Over the last 10 years, national statistics on health has indicated a significant increase in the number of non-communicable diseases such as diabetes and other cardiovascular-related diseases among the population. The major reasons for this significant increase include the lack of awareness and the lackadaisical attitude towards leading a healthy lifestyle. It is also interesting to note that despite the numerous health promotion campaigns and activities conducted nation-wide by the government or non-governmental organizations, the impact and outcomes of these programmes have been minimal in reducing the disease burden. The time has come for healthcare providers, to ask themselves “What has gone wrong and who is to blame?”
The lack of interprofessional collaboration among partners in healthcare delivery in pushing forward the health promotion agenda is to blame. It cannot be denied that in the public sector, the government through the Ministry of Health has done a tremendous job in ensuring the delivery of preventive services via the provision of primary health care services. However, one of the setbacks is that the current public demand has resulted in manpower and the cost of running such programmes being stretched to the limits due to the extreme focus on one group of health care professionals, that is, the medical doctors. Therefore the time has come for engaging a broader group of healthcare professionals in such an activity. With the importance of primary care services being emphasised by international health bodies such as the World Health Organization (WHO), the current training of health professionals has also been transformed. Subjects such as public health and epidemiology which were traditionally taught to only medical students have now been made compulsory subjects in all health professional undergraduate training. For example, public health and epidemiology are core subjects in the curriculum of most pharmacy courses throughout the country. Similarly, public health subjects are also incorporated into the curriculum of nursing programmes and other allied health sciences courses.
Alternatively, in the private sector, primary healthcare providers, comprising general practitioners, dentists and pharmacists are in the best position to take the health promotion agenda further. But unfortunately, although it is mandated that health promotion activities are to be provided by primary health care workers, the uptake among practitioners is very low and interest in providing such intervention is minimal due to the non-profitable nature of such interventions. The problem in our country is that nearly all the relevant health care professionals in the private primary care services work with a silo mentality. Primary care services can only be enhanced when there is coordinated effort. Currently, most of the healthcare providers do not complement each other’s roles and they also tend to put their interest in business first rather than patient care. Feedback from colleagues in both the medical and pharmaceutical fraternity shows that most of them blame the existing out-of-pocket services as the main obstacle towards working in close collaboration with each other. Consequently, business interests and survival in the healthcare market become the top priority for healthcare providers. In the long term, this is unhealthy as the consumers of health are the ones who will be victimised. One may argue that by having too many health professionals to cater to, our primary health care will become too expensive, but this is unlikely as health promotion advice and counselling from community pharmacies for instance, are free of charge or at a very minimal cost.
Furthermore community pharmacists are very well trained to deal with minor illnesses which can be easily managed with over-the-counter preparations. Beside that, by forging interprofessional collaboration, pharmacists will refer their patients to the general practitioners or other allied health personnel if the patients need further diagnosis or out-of-prescription treatment. This has been successfully implemented in many developed nations and it is our belief that this model can be implemented here. It is hoped that both professional bodies and individual practitioners can come together, exchange ideas and discuss the creation of a model for successful interprofessional care. Once a model has been created, it is crucial to carry out a study on its effectiveness in preventive care. This is to ensure that there is sufficient evidence to institute policy changes for the benefit of society.
Associate Professor Dr Mohamed Azmi Ahmad Hassali, M.Pharm, PhD
Dr Jayabalan Thambyappa, MBBS, M.Sc
Discipline of Social and Administrative Pharmacy,
School of Pharmaceutical Sciences,
Universiti Sains Malaysia