I had the opportunity to travel with 35 other pharmacy students (both graduates and undergraduates) to London during Spring Break of 2017. We visited Greenlight pharmacy, the Royal Pharmaceutical Society, and the St. Thomas’ Hospital, along with many tourist attractions. Not only were we able to learn about the pharmaceutical practices in London and compare them to that of the United States, but we were also able to experience the culture of London and tried their amazing cuisines. I will be discussing the pharmacy aspects of the trip in this reflection, but if you are interested in the cultural aspects, please watch the video below:
Growing up in Vietnam, I have always been told how fortunate I was to move to the United States because America is the land of opportunity and the most advanced nation in the world, especially when it comes to healthcare. I had heard numerous stories of patients who died of curable diseases simply because the hospitals in Vietnam did not have the equipment needed to treat them or because they could not afford the costs of treatments. “They would have lived if they were in America,” my mom sadly told me. Therefore, I have never once questioned the healthcare system in the United States. Even when I learned that Canada and many European countries had universal healthcare, I defended my belief by arguing that their healthcare was not free since the fund came from taxes, and that it put patients at risk by making appointment wait time much longer.
However, my belief completely changed when I visited London. The wait time is longer, but it is prioritized based on urgency. For example, patients who have signs of infections will be higher on the list while patients who only need a check-up will be lower on the list. Medications are free for most of the population, which is what I have always dreamed of for the U.S. because I have served so many patients who have to go without their insulin and EpiPen due to the high price. It breaks me each time, but I have to remind myself this is why I am in the medical field. I can and will advocate for my patients and work to improve the healthcare system. I now realize that the healthcare system in the United States is far from perfect, and that we have a lot to learn from other nations.
As a technician at a community pharmacy, I have seen where the pharmacy system has succeeded and where it has failed. One of the most challenging issues is the low patient adherence. To combat the problem, my pharmacy recently introduced a program called SyncScript, where a patient’s maintenance medications would all be filled automatically together. In addition, we have also expanded our free drug list to cover ninety-day supply instead of thirty. Both are to ensure the patient always has the medications that he/she needs to increase adherence. Even with these programs, many patients are still not taking their medications as directed, and have gone a month and even two months without picking up their medications.
During the London trip, we visited a community pharmacy called Green Light Pharmacy and it was unbelievable how much U.S. pharmacy paled in comparison. To combat the adherence issue, the pharmacist calls the patient the day after he/she picks up a new medication to ensure that the therapy is started, then after a week to check up on how well the patient is doing on the medication (any side effects), and finally when a refill is overdue. I truly admire how dedicated the pharmacists are and how they have the patients’ best interest in mind.
Surprisingly, the patient adherence system was not what I loved most about the pharmacy system in London. What fascinated me the most was that London had a centralized pharmacy portal where any pharmacy (with patient’s permission) could access a list of a patient’s past and current medication record. Imagine how much more accurate medication reconciliation would be when a patient transfers from one setting of care to another. Ever since I started working as a technician, I have been asking my pharmacists why we do not have a centralized system where we can access all the medications of a patient, and I have not gotten an explanation. And there I was, in London hearing about how they have a centralized portal. It made me hopeful for the future of the U.S. pharmacy system.
Last but not least, I want to briefly mention two other programs that the pharmacies in London have that we should implement. The first is a standardized prescription pad that all prescribers use and each has a specific ID, so when one goes missing, it can be reported and all pharmacies will get an alert to not fill prescriptions with that ID after the alert date. The second is a Needle Exchange Program where users can come into the pharmacy and receive a box of clean needles and other supplies to use heroin. It sounded ridiculous to me at first since it was as though pharmacies were promoting heroin use. However, the pharmacist explained that addicts will continue to use heroin even if they did not have clean needles, which will end up harming the community more. Also, having users come into the pharmacy provided the pharmacists opportunities to talk to them and create rapport, so they will be more likely to listen to the pharmacists’ advice and come ask for help when they want to quit. All the programs mentioned above amazed me and opened my eyes to possibilities I have never even thought of. The U.S. pharmacy system is far from perfect, and we have a lot to learn from other countries.
All I wish is to be a pharmacist that gives my patients the best care they can possibly have. I do not mean the best care that can be given by the existing pharmacy system, but I am talking about the BEST CARE that can be given by the BEST SYSTEM. Thanks to the London trip, I have learned of several changes that I strongly believe the U.S. needs to implement, such as the patient adherence calls, the centralized patient portal, the prescription pad reporting system, and the Needle Exchange Program. I will advocate these changes to optimize the U.S. pharmacy practices and the care patients receive.