Pharmacy Practice in Malaysia

Pharmacy Practice in Malaysia

Mr. Ng Yen Ping

B. Pharm (Hons), M.Sc (Clin. Pharm), (PhD)

Board Certified Pharmacotherapy Specialist (BCPS), Ambulatory Care Pharmacy Specialist (BCACP) and Certified Clinical Cardiology Pharmacist

In the past decade, new roles for the pharmacists have emerged. Numbers of registered pharmacists in Malaysia has increased dramatically, from a barely of 148 new pharmacists registered with the board of pharmacy Malaysia in 1996 to currently approximately 780 new pharmacists registered per year.  With this expansion rate, Malaysia will achieve the WHO pharmacy to population ratio of 1:2000 by 2016!

Hence, the roles of pharmacists have undergone a tremendous changes  in order to cater for the growing numbers of Pharmacists. Pharmacists in Malaysia are placed in increasing responsible positions within the healthcare delivery system.  Pharmacists in Malaysia are now moving out from “behind the counter” to the “front line” providing direct patient care. In other words, the roles of pharmacists has transitioned from focusing on non-clinical roles such as extemporaneous preparation, stocks inventories, dispensing, laboratory based, and regulatory affairs to a more clinical roles oriented.

The clinical roles of pharmacists had expanded from therapeutic drug monitoring, cytotoxic drug reconstitution, total parenteral nutrition and admixtures, and drug information services that were available decades ago to specialization of clinical pharmacy services, and nuclear pharmacy services for in-patient pharmacy. Pharmacy ambulatory care services had introduced medication therapy adherence clinics (MTAC), Methadone clinics, quit smoking clinics, as well as drive through pharmacy services. Not leaving behind the research pharmacists in all the clinical research centers throughout Malaysia.  This scenario has leaded the schools of pharmacy in Malaysia made substantial curriculum changes to prepare their graduates for these responsibilities.

To date, almost every ward (particularly internal medicine, cardiology, nephrology, critical care, infectious disease, surgical, and pediatric) in the public hospitals in Malaysia is filled with a ward or clinical pharmacist in assisting physicians to prescribe rationally. The ward pharmacists or clinical pharmacist will be the right person to perform the “check and balance” of the healthcare system and this service is highly appreciated by our counterpart members, the doctors, nurses and allied health personnel in the wards. The main responsibilities of the ward or clinical pharmacists are to assure the right drug is ordered for the right patient at the right time, in the right amount and right route and with due consideration of costs and that the patient knows how, when, and why to use both prescription and non-prescription products. They will serve as the source of information pertaining to the drugs for doctors and staff nurses as well as aid in optimizing drug therapy.

Till December 2014, there are a total 51 American Pharmacists Association, Board certified pharmacy specialists in Malaysia. This credential has been established in January 1973 by American Pharmacists Association and now is recognized throughout the world. We have the first batch of pharmacy specialist in year 2011 and now we are in the process to gazette these pharmacists as specialist in their respective fields. Currently, we have 41 pharmacotherapy specialists, six ambulatory pharmacy specialists, two oncology pharmacy specialists, and two psychiatric pharmacy specialists. These pharmacists will be providing more specialized services as according to their filed of specialty. They Manage and assist in more complex healthcare issues. It basically follows the below concept:

As Malaysia progresses from a developing to a new developed nation status by 2020, diseases associated with aging and urbanized lifestyle will be on the rise. The recent Malaysian National Health and Morbidity survey concurred with this gloom prediction. Common chronic diseases like hypertension, dyslipidemia, and diabetes for instances are at increasing trends. Collective failure to manage them optimally is a concern. For example, in the National Health and Morbidity Survey 3, only 26% of treated hypertensives were treated to target. Similar depressing findings of suboptimal management had been seen with other chronic diseases. Medication non compliance is quickly pointed out as one of the possible reasons for this widespread phenomenon. In the era of moving from compliance to concordance and ultimately adherence, Medication Therapy Adherence Clinic (MTAC) was introduced in Malaysia in 2004 as one component of clinical pharmacists in ambulatory care. The objective of this service is to improve patient adherence to medications. This service also involves collaboration between pharmacists and the Medical Officer in providing pharmaceutical care to patients. MTAC performed by pharmacists to conduct therapy monitoring of medicines and provision of information to patients by improving patient understanding about pharmacotherapy treatment and provide motivation so that patients have a positive perception about the disease and treatment received. This service also involves clinical consultations, and alteration of the dose of some drugs such as insulin and warfarin. Among the types of MTAC offered are; Diabetes, Respiratory, Retroviral Disease (RVD), Heart Failure, Rheumatology etc. There are ample evidences to show that pharmacists intervention in the MTAC services greatly improved patients’ adherence and save the healthcare budget directly and indirectly. The MTAC programs are highly welcomed by physicians in Malaysia.

In the same year, 2004, Harm Reduction Working Group (HRGW) was established to advocate the implementation of harm reduction initiatives, consisting of Needle Syringe Exchange Program (NSEP), provision of condom and Methadone Maintenance Therapy (MMT). This is in conjunction to WHO report on the rising HIV cases in Malaysia. The methadone maintenance therapy program was launched in October 2005. This program was implemented at public hospitals, public health clinics, and private clinics. Pharmacists are also part of the members in this program. A pharmacist’s role in Methadone Maintenance Therapy is to optimize each individual’s drug therapy. In collaboration with the physicians, pharmacists will adjust in patient’s MMT and provide each patient’s dose of methadone in a safe, effective and timely manner. The MMT is done through direct observational therapy (DOT). Methadone pharmacist will hold the responsibilities of procurement, supply, storage, dispensing, counseling, documentation and recording.

Apart from the above mentioned services provided by Pharmacists in Malaysia, the most recent services provided is Quit smoking Program. This was launched in year 2010. Pharmacists from both public and private sectors are actively involved in this program. Pharmacists will need to take up the course and pass the exam before they can start providing the services. Those who had successfully attended the course and passed the exam will be accredited as certified smoking cessation service provider. The main role of pharmacists is to counsel patient on ways to quit, advice on nicotine replacement therapy as well as non-nicotine based therapy and discuss on the duration of treatment and their possible adverse effects. Most importantly is to assure patient adhere to the regimen in order to assure a total abstinence.

Overall, the pharmacy practice in Malaysia is following the footsteps of what is currently practiced in the developed countries. Although, the role of pharmacists in patient care has evolved over the years, in Malaysia, pharmacists are still often underused for their expertise and knowledge especially in private sector. There is still more rooms for expansion. Pharmacists in Malaysia are moving steadily towards transformation to provide better pharmaceutical care and improving healthcare status.