CURRENT TRENDS OF PHARMACY EDUCATION AND TRAININGS IN ASIA: PROPER TRANSFORMATION OR NOT?

Transcription

1 CURRENT TRENDS OF PHARMACY EDUCATION AND TRAININGS IN ASIA: PROPER TRANSFORMATION OR NOT? CHEUNG Hon-Yeung BPharm, PhD Department of Biomedical Sciences, City University of Hong Kong 1

2 CONTENT A. Background 1. Self-care and Self-medication Raise Concern about Safety use of Drugs (Primary Patient-care). Predication of Future Career Trend and Projection of Manpower for Pharmacist 3. Proposed New Educational Framework and Reactions from Pharmacy Profession 4. Evolution of Pharm D Education in US B. Impact of Pharm D Program on the Latest Pharmacy Education in Asia 1. Wind of Healthcare Reform Spread Globally. Recommendations for New Curriculum of Pharmaceutical Education by WHO 3. Comparison of Old and New Curriculum C. Criteria of a Successful and Competent Profession 1. Healthcare Systems has Significant Impact on Budget Allocation. Public Perception of Pharmacist Determines the Purposes of Pharmacy Education and Training 3. Distribution of Workloads and Workforces is a Key Factor 4. Academic and Research Achievements of Pharmacy School Affect Resources for Training D. Conclusion

3 BACKGROUND A1. SELF-CARE & SELF-MEDICATION RAISE SAFETY CONCERN Increasing right and autonomy of patients for some medical treatments Tu le of physi ia s pater alis? Increasing demands of medical needs by the aging population Downturn of economy in most advance countries Self-care and self- edi atio attra t a y health are poli y akers i terest: 1. Effectively reduce the burden on health services. Improve compliance and disease outcome [Ref: WHO (011) Global status report on non-communicable disease 010] Promotion of these ideas fuelled critical examination of how health professional should be involved, educated and trained, what they should learn and how they learn. [Ref: WHO (1994), Ninth General Programme of Work, p.-14, Geneva] 3 Primary-Patient-Care also become an acceptable practice in many situations

4 AA. PREDICTION OF FUTURE CAREER TREND FOR PHARMACIST IN WESTERN SOCIETIES A decrease number of the primary care physicians An increase number of patients need treatment, in particular, aged people From dispensing-centric function to service-centric function (more patient care) Medication Therapy Management (MTM) reveals Pharmacists can get involved in medication in the following ways: Attending Patient-Care teaching & Conference Recording patient drug history on admission Monitoring drug-drug interactions Providing drug-related questions for physicians and nurses 4 Providing drug therapy counselling Implementing pharmacokinetic services Ref: Phar a Ma po er Proje t s 009 Natio al Phar a ist Workfor e ur e

5 AB. PHARMACY MANPOWER PROJECTION (PHARMACY WORKFORCE CENTRE, 001) Action-oriented consultations of experts in pharmaceutical education and pharmacy practice were convened several times in the 90s. [Ref: WHO consultative group on the role of the pharmacist: preparing the future pharmacist: Curricular Development, Vancouver, Canada 7-9 Aug. 1997] Some extended roles of pharmacist in health care services were considered based on: 1. Concern for medication safety from accurate dispensing to prescribing, patient monitoring and education. Involvement in intensive care and general medical wards to reduce preventable adverse drug effects 3. Patient-care offers pharmacists more opportunities to become integral members of the health care team Because of the long-standing shortage and demographic imbalance of pharmacists in the US, it was also projected a shortage of 17,000 pharmacists by 00

6 A3A. REACTIONS OF PHARMACY PROFESSION American Association of College of Pharmacy (AACP) initiated to draft a position paper and commissioned to implement change in pharmaceutical education [AACP News, Special Report, 1991 and 1997] APA pro lai ed that A pharmacist holds the health and safety of patie ts He should re der to ea h patie t the full easure of his ability as an essential health practitioner [APhA Code of Ethics] Pharmacy profession thinks that they have a mission to serve society through practices of dispensing, provision of pharmaceutical care and offer advices on rational use of drugs 6

7 FUTURE PRACTICE MODEL FOR PHARMACISTS (1)Interdisciplinary-team-based practice: pharmacists play a leading role with providing pharmaceutical care ()Computerize-base operation: a safer and more efficient environment; medication preparation and dispensing will be centralized and automated (3)Licensed technicians will take more roles in the health care system (4)Increased definition of standardization of pharmacy direct patient care and medication therapy service. All patients will receive organized and systemic care ()Patient will receive comprehensive, multi-disciplinary, accessible and transferable pharmacotherapy plans; pharmacist will take the primary responsibility (6)Collaborative care gives pharmacists the right to initiate, modify and discontinue drug therapy based on protocols developed with their physician partners (7)Certificate specialized pharmacists: the title of Clinical Pharmacist will be acceptable by people and certified in hospital. Ref: Abramowitz PW (009). Theevolution and metamorphosis of the pharmacy practice model. Harvey A.K. Whitney. Am J Health Syst Pharm. 66:1437 7

8 A3B. PROPOSED NEW EDUCATIONAL FRAMEWORK To meet the healthcare need, the following two working objectives were listed among the others for pharmacists: a. To contribute to the formulation of global strategies for implementing resolution WHA47.1 on the role of the pharmacist. b. To develop technical guidelines for introducing, implementing and evaluating change in pharmaceutical education consistent with resolution WHA47.1 To cope with the needs and changes, Center for the Advancement of Pharmacy Education (CAPE) recommended to implement changes in Pharmaceutical Education in 3 aspects: 1. Pharmaceutical Care. Systems Management, and 3. Public Health 8

9 CURRICULUM AND INTERNSHIP FOR PHARM D OF THE STATES Domain Courses Pre-Pharmacy Courses (at least yr of study ) Basic Science Credits 1 Pharmaceutical Science Pharmacy calculation, Biochemistry, anatomy, pharmaceutics, pharmacokinetics, pharmacodynamics, drug information 3 Clinical Pharmacy Pharmaceutical care, patient-care teaching, patient drug history documentary, drug-drug interactions, drug-related survey and investigation, drug therapy counseling, pharmacotherapy Community Pharmacy Practice Experience 10 hr Hospital Pharmacy Practice Experience 40 hr Advanced Pharmacy Practice Experience 9 mo 1 yr To complete a Pharm D education, it takes at least 6 yr to complete, including 1 yr of clinical practice experience 9

10 A4A. ECOLOGY OF PHARMACY EDUCATION AND TRAININGS IN THE LAST THREE DECADES IN US Conclusion: The ratio of PharmD graduates to traditionally trained Pharmacists, is consistantly around 0%, remained almost unchanged throughout the last years indicating that besides the PharmD program, previously existing programs were expanded very fast too. Consequently, job opportunity as reflected by the aggregate demand index (ADI) gradually drops. Source: (1) AACP, July 014; () Brown DL, Am J Pharm Edu,013, 77:90. Note: figure in parentheses is the number of PharmD holders 10

11 A4B. EVOLUTION AND MILESTONE OF PHARM D EDUCATION IN US yr pharmacy program introduced College in California (UCSF) introduced a 6-yr Doctor of Pharmacy program Ninth Floor Project 1st Clinical Pharmacy Practice New version of APhA Code of Ethics for pharmacist announced Massive patient died (140,000 people) and 1 million were hospitalized from adverse drug events Millis Co issio reported that pharmacy education should emphasize not only clinical pharmacy but also social and behavioral pharmacy, There is a e essit of phar a ist s i ter e tio to e sure the effectiveness of pharmacotherapy ACPE issued notice of intent to develop new accreditation standards for the Pharm D program Method to implement pharmaceutical care in community and hospital setting was highlighted in Good Pharmacy Practice in Community & Hospital Pharmacy Settings the Standard of pharmacy service adopted by International Pharmaceutical Federation (FIP) WHO produced a document regarding the role of pharmacist WHO revised Drug Strategy Resolutions (WHA47.1) to reinforce the importance of pharmacists in the healthcare system All colleges of pharmacy started a 6-yr Doctor of Pharmacy FIP i o ju tio ith WHO updated a e ersio of Good Pharmacy Practice The role of the profession will be: (1) prepare, obtain, store, secure, distribute, administer, dispense and dispose 11of medical products; () provide effective drug therapy management; (3) maintain and improve professional performance; and (4) contribute to improve effectiveness of the health-care system and public health.

12 B1. RECOMMENDATIONS FOR REVISION OF PHARMACEUTICAL EDUCATION IN DEVELOPING COUNTRIES After consultation, the WHO concluded that a planning framework is necessary. It can play as a guide to facilitate schools/faculties of pharmacy for curricular revision in most developing countries. The proposed framework covers: Endorse effective use of existing resources; i.e. Recommendations of the WHO information consultation on the revision of undergraduate curricula should receive special attention by all countries. Define the role of contemporary and future pharmacists to possess eve - tar, which is care-giver, decision-maker, communicator, leader, manager, life-long learner, teacher. Revise the curriculum for training a pharmacist as the contemporary role of the pharmacist, plus his or her anticipated future role is a major derivative of the curriculum. 1

13 B3. COMPARISON OF PHARMACY CURRICULUM Number of Curriculum Credits by Different Countries Categories USA(UC) Japan Korea Taiwan Hong Kong Thailand India Pakistan Australia Basic Biomedical Sciences* Professional Trainings** Behavioral Social & Administrative Trainings# Advanced Pharmacy Practice in Hospital Professional Experiences Other Elective Subjects@ Total Credit for Graduation Includes anatomy, physiology, microbiology, biochemistry, immunology, organic chemistry, molecular biology, pathology, phytochemistry, medical genetics ** includes pharmacology, pharmacognosy, dispensing, pharmaceutics, medical chemistry, toxicology, pharmacokinetics, radiopharmaceutics, pharmaceutical microbiolgy # includes pharmacy ethics, law, biomedical statistics, pharmacy communication skill, pharmacoeconomics, epidemiology, 13 research design, pharmacy practics includes liberal art subjects, languages and communication skills

14 B1B. PHARMACY EDUCATION & PRACTICES IN ASIAN COUNTRIES Country Ph Sch Degree & Entry Level for Licence No. Regt Pharm % of Practice in Different Pharmaceutical Sectors Com Hsp/Cln Ind Sal Rgl Acd PbH Oth SPD USA (Cal) 14 PharmD [6] Y Japan 74 BPharm [6] 77, Y Korea 9 BPharm [+4] 40, China 77 BS [4 (+3)] 300,000 (1.4) 1 4(4.3) (10) (4.) Taiwan 8 BPharm[4(+0.4)],PharmD [6], o Y Hong Kong BPharm [4 (+1)], N Thailand 6 BS [], PharmD [6(+1)], India 44(84) BPharm 1,000, Pakistan 10 PharmD [] Singapore 1 BPharm [4(+1)] N Malaysia 13 BPharm [4(+1)] N Indonesia 63 BSc [4(+1)],PharmD [] 3, Aus + NZ 14+ BPharm[4(+1)] 7, Y Y Y N N

15 PHARMACY EDUCATION OVERVIEW IN ASIA 1. Length of pharmacy program differs from country-to-country, but increases beyond four year. Depending on individual country, pharmacy training and education have different emphasis 3. Great deal of similarity in content of professional trainings amongst Asian countries 4. Clinical pharmacy has become an important component of pharmacy education. Graduation destination differ from country-to-country, among community, hospital and industrial pharmacy 6. Training of the latest biotechnological technologies, biopharmaceutical knowledge are inadequate 7. With exception of Japan, Korea and may be Taiwan, resources for R&D in drug discovery and activity, in general, are small and insufficient 1

16 Number of Hospital and Clinic in Taiwan from 1979 to 009 Number of Community Pharmacist in Taiwan from 1993 to 006 hospital NUMBER OF HOSPITALS NUMBER OF CLINIC 0000 NUMBER OF COMMUNITY ASST. PHARMACIST clinic Asst Pharm 8000 Pharm NUMBER OF COMMUNITY PHARMACIST YEAR YEAR Year Community Pharm Hospital Pharm Private Clinic Pharm Other Pharm Total # of Pharmacist (.3%) 187 (30%) 3844 (.6%) 488 (6.97%) (100%) (.8%) 70 (8%) 476 (3.3%) 0 (.7%) 0416 (100%) 16

17 C. CRITERIA FOR A SUCCESSFUL AND COMPETENT PROFESSION 1. Healthcare Systems has Significant Impact on Budget Allocation; a legitimate legal status is critical. Public Perception of Pharmacist Determines the Purposes of Pharmacy Education and Training 3. Cooperation from physician is important. Distribution of Workloads and Workforces is a Key Factor 4. Academic and Research Achievements of Pharmacy School Affect Resources for Training. Meet the local needs and conditions 6. Adequate trainings and good education for students competency 7. Strong scientific supports from academic Continue R&D 17

18 C1. PUBLIC PERCEPTION OF A PHARMACIST S ROLES IN HEALTHCARE Public Perception of a Pharmacist in a recent survey in Hong Kong reveals that less than half of people agreed to use a pharmacist-led approach in self-care. [Ref: You et al (010) BMC Clin Pharm.,11:19] A phar a ist is a perso li e sed to e gage i a phar a, hi h is the art, pra ti e, or profession of preparing, preserving compounding, and dispensing medical drugs [Merrian-Webeter Dictionary] A perso hose jo is to prepare medicines and sell or give them to the public in a shop/store or i a hospital [O ford Ad a ed Lear er s Di tio ar ] 18

19 D. CONCLUSION Mission of Pharmacy Profession: To provide the needs of the society in various pharmaceutical care, including community, hospitals, manufacturing, managed health care and education, regulatory, drug discovery and research Good Pharmacy Practice requires good pharmacy and pharmaceutical care trainings Depending on regional social and economic strength, Pharmacy education may be different. Because of many Changes in healthcare industry and policy, on top of traditional roles, current trend of pharmacy practices will also cover places more emphasis on health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Because changes are so huge and to cope with the need, pharmacy education should be harmonized at the prepharmacy trainings and on top of this foundation, provide specialized trainings at postgraduate level; i.e. the 4+ or 3 year model instead of copying the American model REVISED ROLES OF A PHARMACIST ACCORDING TO FIP S LATEST REPORT: (1) prepare, obtain, store, secure, distribute, administer, dispense and dispose of medical product; () provide effective drug therapy management; (3) maintain and improve professional performance; and 19 (4) contribute to improve effectiveness of the health-care system and public health [Ref: International Pharmaceutical Federation (FIP): Good Pharmacy Practice, 011]

20 A MODEL SOUND GOOD IN ONE PLACE MAY NOT BE SUITABLE FOR ANOTHER PLACE Let always view globally but do thing locally After all, the most important thing for a Pharmacy Profession is to become a competent expert in pharmaceuticals before we can ask for more responsibilities. 0

21 THANK YOU FOR YOUR ATTENTION 1