By Choy Tsun Ho and Ho Wing Hei Phoebe
Before we left Hong Kong for our 12-week exchange programme at University College London in June, we learnt that our supervisor would be Ian Wong, the previous head of the the University of Hong Kong’s pharmacy department. He is now professor of pharmacy practice and head of the research department of practice and policy so it was not surprising to find out that we would be doing clinical practice-related tasks.
During the first three weeks of our exchange, we worked on a systematic review and meta-analysis of observational studies (case control and cohort studies) with Professor Wong. The review evaluates the relationship between the use of antidepressants in pregnant women and its effects on fetuses and children. Since the discovery of antidepressants, the safety profile of these drugs during pregnancy has caused heated debates, with conflicting evidence in the existing literature. Because of the number of articles we had to search, we recruited extra support for screening and data extraction.
Throughout the exchange period, Professor Wong also arranged several visits to UK GP surgeries, community pharmacies and hospitals. This enabled us to compare the healthcare systems between Hong Kong and the UK.
In the GP surgery
In mid-July, we went to a GP surgery to visit a pharmacist who is an independent prescriber specialising in travel medicine.
In the UK, there are plenty of options for pharmacists to progress in their careers and there is emphasis on nurturing future pharmacists to share the workload of doctors. For instance, since 2006, pharmacists can seek further qualification to become an independent prescriber, meaning they can prescribe autonomously for any condition within their clinical competence.
In Hong Kong, the idea of a healthcare professional other than a doctor being able to prescribe seems unorthodox (or even absurd). However, the system has been in place for more than a decade in the UK and things appear to be working well. By allowing certain skilled clinicians of other backgrounds to prescribe in their field of expertise, the workload of doctors can be alleviated. This means doctors can spend more time on complicated cases instead of those that are routine and easily handled by well trained pharmacists or nurses.
In the GP surgery, the pharmacist is responsible for giving advice on the choice of travel medicines and vaccinations. Because the NHS subsidises certain vaccines, it is common for people to visit the clinic and be vaccinated against common travel diseases when they are heading to high-risk areas. During our half-day visit, we shadowed the pharmacist’s counselling of patients and administering vaccinations.
We spent three mornings in three different Day Lewis community pharmacies. Interestingly, we would say its operation is similar to that of a hospital pharmacy in Hong Kong, although on a somewhat smaller scale. Each day, hundreds of prescriptions come in and the pharmacist is in charge of the dispensing and counseling. In contrast, community pharmacies in Hong Kong dispense a lot fewer prescriptions. This is, in part, because Hong Kong does not separate the functions of prescribing and dispensing, unlike the UK (ie, most doctor surgeries dispense medicines as well). In the UK, it seems that pharmacists are the most accessible healthcare professionals, and community pharmacists provide health and drug information readily for free. With the proper recognition, they could be guardians against indiscriminate use of antibiotics and invaluable to the promotion of public health.
In early August, we had the chance to visit both the University College Hospital (UCH) and its cancer centre. We were able to observe the inpatient dispensing process extensively. Although it may be common in the UK, the automated dispensing machine amazed us. Because of its precision and efficiency, the dispensary requires fewer dispensers and technicians than in Hong Kong.
However, we were surprised that patient records and dispensing systems between NHS trusts were not linked and much time was spent doing medicines reconciliation. Given the extensive coverage of the NHS in the UK, a linked and unified system across various levels of healthcare, as in the Hospital Authority of Hong Kong, would greatly improve the use of healthcare resources.
In the UCH Macmillan Cancer Centre we were given the opportunity to carry out a survey with the cancer patients about their chemotherapy experience and feedback on the overall service of the Cancer Centre. It was a rewarding practical experience to communicate with cancer patients face-to-face and listen to their concerns and first-hand experience of chemotherapy, allowing us to gain clinical insights from the patients’ point of view.
In addition, having been in the UCH Cancer Center for two days, we noticed how relaxed the environment was compared with cancer centres in Hong Kong. The spacious waiting area and friendly, helpful staff make the place lively and comfortable. Hong Kong has a lot to learn in terms of improving the palliative care service.
It was amazing to witness how pharmacists in the UK contribute to the healthcare in ways unimaginable in the current context of Hong Kong. The regulations and laws have enabled the profession to progress and serve the UK public in ways that we, in Hong Kong, could only wish for it to become reality one day in the near future.