Topics Project for Promotion of Appropriate Use of Medicines with Medication Support Tools via Clinical Pharmacists in Vietnam
The Access Group of the Global Health Subcommittee of the International Committee of the Pharmaceutical Manufacturers Association of Japan (hereinafter referred to as "the Group"), in collaboration with the Pharmaceutical Department of the National Center for Global Medical Research (NCGM) and the Japan Council for the Proper Use of Drugs, has been working for three years from FY 2019 to FY 2021 to promote proper drug use in the northern region of Vietnam. The activities are being carried out by the Ministry of Health, Labour and Welfare (MHLW). This activity was adopted by the Ministry of Health, Labour and Welfare as one of the projects to promote the international deployment of medical technology. This report describes the results and future challenges of the project, focusing on the activities conducted over the past three years.
At the main gate of Bac Mai Hospital
Background of Activities
A preliminary survey conducted prior to the start of the project revealed that clinical pharmacist services in Vietnam are limited to the routine dispensing of medications and provision of drug information to physicians, with little or no direct medication guidance provided to patients. On the other hand, patient interview surveys have revealed that patients have a low level of understanding of the medicines they take and a strong desire for medication guidance.
Against this background, we decided to customize the explanatory materials for Japanese patients prepared by pharmaceutical companies for Vietnamese patients, and to promote the proper use of pharmaceuticals by having clinical pharmacists, who are experts in pharmaceuticals, provide patients with appropriate information and drug administration guidance using these materials.
*For details on the background and preliminary survey, please refer to the March 2020 issue of the Pharmaceutical Manufacturers Association Newsletter (No. 196).
https://www.jpma.or.jp/news_room/newsletter/196/96t3-01.html
Activities in fiscal 2019
In FY 2019, the first year of the program, two training sessions were held in Vietnam (August 2019 and January 2020) and one in Japan (October 2019) for Bac Mai Hospital, which has a leadership role in national hospitals in Vietnam.
Vietnam Training Program 1 (August 2019)
Through interviews on the roles and duties of clinical pharmacists in the hospital, the actual situation and issues of patient medication guidance were confirmed, and medication guidance materials to be created for this project were discussed.
Japan training (October 2019)
In addition to diabetes treatment and methods of communication with patients conducted by the National Center for Global Health and Medicine (NCGM), we explained efforts by the Japan Council for Proper Use of Drugs and Japanese companies to promote proper use of drugs. In addition, we prepared three kinds of medication support tools based on Japanese patient guidance materials ("Basic Knowledge in Diabetes Treatment" and "General Knowledge about Medicines" booklets, and patient group guidance slides), as well as a questionnaire survey to evaluate the quality of the prepared medication support tools and the adequacy of patient guidance by the patients themselves. The team also prepared a questionnaire for patients to evaluate the adequacy of the medication support tools they had created and the adequacy of patient guidance. After returning to Vietnam, a pilot operation of patient guidance using the completed medication support tool was started.
Vietnam training 2nd (January 2020)
A small seminar on diabetes was held for pharmacists at Bac Mai Hospital and related institutions to introduce the project. The results of a questionnaire survey of patients presented at the seminar showed a high evaluation of the medication support tool and a high level of satisfaction with the medication guidance provided by clinical pharmacists, as well as an improvement in patients' understanding of the effects and side effects of the medication. In addition, the introduction of the project to the northern regional hospitals with a view to subsequent regional development also showed high support for the medication support tools and patient guidance. These results were highly evaluated within the Bac Mai Hospital, and the use of the medication support tool and group patient guidance to patients has continued to be implemented as a new practice for clinical pharmacists.
Diabetes handbook, videos for patient guidance and training)
Activities in FY2020
In FY2020, the second year of the program, plans were made to use the medication support tools created at Bac Mai Hospital in the first year and to expand group patient guidance by clinical pharmacists to other regional hospitals outside of Bac Mai Hospital. However, the spread of a new type of coronavirus infection (COVID-19) made it impossible to provide group medication counseling to patients, so we sought alternative methods. As a result, we decided to switch from group to individual patient medication counseling and to create information materials on the medications that patients were taking and use them for individual counseling.
Pho Noi Hospital and Lao Cai Hospital, which newly joined the project in the second year, created a model for diabetes drug information materials (template including description rules) in cooperation with Bac Mai Hospital, and for frequently prescribed drugs, created information sheets and medication support tools such as videos. The initially scheduled in- and outbound training sessions were all conducted online, and follow-up meetings were held three times to provide detailed support for the creation of medication support tools. The trainee clinical pharmacists provided patient medication guidance using the created medication support tools, and received high evaluations from patients, such as "very useful" for the medication support tools.
Medication instruction and online training using medication support tools
Activities in FY2021
In FY2021, the third year of the program, we planned to further expand the medication support tool and to deploy the medication guidance materials to hospitals that did not participate in the training, with the goal of regular practice of patient medication guidance by clinical pharmacists. In addition, new Dong Anh and My Linh Hospitals joined the project, bringing the total number of hospitals participating in the project to 5. Continuing from FY2020, all trainings and meetings will be conducted online due to COVID-19. cardiac disease used in Japan from the NCGM Pharmacy Department. The lectures on cardiac drugs, anticancer drugs, and countermeasures against drug resistance (AMR) used in Japan were given by the NCGM Pharmacy Department, which helped to improve the knowledge of the Vietnamese clinical pharmacists who were the trainees. In addition, as a medication support tool, 21 types of drug information sheets were produced, focusing on diabetes, cardiac disease, and cancer drugs, which are widely prescribed in Vietnam. In addition, a package of medication guidance materials for diabetes patients was compiled as a medication guidance package, and a briefing session on the package was held by Bac Mai Hospital for pharmacists who were not part of the training program. All 29 pharmacists from 15 facilities who attended the meeting responded that the package was "very useful/very useful" or "useful/useful.
On the other hand, the originally planned individual patient guidance using medication support tools could not be implemented due to the rapid expansion of COVID-19 in the area, but we have confirmed our intention to implement it again after the COVID-19 is settled.
Drug information sheets for patient guidance
For details of activities in each fiscal year, please refer to the Ministry of Health, Labour and Welfare (MHLW) Report on the Project for the Promotion of International Development of Medical Technology.
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The event concluded with a speech by Mr. Takafumi Adachi, Director of Public Relations.
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The event concluded with a speech by Mr. Takafumi Adachi, Director of Public Relations.
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The event concluded with a speech by Mr. Takafumi Adachi, Director of Public Relations.
Achievements to date and future challenges
During the three-year project, a total of 11 clinical pharmacists from five hospitals in northern Vietnam learned knowledge, skills, and know-how to provide patient medication guidance. Through the training, the participating clinical pharmacists created a booklet on "General Knowledge of Medication" and "Basic Knowledge in Diabetes Treatment," six videos for patient guidance, and 30 drug information materials to be used for medication guidance. The creation of these materials helped improve the clinical pharmacists' knowledge and understanding of pharmaceuticals. The five clinical pharmacists who participated in the course actually used these materials to provide medication guidance and realized that such guidance leads to the proper use of medicines.
As for future issues, we believe it is important to create a system to continue the medication guidance by clinical pharmacists that is being built on the foundation of this project, and to create an environment to expand this system throughout Vietnam. As a first step, in the final year of the project, we held an orientation session for pharmacists at medical institutions that were not part of the training program to explain the package of materials for drug administration guidance. The pharmacists who participated in the meeting confirmed their positive intentions to work on medication instruction and the creation of medication support tools, and we got the impression that the spread of medication instruction by pharmacists in a wide area of Vietnam is highly anticipated.
As a concrete response to this issue, we believe that it is necessary to develop a foundation so that the materials created during the three years of training and their utilization methods can be deployed in other regional hospitals and throughout Vietnam, with Bac Mai Hospital taking the lead after the completion of this project. We also hope that these activities will be promoted to the Ministry of Health of Vietnam, and that medication counseling by clinical pharmacists will be developed in a wide area of Vietnam. The Pharmaceutical Manufacturers Association of Japan will continue to support these activities.
We believe that the implementation of patient-oriented medication guidance will improve patients' adherence to medication and understanding of side effects, maximize the efficacy and safety of drugs, and lead to improved health in Vietnam. Ultimately, we hope that this initiative by Japanese pharmaceutical companies will be highly regarded by Vietnamese medical institutions, which will increase their trust in Japanese pharmaceutical companies and expand their business in Vietnam.
( Kanako Takahashi, Yasunori Tawaraki, and Jyunmi Maruyama, Access Group, Global Health Subcommittee, International Committee)