Growing pharmacist roles in Beijing
Taylor Naberhaus on her first day at the Peking Union Medical College Hospital.
In late summer, I had the opportunity to spend 4 weeks learning from the pharmacists at Peking Union Medical College Hospital (PUMCH) in Beijing, China. During this time, I learned how the following qualities of Beijing are integrated into pharmacy practice and allow the pharmacists to effectively serve the population.
Patient care
The outpatient pharmacy at PUMCH fills prescriptions for 7,000 patients each day who travel from all over China, a country roughly the size of the United States, to receive expert medical care. Each patient could be on one to five or more prescription medications. A high-tech system for identification, payment, and dispensing allows the hospital to serve all its patients with only about a 10- to 20-minute wait time, comparable with the wait times at pharmacies here.
On the inpatient side, the hospital contains 2,000 beds that are served by various care teams. At discharge, all patients receive their new medication from the inpatient pharmacy.
Showing their value
With such an enormous need for the dispensing role, one might wonder if there was time for much else in a pharmacist’s schedule. Certainly, the enormous dispensing volume barely allows time for patient counseling in the outpatient setting. However, the role of clinical pharmacy in China is expanding to match their Western pharmacist counterparts.
At PUMCH, there is a geriatric pharmacist, cardiovascular pharmacist, antibiotic stewardship pharmacist, and many more who attend rounds, make recommendations for medication optimization, and assist in dosing. These roles are expanding since their introduction into Chinese pharmacy practice within the last 10 years.
However, the pharmacists in China are facing barriers to their progress. As of April 8, 2017, the profit that pharmacists receive on medications was reduced from 15% on each medication to 0%, in both the inpatient and outpatient pharmacies within the hospital. Pharmacists also cannot be reimbursed for any of the services they provide, including their growing medication therapy management program. Despite this opposition, pharmacists are determined to show their value and worth on the health care team.
The task of proving their value reminds me of the lobbying for provider status in the United States.
Deep roots in tradition
Culture provides notable barriers to practicing Western medicine, such as seeking to provide evidence-based medicine in a population that largely distrusts Western medicine, preferring Chinese traditional medicine. One Chinese traditional treatment seeks to prevent the common winter cold by using a cream on the three hottest days of the year. In this way, the heat will protect the individual in the winter months from catching a cold, which is similar to our vaccination process.
Chinese traditional medicine involves treating the person with different herbs and substances that have been boiled into a fragrant broth. The patient then drinks the broth as their medication. I have heard from reliable sources that the taste of the broth can be quite unbearable, but I enjoyed the herbal scents as I walked the traditional medicine floor. Most of the pharmacists at PUMCH were trained solely on Western medicine, but still had to be aware of the interactions that can occur with the medicinal herbs that are boiled and drank to treat various ailments.
The global view
Globalization has provided the opportunity for pharmacists around the world to learn and grow from the knowledge of one another. While payment structures and governance varies greatly among nations, I have found pharmacists are all striving toward a common goal—to provide the level of patient-centered care to others that everyone would want their own family members to receive.
Learning to provide patient-centered care with fellow pharmacists on the other side of the world was one unforgettable and growing experience.
Taylor Naberhaus is a final-year PharmD candidate at the Drake University College of Pharmacy and Health Sciences.