Chapter 1
The word is derived from the Grecian word ‘pharmakon ‘ significance “ drug ” or “ medical specialty ” and has been used since the 15th and 17th centuries 1. Pharmacy is a wellness profession that combines the wellness scientific disciplines with the chemical scientific disciplines. It ensures the safe and effectual usage of pharmaceutical drugs.
Pharmacy pattern includes modern services that are related to wellness attention: clinical services, supplying drug information and reviewing medicines for safety and efficaciousness intents 1.
1.1.1 The assorted subjects of Pharmacy
Pharmacy can be divided into three major subjects:
a ) Pharmacies
B ) Medicinal Chemistry and Pharmacognosy
degree Celsius ) Pharmacy Practice
Pharmacology is frequently considered to be a 4th subject but is non specific to pharmaceutics, even though it is indispensable. The boundaries between the different subjects and other scientific disciplines like biochemistry are non clear cut. Hence, research work from the assorted subjects is frequently done at the same time 2.
1 The Hormone Shop LLC. The History of Pharmaceutical Compunding. [ place page on the Internet ] . 2010 [ cited 2010 Oct 10 ] . Available from: hypertext transfer protocol: //www.thehormoneshop.com/historyofcompoundingpharmacy.htm
2 Dayanada Sagar College of Pharmacy, Bangalore, India. History of Pharmacy. [ place page on the Internet ] . 2008 [ cited 2010 Oct 10 ] . Available from: hypertext transfer protocol: //www.dscpharmacy.org/pharmacy.php
1.1.2 The Pharmacist and Community Pharmacy
Pharmacists are skilled and highly-trained wellness attention professionals who guarantee optimum wellness results for their patients. In the community pharmaceutics, the druggist has assorted functions and these include amongst others ( Azzopardi, 2010 ) :
a ) the procurance of medicines that are suited for human ingestion
B ) guaranting the appropriate conditions for the storage of medical specialties
degree Celsius ) guaranting the appropriate and safe disposal of expired medical specialties
vitamin D ) dispensing of medicines that are either on a prescription, or pharmacist-recommended or asked for straight by the patient
vitamin E ) point-of-care proving
degree Fahrenheit ) offering general medical advice without the demand of a anterior assignment.
The pattern of community pharmaceutics varies between states. However, the basic maps and duties are the same.
A community druggist builds a particular relationship with the clients, particularly the regular 1s. Hence, communicating accomplishments are of major importance. The pharmacist finds him / herself soothing and hearing out the patient when necessary, and is expected to be understanding and besides a good hearer.
1.2 History of Pharmacy
The first pharmaceuticss, pharmacists as they were once known, were founded in the Middle Ages in Baghdad. The first 1 was founded in the twelvemonth 754 AD by Muslim druggists during the Islamic Golden Age 2. During the eleventh century, community pharmaceuticss were established in southern France and southern Italy. In 1240, Emperor Frederick II issued a decree – the medical profession was to be separated from the pharmaceutics profession. Pharmacy pattern was to be supervised so that drugs of a suited quality would be prepared and produced ( Azzopardi, 2010 ) .
The history of pharmaceutics can be classified into three phases:
a ) combination and dispensing
B ) clinical pharmaceutics
degree Celsius ) pharmaceutical attention.
Originally, the druggists had to fix and distribute medical specialties so they had to stand out at intensifying. The community druggist was hence extremely esteemed because the readying of medical specialties was greatly valued in society.
In fact, at that clip, the druggists and other professionals such as attorneies, medical physicians and parish priests were the leaders in the community. As clip passed, freshly discovered drugs became more unsafe and potent so they started being prepared by fabricating companies. The druggists ‘ function was merely to distribute these drugs ( Al-Shaqha, Zairi, 2001 ) .
2 Dayanada Sagar College of Pharmacy, Bangalore, India. History of Pharmacy. [ place page on the Internet ] . 2008 [ cited 2010 Oct 10 ] . Available from: hypertext transfer protocol: //www.dscpharmacy.org/pharmacy.php
Pharmacists moved to clinical pattern about 25 old ages ago. The original construct of clinical pharmaceutics services was based on the fact that pharmacists ought to utilize their professional cognition to guarantee the appropriate and safe usage of drugs in patients. As a consequence, several druggists presents work in infirmaries, nursing places and some ambulatory clinics. Problems remained within the drug-use-system despite the progresss made in clinical pharmaceutics and documenting and recognizing these jobs has led to the construct of pharmaceutical attention going the new footing for pharmaceutics pattern ( Al-Shaqha, Zairi, 2001 ) .
1.2.1 History of pharmaceutics in Malta
1.2.1.1 History of pharmaceutics in Malta from the late fifteenth century until the reaching of the Knights of the Order of St. John of Jerusalem in 1530
Before 1500, the druggists in Malta were about all Sicilian. In the early fifteenth century, druggists were employed either by the Universita ‘ or by the Hospital of Santo Spirito.
Mastru Salvatore Passa is the first documented druggist in Malta who practised in Mdina and the Hospital of Santo Spirito in Rabat from 1450 to 1475. The medical specialties prescribed in those yearss were chiefly herbal. During this period, Passa frequently travelled to Sicily due to his work, presumptively to import medicative herbs as many herbs did non organize portion of the local vegetation ( Borg, 1998 ) .
1.2.1.2 Pharmacy under the Knights of the Order of St. John of Jerusalem
The Knights of the Order of St. John of Jerusalem arrived in Malta on the 26th October, 1530 and they applied their cognition of pharmaceutics to the pattern in Malta. A Holy Infirmary in Birgu was built and the Grecian druggist, Giacomo Gualterio, who had accompanied the Order to Malta was the apothecary ( Borg, 1998 ) .
Grand Master Nicholas Cottoner established the School of Anatomy and Surgery at the Holy Infirmary in 1676. It is really likely that a Pharmacy class was established in the school ( Borg, 1998 ) .
Under the Knights, the pattern of pharmaceutics in Malta changed bit by bit, but continuously, happening in a similar manner to that in Europe. However, ad-lib readyings remained the same from the times of Mastru Salvatore Passa because the expansion of the pharmaceutical industry still had to happen ( Borg, 1998 ) .
1.2.1.3 Pharmacy under the Gallic and British settlements
The Gallic arrived in Malta in 1798. There were no more than 32 pharmaceuticss under their rule, each one holding an mean patronage of 3,000 patients. No alterations were made to the Torahs regulating the pattern of pharmaceutics under the Gallic. Hence, the day-to-day activities of the druggists were indistinguishable to those of under the Knights. The Torahs established by the Knights of the Order of St. John remained in force until 1900. In their stay in Malta, which lasted for about one hundred old ages, the British left their grade on the pharmaceutics profession. The usage of the English linguistic communication, the names of pharmaceuticss refering to Britain or England and the confer withing room in the pharmaceutics are all such illustrations ( Borg, 1998 ) .
1.2.1.4 Pharmacy in the twentieth century
“ The Medical and Kindred Professions Ordinance ” of the Laws of Malta, governs pharmaceutics Torahs. This was enacted in 1900 as the Torahs regulating the profession at that clip had become out-of-date and needful restructuring. A statute law that allowed druggists to distribute certain medicines without a prescription was enacted in October 1955 and on the 12th October 1955, a list of these substances was published in the Malta Government Gazette ( Borg, 1998 ) .
The Malta Chamber of Pharmacists was founded in 1900 in order to protect the common involvements of the druggists and besides to keep the profession ‘s self-respect. Hence, the profession ‘s criterions were raised by enabling the profession to maintain abreast of the alterations that were happening internationally ( Borg, 1998 ) .
In April 1961, an Extraordinary General Meeting was held by the Chamber to discourse the issue of organizing a Trade Union that would stand for druggists ; all 33 druggists present agreed that this was necessary. One of the Union ‘s aims, among others, was to better the conditions under which the profession was exercised and to advance the involvements of druggists. The Pharmacy Board was set up in 1968 and this was the greatest accomplishment of the Chamber and Union. The Union worked really closely with the Chamber and in 1979 they formed one association, i.e. the Chamber of Pharmacists – Trade Union. This association worked really difficult and it affected the current province of the profession and besides the statute law regulating the pattern of pharmaceutics ( Borg, 1998 ) .
In 1984, after several meetings with the Chamber, it was eventually decided that new pharmaceuticss ought to be owned by druggists and that before allowing new licenses, the population ratio has to be taken into consideration ( Borg, 1998 ) .
Patients could acquire their free medicines from the Central Hospital Dispensary and Government Dispensaries throughout the first 50 old ages of the twentieth century. The latter could be found in most small towns around Malta. In 1954, the Central Hospital at Floriana was turned into the Headquarters of The Malta Police Force as by the late fortiess, St. Luke ‘s Hospital became Malta ‘s General Hospital. Hence, the Out-Patient Dispensary of St. Luke ‘s Hospital became the Cardinal Government Dispensary ( Borg, 1998 ) .
Pharmamed, the first local pharmaceutical endeavor, was founded in 1974. This gave rise to several occupation chances in the industrial field, besides heightening Malta ‘s image abroad.
In 1995, as a consequence of strong and consistent dialogues and representations by the Maltese Chamber of Pharmacists, there was the assignment of the first manager of the Government Pharmaceutical Services ( GPS ) . This was portion of the reform of the GPS and the calling patterned advance of druggists in Government service. It was concluded in 1998 in understanding with the Ministry of Health on the full execution of the GPS reform.
1.2.1.5 Pharmacy in the twenty-first century
In June 2007, Mater Dei Hospital replaced St. Luke ‘s Hospital as the national infirmary of Malta. The last of the forces migrated to Mater Dei by November of that twelvemonth. Hence, the chief Government Dispensary was moved to Mater Dei every bit good 3.
In 2008, the much awaited and debated Scheme of the Pharmacy of Your Choice ( POYC ) was introduced. This Scheme enables the people to hold an easier and more comfy entree to the medicines that are given for free by the Government.
3 Mater Dei Hospital Malta. [ home page on the Internet ] . 2009 [ cited 2010 Oct 23 ] . Available from: hypertext transfer protocol: //malta.cc/health-care/mater-dei-hospital-malta/
Therefore the service that was antecedently provided for by the small town Health Centre Dispensaries was transferred to the community pharmaceuticss. The patients chose the pharmaceutics of their pick. The initial phases of the POYC Scheme do non imagine any alterations in the reimbursement system. Therefore, patients who are entitled to take free medicine will go on to make so ; there is no co-payment ( Grima IC ) . Until January 2011, the POYC Scheme had spread to 96 Maltese community pharmaceuticss and to 17 community pharmaceuticss in Gozo. Following the debut of the Scheme, the small town Health Centre Dispensaries where the Scheme was initiated, were closed down after sufficient clip had elapsed.
Over the past few old ages, the figure of local pharmaceutical fabrication companies has dramatically increased. So has the figure of locally licensed pharmaceutical jobbers who import medicines from EU states. There are more pharmaceutical merchandises registered with the local Medicines Authority. This has had a positive impact on both the private and public pharmaceutical sectors due to the handiness of more different curative categories of medical specialties and more medical specialties that autumn within the same curative category ( Grima IC ) .
Recently, the figure of generic medicinals in the private sector has besides increased well. Nowadays, a druggist can replace a branded prescribed medicinal with a generic merchandise that is cheaper for the patient ( Bugeja, 2007 ) .
Accession into the European Union in May 2004 had a great impact on the medical specialties in Malta, particularly with respects to their handiness. Some medical specialties that were antecedently available were non registered due to the high enrollment costs. Hence, EU accession improved the quality of medical specialties. On the other manus, it had a negative impact on their handiness and affordability ( Bugeja, 2008 ) .
The monetary values of medical specialties in Malta increased well after EU accession in 2004. In fact, harmonizing to surveies carried out, the Maltese are paying about 40 % more than the mean monetary value for medicative merchandises in the European Union 4. In July 2010, the Parliamentary Secretary, Chris Said, announced decreases in monetary values of 62 medical specialties. Some of these decreases were to be implemented instantly whereas with others, when stocks were sold out. Many medical specialties in Malta are overpriced when compared to other EU states, so this was a measure in the right way 5,6.
1.3 Pharmaceutical Care
In 1990, Hepler and Strand looked at the duties of the druggist and at pharmaceutics services in a new manner. They applied the term “ pharmaceutical attention ” and over the old ages druggists have endeavoured to develop pharmaceutical attention patterns ( Foppe, Schulz 2006 ) . Harmonizing to Hepler and Strand ( 1990 ) :
4 Maltastar. The monetary value of medical specialties in Malta under European Commission examination. [ home page on the Internet ] . 2010 [ cited 2010 Oct 27 ] . Available from: hypertext transfer protocol: //www.maltastar.com/pages/rl/ms10dart.asp? a=11804
5 Xuereb M. Makers cut monetary values of 62 medical specialties. Timess of Malta [ series on the Internet ] . 2010 [ cited 2010 Oct 27 ] . Available from: hypertext transfer protocol: //www.timesofmalta.com/articles/view/20100703/local/makers-cut-prices-of-62-medicines
6 Vella Matthew. Medicine importers agree to cuts in monetary values of up to 67 % . MaltaToday [ series on the Internet ] . 2010 [ cited 2010 Oct 27 ] . Available from: hypertext transfer protocol: //www.maltatoday.com.mt/news/medicines/medicine-importers-agree-to-cuts-in-prices-of-up-to-6
“ Pharmaceutical attention is the responsible proviso of drug therapy for the intent of accomplishing definite results that improve a patient ‘s quality of life. These results are ( 1 ) remedy of a disease, ( 2 ) riddance or decrease of a patient ‘s symptomatology, ( 3 ) arresting or deceleration of a disease procedure, or ( 4 ) forestalling a disease or symptomatology. ”
In their definition of pharmaceutical attention, Hepler and Strand looked at the patient ‘s quality of life ( Strand et al, 1991 ) . Pharmaceutical attention involves a druggist collaborating with the patient and members of other wellness attention professions 7. This interprofessional relationship allows the execution, design and monitoring of a curative program that will hold specific curative results for the patient to profit from ( Ford, Jones, 1995 ) . Pharmacists are the last wellness attention professionals to come in contact with the patients. They therefore have a major function in educating them sing drug usage. For this ground, druggists must be adequately trained and have excellent communicating accomplishments in order to supply this service in an effectual mode ( Alkhawajah, 1992 ) . Pharmaceutical attention can hence be seen as the constituent of pharmaceutics pattern that has to be performed by a competent druggist who must be committed, honest, accountable and loyal to the patient ( Strand et al, 1991 ) .
1.4 The Health Care System in Malta
Malta ‘s wellness attention system is divided into the public / national wellness attention system and the private wellness attention system in which pharmaceutical services are provided for by 211 pharmaceuticss that are distributed around Malta and Gozo. The public / national wellness system is based on a theoretical account that is founded on the rules of Equity, Solidarity and Justice.
7 American Pharmacists Association. Principles of pattern for pharmaceutical attention. [ home page on the Internet ] . 2005 [ cited 2010 Oct 12 ] . Available from: hypertext transfer protocol: //www.caremark.com/portal/assset/Principles_of_Practice_for_Pharmaceutical_Care.pdf
1.4.1 The Public Health Care System
The Maltese Government consists of different Ministries, one of these being the Ministry of Health, Elderly and Community Care. This deals with the health care needs of the people and ensures that adequate services are provided for 8.
The chief ends of the Government for the public wellness services include 9:
The concern of the patient, which is a changeless issue
The proviso of wellness attention and its direction
The value for money
The sustainability of public wellness attention.
The Maltese Medicines Authority controls and ensures the quality, safety and efficaciousness of the pharmaceuticals that are available locally. It besides authorizes the medical specialties that are to be placed on the local market.
The Government Health Procurement Services ( GHPS ) is responsible for the buying, storage and distribution of all the pharmaceuticals that are required by the Government Health Services ( GHS ) in Malta. This entity operates with the financess that are allocated yearly by the Government. Procurement of pharmaceuticals is done via tendering processs that are regulated by the Public Service ( Procurement ) and Public Contracts ordinances.
8 Government of Malta. The wellness attention system in Malta. [ home page on the Internet ] . No day of the month [ cited 2010 Oct 25 ] . Available from: The Government of Malta, Web site: hypertext transfer protocol: //www.sahha.gov.mt/pages.aspx? page=156
9 Integrated wellness information system stage 2. [ home page on the Internet ] . 2010 [ cited 2010 Oct 24 ] . Available from: The Government of Malta, The Malta Information Technology Agency Web site: hypertext transfer protocol: //www.mita.gov.mt/TenderFile.aspx? tfid=727
1.4.1.1 Primary Health Care
The Government delivers primary wellness attention via the Health Centres that are distributed around assorted small towns in Malta and Gozo. These Centres were set up in 1980 in order to supply free wellness attention services 9. Besides supplying the free services of general practicians, these Centres besides provide a huge scope of other services, including:
Specialist clinics eg: gynecological clinics and diabetes clinics
Laboratory diagnostic installations
Radiology.
Many people choose to hold the services of private general practicians and / or specializers who work in the primary wellness attention sector. In the private scenario, their services are against payment.
1.4.1.2 Secondary and Tertiary Health Care
These are provided for by public and private infirmaries, found in different locations in Malta. The chief public infirmary is Mater Dei Hospital and it provides a broad scope of services, including graft surgery, unfastened bosom surgery, exigency attention and diagnostic services. Sir Paul Boffa Hospital, another public infirmary, has an oncology and dermatology unit. Mount Carmel Hospital is the island ‘s public psychiatric infirmary.
There are a figure of private infirmaries in Malta, amongst which is Saint James Capua Hospital.
9 Integrated wellness information system stage 2. [ home page on the Internet ] . 2010 [ cited 2010 Oct 24 ] . Available from: The Government of Malta, The Malta Information Technology Agency Web site: hypertext transfer protocol: //www.mita.gov.mt/TenderFile.aspx? tfid=727
1.5 Free wellness services provided by the authorities
The Government provides free wellness services ; free at the point of bringing, as these are straight funded from general revenue enhancement. In Malta, the boundary between the private and public sectors can be seen from two different facets: medical and pharmaceutical ( Wismayer, 2010 ) .
1.5.1 The Medical Aspect
The health care is available to ALL Maltese citizens, irrespective of the societal and fiscal background of the patient. Anybody can turn up at a Health Centre or public infirmary and be given the necessary intervention. Hence, up to a certain extent there is a holistic attitude as no differentiation is made between citizens and whoever requires a healthcare service is provided with what is needed ( Wismayer, 2010 ) .
The seams start to demo up when the services available in the public wellness system are non accessible. That sector of society who can afford to pay, will hence hold to seek the services from the private sector. A instance in point is the long waiting lists for certain needed processs at Mater Dei Hospital.
1.5.2 The Pharmaceutical Aspect
One of the major tools to accomplish good health care is to supply good pharmaceutical attention. From this facet, there is a clearer differentiation between the private and public sectors.
The Government offers free medicines to a figure of people who fall under different classs:
The Schedule II Patients ( Pink Card Holders )
These cards are issued from the Department of Social Security. They are accompanied by a pink signifier which bears the name of the pink card holder. The entire household income is assessed and the entitlement is based on this. Each family has one pink signifier that lists all members. However, every member of the family has his / her pink card. The pink signifier and tap card entitle their holders to free medicine that is listed on the Government Formulary. Diabetics besides have a pink card issued in their name.
There are several mistakes in the disposal of this system, as at that place does non look to be a differentiation between the strata of society, as is the instance with some flush people who are besides in ownership of a pink card. Besides, no differentiation is made between hospital in-patients and out-patients ; there is merely one pharmacopeia for all. 10.
The Schedule V Patients ( Yellow Card Holders )
If a individual suffers from a medical status that is listed under the 5th agenda of the Social Security Act, so he / she can profit from this free service, irrespective of the fiscal place. Examples of these conditions include:
Respiratory conditions
Cardiovascular diseases
Malignant diseases
Schizophrenia
Liver diseases
CNS diseases 10.
10 Ministry for Health, the Elderly and Community Care. Free medicinals. [ home page on the Internet ] . No day of the month [ cited 2010 Oct 12 ] . Available from: The Government of Malta, Web site: hypertext transfer protocol: //www.sahha.gov.mt/pages.aspx? page=8
When a patient is diagnosed with such a status, he / she is referred to a Adviser by the General Practitioner. The Consultant applies for a Schedule V Card for the patient naming the needed medicines. Subsequently, the patient is issued with the Card from the Almoner Section at St. Luke ‘s Hospital. Peoples who possess a xanthous card are merely entitled to take the medicines that are listed on the card for free. The list must be amended if the intervention is changed.
The Government Hospital In-Patients
Any patient occupant in the Government Hospitals is entitled to free medicine. To day of the month, there is merely one Government pharmacopeia for all public infirmaries. It would do more sense if each infirmary had its ain formulary due to the specialization of the infirmaries that varies consequently. These pharmacopeias ought to be put together by the physicians who work at the infirmaries and by the druggists who know what medicines are available and which are best suited for the patients.
Other people entitled to free medical specialties include amongst others:
Members of certain spiritual orders
Inmates of charitable establishments
Refuse aggregation employees
Prisoners
Peoples who are injured on responsibility
Members of the Police Forces below the class of Sub – Inspector
AFM forces 11.
11 Ministry for Health, the Elderly and Community Care. Free medicinals. [ home page on the Internet ] . No day of the month [ cited 2010 Oct 12 ] . Available from: The Government of Malta, Web site: hypertext transfer protocol: //www.sahha.gov.mt/pages.aspx? page=172
1.6 The Pharmacy of Your Choice Scheme
The Pharmacy of your pick Scheme ( POYC ) falls under the umbrella of the Health Division in Malta. The latter is under the portfolio of the Ministry of Health, the Elderly and Community Care. POYC is under the direct duty of the Permanent Secretary of Health. The Scheme started in 2008 after several old ages of treatments and arguments. It enables the people to hold an easier and more comfy entree to the medicines that they are entitled to take for free from the Government.
The Scheme started in 2008 with an estimation budget of a‚¬460,000 and the existent outgo for that twelvemonth amounted to a‚¬366,000. In 2009, the estimation budget was of a‚¬400,000 and that for 2010 was of a‚¬1.5 million. The 2011 budget allocated a‚¬1 million to the Scheme apart from the extra a‚¬400,000 which had to be injected to beef up the electronic system.
The POYC pilot survey started in December 2007 in two pharmaceuticss in the Ghargur country. About 550 patients were registered in these pharmaceuticss. Mgarr was following ( one community pharmaceutics holding about 600 patients ) , followed by Mellieha ( three pharmaceuticss holding about 1500 pateints ) in January 2008 and Naxxar in February 2008 ( Sant Fournier, 2008 ) .
Most community pharmaceuticss enrolled in the POYC when the Scheme was introduced in their small towns. For illustration, in the Mosta country, which includes Naxxar, St. Paul ‘s Bay, Xemxija, Gharghur, Mgarr, Mellieha and Mosta, merely one out of the 24 community pharmaceuticss did non fall in in the Scheme due to miss of infinite ( Zahra, 2007 ) .
With the debut of the POYC Scheme, the small town Health Centre Dispensaries were closed down after sufficient clip had elapsed to let for a seamless passage.
1.6.1 Advantages associated with the POYC Scheme
The chief range of the POYC Scheme was to cut down the long waiting lines at the Health Centre Government Dispensaries. Besides, patients are monitored better by the community druggists who guarantee that the medical specialties are taken in the right manner as more patient advice is given on a one-to-one footing when compared to the old system ( Zahra, 2007 ) . Pharmacy pattern in the community has ever focussed on the constitution of an first-class patient-pharmacist relationship ( Sant Fournier, 2007 ) . This advice is missing in the populace sector as the patients are given the medical specialties they require with hastiness, due to the big figure of people waiting to roll up their medicines. Dosage regimen advice is normally the lone advice given. Many people used to turn to their community pharmacists anyhow to seek advice and to work out any questions they may hold had.
With this Scheme, there is besides a lessening in wastage because patients are non given the medical specialties if these are non required, despite the fact that they are entitled to them. Sant Fournier, the President of the Malta Chamber of Pharmacists, claimed that most patients have become more educated and as a consequence acknowledge the fact that medical specialties are non to be taken as a for granted privilege but must be used rationally ( Borg, Bonello, 2009 ) . The patients find it easier to confide in their accustomed druggist instead than speak to person who they do non cognize.
1.6.2 Problems associated with The POYC Scheme
Harmonizing to Mario Debono, the so General Retailers Trade Union ( GRTU ) Pharmacy and Health Division President, this system has been a success even though it would better if more money is allocated by the Government and if it receives more attending ( Borg, Bonello, 2009 ) .
As with any other late introduced systems, there are defects. Nevertheless, several attempts are being made to screen them out. The chief job that is associated with the POYC Scheme is the big figure of medical specialties that are out of stock. This is doing unneeded emphasis on the druggists and patients. The latter have to travel to a Government Health Centre Dispensary that is still unfastened or to Mater Dei Out-Patients Pharmacy to acquire the medicines that are non available from the Scheme. However, this out of stock job is non the mistake of the POYC Department but it has got to make with the buying system of the Government. In October 2009, Debono stated that a possible ground why such a big figure of medical specialties is out of stock is that some providers have non been paid for their services. Deficits of certain medical specialties abroad could besides take to reduced stock degrees ( Borg, Bonello, 2009 ) .
The Government did non organize any educational runs for the general public sing the execution of the POYC Scheme, even though it was advised to make so ( Sant Fournier, 2009 ) . Hence, druggists were faced with several jobs, including sometimes, heated statements with their patients. It was recommended to hold the run based on the one used for the debut of the Euro in Malta, the Malta Euro Changeover Campaign.
In October 2009. Reginald Fava, the so President of the Malta Chamber of Commerce, Enterprise and Industry, made new proposals to upgrade the POYC system which were “ estimated to cut at least a 3rd of present ingestion and maltreatment ” . He described the current POYC system as being “ obscene ” because harmonizing to him medical specialties were being collected even when they were non required by the patients. Fava suggested that patients ought to pay for the medical specialties they require and will be reimbursed by the Government at a ulterior phase. With this proposed system, the patients would besides hold the option to travel for more advanced or more expensive medicines as compared to their entitlement, and will merely hold to pay the difference in monetary value. Hence, with this proposal, the POYC Scheme would be leting superior medical specialties to be taken for free. It would besides do the Scheme more sustainable as it would cut down the out of stock job, be more cost-efficient for the Government, cut down wastage and maltreatment. The Government would therefore be salvaging on costs and would be in a better place to widen the National Formulary with more recent and advanced medicines ( Borg, 2009 ) . At the minute, this is non possible due to fiscal restraints.
The POYC Scheme affected the day-to-day running of the community pharmaceuticss. Due to the increased work burden, some pharmaceutics proprietors had to use farther staff. The proprietors had to buy a computing machine and a pressman for labels to be issued with every dispensed prescription. They besides had to use for internet service at the pharmaceutics. Besides, some pharmaceuticss had to do the necessary agreements to increase postponing infinite to suit the hebdomadal bringing of medical specialties from the POYC Department. Some pharmaceuticss even needed to put in another air-conditioning unit. True, the Government subsidized these disbursals to a maximal capital outgo of a‚¬6,990 ( Lm 3,000 ) . After the Memorandum of Understanding was signed, dialogues were held and the sum was capped at a‚¬9,000.
Harmonizing to an article on the The Malta Business Weekly that was published in November 2009, merely the druggists who own the pharmaceutics are happy with this new system. The employed druggists have had their work burden doubled, if non trebled. Hence, they do non give their patients the service that they used to give before the execution of the Scheme ( Attard, 2009 ) .
1.6.3 The Memorandum of Understanding
The really first papers on the POYC Scheme was submitted to the Government by the Malta Chamber of Pharmacists in 1987. It took 20 old ages of dialogues and arguments for the Memorandum of Understanding ( MOU ) sing the execution of the POYC Scheme to be signed. Signing in fact took topographic point on the 28th July, 2007 ( Sant Fournier, 2007 ) . The MOU was signed by Frank Mifsud, the Permanent Secretary of the Ministry of Health, the Elderly and Community Care ( MHEC ) and Alfred Camilleri, the Permanent Secretary of the Ministry of Finance as representatives of the Government and besides by Mary Ann Sant Fournier, who represented the Malta Chamber of Pharmacists and Mario Debono, who appeared on behalf of the GRTU.
It was agreed that the POYC had to be implemented in stages. In Phase 1, the patients would hold to register at a pharmaceutics of their pick. After enrollment processs were complete, the patients would go forth their prescriptions and relevant paperss at the pharmaceutics. These would so be taken to the primary health care sector where they would be processed and the needed medicines would so be prepared by the druggists and / or pharmaceutics technicians working at that place. The patient-specific pre-packed medical specialty bundles would so be distributed to the community pharmaceuticss from where they would be handed over to the patient. This undertaking had to be piloted for four months in Gzira and Mosta, after which a national roll-out had to follow. It is to be noted nevertheless, that Phase 1 was ne’er implemented ( Sant Fournier, 2007 ) .
In Phase 2, the take parting pharmaceuticss in the Scheme would hold to fix and distribute the medicines which would be supplied to them by the Government. The latter would pay a fee to the pharmaceuticss for their services. The pharmaceuticss therefore had to implement an Information and Communication Technology ( ICT ) System which would finally take to the debut of patient-medication records. The patients who registered at the pharmaceutics of their pick, would have a signifier from the POYC Department that comprises vouchers that have voucher Numberss on them. These would enable the druggist to entree the patient ‘s medicine records. The measures of medicines dispensed would so be entered into the system and sent to the POYC Department ( Sant Fournier, 2007 ) .
In Phase 3, the pharmaceuticss taking portion in the Scheme would be responsible for the procurance and packaging of the medicines that the patients are entitled to take. A Government reimbursement theoretical account would be introduced on the lines of European and international patterns ( Sant Fournier, 2007 ) .
Harmonizing to the MOU, each local council should hold at least one community pharmaceutics registered in the Scheme. Otherwise, a new pharmaceutics licence will hold to be issued in that peculiar vicinity to run the POYC Scheme. A pharmaceutics that joined the Scheme can choose out after giving a twelvemonth ‘s notice and must go on functioning the patients registered there during that twelvemonth. If a pharmaceutics wishes to fall in the Scheme once more after choosing out, it may make so after five old ages from the original opt out determination.
A Standing Advisory Committee ( SAC ) was set up within two hebdomads of the sign language of the MOU. This consisted of a president and a member who was nominated by the Permanent Secretary MHEC, a member who was nominated by the Permanent Secretary of the Ministry of Finance, a member who was nominated by the Malta Chamber of Pharmacists and another nominated by the GRTU. Another member nominated by the Union Haddiema Maghqudin ( UHM ) sees to the working patterns and involvements of its members. The SAC has assorted aims, amongst which are that it sees to the logistics that are required for the POYC Scheme, proctors such execution and makes certain that an audit is carried out on a regular basis.
In July 2008, the SAC decided to halt further roll-out of the POYC Scheme. Sant Fournier stated in The Times on the twentieth August, 2009 that “ this was to implement the Agreement which states that the POYC undertaking should be evaluated, reeingineered as needed to continue with the rollout ” . Up till October 2009, the POYC Scheme had covered merely 33 % of all the pharmaceuticss in Malta and Gozo 12.
Since the sign language of the MOU, several meetings between the pharmaceutics proprietors who opted to fall in in the POYC Scheme, their managing druggists and the SAC were held. The first meeting was held on the twenty-seventh August, 2007. These meetings proved to be really fruitful as questions by pharmaceutics proprietors and druggists were tackled.
The distribution of the pharmaceuticals ( and other points related to the Scheme ) to the community pharmaceuticss are under the duty of the Ministry of Health. The SAC may choose for an alternate, one time there is a national roll-out of the POYC Scheme.
The community pharmacies take parting in the POYC Scheme are paid for their services by the Government at a fixed rate. The fees per patient per twelvemonth are as follows and they are nonexempt:
Year 1 – a‚¬18.64 ( Lm 8 )
Year 2 – a‚¬ 20.97 ( Lm 9 )
Year 3 – a‚¬ 23.30 ( Lm 10 )
Year 4 – a‚¬ 25.63 ( Lm 11 )
Year 5 – a‚¬ 27.96 ( Lm 12 )
12 Maltastar. POYC strategy covering 33 % of all pharmaceuticss. [ home page on the Internet ] . 2009 [ cited 2010 Oct 17 ] . Available from: hypertext transfer protocol: //www.maltastar.com/pages/rl/ms10dart.asp? a=462
1.7 Decision
Over the old ages, community pharmaceutics in Malta has evolved well. The involvements of the patients are given top precedence and this is clearly demonstrated by the execution of the POYC Scheme. This is centred around the patient and was in fact introduced for the patient to profit from. In January 2011, it was nevertheless stated that the whole system was “ in hazard ” . The pharmaceutics proprietors claimed that they were in fact losing money due to the tax-cut trade that came with the system. This was vehemently denied by the Minister of Finance ( Xuereb, Schembri, 2011 ) .
The married woman of the American Ambassador to Malta, Caroly Keenan Kmiec, made a figure of of import points about the wellness attention system in Malta. These were published in an American diary, the Los Angeles Times, on the 19th March 2010. At that clip, the American Congress was fixing to reform the wellness attention in the United States. The article praised the success of Malta ‘s attempts in doing the health care available for everybody. It included points raised during a treatment that was held at Mater Dei Hospital between Maltese and American functionaries 13.
The fact that the Maltese Health Care System was commented upon in such a positive mode in an American diary is really esteemed for Malta.
13 Maltastar. Malta ‘s wellness services served as a footing for USA wellness services – Ambassador ‘s married woman. [ home page on the Internet ] . 2010 [ cited 2010 Oct 25 ] . Available from: hypertext transfer protocol: //www.maltastar.com/pages/rl/ms10dart.asp? a=7999
1.8 Purposes and Aims
The consequence the POYC Scheme had on the community pharmacists provided several barriers that impeded the everyday proviso of pharmaceutical attention. Such barriers chiefly include the deficiency of clip to supply the service and deficiency of wage from the Government.
This survey therefore aimed to:
identify and quantify the activities refering to the Scheme that are undertaken by the three chosen community pharmaceuticss, together with any disbursals incurred
look into the grade of commonalty of their work patterns
give an penetration on the fiscal impact of the POYC Scheme on the community pharmacies where it has been introduced.
As a consequence of this quantification, the reimbursement by the Government was questioned to see if it is equal.
The inefficiencies in the system at the pharmaceutics degree were highlighted. This allowed the perceiver to do suggestions for the necessary alterations required to break the system, including computing machine system alterations that could be introduced.
The POYC Scheme is a really clip devouring procedure for the community druggist. A balance must hence be created between the available clip the druggists / forces have for POYC and the Scheme ‘s demands. By keeping this balance, more clip can be allocated to the daily running of the pharmaceutics and patient advice. Suggestions to keep this balance were given.