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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

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
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
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
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
ttuhsc sop exchange agreements5
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
ttuhsc sop exchange agreements6
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 agreements7
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 agreements8
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 state of healthcare
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
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 practice12
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 practice13
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 practice14
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
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
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
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 experiences18
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 experiences19
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 experiences20
JAPAN:My Experiences
  • International Conferences on Experiential Training
    • Invited twice to speak on relevant experiential training topics
      • Preceptor development
      • Continuous professional development
japan insights
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
thailand
THAILAND

Larvae

thailand state of healthcare
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 healthcare24
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
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
thailand state of healthcare26
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
thailand wat pho temple
THAILAND Wat Pho Temple
  • 1st site for “Thai massage”
  • Massage school still exists on temple property
thailand state of healthcare28
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
thailand khon kaen university29
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
thailand khon kaen university30
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
thailand state of pharmacy practice
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 university32
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
thailand khon kaen university33
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
daily compounding list
Daily Compounding List
  • Sodium fluoride
  • White vaseline
  • PEG 400
  • Phenytoin sodium
  • Sodium thiosulfate
  • Ganciclovir
  • Eucalyptus oil
  • Rose oil
  • MCT oil
thailand khon kaen university35
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
thailand my experiences
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
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
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
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