The misuse of medication is a serious problem in China. In 2018, The National Health Commission issued a notice to improve the regulation and verification of prescriptions in medical institutions. [1] This notice stipulated that pharmacists are primarily responsible for prescription verification, and all the prescriptions should be checked by licensed and trained hospital pharmacists before drugs are dispensed. Hospital pharmacists are responsible for making sure that medications are prescribed appropriately and according to regulations. 

However, this regulation has caused concerns because of the shortage of trained pharmacists. Until July 2018, the total number of registered pharmacists in China was 430,566, with an estimated 3.1 pharmacists per 10,000 people, which is lower than the international average (4 pharmacists per 10,000 people). [2] Quite a few medical institutions are desperately short of available hospital pharmacists. The training available for pharmacists is also another cause for concern as not all medical schools provide standardised training programs. 

A further issue is lack of recognition for the role of pharmacists, which hinders the implementation of prescription verification. This could be because some physicians may not understand the responsibilities of pharmacists or value their work sufficiently. Some physicians may not fully recognise extensive knowledge hospital pharmacists can have, and the importance of sharing their pharmacy expertise. 

Secondly, physicians and hospital pharmacists do not routinely work in a collaborative manner as members of an interdisciplinary team. Interactions among physicians and hospital pharmacists are infrequent and in most cases of short duration. There can also be a tension if pharmacists make recommendations for prescriptions to be modified, for example due to concerns about adverse drug reactions. There is a need for hospital management systems to help physicians and pharmacists to establish good working relationships with one another and be supportive of their work in order to improve patient care. 

Finally, the role of pharmacists needs to be improved in terms of the education and training, as well as their professional value and career development. With the development of an information system in China, an increasing number of hospitals have started using an automatic dispensing system to improve the efficiency of the pharmaceutical service. This new trend may advance pharmaceutical care in hospitals, but weaken the role of hospital pharmacists.

To promote prescription verification successfully in hospitals, some efforts could be considered. Firstly, collaborative relationships among hospital physicians and pharmacists need to be strengthened. For physicians, it is necessary to learn from hospital pharmacists, to communicate with them, and collaborate. Secondly, pharmacists need more opportunities for training and career development. Training programmes could also specifically target interdisciplinary collaboration to provide physicians with an awareness of the role of pharmacists. Third, hospitals should make the regulation of prescription verification be more feasible and practical.

Zhijie Xu is a masters student and resident at Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine 

Lizheng Fang is a professor at Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine

Lirong Shen is a clinical pharmacist at Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine

Mi Yao is a medical student at University of Birmingham, Institute of Applied Health Research 

Competing interests: none declared

References:

1       General Office of National Health Commission of the People’s Republic of China. The notice about regulation of prescription checking in medical institutions. 

2       China Food and Drug Administration. Registry platform of licensed pharmacist. http://zyys.sfda.gov.cn (accessed July 16, 2018; in Chinese).

3       Xinhuanet. Dilemmas for clinical pharmacists: patients do not appreciate and doctors do not acknowledge.

4       Zeng L, Li J. Investigation on hospital pharmacists in 15 provinces and cities in the background of health care reform in China. Chinese Pharmacists, 2015; 18: 1714-1717 (in Chinese).   

5       Zhang Z, Hua Y, Xin H, et al. A case of multi-system integration project for outpatient pharmacy. China Digital Medicine, 2015; 6: 5-7(in Chinese).