Pharmacy in Hong Kong
In this article Pamela Mason, MRPharmS, describes pharmacy practice in Hong Kong
The Pharmaceutical Journal Vol 267 No 7179 p911-936
22-29 December 2001
Since Hong Kong reverted to Chinese rule in 1997, little has changed — on the surface at least. Cars still drive on the left, most wall outlets take three square pin plugs, and the pillar boxes, although changed from red to green, are the same ones we can all recognise at the end of our own streets. But that is just the surface, and the people of Hong Kong are all too aware of the uncertainties that face them over the next few years.
Pharmacists are no exception. Hong Kong’s pharmacy practice has, not surprisingly, been influenced by the British system, although during the past 30 years or so, it has lagged behind pharmacy in the United Kingdom without moving forward far in its own direction. Some of the terminology in use reminds of me of my early days as a pharmacist in the mid 1970s and has quite a quaint ring to it. Pharmacy owners, who do not have to be qualified pharmacists, are known legally as “authorised sellers of poisons”. In fact, all medicines in Hong Kong are legally classified as poisons. There are part 1 poisons which have to be sold under the supervision of a pharmacist, part 1, schedule 1 poisons for which the pharmacist has to make an entry in the poisons book and part 1, schedule 3 poisons which should only be supplied with the authority of a prescription. Finally there are part 2 poisons, which can be sold outside of pharmacies by “listed sellers” of poisons who require a licence to do so.
Outlets selling only traditional chinese medicines are currently unregulated, but government thinking is moving towards regulation
Although these legal categories are roughly equivalent to our prescription only, pharmacy only and general sale list medicines, there are some interesting differences in detail. Salbutamol inhalers and betahistine tablets are effectively P medicines, and products containing phenylpropanolamine — also P medicines — have, in the light of the recent scare in relation to stroke, been shifted to schedule 1 for which the pharmacist must make a record. Histamine H2-antagonists (Zantac, Tagamet and Axid) are part 2 poisons, available as our GSL medicines on open shelf in a variety of outlets, and can be bought without a pharmacist’s supervision — as can oral contraceptives.
In theory, the prices for OTC medicines are fixed, but as history unfolds and Hong Kong residents become more used to travelling to China, they also become more used to bargaining. They bring these skills back with them to Hong Kong, where they expect to be able to obtain OTCs at lower prices than those on the shelf. “If you want to stay in business, it’s something you have to take on board,” pharmacy owner Clarence Wong told me.
Another interesting thing is that until the mid 1990s pharmacists had to train abroad — there was no pharmacy faculty in Hong Kong — and those pharmacists I met had completed their degrees in countries as diverse as the United States, the UK, Taiwan, Australia and Singapore. Nowadays, pharmacy students study on a three year degree programme at the Chinese University in Hong Kong and complete 12 months of preregistration training, at least six months of which must be in a hospital.
There are just over 300 community pharmacies in Hong Kong, one for every 20,000 people (compared with one per 4,500 in the UK) and most employ just one pharmacist. But they are not all rushed off their feet, far from it. This is because pharmacists do little dispensing, with many dealing with no more than 10 items a day and it is rare to see a computer in a pharmacy.
In common with several other countries in Asia (eg, Singapore, Malaysia, Thailand), the process of prescribing and dispensing has not been separated, and this means in the community that doctors tend to do both. So, under the current circumstances, more pharmacies would not be sustainable, and most owners say how difficult it is to make a living from sale of OTCs alone.
Indeed, sale of prescription items like antibiotics is not unknown in Hong Kong pharmacies, supposedly to help make ends meet. The Hong Kong Pharmaceutical Society, which celebrated its 50th anniversary in 1999, is aware of this situation, and recent statistics suggest that their efforts to curtail such practice are starting to be rewarded. Pharmacists are hoping to do more and more dispensing in the future, and those I spoke to seemed rather surprised when I told them — slightly tongue in cheek, of course — that we in the UK are trying to get rid of it. Or more seriously, that we are trying to reduce our dependence on income from prescriptions.
In the current circumstances, Hong Kong pharmacy owners, not surprisingly, see prescriptions as a means to improve their standard of living, and their employee pharmacists see prescriptions as a means of enhancing their professional role, because it means they will see more patients.
However, this freedom from counting and pouring means that pharmacists have a golden opportunity to provide advice and counselling to patients, and one that the “leading edge practitioners” have seen and are trying to grasp. But, as they realise, there is a huge job to be done in educating patients to understand the value that pharmacists can give.
Angie Mao, a pharmacist who provides diagnostic services, health promotion advice and advice on common ailments
One pharmacist I met, Angie Mao, who had trained in the United States, was clearly running a successful pharmacy by seeing patients, sometimes by appointment, throughout the day, providing diagnostic services such as blood glucose monitoring, health promotion advice including nutrition as well as advice on all the usual common ailments. Moreover, she encourages people to come to her when they have problems with their prescription medicines, even though she, like other pharmacists, does relatively little dispensing. She relishes the professional satisfaction of having a type of practice which appears pretty close to that advocated by Professor Linda Strand in Minnesota. However, the fact that her pharmacy is in a relatively wealthy area of Hong Kong with a large expatriate population does undoubtedly help.
A discussion of pharmacy in Hong Kong would be incomplete without mention of that other unique, and well known, feature, traditional Chinese medicine (TCM). Not all pharmacies stock a huge variety of Chinese medicines, but several pharmacies are divided down the middle with one half selling “western” medicines and the other half, traditional chinese medicines.
There are some outlets which are not pharmacies, but which sell eastern medicines alone. These latter outlets are currently unregulated, but government thinking is moving towards regulation, and pharmacists who have traditionally had little training in this area, can now obtain a certificate or diploma in this discipline.
In addition, TCM clinics are starting to be set up in hospitals, and there is a growing integration between eastern and western medicine.
Mr Kwing Yee Lin, consultant for the Eu Sang Group, a chain of outlets selling herbs and traditional chinese medicines
The cost of health care to patients in Hong Kong is pretty reasonable as it is heavily subsidised, especially in hospitals, which is where people on low incomes tend to go. A consultation with a doctor in a hospital currently costs about £3.50 and a stay in hospital, including any surgery, about £6.50 a day, but costs are likely to rise during the next year, and the population is now being encouraged to save for health care bills. There are some general practitioners in the community, but there are many specialists too, and with a consultation costing anything from £15?60, people have to be reasonably well off to visit one. However, some people will always be prepared to pay for the promise of good health, whether it works in reality or not. Kwing Yee Li, a former government chief pharmacist, now a consultant for the Eu Sang Group (a chain of outlets selling herbs and TCM), who, incidentally spent time at the Royal Pharmaceutical Society in 1969 learning about UK pharmacy law, told me about a piece of ginseng he had seen fairly recently. No more than a foot long, it had its origins in the Chang Pak mountain in China, which is apparently famous for ginseng. The price? The same as two Mercedes Benz. I was stunned, and yes, apparently, somebody did buy it.
Pamela Mason is a freelance pharmaceutical writer from Sydenham, London
Citation: The Pharmaceutical JournalURI: 20005699
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