Your Friendly Neighborhood Pharmacist

A convenient place to stock up on over-the-counter medicines, supplements and toiletries, the community pharmacy has long been an integral part of many neighbourhoods. However, its full potential as a provider of primary healthcare services is often underutilised. In line with the theme of this year’s World Pharmacists’ Day, “Pharmacy Strengthening Health Systems”, Dr Wong Pei Se, Associate Professor at School of Pharmacy, International Medical University, speaks about the role of community pharmacists in the healthcare system.

The National Survey on the Use of Medicines (NSUM) by Malaysian consumers in 2015 ^[2] highlighted that only five per cent of respondents would consult a pharmacist on health problems. In a 2021 study,^[1] it was reported that Malaysians on average visited community pharmacies 31 times a year. This is comparable to the average in developed countries such as Australia, the US and the UK.

Over the years, consumers have grown more aware of the role of the pharmacist, possibly spurred on by the COVID-19 pandemic when people started to rely on the pharmacist for information and guidance on the ‘tools’ to fight the virus – from medication to sanitisers and masks. However, anecdotal evidence suggests that Malaysians often still miss out on the real gem in these outlets: the friendly pharmacist behind the counter – a reliable first stop for medical and general health advice.

“Community pharmacists can help manage minor ailments, give advice and help to educate the public on different aspects of ailments and treatments available,” says Dr Wong Pei Se. Pharmacists are also able to guide customers onto the right medical path – when you are not sure whether you need to see a doctor, or even which doctor you need to see.

Potential of Prevention

Studies have shown that having the service of pharmacists within communities leads to better medical outcomes and patient care.^[3] Dr Wong explains, “We want to intervene before people get a heart attack, before a stroke, before diabetes leads to kidney problems. These are things that we can manage at the community level so that people don’t end up going to the hospital.”

This is perhaps one of the biggest roles that a pharmacist plays – supporting healthy living and self-care in communities. Pharmacists are in an optimal position to help the public prevent illnesses and stay healthy through basic health advice on exercise regimes, nutrition and health supplements.

They help people manage non-communicable diseases like diabetes and heart issues. Many pharmacies provide screening and monitoring services for blood pressure, sugar and cholesterol levels. Although there are many devices that can be used at home, this service is an alternative for those who are not willing to invest in a device or who are just not comfortable self-administering these tests. This saves people from making the trek to a hospital or a clinic. It also means that patients don’t find themselves delaying monitoring for months as they wait for their follow-up appointments.

With Great Access Comes Great Power

At the end of the day, it boils down to making health convenient for people – and this convenience largely comes from the great accessibility that pharmacies offer. There were over 3,000 pharmacies in Malaysia.^[4] “In urban areas, every five to 10 km you may find one,” says Dr Wong.

At pharmacies, you don’t need to register or make appointments. The consultation is free and when you just need to ask a few questions, or if you are unsure of the medical severity of your condition, these are factors that make a big difference.

For example, Dr Wong says that the many people who have skin problems such as acne, wouldn’t go to a doctor as their first step. They would more likely try out the products at a pharmacy first and only if this fails, would they seek out a doctor. In such a circumstance, pharmacists can guide a customer through the many options of skincare available and also advise a customer if their situation warranted a visit to the doctor.

“Pharmacists have become a very accessible primary care service provider,” says Dr Wong. When clinics are overcrowded and when there is an unexpected burden on the system, pharmacies can help to optimise a healthcare system.

The Future of Pharmacy

As with all other industries, pharmacy is constantly evolving to suit the needs of the community. In the past few years, digital platforms have been pushed to the fore by the pandemic and pharmacies have not been left out of this technological leap.

“During the lockdowns, pharmacies started doing deliveries and digital health platforms became a very common communication method,” says Dr Wong. Long-time customers would send messages over WhatsApp to get advice as well as to order products ahead of time for convenient pick-ups or deliveries. This trend continues beyond COVID-19 and has contributed further to the convenience of the consumer.

On a bigger scale, according to Dr Wong, the other trend that is moving the pharmaceutical industry forward is personalised medicine and pharmacogenomics.

Personalised medicine is an approach where a patient’s treatment is individualised. This approach is based on the fact that each person is unique in their genetic workups, lifestyles and health conditions, therefore each patient should be provided medicine that’s effective and appropriate for them as an individual.

Pharmacogenomics is the field that looks into how individual genetics affect the effectiveness of medicine. “It studies how our different genetics will affect how and when you should take a particular medicine, how it is absorbed into your body, how it interacts with your body, the side effects that you may have,” says Dr Wong.

However, it’s not something that can be done across the board. According to Dr Wong, because pharmacogenomic tests are costly, it is available for certain medication, for example cancer treatment which in itself can be very expensive and has many side effects.

Moving Community Forward

The pieces are in place, the players are well positioned, but there are certain aspects of a pharmacy that creates barriers in the minds of the public. “The pharmacy is seen as a business. There is a perception that pharmacists only want to sell their products: People feel that the more I talk to you, the more you will want to sell me things,” says Dr Wong.

Privacy is also a big issue. Unlike at the clinic, a pharmacy doesn’t have private consultation rooms and this may hinder people from asking more personal issues. As Dr Wong describes: “If you have a very private question and you see ten people ahead of you, you probably wouldn’t want to ask it.”

Besides these reservations that customers may have, the community pharmacist still holds a unique position of being part of the community and privy to certain lifestyles and habits of the neighbourhood that can cast light on health issues. They have the opportunity to build relationships and walk together with their customers not just through sickness, but in health.

They play a big role in putting health back into the people’s hands, and provide easy access to reliable information. So, the next time you are tempted to google ‘signs and symptoms’ and try to self-diagnose, why not pop over to your friendly neighbourhood pharmacist instead?

References

^[1] Hamidi, N., Tan, Y.R., Jawahir, S. et al. Determinants of community pharmacy utilisation among the adult population in Malaysia: findings from the National Health and Morbidity Survey 2019. BMC Health Serv Res 21, 649 (2021).

^[2] Mohamad Azmi H FS. a National Survey on the Use of Medicines (NSUM) By Malaysian Consumers. Pharm Serv Div: Ministry Health Malaysia; 2016.

^[3] Seabury SA, Lakdawalla DN, Dougherty JS, Sullivan J, Goldman DP. Medication adherence and measures of health plan quality. Am J Manag Care. 2015;21:379–389. [PubMed] [Google Scholar]; Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev. 2019;12:1–151.

^[4] Tew, M.M., Hatah, E., Arif, F. et al. Geospatial analysis of distribution of community pharmacies and other health care facilities providing minor ailments services in Malaysia. J of Pharm Policy and Pract 14, 24 (2021). https://doi.org/10.1186/s40545-021-00308-9