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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

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Cima lecture series pharmacy practice in japan and thailand experiences as a visiting professor l.jpg

CIMA Lecture SeriesPharmacy 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 l.jpg

  • Discuss TTUHSC SOP exchange agreements

  • Describe the government healthcare systems in Japan and Thailand

  • Compare/contrast pharmacy education systems between the US, Japan, & Thailand

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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



Available at: Accessed April 4, 2010.

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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

    • KhonKaen University School of Pharmacy, KhonKaen, Thailand

      • 2009 to present

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TTUHSC SOP Exchange Agreements

  • Faculty exchange

    • Visiting Professor

      • 6 week experience

      • Teach elective course

      • Participate in scholarly activities

    • Visiting Teaching Professor

      • 1-2 week experience

      • Teach core content within particular curricular area, ie cardiovascular module

  • BS program: translator

  • Masters programs: no translator

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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JAPAN:My Experiences

  • International Conferences on Experiential Training

    • Invited twice to speak on relevant experiential training topics

      • Preceptor development

      • Continuous professional development

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  • 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

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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

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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

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THAILAND:KhonKaen 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

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THAILAND:State of Healthcare

  • Holistic Health Care Unit

    • Alternative medicine units on hospital ward

    • Therapeutic “Thai” massage

    • Facial spa

    • Foot spa & massage

    • Herbal compress techniques

  • Oil massage & aromatherapy

    • “Tiger Balm” applications

  • Traditional Thai knowledge

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THAILAND Wat Pho Temple

  • 1st site for “Thai massage”

  • Massage school still exists on temple property

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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 keyrole in recommending drug therapies based on symptoms

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THAILAND:KhonKaen 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

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THAILAND:KhonKaen 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

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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

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THAILAND:KhonKaen 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

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THAILAND:KhonKaen 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

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Daily Compounding List

  • Sodium fluoride

  • White vaseline

  • PEG 400

  • Phenytoin sodium

  • Sodium thiosulfate

  • Ganciclovir

  • Eucalyptus oil

  • Rose oil

  • MCT oil

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THAILAND:KhonKaen 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

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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

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  • 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

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  • 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