Virtual
Pharmacy in Europe Mar01 |
A
medical diagnostic machine (MDM) - the size of a 50cm Television screen -
mounted on the wall of a bathroom (a standard fitting) has a digital
camera, audio-visual phone, email, PC, printer and diagnostic testing
facility for body temperature, blood, urine and blood pressure. It allows
instant contact with the local Doctor's surgery. It transmits
high-resolution pictures of skin or other body parts. It can
electronically transmit the results to both the Doctor and a hospital
consultancy service for analysis, diagnosis and for issuing prescription
for required medicines. The prescription is emailed to the appropriate
wholesaler of medication for delivery by courier to the patient, complete
with instructions for dosage, storage and an explanatory note of tests and
the nature of the illness. A copy of the prescription is automatically
recorded on the Doctor's database as well as the patient's medical card. The MDM is regularly serviced
for inputs by service contractors and the cost of this, as well as the
cost of the consultation and medicines, are billed electronically to the
health insurer, e.g., government or private insurance company or a
combination of the two. Every person has a pin number and a medical card
with a photo. Such a card, regularly updated with the medical history of
the person, allows direct access of medical information wherever and
whenever required. Although there is already
technology that can allow such practice to be implemented, the European
apothecary need not fear for a while! Clearly, there are substantial
savings for governments, private health insurers and industries employing
large labour forces in using virtual health delivery programmes. However,
there are many patients, especially the elderly in rural areas, who will
miss a personal visit to their local pharmacy (apothecary) to enjoy a chat
with the pharmacist - a reassuring experience that may still have some
medical value! In
Denmark it is almost impossible to start a new pharmacy shop as one has to
buy an existing business from a willing seller. In Sweden all 900
pharmacies countrywide are owned by the Government - a state
monopoly! In Finland a pharmacist can own a maximum of 4 pharmacies except
the University of Helsinki which owns 16 pharmacies. In most continental
European countries, only a pharmacist can own a pharmacy and only
medicines may be sold. In the
UK, anyone can own any number of pharmacies and sell anything including
food, cosmetics and cameras. There are also differences in curriculum of
pharmacy courses and training leading to professional registration. There
is as yet no implementation of EU directive for mutual recognition of
qualifications. Antibiotics and other prescription-only medicines are
available without prescription in some EU countries and not in others. A
Doctor's prescription from one EU country may not be accepted in another
country causing considerable difficulty for frequent travellers requiring
repeat medication for diseases such as asthma, blood pressure and
diabetes. The same medicine can vary in price by more than 100% in the
different Member States - a difference that cannot be justified and which
inevitably leads to parallel importation profiting the middlemen. In many
continental European countries, the pharmacist is perceived as a
professional commanding high respect, status and income - in the UK, the
retail pharmacist is not held in such high esteem. To this day, the
apothecary continues to operate in a protected way unaffected by the
Single Market of the EU! Information should be, but
currently is not, at the centre of healthcare delivery. Very few patients
have in depth knowledge of their illnesses and the best treatment options.
They rely on their Doctor’s judgement - a judgement that may be made
without use of appropriate equipment, testing facilities and information
on availability of hospital beds and specialist consultants. Doctors are
unable to instantly access previous medical records of new patients
thereby exposing them to further risk. The
advances in Information Technology offer vast opportunities to create,
store, transmit and analyse data on symptoms, treatment options,
medication prescribed, side effects and costs. Every government seeks to
rationalise the cost of health delivery as they face high expectations of
citizens and an increasingly ageing population. Detailed information is an
important tool for governments in their search for a health system based
upon highest value added. There are, at present, significant differences
in national health expenditure of EU Member States. Some are seeking to
establish partnership with Health Insurance companies that will make use
of such advances in IT to achieve substantial savings. Therefore the EU requires
appropriate legislation to regulate the e-commerce in medicines.
Safeguards on privacy, authority and validity of consultation, accuracy in
dispensing of prescription and verification of the patient on delivery are
only some aspects requiring new technical solutions. Appropriate EU
guidelines must be established for availability of detailed information on
chemical constitution of medicines, efficacy, toxicity, contraindications,
dosage availability and cost that can be readily accessed on the internet
by both patients and doctors. Increasing mobility within the
EU, rising aspirations of our citizens for better health leading to higher
expectations of quality treatment and an ageing population will require
substantial national expenditure on health services. European pharmacists
must adapt quickly to advances in technology so that they remain an
essential link in the chain of professionals required to deliver the best
for our citizens!
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