Rise of pharmacist-managed clinics in Guangdong Province, China

Previously, hospital pharmacies could sell drugs to patients with markups in China. In 2009, the Chinese government passed the Zero-Markup Drug Policy, which strives to contain the costs of drugs and ultimately reduce the financial burden to the public, and drug price markups ended in China’s public hospitals in 2017. Thus pharmacy departments in China’s public hospitals must transform from drug supply to clinical service. The European Statements of Hospital Pharmacy issued by European Association of Hospital Pharmacists (EAHP) also emphasises clinical pharmacy services by hospital pharmacists. As hospitals have outpatient departments in China, opening pharmacist-managed clinics in hospitals is a good choice.

Guangdong Province is the richest province in China. In 2016, working with the American Pharmacists Association (APhA), the Guangdong Province Pharmaceutical Association (GDPA) delivered the APhA Delivering Medication Therapy Management Services (MTMs) certificate training programme to the hospital pharmacists in Guangdong Province. Fifty five pharmacists achieved the certificates and 13 of them also achieved the trainer certificates in November 2016. According to the APhA trainer, MTMs is a model to improve medication use in patients with complex medication regimens, therefore it can be applied to manage medication for other diseases besides chronic diseases in the elderly. Based on the MTMs training which was mentioned above, in February and April, 2017, the GDPA twice appealed to hospital pharmacists to open clinics and get the payment from all potential sources of income. Up to now, more than 30 tertiary hospitals in Guangdong Province have opened the pharmacist-managed clinics, including anti-thrombosis, MTMs and pregnancy medication clinics. Opening pharmacist-managed clinics has become one of the evaluation criteria of high-level hospitals in Guangdong Province, which is directed by the Health and Family Planning Commission of Guangdong Province, and more and more hospitals plan to open pharmacist-managed clinics.

The GDPA also appealed to hospital pharmacists to implement the tests related to medication use, including point-of-care tests, therapeutic drug monitoring and gene detection. The pharmacy departments in some hospitals, such as Guangdong Province General Hospital and Sun Yat-sen Memorial Hospital, Sun Yat-sen University, already had their own laboratories. As pharmacists have no right to prescribe, the GDPA called on pharmacists to implement collaborative drug therapy management (CDTM), which is common in the United States.¹ The GDPA issued the Recommended Text of Antithrombotic Agreement between Pharmacists and Physicians in March, 2017. In some hospitals, the agreements have been signed.

Now pharmacist-managed clinics are known all over the country. Guangming Daily, one of four major national newspapers in China, commented on the pharmacist-managed clinics in Guangdong Province and suggested that pharmacists should be given more say in disease treatment.² Guangzhou Daily, an important newspaper in Guangdong Province, reported the CDTM in the pharmacist-managed clinics,³ which solves the problem that pharmacists have no right to prescribe in China, arousing the concern of the hospital pharmacy community in the whole country.