Akintunde Obembe, the newly elected chairman of the Lagos State Branch of Pharmaceutical Society of Nigeria (PSN) was the past editor ? in ? chief and social secretary of the association. He has also served at committee level of both state and national levels of both PSN and the Association of Community Pharmacists of Nigeria (ACPN). He spoke with BEN UKWUOMA on a wide range of contemporary health matters. Excerpts:
THE issue of who has a right to dispense antimicrobial drugs is a recurrent issue. What is the proper thing to do?
For the records, the Pharmacy Act stipulates in Part III Section 7 that ?no person shall mix, compound, prepare or dispense a drug or poison unless he is a dispenser or a chemist or being a missionary has received a permit in that behalf issued in accordance with the regulations made under this Act,?
This is corroborated in Sections 6.16.2(1) of National Drug Policy 2005 which states inter ? alia ?only duly licensed pharmacists shall have authority to supply, sell and dispense drugs to the public. Such sales shall take place in premises licensed for that purpose, which shall be subject to regular inspection.?
The National Drug Policy 2005 incidentally is a policy document initiated at the instance of the Federal Ministry of Health in partnership with the European Union, DFID and World Health Organisation. We are, therefore, convinced that the honourable minister, who is the official symbol of best practices in the Health Sector, will continue to champion global standards, which recognises pharmacists as the only experts on medications because of their peculiar mode of training on the totality of drug use including its synthesis, pharmacokinetics, side ? effects, Advance Drug Reactions and indeed other salient.
Media reports have quoted the minister as claiming that abuse of antimicrobials, because of uncontrolled access to drug stores especially Patent Medicine Vendor is a major problem. He also lamented wrong medication and non ? compliance of appropriate dosage regimens as part of the problem. The veracity of these submissions is immutable.
We, however, urge the Federal Ministry of Health to exercise stricter control on the Federal Task Force domiciled in NAFDAC and the Pharmacists Council of Nigeria to intensify efforts geared at making these enforcement bodies to seal the plethora of unregistered drug premises in accordance with relevant statutes because they add a significant dimension to the unfortunate challenges. It is noteworthy that the minister acknowledged that hospitals contribute to the problem of antimicrobial resistance through hospital-acquired resistance to drug.
It is a statement of fact that private hospitals that do not engage pharmacists, yet stock drugs, which are handed over to the public by quack dispensing assistants and auxiliary nurses with no counseling do as much damage as the Patent Medicine Vendors.
Even in the public sector, we witnessed a bizarre phenomenon when Antiretroviral (ARV) drugs were strangely handed over for dispensing to a group of public sector doctors, who styled themselves ARV doctors.
The Pharmaceutical Society of Nigeria (Lagos State Branch) advises the Federal Ministry of Health that the only way drug use therapy can work is to tow global inclinations, which dictate separation of professional roles in the prescribing and dispensing of drugs.
Nigeria continues to cause serious problems for the rest of the world because of the easy access to all cadres of drugs, as well as, unprofessional dispensing techniques. Huge sums devoted to Research and Development of drugs will continue to amount to a waste, if the Federal Government through Federal Ministry of Health does not re ? strategise to achieve sanity holistically in the health sector.
We are calling for an antibiotic policy that places emphasis on appropriate prescribing and dispensing of drugs in Nigeria. This policy if well implemented, has a tendency to reduce glaring abuses in the use of anti ? microbials in Nigeria.
It appears so much is happening in pharmacy practice as it affects PSN and Pharmacists Council of Nigeria, (PCN) relationship. What is the way forward?
Ordinarily, I would have preferred to forward my impressions and the PSN (Lagos State Branch) perspective directly to the Federal Government, but since the enquiry is about the way forward, I will posit that parties in this impasse must think more of the future of pharmacy practice.
The genesis of this crisis was unlawful appointment of representatives of Pharmaceutical Society of Nigeria (PSN) on the Board of the Pharmacists Council of Nigeria (PCN). Even when the principal officers of the Pharmacists Council of Nigeria have attempted to defend themselves, the perception sticks that they influenced this unwieldy event.
The dimensions of this crisis is widening as the Registrar of PCN has refused to sign and issue licenses to pharmacists and companies in 2011 on grounds that they have not participated in MCPD. I will advise the Registrar and other PCN members to immediately proceed and issue these licenses.
I won?t dwell on only legal principles in advocating this, it is a fact that the Annual General Meeting (AGM) of PSN can annul directives of PCN, which is the plank invoked by PSN to annul the directive of PCN on the MCPD participation. There is also a valid court order from the Federal High Court, Lafia that bars the Pharmacists Council of Nigeria from using the MCPD as a condition precedent in the recertification of pharmacists.
Specifically, the court order declared that once a pharmacist pays the annual prescribed fees in a given year, he is entitled to his licence. These legal positions take precedence in any decorous order. I am admonishing the Registrar that it is difficult to win a war against your own ?constituency? especially when they stand on their perceived rights.
The Federal Government through the Federal Ministry of Health must follow dictates of due process to solve this imbroglio now. For reasons of commonsense, the Pharmacists Council of Nigeria must stop the MCPD, which it has held for 10 years. The court order, which bars linkage of MCPD to recertification, must be upheld.
I appeal to the Federal Ministry of Health not to allow this situation in pharmacy to deteriorate to violence and new wave of litigations being threatened by younger pharmacists. I hope somebody in government is listening.
The National Health Insurance Scheme (NHIS) approach to managed care is not acceptable to the PSN. How do you reconcile the issues?
For many years, the PSN and its affiliate groups have identified designation of 20 and 30 care centre as points to pay capitation fees as a major flaw. In the ideal, Only primary care centres should qualify for capitation payments. The other revolves around NHIS?s choice of Global Capitation as payment mechanism in the scheme.
I have always evaluated the response of the NHIS through its Executive Secretary, Dr. Dogo Mohammed, a medical doctor.
Mohammed hides under the platform of easy access to care facility to argue that 20 and 30 care facilities must be capitated. He believes that patients (enrollees) will not like a situation where they visit a doctor in one location and move several kilometres away to fill prescription in pharmacies.
His postulation is that enrolees love One?Stop facilities, which are facilities that have all care ? providers under one roof. The one ? stop facilities would have been the ideal, but they are not replicated in our healthcare setting today.
The fundamental principle to note, however, is that there are statutory positions that govern health services in Nigeria. There are also norms, health policies and drug policies to abide with. Section 7 of Part III of the Pharmacy Act is very unambiguous that only pharmacists must sell, supply and dispense drugs in registered premises to clients.
Section 16.6(I) of the National Drug Policy 2005 also amplifies this when it declares that only duly licensed pharmacists shall dispense drugs in registered outlets renewable by the Pharmacists Council of Nigeria.
It is tragic that Mohammed and his management team have unilaterally changed these statutes under the guise of easy access to facilities probably because they ?love? enrollees more than the rest of us.
For the records, the issue of convenience or access to facilities cannot be tied to emergencies like the NHIS wants us to believe because most clients are out ? patients who can sometimes fill their prescriptions at their convenience.
Is it proper to allow pharmacists to participate in ward rounds?
It is a statement of fact that Pharmacy and Medicine are two distinct professions, which from all intents and purposes guarantees clear job descriptions.
Globally, it is the recognised duty of pharmacists, who are medication experts to dispense drugs in any credible drug supply system, while doctors are saddled with the responsibility of diagnosing disease states and prescribing drugs for client.
Professionalism is geared towards separation of roles and it is therefore very logical to imply that a pharmacist on ward rounds cannot venture into diagnosis or prescribing drugs for patients.
Pharmacists are one of the most accessible healthcare professionals and more fully utilising their clinical training will extend care. Pharmacists have particular expertise in the use of medicines. The clinically focused pharmacist curriculum typically has far more medication focused education hours than other healthcare professionals.
This expertise and skill make pharmacists contribution to the healthcare team important to both optimises therapy and to prevent medication related problems. No other professional in healthcare has the understanding and expertise across the full range of medicines available, including the various formulations and products, as the pharmacist. Pharmacists also reinforce preventive heath measures and medication adherence.
In instances where a doctor is not convinced about the quality of advice he gets, he is certainly not bound to accept the advice from the pharmacists. The relevant issue remains that pharmacists services and involvement in patient-centered care have been associated with improved health and economic outcomes, a reduction in medicine- related adverse events, improved quality of life, and reduced morbidity and mortality.
These accomplishments of pharmacists have been achieved through gradual expansion of traditional roles and, in some case through the emergence of collaborative drug therapy management programmes.
Healthcare practice cannot continue to be inclined on a peculiar Nigerian style, as healthcare practice is a global phenomenon, which practitioners must as of a need embrace.
In the developed world, it is a compulsory dimension to see pharmacists as part of a team of health workers on ward rounds actively seeking to optimise outcomes from drug therapy. The value pharmacists offer on such rounds revolves around medication use review, which boosts optimal therapeutic outcomes.
Even in Nigeria, the University College Hospital, Ibadan now has pharmacies in all wards, which compels pharmacists to oversee dispensing responsibilities. Pharmacists participate in ward rounds at University College Hospital, Ibadan, National Orthopaedic Hospital, Igbobi, and other serious health institutions. Pharmacists are very much appreciated today by doctors and other stakeholders in these health institutions.
It has become fashionable to inculcate Unit Dose Dispensing System (UDDS) as a compulsory component of the hospital system. The UDDS guarantees a pharmacist ? patient discourse, which obviously allows an interphase that boosts professionalism in the best interest of patients as they have unfettered access to the expertise of pharmacists, who dispense drugs directly to patients in hospital wards.
The benefits of this, is that a patient has insight into his drug regimen, potential side-effects and adverse drug reactions as well as other details like drug-drug interactions, food ? drug interactions and drug-disease interactions.
On the basis of the above you are just likely to meet a pharmacist in the wards like the dispensary pharmacist in hospitals accompany doctors when seeing patients and support the clinical team by offering advice on medication as it relates ADRS, Pharmacokinetics and other parameters.
Pharmacists work in close range with other health professionals on wide spectrum health matters. Pharmacist are in an ideal position in this era of Pharmaceutical care to excel because, Pharmaceutical Care involves taking direct responsibility for patients and their disease states, medications and the management of each in order to improve the outcome for each individual patient. The advantages of pharmaceutical care include: -
? Decreased medication errors
? Increased Patient compliance in medication regime
? Better chronic disease state management
? Strong pharmacist?patient relationship
? Decreased long-term costs of medical care
This escalating complexity of care is demanding of a multidisciplinary approach, incorporating the expertise of the various disciplines to optimise patient outcome. This is particularly true as the range of treatments expands and diseases and procedures that were once reserved for exceptional cases (such as heart transplants) are now becoming routine.
Pharmacists, as medication experts must be encouraged to provide assistance and leadership in managing the patients? medicines therapy regimens.
Many factors in the healthcare landscape lend support for the expanded services of pharmacists in many countries. Nigeria cannot afford to be an exception, thus compelling a need for all stakeholders to respond positively to these emerging challenges and concepts.
No comments:
Post a Comment