Transcript brouse_050510 - Texas Tech University Health Sciences Center

CIMA Lecture Series
Pharmacy Practice in
Japan and Thailand:
Experiences as a Visiting
Professor
Sara D. Brouse, Pharm.D., BCPS, AQ
Cardiology
Associate Professor of Pharmacy Practice
Advanced Practice Pharmacist—
Cardiology/Critical Care
May 5, 2010
Objectives
 Discuss TTUHSC SOP exchange agreements
 Describe the government healthcare systems in
Japan and Thailand
 Compare/contrast pharmacy education systems
between the US, Japan, & Thailand
State of US Pharmacy Practice
 1977 – First US policy adopted supporting
single, doctorate degree in pharmacy by
pharmacy organization
 1995 – deadline for drafting plan for conversion
to 6-year PharmD degree
 2000 – deadline for conversion to 6-year PharmD
degree or loss of accreditation
 By 2010, most states passed legislation allowing
collaborative practice agreements,
immunization by pharmacists
AACP COMMISSION TO IMPLEMENT CHANGE IN PHARMACEUTICAL EDUCATION
A Position Paper ENTRY-LEVEL EDUCATION IN PHARMACY: A COMMITMENT TO CHANGE
Available at: http://www.aacp.org/resources/historicaldocuments/Documents/COMMISSPOSPAPER3.pdf.
Accessed April 4, 2010.
TTUHSC SOP Exchange
Agreements
 Faculty exchange program
 Kobe Gakuin University School
of Pharmacy, Kobe, Japan

2002 to present
 Keio University School of
Pharmacy, Tokyo, Japan
(formerly Kyoritsu University
of Pharmacy)

2004 to present
 Khon Kaen University School
of Pharmacy, Khon Kaen,
Thailand

2009 to present
TTUHSC SOP Exchange
Agreements
 Faculty exchange
 Visiting Professor
 6 week experience
 Teach elective course
 Participate in scholarly
activities
 Visiting Teaching Professor  BS program:
translator
 1-2 week experience
 Masters
 Teach core content within
programs: no
particular curricular area, ie
translator
cardiovascular module
TTUHSC SOP Exchange
Agreements
 Faculty exchange
 Visiting Professors to
Texas Tech SOP


1-2 week experience
Arrange shadowing
experiences
 Faculty teaching models for
problem based learning,
active learning, experiential
training
TTUHSC SOP Exchange
Agreements
 Student/Resident exchange
program
 Keio University School of
Pharmacy, Tokyo, Japan


11 students from Keio to Texas
Tech (2006-present)
 Masters in clinical pharmacy
candidates
2 students from Texas Tech to
Keio (2009-present)
 Doctor of pharmacy candidates
TTUHSC SOP Exchange
Agreements
 Student/Resident exchange
program
 Khon Kaen University
School of Pharmacy, Khon
Kaen, Thailand


2 students from Khon Kaen to
Texas Tech (2009 to present)
1 pharmacy resident from
Khon Kaen to Texas Tech
(2009)
JAPAN
JAPAN: State of Healthcare
 Socialized medical model
 Universal healthcare provided to citizens
 Physician-dominated practice model
 All other healthcare disciplines subordinate
 Pharmacists not allowed to touch patients
 Cannot administer medications/immunizations
or perform diagnostic testing (BP, blood
glucose)
 Patients kept sheltered from diagnosis
 Lack of patient counseling by pharmacists
about medications
JAPAN: State of Pharmacy
Practice
 Hospital length of stay: 28 days
 Some hospital pharmacies dispense 2 week
supply of meds
 Patients self-administer medications other
than intravenous
 Many hospitals have nurses mix all IV
medications on hospital ward
 30-40 pharmacists for 1000-bed hospital
 No pharmacy technicians
 Cost and safety burden
JAPAN: State of Pharmacy
Practice
 PMDA = pharmaceutical manufacturing drug
administration
 Similar to FDA
 Approves medications for use in Japan
 Coordinates safety monitoring
 Medical focus on prescription drugs
 Little emphasis on herbal remedies
JAPAN: State of Pharmacy
Practice
 Until recently, physicians dispensed
medications directly from offices
 After law change, now physicians required to
transmit prescriptions to a pharmacy
 Additional safety check
 Electronic means (fax, email)
 More than 1 medication per “prescription”
 No refills allowed
 Expanded scope of “pharmacies” from
convenience stores to true full-service
pharmacies
JAPAN: State of Pharmacy
Practice
 Types of outpatient pharmacies
 Community pharmacy



Similar to community pharmacies in US
Dispense prescription and non-prescription
medications
Licensed pharmacist
 Drugstore



Not required to have a pharmacist on staff
Non-prescription medications
Health and beauty products
JAPAN: State of Pharmacy
Education
 Ministry of Education
 Until 2006, pharmacy was 4-year degree program
(4 years post-high school)
 Bachelor’s degree in pharmacy
 Bridge to graduate school in pharmaceutical sciences
 No therapeutics courses
 No practical experiential training experiences
 ~200-250 students/class
 Post-2006, mandatory 6-year bachelor’s degree
 Also available Ph.D. in pharmacy
 Did not approve “Pharm.D.” in Japan
JAPAN: State of Pharmacy
Education post-2006
 6-year bachelor’s program
 Addition of 6 months experiential training


3 months hospital pharmacy practice
3 months community pharmacy practice
 Provision of “therapeutics” portion of curriculum

Application of pharmacology
 Expansion of “clinical” faculty to bridge gap
between science and practice
 Expansion of practice-based curriculum

Problem-based learning courses
JAPAN: My Experiences
 Kobe Gakuin
University
 Visiting Professor, 6
weeks (2004)
 Taught 1 credit hour
elective course for
bachelor’s of
pharmacy students
 Translators for each
lecture
JAPAN: My Experiences
 Kobe Gakuin University
 Gave formal faculty seminar
on “Evolution of Pharmacy
Practice in the US”
 Collaborated on 4 papers
related to development of
pharmacy practice
 Experiential training,
preceptor development,
community pharmacy
practice in US,
collaborative practice
agreements
JAPAN: My Experiences
 Kyoritsu University of
Pharmacy / Keio University
School of Pharmacy
 Visiting Teaching Professor,
(2005-10)
 Taught cardiology subjects
within Masters of Clinical
Pharmacy degree program
 English lectures provided to
Masters of Clinical Pharmacy
Students
 Therapeutic case focus
JAPAN: My Experiences
 International
Conferences on
Experiential Training
 Invited twice to speak
on relevant
experiential training
topics


Preceptor development
Continuous
professional
development
JAPAN: Insights
 Similar issues exist
 Development of quality experiential training sites
to meet demand

Mentoring model at practice site
 Challenges
 Mindset traditionally against interprofessional
collaboration
 Few role models for students / new pharmacists
 No pharmacy residency programs
 Surplus of pharmacists for practice-based
positions

>10,000 graduates/year
Larvae
THAILAND: State of
Healthcare
 Socialized medicine
 Both government and
private healthcare
available
 Government healthcare
inexpensive, so many
select based on price
 Government hospitals
& clinics at capacity
 Hospitalization $1/day
 Strict medication
formulary
THAILAND: State of
Healthcare
 National Drug Formulary
 5 classes of medications



Classes 1 & 2: general medicines
Classes 3 & 4: high-cost or high toxicity risk meds
 Only available in large urban hospitals
Class 5: new medications
 Defines drugs by generic name

Individual hospitals choose brand name manufacturer
or “local made” generic equivalent
 If patients use non-national formulary medication,
must pay out-of-pocket for drug cost
THAILAND: Khon Kaen
University
 Government Hospitals
 Belief in using natural elements for healing
 Open hallways, pharmacy waiting area, wards,
ICU & ward windows
 Fresh water bowls with fresh flowers in middle
of ICU
 Ceiling fans circulate air throughout units and
bring in fresh air from outside
 Lack of air conditioning in government hospitals
 Holistic medicine unit for Thai massage, “Tiger
Balm” applications, herbal compresses
THAILAND: State of
Healthcare
 Holistic Health Care
Unit
 Alternative medicine




units on hospital ward
Therapeutic “Thai”
massage
Facial spa
Foot spa & massage  Oil massage &
aromatherapy
Herbal compress
 “Tiger Balm” applications
techniques
 Traditional Thai knowledge
THAILAND Wat Pho Temple
 1st site for “Thai massage”
 Massage school still exists on temple property
THAILAND: State of
Healthcare
 All medications ‘over the
counter’
 Antibiotics, opiates,
derm
 Brand name products &
“local made” products
available before brand is
off-patent
 Regulated by Thai FDA
for bioequivalency
 Products still can vary
by company
 Pharmacists play key
role in recommending
drug therapies based
on symptoms
THAILAND: Khon Kaen
University
 Community Pharmacy
 Faculty of Pharmaceutical
Sciences run 2 campus
community pharmacies



Training of students to learn the
clinical aspects & management
of community pharmacies
Carry products from reputable
companies
Offer counseling and front-line
provider of health-care to
patients
 Logbook record of controlled
substances
THAILAND: Khon Kaen
University
 6-year Pharmacy degree
program starting 2009
 Doctor of Pharmacy
(Pharm.D.) from 2009

Students enroll in either
“Thai” program or “English”
program
 175 students/class
 Previously 5-year
Bachelor’s degree



Masters --Clinical Pharmacy
Masters--Pharmaceuticals
Masters--Pharmacy
Management
THAILAND: State of
Pharmacy Practice
 Thai pharmacy degree programs and practice
modeled after US pharmacy model
 Pharmacology and therapeutics
 Clinical application of medications for disease
treatment
 Clerkship rotations for students (~ 9 months)
 Many faculty trained in US for PharmD,
residencies, & fellowships
 Pharmacists enjoy high level of clinical practice as
providers (esp community pharmacy)
 No prescriptive privileges in hospitals but round
with physicians & make recommendations
THAILAND: Khon Kaen
University
 Center for Research and Development in Herbal
Health Products (CRD-HHP)
 To increase herb and herbal health product
research to support commercial development

Quality, efficacy, safety of herbals
 To support research endeavors of masters
degree students
 To develop herbal patents
THAILAND: Khon Kaen
University
 Center for Research and
Development in Herbal
Health Products (CRD-HHP)
 Rice bran cream
 Citronella grass cream
 Turmeric lotion
 Aloe vera lotion
 Glycerin soap
 Gel nanotechnology
products of Kaempferia
parviflora
Daily Compounding List
 Sodium fluoride
 White vaseline
 PEG 400
 Phenytoin sodium
 Sodium thiosulfate
 Ganciclovir
 Eucalyptus oil
 Rose oil
 MCT oil
THAILAND: Khon Kaen
University
 Central Lab
 Faculty of Pharmaceutical Sciences run a central
lab to support the university teaching hospital





Laboratory analysis & interpretation
Drug levels in biological samples (therapeutic drug
monitoring, or TDM)
 Theophylline, Vancomycin, Aminoglycosides,
Phenobarbital
Drug levels in biological samples (analysis)
 Paracetamol, salicylate, diazepam
Metal level analysis
Toxic level analysis
 Gastric and urine samples
THAILAND: My Experiences
 Khon Kaen University
 Lectured to “English
program” Doctor of
Pharmacy students

Cardiovascular
pharmacology &
therapeutics
 Toured university
(government) hospital
 Toured campus
community pharmacies
THAILAND: Insights
 Similar issues exist
 Control of hospital-acquired pathogens in
hospitals
 Cost-containment of expensive inpatient
medications through formulary process
 Similar practice models for pharmacists
 Challenges
 Overcrowding amongst public facilities due to
lack of resources
 Purity/efficacy concerns with certain available
drug products
Conclusions
 Similar issues exist amongst the US, Japan, &
Thailand regarding
 Regulation of government healthcare & cost
containment
 Education of pharmacy students
 Future collaboration globally amongst
healthcare providers can provide insight into
how others solved similar issues successfully
 Exchange collaborations are win-win
opportunities for both institutions
Questions?