Public Opinion On Dispensing Doctors In MalaysiaCorrespondence Address :
Dr. Mohamed Azmi Ahmad Hassali,(Ph.D.)Discipline of Social and
School of Pharmaceutical Sciences,
Universiti Sains Malaysia, 11800Minden, Penang, Malaysia. Tel:
+604-6534085, Fax: +604-6570017.
The pharmacy profession has undergone tremendous changes especially in the last four decades. Within this context, the current pharmacy practice is becoming more patient-oriented and has opened an avenue for pharmacists to engage in a more prominent role as healthcare providers in the healthcare system (1). The modern pharmacists consider pharmaceutical care as the focus of their practice (2). Moreover, throughout the period from the ancient apothecary system to the modern era of pharmaceutical care, dispensing was considered as the core responsibility of a pharmacist (3). This enabled the pharmacists to establish direct contact with patients and thus, to provide valuable patient care services that included patient counseling, adverse drug reaction (ADR) monitoring and reporting, among others.
Malaysia is a developing country in South East Asia, which still follows a traditional â€˜dispensing doctorsâ€™ system. Doctors in Malaysia still dispense medications as a part of their professional practice. There is still no separation of functions related to drug dispensing and prescribing between doctorsâ€™ clinics and pharmacies. Registered pharmacists are not the only professionals with the legal right and responsibility of dispensing medications.
The perception of the general public towards this practice in Malaysia is not known. Hence, we conducted a survey with the primary objective of studying the perception of the general public towards the dispensing doctorsâ€™ practice. This study was a cross-sectional survey using a questionnaire. The survey instrument consisted of three parts: the demographic profile of the respondents, three items to explore the perception towards dispensing separation and 19 items related to the publicâ€™s perception about dispensing doctors in Malaysia. The survey was carried out from August 4 to August 15, 2008 in the State of Penang.
Of the 1000 respondents who participated in the study, 578 (57.8%) were male. Three hundred and six (30.6%) of the respondents were aged less than 20 years, 464 (46.4%) were in the age group 20-29, 187 (18.7%) were in the age group of 30-39 years, 38 (3.8%) were in the age group of 40-49 years, and 5 (0.5%) were more than 49 years old. Of the total respondents, 37 (3.7%) had primary education, 365 (36.5%) had secondary education and the remaining 598 (59.8%) had a tertiary-level education. Furthermore, 374 (37.4%) of the respondents had visited at least one general practitioner (GP) in the past 2 months and 339 (33.9%) had visited a community pharmacist at least once in order to get some health-related advice or to purchase medicines, health devices or health supplements.
Only 268 (26.8%) of the respondents had answered â€˜yesâ€™ to the question â€˜do you agree with the implementation of dispensing separation in Penang?â€™, while the remaining 732 (73.2%) of them answered â€˜noâ€™. Interestingly, 616 respondents (61.6%) had the willingness to get medications prescribed by their doctor, from a pharmacy. Similarly, 54.3% of the respondents thought that a pharmacist is more reliable than a doctor in explaining the uses and side effects of medicines and drugs.
The detailed responses of the public towards dispensing doctors are listed in (Table/Fig 1).
Overall, it was seen that the public liked the concept of â€˜dispensing doctorsâ€™ in Malaysia. This might be because of their convenience.
Note: SA = strongly agree; A G= agree; DS = disagree; and SD=strongly disagree.
Considering the importance of the pharmacistâ€™s role in the healthcare system, few countries in this region such as Korea (4) and Taiwan (5) have made attempts to separate dispensing from prescribing. The act of dispensing by doctors provides easy access to medicines and convenience to the patients. However, in case of minor and self-limiting ailments, it is bothersome for the patients to pay the consultation charges to the doctors, as well as pay for medications. A study reported that the dispensing doctors make a huge markup in the prices of medicines (upto 50% - 76%) for innovator brands and 316% for generics (6).
Currently, hot debates are going on in Malaysia between the government, pharmacists and doctors regarding dispensing doctors and the implementation of dispensing separation (7),(8). Unfortunately, doctors seem reluctant to loose this right of â€˜dispensingâ€™. The National Medicines Policy of Malaysia states that medical and dental practitioners are allowed to dispense medications, but to improve the quality of the use of medicines in the future, the prescribing and dispensing must be separated. It also mentions that the pharmacists have a central role in dispensing medications and counseling patients on their use (9).
In the era of â€˜responsible self medicationâ€™ by pharmacists (10), this can be a blow to the patients. In conclusion, we do not know whether this is a failure of the professional pharmacy organizations or not, but it is definitely a failure for the practicing pharmacists.
The authors would like to acknowledge all the first year pharmacy students of the School of Pharmaceutical Sciences at the Universiti Sains Malaysia led by Mr Moo for helping the authors in conducting the survey.
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