on ensuring that optimal therapeutic outcomes are achieved in patients and an overwhelming proportion of the GPs agreed that if dispensing separation was to be implemented, they will work collaboratively with the community pharmacists to monitor patients’ therapeutic outcomes. This is consistent with previous studies conducted which have found that prescribers are in favour of the new extended roles of practising pharmacists as patient counsellors and drug information providers, especially in developed nations.^9,16 In developed countries, professional relationships between the prescribers and pharmacists are good due to the professional services offered by the pharmacists.¹⁶ Pharmacists are being challenged to become key players in the prescribing process, as well as becoming advocates for patients through optimizing and monitoring drug use.³ This has resulted in provision of new and innovative services on patient care by pharmacists compared to their traditional role as drug dispensers.⁶

This pilot study showed that the majority of the GPs believed that the community pharmacists were not well-educated in clinical therapeutics, performing diagnosis of minor illnesses and selected screening tests. But this was not consistent with their agreement that the profession had undergone major changes. Some of the medical practitioners also disagreed with maintaining complete medication profiles of the patients by the pharmacists. The GPs were probably uninformed about the current aspects of pharmacists’ training and curriculum which are more patient-oriented rather than product-oriented²⁰ and deliver in-depth training in pharmacotherapeutics. Most doctors would favour an extension of the activities of community pharmacists but have concerns about their role in screening and counselling patients and in prescribing.²¹ The study conducted by Barber et al  reported that lack of awareness emerged as a major barrier, with GPs reporting that they had little idea of the training and skills of pharmacists, and pharmacists reporting that GPs were not aware of their role in health care and believed that their contribution was undervalued.⁷ These findings highlight the needs to develop and incorporate topics on inter-professional relationships in the current medical and pharmaceutical curriculum and to emphasize on collaborative care between physicians and pharmacists. Both professions should have a good understanding of and insight on practice from global perspective, professional training, rights and responsibilities as well as inter-professional relationships.

Majority of  GPs (about 60% - 70%) were not comfortable with community pharmacists being given the right to make changes on a prescription that could harm a patient without prior consultation with the prescriber and disagreed that community pharmacist is the best person to advise them on rational use of medicines. In recent times, much focus is placed on the new roles of the community pharmacists in certain developed countries like Australia, USA and UK.²² The health-advice roles of the pharmacists in these countries are highly appreciated and accepted by general practitioners. In most developed nation, general practitioners in UK for example appreciated the community pharmacists’ involvement and efforts in ADR reporting and drug information.^23,24 However, a survey on physicians’ opinions towards expanded clinical pharmacy services found that general medical practitioners generally opposed pharmacists performing autonomous decision-making tasks, but favoured adjunct tasks such as patient counseling.¹⁰ Muijrers et al in their study reported that some aspects of the pharmacist’s current role, such as providing advice and medication-control, are already well received by general practitioners.²⁵ However, other aspects, such as prescribing medications and adjusting an ongoing pharmacotherapy, are often less well-perceived.²⁵ Physicians are open to pharmacists' responsibilities related to detecting and preventing medication errors, providing patient education, and suggesting use of non-prescription medications.¹²

As this was only a pilot study, the sample of selected clinics limited to only district A, the results may not apply to all GPs in Malaysia. There may be potential respondent bias, as the response rate of 50% was relatively low. However, it is often difficult to recruit GPs into this type of research. We did not conduct a detailed missing data analysis on the non respondents. As completion of questionnaires was not done anonymously but in the presence of researcher, there may also be bias response (if applicable). Nevertheless, findings of this study could be early indicators of Malaysian GPs’ perception of professional training and roles of community pharmacists in Malaysia. A nationwide survey is strongly recommended to complement the current findings and provide conclusive insights into the current issues.

CONCLUSION

Good patient care would need a strong collaborative approach between GPs and community pharmacists. This study suggests that Malaysian GPs are aware that current professional training of CP is more patient oriented; they are willing to collaborate with CP in monitoring drug therapy and adverse drug effects; they recognized the role of CPs as educators and advisers to patients on safe use of drugs and choice of non prescription drugs. However Malaysian GPs are not prepared for CPs to diagnose minor ailments, write prescriptions or to conduct screening tests. They strongly disagreed that CPs be given the right to make changes to their prescription without informing them or to maintain complete medication profile of patients. Development and incorporation of topics related to inter-professional relationships in the current medical and pharmaceutical education curriculum will help to improve working collaboration between physicians and pharmacists.

ACKNOWLEDGEMENTS

We are grateful to all GPs who participated in this pilot study.

REFERENCES

1. Smith F. Community pharmacy in Ghana: enhancing the contribution to primary health care. Health Policy Plan. 2004;19(4):234-41 [PubMed] [Full text]
2. World Health Organization. The role of the pharmacist in the health care system. Report of a WHO consultative group, New Delhi, India, 13-16 December 1988. Geneva: World Health Organization; 1994 [Full text]
3. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-43 [PubMed]
4. Rodgers S, Avery AJ, Meechan D, et al. Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs. Br J Gen Pract. 1999;49(446):717-20 [PubMed] [Full text]
5. Schumock GT, Butler MG, Meek PD, Vermeulen LC, Arondekar BV, Bauman JL. Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy. 2003;23(1):113-32 [PubMed]
6. Canadian Pharmacists Association. Pharmacists and primary health care. 2004 [cited 2008 22 April]. Available from: http://www.pharmacists.ca/content/about_cpha/whats_happening/cpha_in_action/pdf/primaryhealth2a.pdf
7. Barber ND, Batty R, Ridout DA. Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom. Am J Health Syst Pharm. 1997;54(4):397-405 [PubMed]
8. Hughes CM, McCann S. Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment. Br J Gen Pract. 2003;53(493):600-6 [PubMed] [Full text]
9. Blenkinsopp A, Jepson M, Drury M. Using a notification card to improve communication between community pharmacists and general practitioners. Br J Gen Pract. 1991;41(344):116-8 [PubMed] [Full text]
10. Ritchey FJ, Raney MR, Keith TD. Physicians' opinions of expanded clinical pharmacy services. Am J Public Health. 1983;73(1):96-101[PubMed] [Full text]
11. Harding G, Taylor KM. Professional relationships between general practitioners and pharmacists in health centres. Br J Gen Pract. 1990;40(340):464-6 [PubMed] [Full text]
12. Ranelli PL, Biss J. Physicians' perceptions of communication with and responsibilities of pharmacists. J Am Pharm Assoc (Wash). 2000;40(5):625-30 [PubMed]
13. Pharmaceutical Service Division. Poison act 1952. 2004 [cited 2008 20 April]. Available from: http://www.pharmacy.gov.my/html/legislations/Poison%20act%201952.pdf
14. Pharmaceutical Service Division. Annual report 2006: pharmaceutical services program. 2006 [cited 2008 20 April]. Available from: http://202.144.202.76/pharmacy_portal/view_file.cfm?fileid=122
15. Hong CM, Chuang VTG. The opinion and knowledge of Malaysian public towards dispensing separation.  6th Malaysian Pharmacy Scientific Conference; 22-23 September 2006, Selangor. p. 26
16. Adepu R, Nagavi BG. General practitioners’ perceptions about the extended roles of the community pharmacists in the State of Karnataka: A study. Indian Journal of Pharmaceutical Sciences. 2006;68:36-40 [Full text]
17. International Pharmaceutical Federation. Standards for quality of pharmacy services. 1997 [cited 2008 22 April]. Available from: http://www.fip.org/files/fip/Statements/latest/Dossier%20004%20total.PDF
18. Awad A, Matowe L, Capps P. Medical doctors' perceptions and expectations of the role of hospital pharmacists in Sudan. Pharm World Sci. 2007;29(5):557-64 [PubMed]
19. Wledenmayer K, Summers RS, Mackle CA, et al. Developing pharmacy practice - a focus on patient care. Geneva: World Health Organization; 2006 [Full text]
20. Smith WE, Ray MD, Shannon DM. Physicians' expectations of pharmacists. Am J Health Syst Pharm. 2002;59(1):50-7      [PubMed]
21. Spencer JA, Edwards C. Pharmacy beyond the dispensary: general practitioners' views. BMJ. 1992;304(6843):1670-2      [PubMed] [Full text]
22. Haig GM, Kiser LA. Effect of pharmacist participation on a medical team on costs, charges, and length of stay. Am J Hosp  Pharm. 1991;48(7):1457-62 [PubMed]
23. Beswick T, Elliott DN. Doctors and pharmacists-working together. Br J Gen Pract. 1991;41(347):259 [PubMed] [Full text]
24. Drury M. Doctors and pharmacists-working together. Br J Gen Pract. 1991;41(344):91 [PubMed] [Full text] Muijrers PE, Knottnerus JA, Sijbrandij J, et al. Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist. Pharm World Sci. 2003;25(5):235-41 [PubMed]