February 6, 2012

Shifting the pharmaceutical care model in Hong Kong

UW Health Sciences/UW Medicine

Hong Kong has a strong healthcare system, but as one of the most densely populated regions in the world, it continues to be challenged by an ever-expanding populace. The typical teaching hospital in Hong Kong has between 1,200 and 1,900 beds with only 20 to 30 pharmacists on staff. The pharmacists and physicians in Hong Kong’s hospital system are increasingly overwhelmed by heavy workloads. Whats more, the region’s health care system has been tested by a few public health crises in the past decade — most notably the 2003 SARS outbreak and the 2009 H1N1 epidemic.

The Hong Kong Hospital Authority (HKHA) is seeking to expand the clinical services that pharmacist’s in Hong Kong offer, with a stronger emphasis on direct patient care rather than on dispensing.

Expanding the pharmacists role and increasing the number of pharmacists in hospitals will ease the burden on physicians and allow healthcare providers to more easily respond to public health crises. It will also make better use of the pharmacist’s expertise.

This past October, three UW School of Pharmacy professors traveled to Hong Kong to provide geriatric pharmacotherapy training. Associate Professor of Pharmacy Lingtak-Neander Chan, Professor of Pharmacy Al Ellsworth and Clinical Associate Professor of Pharmacy Annie Lam, all practicing pharmacists, were invited by the Chinese University of Hong Kong (CUHK) to lead a two-week certificate program and clinical skills workshop for 24 Hong Kong pharmacists. The Hong Kong Hospital Authority commissioned this program as part of its larger effort to restructure the region’s pharmacy practice model.

UW faculty members Al Ellsworth (blue shirt with bowtie), Annie Lam (flowered shirt), and Lingtak-Neander Chan (blue with necktie) stand in the center of Hong Kong pharmacists they trained.

UW faculty members Al Ellsworth (blue shirt with bowtie), Annie Lam (flowered shirt), and Lingtak-Neander Chan (blue with necktie) stand in the center of Hong Kong pharmacists they trained.

“The knowledge base of pharmacists in Hong Kong is excellent — from basic pharmacology to general practice guidelines,” said Lingtak-Neander Chan. “But pharmacists there haven’t been given the opportunity to directly apply their knowledge and refine their skills on the bedside or in the clinic.”

The training program led by Chan and his colleagues taught how to provide clinical pharmacy services to older adults and to evaluate their disease states to create patient-specific management plans. It covered a range of geriatric pharmacy topics, including common medication-related problems and geriatric- and drug-induced diseases. Chan and Lam, both from Hong Kong, tailored the curriculum to meet the regions cultural needs.

The training also included a full-day physical exam workshop, led by Ellsworth, who is also a UW professor of family medicine. Chan, who is also a UW Nutrition Sciences interdisciplinary faculty member, provided nutritional management training. In addition, the UW professors joined the Hong Kong pharmacists and physicians on rounds at a few major teaching hospitals.

“It was a great opportunity for the pharmacists to participate as contributing members of the healthcare team,” said Lam. “The physicians were very welcoming.”

Ultimately, having pharmacists participate in rounds, like they do in many hospitals in the United States, can improve the cost-effectiveness of drug therapy and prevent medication-related adverse events.

Chan — who is passionate about advocating for the role pharmacists can play in improving health outcomes — has been collaborating with the Hong Kong Hospital Authority for ten years. He was previously part of a collaboration between the authority and the University of Illinois at Chicago while he was on faculty there. After he joined the UW School of Pharmacy in 2004, he stayed in contact with colleagues in Hong Kong. He has gone back twice to provide training and resources.

He has also helped arrange for a handful of Hong Kong pharmacists to visit Seattle and shadow area pharmacists. Those visiting pharmacists sought advice from Chan on how to implement innovative programs back in Hong Kong. Several individuals returned to Hong Kong to start successful hospital pharmacy programs in the acute care and critical care setting. These programs have been embraced by the collaborating physicians.

All of the pharmacists Chan has met in Hong Kong, he said, are excited and enthusiastic about the future of their profession.

At present, the Hong Kong Hospital Authority is gearing up to hire more pharmacists. The CUHK School of Pharmacy is increasing its enrollment. And the Hong Kong Academy of Pharmacy recently collaborated with the American Society of Consultant Pharmacists to establish a medication therapy management certification program. In fact, Annie Lam spent another week in Hong Kong to help launch this training program.

“The pharmacists in Hong Kong would like to shift from a role of drug distribution to a role of providing clinical services,” said Chan, citing a recent ‘International Journal of Pharmacy Practice article that reflected this sentiment. “I look forward to seeing that happen for the profession of pharmacy in Hong Kong in the years to come.”