Can the shortage of licensed pharmacists in many places to encourage "remote trial prescriptions" be alleviated?

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Recently, many provinces have issued intensive policy documents to encourage pharmaceutical retail enterprises to promote the "remote review of licensed pharmacists". How will this measure be implemented? Whether it can effectively solve the dilemma of the large gap of licensed pharmacists? A series of problems have also triggered discussions in the industry.

Many documents issued to encourage the implementation of "remote review party"

According to incomplete statistics, policies have been issued in Hunan, Shaanxi, Fujian, Chongqing, Yunnan, Hainan, Shanxi, Heilongjiang and other places to support the implementation of many policies such as remote review of retail pharmacies.

This month alone, the drug regulatory authorities of several provinces issued documents.

Earlier this month, the Yunnan Provincial Drug Administration issued a message clarifying that the "Opinions of the Yunnan Provincial Drug Administration on Further Promoting the Healthy Development of Pharmaceutical Retail Enterprises" will be formally implemented on August 5.

The "Opinions" proposed that pharmaceutical retail companies should be encouraged to implement a system of retaining prescriptions for patients with chronic diseases, and to carry out remote pharmaceutical services and prescription review services for licensed pharmacists.

Since then, the official website of the Heilongjiang Provincial Drug Administration has also issued the "Regulations on Online Remote Network Review of Prescriptions by Licensed Pharmacists in Drug Retail Chain Enterprises in Heilongjiang Province (Trial)", which clearly regulates and promotes the online remote network review of prescriptions by licensed pharmacists.

In addition to the above two provinces, the Shaanxi Provincial Food and Drug Administration has also recently issued the "Guiding Opinions on the Construction of Remote Service Centers for Licensed Pharmacists in Pharmaceutical Retail Chain Enterprises in Shaanxi Province (Trial)".

The document proposes to encourage social organizations such as pharmaceutical retail chain enterprises and pharmaceutical retail enterprise industry associations with a certain scale to establish remote service centers for licensed pharmacists to standardize prescription review and rational drug use guidance.

How does "remote review party" operate?

The "remote reviewer" involves a series of issues such as personnel, facilities and equipment, as well as workflow specifications, and government supervision. The reporter noted that these issues have also been clearly stipulated in the published local policy documents.

-The number of people is equipped with a clear proportion.

How to match the number of licensed pharmacists when implementing online remote prescription review? For this problem, all localities have their own policies.

For example, according to Shaanxi's regulations, the number of stores that carry out remote licensed pharmacist service centers shall not be less than 30, the number of licensed pharmacists for remote service in chain stores below 100 shall be 30% of the number of stores, and the number of licensed pharmacists in drug retail chain enterprises with more than 100 stores shall be at least one licensed pharmacist for every 10 additional stores, of which the number of licensed traditional Chinese medicine pharmacists shall not be less than 20%.

In addition, it is clearly stated in the regulations that licensed pharmacists for remote service are full-time engaged in prescription review and medication guidance services in remote stores.

Heilongjiang has also made it clear that the headquarters of the drug retail chain has set up a remote network prescription examination studio for licensed pharmacists, and the number of licensed pharmacists in the studio should be commensurate with the scale of operation of the enterprise.

Take 20 stores (less than 20 stores are counted as 20) with at least 3 licensed pharmacists as the base. For those who operate Chinese herbal pieces, one of them must be a licensed pharmacist. For every additional 20 stores (less than 20 stores are counted as 20), one licensed pharmacist shall be added. If the number of licensed Chinese medicine tablets is increased in stores, the number of licensed Chinese pharmacists shall be implemented with reference to the above.

-- Review party "leaving marks in the whole process"

In addition to staffing, many places have also clarified the review process in policy documents.

For example, according to Hunan's previously issued "Hunan Province Licensed Pharmacists Remote Review Prescription Setting Specification", stores scan prescriptions through management ports and transmit prescriptions to be reviewed accurately to headquarters through the network.

The remote audit room shall be equipped with remote audit management software connected with the enterprise management software. The remote audit management software shall include functions such as fingerprint confirmation, remote audit, prescription review, prescription registration, online video and prescription saving.

It is worth mentioning that, according to the regulations, after the remote prescription examination room receives the uploaded prescription, the on-the-job licensed pharmacist shall timely and carefully examine the pending prescription uploaded by the store, so as to achieve "four checks and ten pairs" (I .e. investigation and punishment of prescription, division, name and age; Check the name, dosage form, specification and quantity of the drug; Check the compatibility, taboo on the drug properties, usage and dosage; Check the rationality, on clinical diagnosis), and sign an opinion of adoption or non-adoption. For prescriptions that are not approved, the reasons should be indicated on the prescription.

In addition, the audited prescription is sent to the store after being confirmed by the fingerprint of the licensed pharmacist of the reviewing party.

Shaanxi's regulations clearly state that the prescription and image data reviewed by remote service can be uploaded to the special server in time for encryption and storage for future reference to prevent modification and deletion of prescription pictures.

The image data can be encrypted and sealed on the server for future reference, and the image data can be stored for not less than 1 year. The prescription list of common drugs is kept for more than 1 year. The prescription list containing compound preparations and other special management drugs is kept for more than 2 years.

In addition, the policy also specifically proposes that enterprises install high-definition video equipment in the remote service center and connect with the drug regulatory department through the Internet, so as to realize the real-time monitoring of the remote service of licensed pharmacists by the provincial drug administration.

Can "Remote Trial Prescription" Solve the Dilemma of Licensed Pharmacist Shortage?

According to the ''2018 Annual Drug Supervision Statistics Annual Report'' published by the State Drug Administration, as of the end of November 2018, there were 508000 ''Drug Business License'' companies nationwide, including 14000 wholesale companies; 5671 retail chain companies, retail There are 255000 chain stores; 234000 retail pharmacies.

According to relevant data from the Licensed Pharmacist Qualification Certification Center of the State Drug Administration, as of the end of December 2018, the number of registered licensed pharmacists nationwide was 468000. There are 418600 licensed pharmacists registered in the social pharmacy.

Based on the calculation of 489000 retail pharmacy stores, each store has an average of less than 1 registered licensed pharmacist. This has also led to the phenomenon of licensed pharmacists "hanging certificates" repeatedly.

From the perspective of industry insiders, the most important thing for remote review is to save the employment cost of the pharmaceutical retail industry. Retail pharmacies do not need to equip each store with a licensed pharmacist every day to complete the review. At the same time, they also provide consumers with an insurance for purchasing prescription drugs in pharmacies.

However, some people in the industry are worried that the large-scale liberalization of remote review may only alleviate the contradiction of the gap of licensed pharmacists in a short time.

Because although video and voice can interact with consumers, it is still difficult to achieve the effect of direct communication. Like Internet hospitals, online hospitals ultimately rely on offline communication and supporting medical services to improve.

In addition, how to strengthen the supervision during the implementation of remote review parties and explore the interconnection and real-time sharing of prescription information, medical insurance settlement information and drug retail consumption information of medical institutions is also the key to the implementation of the guarantee policy.

At the same time, in the view of industry insiders, in order to solve the problem of "licensing" of licensed pharmacists in pharmacies in the future, it is also necessary to promote the implementation of "multi-point practice" of pharmacists and increase the training of licensed pharmacists.

Whether the "remote trial prescription" can effectively solve the problem of shortage of licensed pharmacists, let the public enjoy convenience, and at the same time establish a reliable and safe guarantee, it still needs time to test.