Pharmacy practice in developing countries

Pharmacy Practice in Developing Countries Achievements and Challenges Edited by Ahmed Ibrahim Fathelrahman Mohamed Izham Mohamed Ibrahim Albert I Wertheimer AMSTERDAM • BOSTON • HEIDELBERG • LONDON NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an imprint of Elsevier Academic Press is an imprint of Elsevier 125 London Wall, London EC2Y 5AS, UK 525 B Street, Suite 1800, San Diego, CA 92101-4495, USA 50 Hampshire Street, 5th Floor, Cambridge, MA 02139, USA The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK Copyright © 2016 Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-0-12-801714-2 For information on all Academic Press publications visit our website at https://www.elsevier.com/ Acquisition Editor: Kristine Jones Editorial Project Manager: Molly McLaughlin Production Project Manager: Karen East and Kirsty Halterman Designer: Greg Harris Typeset by TNQ Books and Journals www.tnq.co.in Dedication I dedicate this work to my big family, my mother Suad Eltohami, my wife Khadeja, and my children Huzaifa, Muaz, Ans, Sarrah, and Ibrahim, for their support and sacrifice and to the soul of my father Ibrahim Fathelrahman who left our life just one year ago I dedicate this work to Mr Mohamed Osman Ibrahim Altahir, my English teacher at Eldium secondary school, Khartoum (1983–1984), from whom I learned the basics of the English language I also dedicate this work to all those who taught me the ABCs of pharmacy, those who supported and encouraged me throughout my life in the study of pharmacy, and those who played significant roles regarding my knowledge, skills, and professional orientation Writing this book is not the outcome of the three years it took to be completed It was enriched, inspired, and fueled by more than 20 years of exposure and learning from others I specifically dedicate my work to those who occupy a special place in my heart: Professor Zedan Zeid Ibraheim (Egypt), Professor Atef Abdel-Monem (Egypt), Professor Ab Fatah Ab Rahman (Malaysia), Professor Rahmat Awang (Malaysia), Dr Maizurah Omar (Malaysia), Professor Ron Borland (Australia), and Professor Mohamed Izham M Ibrahim, who is a coeditor of this book –Ahmed Fathelrahman This book is sincerely dedicated to my beloved wife, Norlela, who has made my writing of this book energizing; not to forget my six lovely children, Syazwan, Fatin, Daniel, Najihah, Imran, and Aiman, as well as my compassionate parents All of them have been my inspiration and an ongoing motivation in life and I truly hope that one day they can understand the reason behind the countless hours spent in front of my computer Dedication I would also like to devote this book to the neglected population worldwide, with high aspiration that pharmacists around the world will continue to serve them better Thank you to the health care environment, which has encouraged me to continue writing for the past 20 years Last, it was indeed a pleasure to be working since 1995 alongside my professor, Albert I Wertheimer, especially on this book –Mohamed Izham MI To Joaquima with thanks for permitting me the time to work on the book and spend less time with the family I hope the final product makes that seem like a good decision –Albert Wertheimer Contributors Patricia Acuna  Faculty of Pharmacy, Universidad de Valparaiso, Valparaiso, Chile Muhammad Adnan  College of Pharmacy and Dentistry, Buraydah Private Colleges, Buraydah, Al-Qassim, Saudi Arabia Mohammed Fadlalla Ahmed Babekir  Department of Clinical Pharmacy, Buraydah Colleges, Buraydah, Al-Qassim, Saudi Arabia Kadir Alam  Manipal College of Medical Sciences, Pokhara, Nepal Qais Alefan  Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science & Technology, Irbid, Jordan Abubakr Abdelraouf Alfadl  Department of Pharmacy Practice, Uniazah College of Pharmacy, Qassim University, Uniazah, Al-Qassim, Saudi Arabia Mahmoud S Al-Haddad  Department of Clinical Pharmacy, Faculty of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia Ahmed Al-Jedai  College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; King Faisal ­Specialist Hospital & Research Centre, Riyadh, Saudi Arabia Ahmad Almeman  School of Medicine, College of Medicine, Qassim University, Buraydah, Saudi Arabia; Prince Sultan Cardiac Center, Buraydah, Saudi Arabia Yaser Mohammed Ali Al-Worafi  College of Pharmacy, University of Science and Technology, Yemen; College of Pharmacy-Unizah, Qassim University, Buraydah, Saudi Arabia Sybil Nana Ama Ossei-Agyeman-Yeboah  Walden University, Minneapolis, MN, United States; West African Health Organisation, Bobo-Dioulasso, Burkina Faso Tri Murti Andayani  Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia Mukhtar Ansari  College of Pharmacy, University of Hail, Saudi Arabia Ahmed Awaisu  College of Pharmacy, Qatar University, Doha, Qatar Nathorn Chaiyakunapruk  School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand; School of Population Health, University of Queensland, Brisbane, QLD, Australia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA Teerapon Dhippayom  Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand Mahmoud Elmahdawy  Central Administration for Pharmaceutical Affairs (CAPA), Ministry of Health, Cairo, Egypt Tarek Mohamed Elsayed  International Islamic University Malaysia, Kuantan, Malaysia Gihan H Elsisi  Central Administration for Pharmaceutical Affairs (CAPA), Ministry of Health, Cairo, Egypt xxi xxii Contributors Yu Fang  Department of Pharmacy Administration, School of Pharmacy, Health Science Center, Xi’an Jiaotong University, Shaanxi, China Ahmed Ibrahim Fathelrahman  Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia Abdulsalam Halboup  Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science & Technology, Irbid, Jordan Mohamed Azmi Ahmad Hassali  Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia Azhar Hussain  Hamdard University, Islamabad Campus, Islamabad, Pakistan Inas Rifaat Ibrahim  Department of Pharmacy, Alyarmouk University College, Baghdad, Iraq Mohamed Izham Mohamed Ibrahim  College of Pharmacy, Qatar University, Doha, Qatar Shazia Jamshed  Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia Sirada M Jones  Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand Shahid Karim  College of Pharmacy and Dentistry, Buraydah Private Colleges, Buraydah, Al-Qassim, Saudi Arabia Nadir Kheir  College of Pharmacy, Qatar University, Doha, Qatar Nadeesha Lakmali  National Drug Quality Assurance Laboratory, Ministry of Health, Colombo, Sri Lanka Shafiu Mohammed  Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria Gamal Khalafalla Mohamed Ali  Central Medical Supplies Public Corporation, Khartoum, Sudan Dhakshila Niyangoda  Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka Satibi Satibi  Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia Ooi Guat See  Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia Asrul Akmal Shafie  Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia Nithima Sumpradit  Bureau of Drug Control, Food and Drug Administration, Ministry of Public Health, Nonthaburi, Thailand Waleed M Sweileh  Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine Abdul Rasoul Wayyes  King’s College, London, United Kingdom; Alrafidain University College, Baghdad, Iraq Albert I Wertheimer  Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, PA, USA Rabiu Yakubu  Jigawa Medicare Supply Organization, State Ministry of Health, Dutse, Nigeria Mirghani A Yousif  Department of Clinical Pharmacy, Taif University, Taif, Saudi Arabia Shukry Zawahir  Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka Zhi Yen Wong  Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia Sa’ed H Zyoud  Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine Foreword by Joseph T DiPiro, PharmD* The new book by Drs Fathelrahman, Ibrahim and Wertheimer, Pharmacy Practice in Developing Countries: Achievements and Challenges, explores the current state of pharmacy practice in 19 countries in Asia, the Middle East, Africa, and Latin America This is not an easy task given the dynamic changes that are occurring in disease, health care and pharmacy throughout the world Our societies are changing and experiencing more burden from chronic diseases such as diabetes and hypertension, and people in many societies have greater expectations from their health care systems In addition to addressing acute health needs, health care systems are changing to address chronic diseases and promote wellness, and people are becoming more knowledgeable about their health through education and global communication There are many reasons for changes in the practice of pharmacy, including the process and regulation of drug distribution with greater accessibility to medicines, the increasing prevalence of chronic diseases and the greater reliance on medications to treat chronic diseases As pharmacists from around the world communicate, in developed and developing countries, we find that there are many similarities in our practice that focus on and include:   • Assuring effective delivery of medications to patients • Minimizing potential adverse effects from the medications or drug interactions • Assisting health care providers and patients to become more knowledgeable about medications • Promoting medication adherence • Assuring the quality of medicines • Assuring access to medications under conditions of inadequate financial resources The culture and traditions in different countries can determine the place of pharmacists in society and the reliance that health care consumers place on pharmacists In many countries pharmacists are the most accessible health care professional and have great opportunity to recommend and implement wellness and treatment strategies What pharmacists can * Dean and Archie O McCalley Chair, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA xxiii xxiv  Foreword by Joseph T DiPiro, PharmD contribute to health care is determined by the nature of their training and the legal authority within their country However, in many countries the number of pharmacists is not sufficient to provide the type of care that is needed Knowing how care by pharmacists is provided in different countries will assist all pharmacists in identifying the best practices and striving to use them in their own country While pharmacy practice varies considerably among countries, there is a consistent and growing interest in progressive pharmacy practice that goes by different terms, such as clinical pharmacy or pharmaceutical care It is patient-focused practice where the pharmacist has a responsibility to the patient As a part of this transformation in practice other aspects of progressive practice are developing, such as the pharmacists role in a health care team, personalized medicine, and population health In the final chapter of this book the authors provide a well thought out summary of the issues that account for the gap in practice between countries: professionalism, decision making, the healthcare team, access to patient information, quality of the academic programs, continuing education, country standards of practice, and scholarly activity to advance practice An important factor that will surely advance practice in all countries is the quality of pharmacy education, both for students entering the profession and for practitioners advancing their knowledge Pharmacy education is becoming more standardized at a higher level than in the past As education improves, so will practice Progress in pharmacy education and practice is coming from many different countries throughout the world All countries have something to offer and all countries have something to learn from what others are doing to improve practice By promoting cross-country understanding about our profession, this book will be very helpful for anyone with an interest in advancing pharmacy practice across the world and for anyone who is committed to improving practice in their own country Foreword by Thony Björk, MSc Pharm* Pharmacy practice, wherever it is performed, aims to optimize health outcomes to patients and add value for health systems across the world To achieve this, access to medicines and medicine safety must be in focus, as well as to improve treatment outcomes of individual patients This can be done in many different ways, depending on variations in national or local needs, in national or international policy and regulations and of course in available resources You cannot say that one model to practice pharmacy is better than the other You have to consider also the culture and the environment the pharmacy has to operate in, not least the political environment But of course it is possible to develop and improve the pharmacy practice by learning from each other and to find out some elements of best practice The most important is to always look at the outcome for the patient The correct treatment and use of medicines for each individual is the goal Although we cannot forget that good pharmacy practice also aims to improve all public health and to contribute to the efficiency and quality of the health system Calculations indicate that the cost of problems with the use of medicines is equal to or greater than the cost of the medicines themselves New medicines are also more and more expensive and not always affordable for health care Managing the costs of medicines is critical to making the best use of limited resources to maximize health care for as many people as possible Falsified medicines, expired medicines and unlicensed medicines are a growing problem in many countries, and it is essential that pharmacies have developed standards for how to handle these matters * Senior Vice President and Senior Advisor Pharmaceutical Affairs, Apoteket AB (Sweden) Vice President, International Pharmaceutical Federation Member of the board of the Swedish Medical Agency Former President of the Swedish Pharmacists Association, the Nordic Pharmacy Association and the Pharmaceutical Group of European Union xxv xxvi  Foreword by Thony Björk, MSc Pharm Supplying consumers with medicines alone is not sufficient to achieve the goals of the treatment Pharmacists have a greater responsibility to handle all the medication-related needs that the patient has to improve the outcomes of medicines use In 1992 the International Pharmaceutical Federation (FIP) developed standards for pharmacy practice; “Good pharmacy practice in community and hospital pharmacy settings” Following recommendations from the WHO Expert Committee and the endorsement of the FIP Council in 1997, the FIP/WHO joint document on good pharmacy practice (GPP) was published in 1999 In 2011 the FIP/WHO Joint Guidelines on Good Pharmacy Practice - Standards for Quality Services was revised In collaboration with WHO, a first edition of a practical handbook ”Developing pharmacy practice — a focus on patient care” was published in 2006 This handbook gives advice on how to meet the changing needs of pharmacists, setting out a new model for pharmacy practice and also presenting a step-by-step approach to pharmaceutical care The “Bangkok declaration on good pharmacy practice in the community pharmacy settings” (2007) in the South-East Asia Region was adopted by the FIP South-East Asia Pharmaceutical Forum and set out the commitment of its Member Associations towards raising standards of pharmacy services and professional practice The FIP sets out six components to achieve a good pharmacy service:   • being readily available to patients with or without an appointment; • identifying and managing or triaging health-related problems; • health promotion; • assuring effectiveness of medicines; • preventing harm from medicines; and • making responsible use of limited health-care resources The FIP defines the mission of pharmacy practice as contributing to health improvement and helping patients with health problems to make the best use of their medicines To improve the use of medicines, pharmacists have responsibilities for many aspects of the process of medicines use, each of which is important to achieve good outcomes of treatment, prescribed or self-care This book offers an excellent overview of the history and development of pharmacy practice in 19 different countries across Africa, Asia and South America The authors focus on the problems and the possibilities they have identified in each analyzed country but also they offer solutions for the future Pharmacy Practice in Chile  425 Figure Drug market share by type of marketing in terms of percentage of the total revenue Source: Report “The Pharmaceutical Market in Chile,” Ministry of Economics, 2013 Related: those drugs marketed under a name other than the active principle From own brand: those produced by the same laboratories belonging to the pharmacy itself According to Vassallo, one of the most important factors underlying the major changes in the pharmaceutical market in Chile since 1995 is the emergence of three pharmacy chains in the late 1990s Today they represent over 90% of the retail pharmaceutical market This structure has allowed them to exert a great bargaining power and, therefore, to have the ability to manage drug prices At the same time, agreements between these pharmaceutical chains and department stores have also allowed people to access credit At the beginning of the twenty-first century, competition between chains caused a significant drop in prices of drugs that adversely affected their own profits Subsequently, drug prices increased progressively One of the reasons that explained this behavior was collusion between pharmacy chains, which has been recently confirmed by the Chilean courts As was mentioned, a report from the Ministry of Economics showed that similar drugs accounted for 46.5% of 2012 revenues of pharmacies, followed by branded pharmaceuticals (41%), pharmacies’ own branded drugs (7%), and generics (5.3%) An analysis carried out between 2008 and 2012 showed that the proportion of sales by brand was maintained, similar drugs went down between and 2%, own brand increased by 2.3%, and generics decreased by 0.6% (Figure 8) The same distribution was observed by units sold in 2012 and shows the high consumption of similar drugs (38.6%) versus 28.5% for generics, 20.6% for brands, and 12.3% for own pharmacy brands (Figure 9) 426  Chapter 19 Figure Drug market share by type of marketing in terms of percentage of total units sold Source: Report “The Pharmaceutical Market in Chile,” Ministry of Economics, 2013 Figure 10 Relationship between percentage of total out-of-pocket health expenditure and socioeconomic status: 2009–2010 Source: National Health Survey (2009–2010), Ministry of Health In: CENAFAR, 2013 Regarding the population’s total expenditure on health in 2009–2010, 55% was due to drugs, with a gradient disfavoring the poorest, at approximately 68% (Figure 10) Moreover, the CASENm National Survey revealed that 33% of patients buy all the medicines prescribed mSurvey conducted by the government of Chile since 1985, characterized by measuring the socioeconomic conditions of households in the country in terms of access to health, education, work, and housing conditions This survey provides data such as the poverty and indigence of the population and income distribution, among others The design allows for guidance of new projects and making changes to remuneration schemes of benefits to improve targeting those selected Universities, academic institutions, and other entities are also users of the information provided by the CASEN survey Pharmacy Practice in Chile  427 In terms of drug prices, Chile does not have a policy of price regulation concerning the private sector or retail The Chilean market displays a large dispersion, and the differences can be as high as 6533% In the public system, although CENABAST is the entity in charge of buying medicines and medical supplies, it is far from managing all public purchases In Chile, drug consumption is mainly determined by the patients’ needs and the choice made by health professional prescribers However, the pharmaceutical market has imperfections, which determine relative importance of other factors, such as:   • Prescriber’s information regarding the supply of drugs on the market; • Therapeutic equivalence and relative prices; • Effect of the pharmacist and the pharmacy technician on the patient’s final election of a certain drug; • Marketing exercised by the pharmaceutical industry on physicians and the patients themselves; • Loyalty to established brands In Chile there is insufficient information on drug use The available data correspond to results from the National Health Survey 2009–2010 mainly based on self-report of respondents and on the diagnosis and analysis of the CASEN survey applied in 2009 In summary, it can be concluded that:   • Women have a prevalence of at least one drug compared to men, adjusted for age (64% vs 40.7%, p