Abstract
At present, the problem of hospital congestion is becoming increasingly severe. One approach to solving the problem is to provide medication refills from accredited pharmacies located outside of hospitals. In addition, as a result of the coronavirus disease 2019 (COVID-19) pandemic, it is vital to restrict the number of non-urgent hospital visits in order to reduce hospital overcrowding and the spread of infection and transmission among patients. Moreover, it will improve resource utilization for addressing more difficult situations. This research aims to support the implementation of the policy to achieve the goal of reducing the congestion in hospitals and being able to meet the needs of service users, so that the policy can be implemented effectively and appropriate approaches for adapting during the challenge period can be obtained. The research results on “Approach and Feasibility for Transfer Pharmacy Service from Hospital to Community Pharmacy” are summarized as follows. According to the results of a survey of 255 service users in Bangkok and its vicinities, the results reveal that a majority of the samples faced problems with congestion in hospitals. 84.30% of the sample experienced a long waiting time for outpatient to see a doctor, while 74.10% experienced a long waiting time for outpatient pharmacy. In terms of service users’ behavior, most of them visit pharmacies every two to three months and visit pharmacies near their homes or workplaces. The most requested additional services in pharmacy are initial screening for disease, followed by medicine refills for chronic non-communicable diseases (NCDs), emergency care related to medicines, and vaccinations, respectively. Furthermore, more than 80 percent of service users want to participate in the hospital congestion reduction project. However, the project is still relatively unknown, with nearly 75% of service users do not know the details of the project. For the study of the expansion of pharmaceutical services to community pharmacies and additional cost of services, we use in-depth interviews with (1) 70 pharmacists and owners of community pharmacies (2) related-network organizations such as the Pharmacy Council of Thailand, Thai Pharmacies Association, and
Community Pharmacy Association (Thailand) and (3) 24 staffs and hospital administrators who participated in the program. The results indicate that all three sectors agreed that there are eight services that hospitals can transfer to community pharmacies: 1) blood pressure measurement 2) blood glucose test 3) medicine home delivery service 4) consultation on medication matters and supervising the appropriate prescription of medication for patients 5) explanation of medication side effects and monitoring for adverse drug reactions (ADRs) 6) Counseling via email/telephone/other channels 7) initial screening for disease and 8) medicine refills for chronic non-communicable diseases (NCDs). Moreover, all community pharmacies agree that the additional expenses associated with the services are not substantial, and all costs are variable costs. The additional costs are the opportunity costs which are in the range of 822-1,378 baht per day or 24,660-41,340 baht per month. Suggestions for expanding pharmacy services to community pharmacies, the community pharmacies should expand their services by acting as “Screening and initial counseling unit for treatment under the supervision of the host hospital” and adding all eight services to community pharmacies. However, we should focus mainly on essential services such as initial screening for disease, medicine refills for non-communicable diseases (NCDs) treatment, consultation on medication matters, and supervising the appropriate medicine prescription for patients. Nevertheless, extending pharmacy services incurs opportunity costs for the pharmacies. As a result, the government should provide budget support to participating pharmacies in the range of 24,660–41,340 baht per month or cover the expense of time spent consulting and delivering services, in the range of 187.50–312.50 baht per person per time.
