The Significance of Community Pharmacies' Services Beyond Dispensing Separation

The debate on dispensing separation (DS) for community pharmacists in Malaysia has been ongoing for decades, giving rise to numerous arguments.¹ Despite the benefits of DS, which include optimizing patient safety, reducing medication errors, and lowering medication costs, the implementation of this policy in our country remains unachievable, despite strong public support and evidence.^2,3

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In view of the evolving role of community pharmacists, who have transitioned from medication dispensing to providing patient care services, pharmacist practitioners in community-based settings are now capable of developing innovative pharmacy practices and offering patient care services as a step towards eliminating DS. Hence, Malaysian community pharmacists should explore alternative initiatives that hold more promise in enhancing health care quality and improving public health.

Community Pharmacist-led Medication Review

Community pharmacists are among the most accessible and trusted health care professionals due to their proximity to the community, which enables easy access to public health services. Contributed to their accessibility, community pharmacies are appropriate locations for pharmacists-led medication review, allowing for pharmaceutical care interventions, tackling poor medication management, addressing drug-related problems, monitoring and optimizing use of medication, and managing poor compliance with drug therapy and inappropriate drug selection.⁴

Community pharmacies are well-positioned to deliver medication review services, particularly in high-risk groups of patients who are taking high-risk medications such as warfarin, and those with asthma or chronic obstruction pulmonary disease and post-discharged patients. Medication reviews performed by community pharmacists can encompass prescription reviews, compliance assessments, concordance reviews, and clinical medication reviews.⁵

Post-Discharge Community Pharmacy-Based Medication Reconciliation and Adherence Review

After the hospital stay, patients are discharged home with new medications or changes to their pre-admission medication regimen. Some may transition to primary care or outpatient settings for ongoing treatment. This transition of care is a critical juncture where patients are vulnerable to medication-related issues, including medication discrepancies, non-adherence, and adverse drug events, which can lead to rehospitalization or even death.⁶

In Canada, these issues have been addressed by community pharmacists through a medication reconciliation and adherence review program known as MedsCheck.⁷ MedsCheck has reported a reduction in the risk of death and re-hospitalization among older adults after discharge.⁸

Specialized Care Services by Community Pharmacists

Community pharmacies have the potential to offer specialized health services beyond traditional dispensing and counseling activities, especially since they are easily accessible without the need for appointments or referrals. This makes them ideal for extended patient-centered care services, which are in high demand today.⁹

In addition to medication counseling and reconciliation, community pharmacies should prioritize specialized care services such as anticoagulation monitoring, diabetic and hypertensive care, asthma care, women's health initiatives, and minor ailment care when delivering patient-centered services to the community. Furthermore, community pharmacists can contribute to chronic disease management, including asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis, and palliative care.¹⁰ Evidence shows the effectiveness of pharmacist interventions in improving asthma control, reducing coronary heart disease (CHD) risk factors, lowering HbA1c levels, decreasing systolic blood pressure, enhancing antidepressant therapy adherence, and improving osteoporosis screening among elderly women.^11-16

References

1. Shafie AA, Hassali MA, Azhar S, See OG. Separation of prescribing and dispensing in Malaysia: a summary of arguments. Res Social Adm Pharm. 2012;8(3):258-262. doi:10.1016/j.sapharm.2011.06.002
2. Hassali, MA. Public Perceptions towards Implementation of Dispensing Separation: Results from a Cross Sectional Analysis. J Pharma Care Health Sys. 2015:02(04). doi:10.4172/2376-0419.1000143
3. Shafie AA, Hassali MA. Willingness to pay for a pharmacist's dispensing service: a cross-sectional pilot study in the state of Penang, Malaysia. Pharm Pract (Granada). 2010;8(2):116-121. doi:10.4321/s1886-36552010000200006
4. Krska J, Cromarty JA, Arris F, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30(3):205-211. doi:10.1093/ageing/30.3.205
5. Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74(4):573-580. doi:10.1111/j.1365-2125.2012.04331.x
6. Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565-571. doi:10.1001/archinte.166.5.565
7. Dolovich L, Consiglio G, MacKeigan L, et al. Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013. Can Pharm J (Ott). 2016;149(5):293-302. doi:10.1177/1715163516662670
8. Lapointe-Shaw L, Bell CM, Austin PC, et al. Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study. BMJ Qual Saf. 2020;29(1):41-51. doi:10.1136/bmjqs-2019-00954
9. Rasheed MK, Alqasoumi A, Hasan SS, Babar ZU. The community pharmacy practice change towards patient-centered care in Saudi Arabia: a qualitative perspective. J Pharm Policy Pract. 2020;13:59. doi:10.1186/s40545-020-00267-7
10. George PP, Molina JA, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management - a literature review. Ann Acad Med Singap. 2010;39(11):861-867.
11. Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25(2):144-153. doi:10.1093/pubmed/fdg030
12. Côté I, Grégoire JP, Moisan J, Chabot I, Lacroix G. A pharmacy-based health promotion programme in hypertension: cost-benefit analysis. Pharmacoeconomics. 2003;21(6):415-428. doi:10.2165/00019053-200321060-00005
13. Crockett J, Taylor S, Grabham A, Stanford P. Patient outcomes following an intervention involving community pharmacists in the management of depression. Aust J Rural Health. 2006;14(6):263-269. doi:10.1111/j.1440-1584.2006.00827.x
14. Elliott ME, Meek PD, Kanous NL, et al. Pharmacy-based bone mass measurement to assess osteoporosis risk. Ann Pharmacother. 2002;36(4):571-577. doi:10.1345/aph.1A299
15. Krass I, Armour CL, Mitchell B, et al. The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia. Diabet Med. 2007;24(6):677-683. doi:10.1111/j.1464-5491.2007.02143.x
16. Mangiapane S, Schulz M, Mühlig S, Ihle P, Schubert I, Waldmann HC. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother. 2005;39(11):1817-1822. doi:10.1345/aph.1G180