Do medical students agree with pharmacist-led patient self-management in Hong Kong?

Dear Sir

Role of pharmacists in Hong Kong are primarily responsible for dispensing drugs while other roles are very limited. Physicians are dominant and many of them have hesitation in delegating tasks to pharmacists. However, the development of interdisciplinary health services is an important component of primary care (World Health Organization, Primary Health Care 1978).

A pharmacist-led self-management approach is a model in managing chronic diseases of which a partnership between pharmacists and patients is established (Bodenheimer et al. 2002). We conducted a focus group study in 2008 with 11 Year-4 medical students and 12 final-year pharmacy students divided into four homogeneous groups. Patient self-management, roles of pharmacists and collaboration were discussed. The aims of this study were to understand students’ perspectives in self-management of patients with chronic conditions and their differences in attitudes towards pharmacist-led self-management.

We found that all students agreed with the concept of patient self-management, but medical students did not think pharmacists were capable to lead. Though the pharmacy students believed that they were competent, the medical students were concerned that pharmacists did not have the relevant training and knowledge in self-management and monitoring patients’ chronic conditions. Many of the medical students were not familiar with the roles of pharmacists except drug management, so they were unsure whether pharmacists could play any role in self- management. The pharmacy students believed that they were well trained and competent to manage general chronic conditions and mild disease cases, provide health education, supervise patients in lifestyle change and refer patients back to doctors when alarming symptoms arose. If they could have the relevant training, they could even extend their roles in managing Chinese medications. Many of the medical students were concerned that the collaboration might potentially interfere with the functions and income of physicians. They suggested having guidelines established to clearly define the roles in order to avoid overlapping. However, pharmacy students believed that they could collaborate effectively with other health professionals.

The medical students were lack of knowledge on the roles and unfamiliar with the training of pharmacy profession which could jeopardize their collaboration. The contradictions between students on the expertise of pharmacy profession could be improved by incorporating interdisciplinary education into the curricula which is important to enhance acceptance and develop positive attitudes towards other professions. Pharmacist-led patient self-management needs to be developed gradually with the support of government, including delivery of health services involving interdisciplinary teams.