Conversations with Pharmacy Leaders in Hong Kong (2) – The Future of Pharmacy: Promoting the Roles of Pharmacists, Primary Healthcare and more

CHAN, Stephanie Nok-Yana; CHOW, Tiffany Hoi-Yeeb; CHONG, Donald Wing-Kitc*

a Tseung Kwan O Hospital, 2 Po Ning Lane, Hang Hau, New Territories, Hong Kong SAR, China

b Ruttonjee Hospital, 266 Queen’s Rd E, Wan Chai, Hong Kong SAR, China

c Haleon (GSK Consumer Healthcare Ltd.), 23/F, Tower 6, The Gateway, 9 Canton Road, Tsim Sha Tsui,

Kowloon, Hong Kong SAR, China (*Corresponding author)



Pharmacy Education & Practice
HKPharm J Volume 31 (1), Jan-Apr-2024 (2024-04-29): P.8-11

ABSTRACT

Mr. William Chui, the newly appointed Chief Pharmacist of the Hospital Authority, has always been actively promoting the role of pharmacists and advocating public education. With over 30 years of experience in the field of hospital pharmacy, during his term of office as the Pharmacy Department Manager of Queen Mary Hospital, he took the lead in reforming the profession and developing new clinical services. In this interview, William opens up on his view of the future of pharmacy, including primary healthcare, hospital pharmacy, and more.

When asked about his thoughts on the pharmacy profession, William summarized it into one simple sentence: to ensure that the general public understands the role and importance of a Pharmacist, and values the profession in the healthcare industry. To be exact, the societal value of the pharmacist is not just about dispensing medication, but providing people-centered pharmaceutical care and empowering patients, which can eventually improve therapeutic outcomes and quality of life.

 

Information is Power

William sees drug education and empowerment as a major role of pharmacists. In the past, the old mindset of healthcare professionals was to inform patients of their treatment regimen and hope that they believe the information shared. A territory-wide survey revealed that the majority of patients consulting practitioners are not aware that they participate in the decision of their drug treatment with their practitioners. In fact, patients were only passively following the assigned treatment regimen without a good understanding of their medication and the expected therapeutic outcome.

 

William believes “information is power.” In 2002, he worked with fellow members of the Society of Hospital Pharmacists of Hong Kong (SHPHK) to establish the Drug Education Resources Centre (DERC). Apart from drug information, DERC also provides disease-related and general health information to the general public, so that people can engage in their therapy and enhance self-management. Some people think that “self-management” is equivalent to purchasing medicines at pharmacies by themselves, but actually patient empowerment can achieve more. After knowing the signs and symptoms of minor ailments, people can take the initiative to modify their lifestyles and monitor disease progress. Also, by improving the drug knowledge of patients, they can ask appropriate questions during follow-ups and actively participate in the decision-making process with doctors. When patients are engaged in the therapy, they are more likely to adhere to their drug treatment. As a result, education can increase public health awareness and improve the safety and efficacy of treatment.

 

However, this poses the question: how can pharmacists efficiently and effectively share drug information with the whole society? At the moment, drug counseling and drug talks are the major way for pharmacists to empower patients. These channels only allow pharmacists to reach a limited amount of audience. William thinks that by utilizing the media, health information and knowledge can be delivered to a much wider audience.

   

 

For instance, during the COVID-19 outbreak, there was widespread information on the internet and media regarding vaccines. The general public may be confused regarding which vaccine to choose and whether an additional booster is necessary. During the pandemic, William quickly recognized and addressed public concerns by providing professional advice through media and press releases. For instance, William advocated the use of one-third of the adult dose of BioNTech in children and the importance of receiving a 3rd dose as a booster for longer protection from COVID-19. This experience proved that the media is a powerful tool to empower citizens to make informed decisions and promote the role of pharmacists.

 

Providing Pharmaceutical Care and Patient-Centered Services

In a hospital setting, doctors provide medical care, nurses provide nursing care, and pharmacists provide pharmaceutical care. Due to the nature of the healthcare system, a patient’s consultation time with doctors is often very short. The introduction of Ward and Ambulatory Pharmacy Services in the Hospital Authority can fill the gap. Currently, there are Ward Pharmacist Services to review patients’ medication profiles at admission and before discharge. There are also Ambulatory Pharmacist-led Clinics for stable patients with chronic diseases. During consultation, Clinical Pharmacists help review treatment outcomes, manage side effects of drug treatment, and assess patient adherence. After implementation, there is positive feedback from patients and doctors. Clinical Pharmacists can assist in identifying and solving drug-related problems, so doctors can focus more on diagnosis and disease monitoring, which enhances the quality of care in terms of safety, efficacy, and quality of life.

 

 

In addition, Telepharmacy is another successful clinical pharmacy service started during COVID-19. After receiving Tele-diagnosis by doctors, patients can receive pharmacist counseling via video conference. Patients are highly satisfied with Telepharmacy services as it saves traveling time and addresses patients’ drug-related problems promptly. The service is beneficial to patients with disability and carers as they can join the consultation easily. After the pandemic, patients can still arrange Telepharmacy services between doctor follow-ups, so pharmacists can check in and review a patient’s medication regimen and collaborate with doctors to make changes where necessary. For example, a Clinical Pharmacist can view laboratory results of a patient to understand his/her treatment effects and disease progress, check whether the patient is experiencing medication side effects, and offer advice on how to manage the side effects.

 

As the former Pharmacy Department Manager at Queen Mary Hospital, a teaching hospital, William felt the need to constantly develop and improve Clinical Pharmacy Services.

He proposed that Pharmacist-led Clinics can be extended to other clinical areas, such as a Drug Allergy Clinic. Clinical Pharmacists can gather necessary information and conduct a full drug allergy test to assess whether the patient has a true allergy to a specific drug. Currently, β-lactam antibiotics are widely used as the empirical treatment for infections, but β-lactams are also frequently associated with drug allergy. According to the Hong Kong Drug Allergy De-labelling Initiative, 1 in 50 people were documented to have β-lactam allergies. However, a large proportion of the recorded allergies were found to be inaccurate after a full drug allergy test. With incorrect allergy labeling, a patient’s antibiotic choices become limited, which can negatively impact therapeutic outcomes and patients’ health. In the proposed clinic, a Clinical Pharmacist would be able to perform drug allergy testing, assess the severity of the allergy, and log the allergy into the patient’s profile. Also, Clinical Pharmacists can work with physicians to determine whether a re-challenge is safe based on the allergy severity and oversee the whole re-challenge process. By updating allergy profiles and removing unnecessary allergy labels, patients are open to more treatment options, and thus ensure appropriate use of antibiotics.

 

With many of the pharmacy service initiatives mentioned by William, collaboration between healthcare professionals appears to be evident. In the case of the Allergy Clinic, Clinical Pharmacists would consult with the patients individually and collaborate with doctors when deciding whether a patient should rechallenge a certain medication. For Telepharmacy, Clinical Pharmacists can consult with patients in between follow-ups, which allows the Clinical Pharmacist to share expert drug advice with doctors, and work together to make changes to treatment regimens where necessary. Clinical Pharmacists can make use of their expertise to ensure safe medication use.

 

Future Direction of the Pharmacy Profession

William believes Primary Healthcare is the future direction for Hong Kong’s healthcare system and the pharmacy profession. In the model of care, primary healthcare acts as the first point of contact for the general public. Primary healthcare is responsible for public education, screening and prevention of diseases, and quick referrals to secondary care providers. Secondary care focuses more on problems that require more specialized clinical expertise (e.g. hospital care), whereas tertiary care involves the management of more complex disorders that require highly specialized treatment and expertise.

As a result, doctors and hospital pharmacists can focus on treating advanced complicated cases, while community pharmacists can be part of primary healthcare by empowering the general public and managing minor ailments. Holistic care starts with disease prevention. By promoting lifestyle modification and early screening, there is better disease prognosis and thus effectively reducing the healthcare burden, which benefits the general public, as well as all parties in the healthcare system.

 

Apart from primary healthcare, William believes that public-private partnerships or the “Co-Care” concept can be the future of Pharmacy. The public and private sectors should work together to share the healthcare burden. For example, stabilized patients from public hospitals could be transferred to Family Doctors for further management in the community. The same concept can be applied to pharmaceutical care. We should make better use of Community Pharmacists, who can act as “Family Pharmacists”. Given the increasing tobacco tax, smoking cessation programmes may become a major Community Pharmacist service. Another possible role is to be a Medication Review Pharmacist for old-aged home residents. Elderly often suffer from polypharmacy, leading to increased risk of medication incidents. Community Pharmacists can conduct regular visits and medication reviews to ensure safe drug use in residential care homes.

 

It is Just the Beginning

In the interview, William shared many possible directions for the development of Pharmaceutical Care, namely public-private collaboration and community pharmacy services. He hopes to expand pharmaceutical services in order to reach out to the general public and promote the roles of pharmacists.

As the newly appointed Chief Pharmacist of the Hospital Authority, William highlighted three areas as his top priorities: promoting the safe and judicious use of drugs, developing and expanding Clinical Pharmacy Services (Ward and Ambulatory Pharmacists), and strengthening collaboration between hospital pharmacies and primary healthcare providers to provide holistic care for Hong Kong people. He added, “It is just the beginning”.

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2024-04-29 於2024月04月25日

When asked about his thoughts on the pharmacy profession, William summarized it into one simple sentence: to ensure that the general public understands the role and importance of a Pharmacist, and values the profession in the healthcare industry. To be exact, the societal value of the pharmacist is not just about dispensing medication, but providing people-centered pharmaceutical care and empowering patients, which can eventually improve therapeutic outcomes and quality of life.

 

Information is Power

William sees drug education and empowerment as a major role of pharmacists. In the past, the old mindset of healthcare professionals was to inform patients of their treatment regimen and hope that they believe the information shared. A territory-wide survey revealed that the majority of patients consulting practitioners are not aware that they participate in the decision of their drug treatment with their practitioners. In fact, patients were only passively following the assigned treatment regimen without a good understanding of their medication and the expected therapeutic outcome.

 

William believes “information is power.” In 2002, he worked with fellow members of the Society of Hospital Pharmacists of Hong Kong (SHPHK) to establish the Drug Education Resources Centre (DERC). Apart from drug information, DERC also provides disease-related and general health information to the general public, so that people can engage in their therapy and enhance self-management. Some people think that “self-management” is equivalent to purchasing medicines at pharmacies by themselves, but actually patient empowerment can achieve more. After knowing the signs and symptoms of minor ailments, people can take the initiative to modify their lifestyles and monitor disease progress. Also, by improving the drug knowledge of patients, they can ask appropriate questions during follow-ups and actively participate in the decision-making process with doctors. When patients are engaged in the therapy, they are more likely to adhere to their drug treatment. As a result, education can increase public health awareness and improve the safety and efficacy of treatment.

 

However, this poses the question: how can pharmacists efficiently and effectively share drug information with the whole society? At the moment, drug counseling and drug talks are the major way for pharmacists to empower patients. These channels only allow pharmacists to reach a limited amount of audience. William thinks that by utilizing the media, health information and knowledge can be delivered to a much wider audience.

   

 

For instance, during the COVID-19 outbreak, there was widespread information on the internet and media regarding vaccines. The general public may be confused regarding which vaccine to choose and whether an additional booster is necessary. During the pandemic, William quickly recognized and addressed public concerns by providing professional advice through media and press releases. For instance, William advocated the use of one-third of the adult dose of BioNTech in children and the importance of receiving a 3rd dose as a booster for longer protection from COVID-19. This experience proved that the media is a powerful tool to empower citizens to make informed decisions and promote the role of pharmacists.

 

Providing Pharmaceutical Care and Patient-Centered Services

In a hospital setting, doctors provide medical care, nurses provide nursing care, and pharmacists provide pharmaceutical care. Due to the nature of the healthcare system, a patient’s consultation time with doctors is often very short. The introduction of Ward and Ambulatory Pharmacy Services in the Hospital Authority can fill the gap. Currently, there are Ward Pharmacist Services to review patients’ medication profiles at admission and before discharge. There are also Ambulatory Pharmacist-led Clinics for stable patients with chronic diseases. During consultation, Clinical Pharmacists help review treatment outcomes, manage side effects of drug treatment, and assess patient adherence. After implementation, there is positive feedback from patients and doctors. Clinical Pharmacists can assist in identifying and solving drug-related problems, so doctors can focus more on diagnosis and disease monitoring, which enhances the quality of care in terms of safety, efficacy, and quality of life.

 

 

In addition, Telepharmacy is another successful clinical pharmacy service started during COVID-19. After receiving Tele-diagnosis by doctors, patients can receive pharmacist counseling via video conference. Patients are highly satisfied with Telepharmacy services as it saves traveling time and addresses patients’ drug-related problems promptly. The service is beneficial to patients with disability and carers as they can join the consultation easily. After the pandemic, patients can still arrange Telepharmacy services between doctor follow-ups, so pharmacists can check in and review a patient’s medication regimen and collaborate with doctors to make changes where necessary. For example, a Clinical Pharmacist can view laboratory results of a patient to understand his/her treatment effects and disease progress, check whether the patient is experiencing medication side effects, and offer advice on how to manage the side effects.

 

As the former Pharmacy Department Manager at Queen Mary Hospital, a teaching hospital, William felt the need to constantly develop and improve Clinical Pharmacy Services.

He proposed that Pharmacist-led Clinics can be extended to other clinical areas, such as a Drug Allergy Clinic. Clinical Pharmacists can gather necessary information and conduct a full drug allergy test to assess whether the patient has a true allergy to a specific drug. Currently, β-lactam antibiotics are widely used as the empirical treatment for infections, but β-lactams are also frequently associated with drug allergy. According to the Hong Kong Drug Allergy De-labelling Initiative, 1 in 50 people were documented to have β-lactam allergies. However, a large proportion of the recorded allergies were found to be inaccurate after a full drug allergy test. With incorrect allergy labeling, a patient’s antibiotic choices become limited, which can negatively impact therapeutic outcomes and patients’ health. In the proposed clinic, a Clinical Pharmacist would be able to perform drug allergy testing, assess the severity of the allergy, and log the allergy into the patient’s profile. Also, Clinical Pharmacists can work with physicians to determine whether a re-challenge is safe based on the allergy severity and oversee the whole re-challenge process. By updating allergy profiles and removing unnecessary allergy labels, patients are open to more treatment options, and thus ensure appropriate use of antibiotics.

 

With many of the pharmacy service initiatives mentioned by William, collaboration between healthcare professionals appears to be evident. In the case of the Allergy Clinic, Clinical Pharmacists would consult with the patients individually and collaborate with doctors when deciding whether a patient should rechallenge a certain medication. For Telepharmacy, Clinical Pharmacists can consult with patients in between follow-ups, which allows the Clinical Pharmacist to share expert drug advice with doctors, and work together to make changes to treatment regimens where necessary. Clinical Pharmacists can make use of their expertise to ensure safe medication use.

 

Future Direction of the Pharmacy Profession

William believes Primary Healthcare is the future direction for Hong Kong’s healthcare system and the pharmacy profession. In the model of care, primary healthcare acts as the first point of contact for the general public. Primary healthcare is responsible for public education, screening and prevention of diseases, and quick referrals to secondary care providers. Secondary care focuses more on problems that require more specialized clinical expertise (e.g. hospital care), whereas tertiary care involves the management of more complex disorders that require highly specialized treatment and expertise.

As a result, doctors and hospital pharmacists can focus on treating advanced complicated cases, while community pharmacists can be part of primary healthcare by empowering the general public and managing minor ailments. Holistic care starts with disease prevention. By promoting lifestyle modification and early screening, there is better disease prognosis and thus effectively reducing the healthcare burden, which benefits the general public, as well as all parties in the healthcare system.

 

Apart from primary healthcare, William believes that public-private partnerships or the “Co-Care” concept can be the future of Pharmacy. The public and private sectors should work together to share the healthcare burden. For example, stabilized patients from public hospitals could be transferred to Family Doctors for further management in the community. The same concept can be applied to pharmaceutical care. We should make better use of Community Pharmacists, who can act as “Family Pharmacists”. Given the increasing tobacco tax, smoking cessation programmes may become a major Community Pharmacist service. Another possible role is to be a Medication Review Pharmacist for old-aged home residents. Elderly often suffer from polypharmacy, leading to increased risk of medication incidents. Community Pharmacists can conduct regular visits and medication reviews to ensure safe drug use in residential care homes.

 

It is Just the Beginning

In the interview, William shared many possible directions for the development of Pharmaceutical Care, namely public-private collaboration and community pharmacy services. He hopes to expand pharmaceutical services in order to reach out to the general public and promote the roles of pharmacists.

As the newly appointed Chief Pharmacist of the Hospital Authority, William highlighted three areas as his top priorities: promoting the safe and judicious use of drugs, developing and expanding Clinical Pharmacy Services (Ward and Ambulatory Pharmacists), and strengthening collaboration between hospital pharmacies and primary healthcare providers to provide holistic care for Hong Kong people. He added, “It is just the beginning”.

Author’s background

CHAN, Stephanie Nok-Yan is currently a Pharmacy Intern at Tseung Kwan O Hospital. For enquiries, please contact her through the email address: nychan2001@gmail.com  

 

CHOW, Tiffany Hoi-Yee is currently a Pharmacy Intern at Ruttonjee Hospital. For enquiries, please contact her through the email address: tiffanyhychow@gmail.com

 

CHONG, Donald Wing-Kit is currently the Regulatory Affairs Director, Consumer Health at Haleon (GSK Consumer Healthcare) in Hong Kong. For enquiries, please contact him through the email address: donald.x.chong@haleon.com

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