Barriers created by the Ministry between the pharmacist and the patient: is it possible to overcome them?
There is a Lithuanian folk saying – measure nine times, cut the tenth. It is the first thing that comes to mind when you think about how changes are happening, or perhaps it would be more accurate to say, not happening, in the field of pharmacy operations and pharmaceutical services. For a long time, the pharmacy is not just a place to pick up medicines, people come here with all kinds of concerns. Everyone agrees that the volume of services provided in pharmacies must grow – both patients, pharmacies and the Ministry of Health. Nine generations have already been measured, but there are still no real changes.
Yes, there are discussions, working groups, commissions are formed, procedures, descriptions, analyzes are carried out, promises about rapid changes are constantly shared. However, the patients’ problems that we have to solve are not paper-based, so paper-based solutions and endless promises are not enough. In its report, the State Audit Office drew attention to the excessively lax attitude of the institutions and the work that could not be done at all. We want to believe that this will wake up the responsible institutions from their lethargic sleep and force them to start implementing changes: solving the issue of drug shortages in pharmacies and their better physical availability, improving the vaccination procedure in pharmacies, creating real functioning pharmaceutical care services.
The problem of drug shortages – let’s at least do what we can
The issue of drug shortage has been discussed in the public space for several months. What is both saddening and laughable is that this issue is being ignored even by those who have all the tools in their hands to solve it quickly.
Admittedly, supply disruptions are also caused by external problems, such as the lack of active ingredients, logistical disruptions, and increased global demand for certain drugs. However, there is also a lot of work that has not yet been done in the “courtyard” of our authorities, so that patients can purchase medicines already available in the Lithuanian pharmacy network.
It is common for a pharmacist to be unable to replace a drug prescribed by a doctor. This happens very often with antibiotics. Then the patient must go back to the doctor and ask for another medicine to be prescribed. In the digital age, this is absolutely incomprehensible, especially since there is a simple way to solve it – to supplement e. the health system with functionality that allows a personal health care specialist, when prescribing a medicine, to see which medicines are missing and which are available in pharmacies, and to prescribe those preparations that the patient will be able to purchase accordingly. Why is this functionality still not available?
We can easily imagine what the consequences would be for businesses or residents if they do not comply with the deadlines set by the law and carry out their duties with constant delays. Meanwhile, if the deadlines are not met, nothing threatens the state institutions, only that all the rest have to go over their heads, implementing things that cannot be implemented.
Pharmaceutical care is still not available in pharmacies
For several years, it has been said that the service of extending prescription drugs in pharmacies would be extremely valuable to the public. Routine work for personal health care specialists would be reduced, patient queues would be shortened, and patients who have been taking the same medication for a long time could, with the approval of their attending physician, renew the prescription at the pharmacy and immediately receive the necessary medication.
There are glimmers that this year the talks will finally end and pharmacies will have the option of extending the prescription. We expect this with some doubt, because we have experience when the pharmaceutical service remained only on paper. Back in 2016 the pharmaceutical care service for patients using inhaled medicinal products was regulated, pharmacies prepared for it, equipped offices, but disproportionate requirements and insufficient information of personal health care specialists led to the fact that the service remained only on paper.
We are similar to the countries of the European Union (EU), so this, the issue of extending prescriptions, should not be an exception. If we want to improve population health indicators, we need to create a system where patients can use more extensive pharmaceutical care services in pharmacies.
Will we reach the potential of EU pharmacy vaccinations?
Today, you can get vaccinated against influenza, tick-borne encephalitis and pneumococcal infection in pharmacies. The number of people getting vaccinated in pharmacies is increasing every year, and at the same time, the number of questions is also increasing, why pharmacies only vaccinate with these vaccines and why children from the age of 12 cannot be vaccinated in pharmacies.
It has to be agreed that the development of vaccination in pharmacies is much too slow. And it’s not the pharmacies that are “stopping” here, but the responsible institutions. Pharmacies are preparing, investing in vaccination offices, creating the necessary conditions to offer patients the most convenient vaccination, but they lack permission to vaccinate not only against three, but also against many other diseases. Pharmacies should be given the opportunity to vaccinate with so-called travel vaccinations, for which residents constantly ask pharmacists: typhoid, cholera, hepatitis A, hepatitis B, rabies, diphtheria, tetanus, whooping cough and others. Vaccinations against these diseases have long been available in pharmacies in Denmark, the United Kingdom, the United States of America, Portugal and other countries.
Another important issue is that currently, patients in the risk group against influenza or pneumococcal infection cannot be vaccinated free of charge in pharmacies, although they can in personal health care institutions. The government constantly announces that as many residents as possible, especially those in the risk group, should be vaccinated, so why are conditions not created for such patients to carry out state-reimbursed vaccinations in pharmacies?
Let’s use the competences of specialists for the health of the population
We all understand that personal health care must be closer to the population so that people can get the necessary services and medicines faster. However, the State Control in its report points out that the physical availability of medicines to patients is insufficient. This problem has several layers, one of which is the training of pharmaceutical specialists and the recruitment of their competencies.
When it comes to training future pharmacists, the state should provide more funding, which has been requested for years. It is true that last year 11 state-financed places were allocated for pharmacist studies, but this is significantly less than the market demand and the universities’ capabilities.
We also miss solutions that empower pharmacotechnicians more. Since last year, banning them from working in pharmacies with remote pharmacist supervision in pharmacies, not only closed 34 pharmacies, but also reduced the total working hours of all pharmacies by 4,500 hours per week, so all together we have 64 pharmacies that are no longer working.
Pharmacotechnicians have education, competencies and skills that could be employed in other functions. After all, when narrowing the functions to one, it does not cost anything to think about assigning other functions to these specialists. For example, in EU countries, pharmacotechnicians vaccinate patients who are consulted by a pharmacist beforehand. The university, which currently prepares pharmacotechnicians, also trains nurses, so it would be easy to provide additional qualifications to pharmacotechnicians, only decisions in state institutions are needed. Enough measuring, it’s time to cut.
Therefore, we are very much waiting for the reaction of the state institutions to the audit report of the State Audit Office regarding the availability of medicines to the population and specific obligations, what, when and how they are going to improve. We hope to hear this already this month in both the Seimas Audit and Seimas Health Affairs Committees.
Kristina Nemaniūtė-Gagė, chairwoman of the Lithuanian Pharmacy Association
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– 2024-04-02 17:00:23
