Cadangan rang undang-undang farmasi tidak wajar

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Photograph: Wikipedia

[ENGLISH VERSION BELOW] Persatuan Pengguna Pulau Pinang (CAP) berasa kecewa dengan keputusan Kementerian Kesihatan untuk tidak mengasingkan tugas memberi dan mempreskripsi ubat.

Kementerian Kesihatan ternyata telah tunduk kepada tekanan lobi perubatan yang berpengaruh dengan mengelak daripada membentuk satu sistem yang mengasingkan tugas-tugas mempreskripsi dan memberi ubat. Mengasingkan tugas mempreskripsi dan memberi ubat sudah lumrah di negara maju. Adalah sesuatu yang ironik bahawa negara yang beraspirasi untuk mencapai status pendapatan tinggi menjelang 2020 mengambil langkah ke belakang dalam amalan penjagaan kesihatan.

Adalah sama sekali tidak wajar untuk mengatakan langkah tersebut diambil demi memenuhi keperluan pesakit, khususnya mereka yang tinggal di luar bandar. Negara-negara seperti India dan Indonesia dengan jumlah penduduk luar bandar yang besar sudah lama mengamalkan pemberian dan preskripsi ubat secara berasingan tanpa sebarang masalah.

Sudah menjadi norma sejagat bahawa doktor memeriksa dan mempreskripsi ubat sementara ahli farmasi mengaudit dan memberikan ubat. Untuk membuat keputusan dasar dan menggubalnya dalam cara yang bercanggah dengan amalan sejagat amat membingungkan dan tidak adil. Atas alasan apakah Kementerian Kesihatan mengenepikan profesi bagi peranan pentingnya?

Apa yang sepatutnya dititikberatkan oleh Kementerian Kesihatan sebagai badan yang mengawal selia kesihatan awam adalah keselamatan ubatan – yang telah dikenal pasti oleh pertubuhan kesihatan terkemuka seperti Pertubuhan Kesihatan Sedunia (WHO), Pusat Keselamatan Makanan dan Ubatan Amerika, dan pihak Keselamatan Kesihatan Kebangsaan UK sebagai keutamaan dalam menangani cabaran keselamatan pesakit.

Laporan Institut Perubatan Amerika pada 2007 menunjukkan kesilapan dalam pemberian ubat sering berpunca daripada proses preskripsi ubatan. Sekurang-kurangnya separuh daripada kesilapan mempreskripsi ubat dikesan dan diperbetulkan apabila ahli farmasi meneliti semula isu keselamatan dan kesesuaian pemberian ubat tersebut. Mempunyai doktor sama yang mempreskripsi dan memberikan ubat di Malaysia menghapuskan jaring keselamatan itu.

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Standard amalan secara umum di Malaysia masih belum setaraf dengan tanda aras antarabangsa. Kita masih mempunyai doktor yang tidak melabel ubat mereka dan cuma memberikan kepada pesakit sampul plastik yang mengandungi beberapa butir ubat di dalamnya. Sudah menjadi amalan biasa juga bagi kakitangan yang mengendalikan ubat terdiri daripada mereka yang tidak terlatih. Justeru tidak ada pemeriksaan bagi memastikan keselamatan dan kesesuaian preskripsi dan sebarang potensi masalah yang ada kaitan dengan ubat yang diberikan. Hal ini sepatutnya menjadi perhatian dan tumpuan utama Kementerian Kesihatan.

Sehubungan itu CAP menggesa Peguam Negara menolak rang undang-undang ini kerana ia bercanggah dengan prinsip asas keselamatan ubatan.

SM Mohamed Idris ialah presiden Consumers Association of Penang (CAP).

English version:

Proposed Pharmacy Bill – Unjustified

The Consumers Association of Penang is disappointed at the Ministry of Health’s decision not to separate the roles of dispensing and prescribing.

Clearly, the Ministry of Health has bowed down to the pressure of the powerful medical lobby in refusing to create a system of separation of duties in prescription and dispensing. Separation of dispensing and prescribing is the norm in developed countries. It is most ironic that a nation aspiring to attain high-income status by 2020 takes a retrogressive stand in healthcare practices.

It is completely unjustifiable to say that this is to cater to the needs of patients especially in rural areas. Countries like India and Indonesia with large rural populations have long practised separation of dispensing and prescribing with no issues. It is the universal norm that doctors diagnose and prescribe while pharmacists audit and dispense. To make a policy decision and legislate against this universal practice is absolutely mind-boggling and unfair. On what basis does the Ministry of Health deny a profession of its fundamental role?

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What should be of paramount importance to the Ministry of Health as custodians of public health is medication safety – which has been identified by leading health organisations like the World Health Organisation, US Food and Drug Safety and UK’s National Health Safety as the main priority in addressing patient safety challenges.

A 2007 US Institute of Medicine report showed that medication errors originate most often during the medication prescribing process. At least half of these prescribing errors are detected and corrected when pharmacists review the safety and appropriateness of the medication. Having the same doctor prescribe and dispense as in Malaysia eliminates that safety net.

Standards of general practice in Malaysia are still not up to international mark. We still have doctors not labelling their medications and giving patients just a plastic envelope with some pills in it. It is also common practice that the staff handling medications is not trained for the job. Hence there is no check for the safety and appropriateness of the prescription and any potential-medication related problems. This should be the primary concern of the Ministry of Health.

CAP urges the attorney general to reject this bill as it contravenes the basic principle of medication safety.

SM Mohamed Idris is president of the Consumers Association of Penang (CAP).

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