Malaysia - Educating patients is important

THE Malaysian healthcare system appears successful in delivering good health outcomes at a reasonable cost.

However, despite accolades from international bodies, such as the World Health Organisation, the chief problem in the Malaysian healthcare system, which has yet to receive adequate attention from the government, is quality.

Patients complain about long waits, a lack of explanation or “informed consent” procedures and poor physical facilities.

More sources of concern are weaknesses in professional standards, inadequate continuing medical education and lack of quality control, especially in the private sector, despite laws and regulation governing them.

Within this context, a successful health system has three attributes: healthy people (a population that attains the highest level of health possible), superior care (care that is effective, safe, timely, patient-centred, equitable and efficient) and fairness (treatment is applied without discrimination or disparity to all, regardless of age, group identity or place and that the system is fair to the health professionals, institutions and businesses supporting and delivering care).

A sustainable health system also has three key attributes: affordability (for patients and families, employers, and the government), acceptability (to key constituents, including patients and health professionals) and adaptability (that is, a health system must respond adaptively to new diseases, changing demographics, scientific discoveries and dynamic technologies to remain viable).

In many health systems around the globe, primary-care physicians (general practitioners, or GPs) play a central role as gatekeepers to the rest of the system. In Malaysia, GPs work mainly in private practice, receiving fee-for-service payments.

Similarly, a majority of Malaysian GPs derive a substantial proportion of their income from dispensing medication to patients, and they are the major obstacle to the implementation of the separation in dispensing between a GP clinic and a community pharmacist.

The Malaysian healthcare is not linked to a private provider or group of providers. Such a fragmented system needs to be reformed to improve efficiency and safety. We live in a time when consumers and patients want to know more about the food they consume and the drugs they take, and their appetite for information is growing.

Yet the nation is also facing a communication gap that has implications on public health. This gap extends from what patients want to know about their medicines.

Evidence from local and international studies suggests that inadequate communication about drugs is one reason why 30 to 55 per cent of patients deviate from their medical regimens.

Patients’ misunderstanding of the use of medication is also an underlying cause of adverse drug reactions.

The expansion of the pharmacist’s obligation to inform patients has been acknowledged in the pharmacists’ code of ethics.

So far, however, economic considerations and constraints on physicians’ time have hampered efforts to ensure that patients receive such counselling.

Although the amount of time physicians can spend discussing medications with patients is limited, the medical profession has traditionally been committed to patient education.

There are relatively few barriers to healthcare providers outlining to patients the risks of prescribed drugs. The question, therefore, is not one of principle but of implementation.

Physicians, not through untrained dispensers, need to re-examine the amount of information they must give to patients and the way to deliver it. In addition, GPs need to acknowledge that pharmacists should have a larger role in patient medicine-related education and advise patients to expect counselling when they fill their prescriptions for medicines.

Although the cooperation of many groups is important, the pivotal role, and primary responsibility for the use of drugs, belongs to the physician and pharmacist. Their involvement will determine whether a renewed patient-education campaign will make a difference in public health.

Prof Dr Mohamed Azmi Ahmad Hassali

Professor of social and administrative pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang

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