An International Comparison of Healthcare and Pharmacy Practice Jason Milton, Pharm.D. Candidate College of Pharmacy University of Georgia June 02, 2006

Improvements in Vietnamese Health Care Practices Ranks 116 of 191 WHO organizations in adjusted life expectancy 1 (Much better than many wealthier countries) Ranks 116 of 191 WHO organizations in adjusted life expectancy 1 (Much better than many wealthier countries) Significant decreases in infant and under- five mortality rates 2 Significant decreases in infant and under- five mortality rates 2 Progress in providing vaccinations for many preventable diseases 2 (Measles, diphtheria and tetanus) Progress in providing vaccinations for many preventable diseases 2 (Measles, diphtheria and tetanus)

Improvements in Vietnamese Health Care Practices Complete eradication of Polio (1996) 2 Complete eradication of Polio (1996) 2 Emphasis on active prevention at “grass roots” level Emphasis on active prevention at “grass roots” level Expansion of privatized medical care and insurance coverage (1992) 3 Expansion of privatized medical care and insurance coverage (1992) 3

Improvements in Vietnamese Health Care Practices 3 YearPolicy/Strategy 1989 Fee for service Private practice Pharmaceutical sale 1992 Health insurance Legal document on private practice 1994 Upgrading CHC system Health policy unity at MOH

Improvements in Vietnamese Health Care Practices 3 YearPolicy/Strategy 1996 National drug policy Socialization of health care 1997 Provincial health system model 1999 Redefine goals of health sector reform

Health-related Challenges and Current Activities of Vietnam 2 One of the fastest growing economies in the world One of the fastest growing economies in the world Spend 5-6% GDP on healthcare Spend 5-6% GDP on healthcare Significantly lower than many Asian countries, but higher than others around the world Significantly lower than many Asian countries, but higher than others around the world Laos spends 3.1% Laos spends 3.1% Cambodia spends 11.8% Cambodia spends 11.8% 25% spent in public sector 25% spent in public sector

Health-related Challenges and Current Activities of Vietnam “Strategy for People’s Health Care & Protection, ” “Strategy for People’s Health Care & Protection, ” Improve equality in access to and use of health care services Improve equality in access to and use of health care services Improve quality of health care services at all levels Improve quality of health care services at all levels Similar goals to “Healthy People 2010” in the US Similar goals to “Healthy People 2010” in the US

Barriers to Effective Health Care Absence of actively enforced drug policy Absence of actively enforced drug policy Incomplete integration of technology Incomplete integration of technology Incomplete coverage of health services under socialized medicine Incomplete coverage of health services under socialized medicine Absence of formal professional standards for some health care professionals Absence of formal professional standards for some health care professionals

Pharmacy Practice in Vietnam

Greater use of herbal agents compared to western world Greater use of herbal agents compared to western world Retail pharmacies are not covered under national program of socialized medicine Retail pharmacies are not covered under national program of socialized medicine Owned by pharmacists, but most pharmacies are not operated under their direct supervision Owned by pharmacists, but most pharmacies are not operated under their direct supervision No formal record keeping systems in place No formal record keeping systems in place Improper drug storage appears to be a large problem Improper drug storage appears to be a large problem

Improper Drug Storage

Pharmacy Practice in Vietnam Prescriptions are not required Prescriptions are not required 90% of drugs dispensed are released without a prescription 4 90% of drugs dispensed are released without a prescription 4 50% of antibiotics dispensed are dispensed with a 2.5 or less days supply 4 50% of antibiotics dispensed are dispensed with a 2.5 or less days supply 4 Antibiotic resistance Antibiotic resistance Exacerbation of symptoms Exacerbation of symptoms

Antibiotic Resistance 5 Type of specimen OrganismPatients(n=200)% Nasopharynx H. influenzae M. catarrhalis S. pneumoniae Throat S. pyogenes

Antibiotic Resistance 5

Pharmacy Practice in Vietnam The role of a pharmacist is certainly not recognized The role of a pharmacist is certainly not recognized WHO states that “the pharmacist is expected to be a communicator, a quality drug supplier, a trainer and supervisor, a collaborator, and a health promoter.” 1 WHO states that “the pharmacist is expected to be a communicator, a quality drug supplier, a trainer and supervisor, a collaborator, and a health promoter.” 1 Many professionals and patients are unaware of pharmacists’ capabilities Many professionals and patients are unaware of pharmacists’ capabilities

Pharmacy Practice in Vietnam 6 PharmacistsMDsPtsStudentsTotal Counselor31138 Assistant To MD Business-person11204

Barriers to Healthcare and Pharmacy Practice in the US Substance abuse among patients and professionals Substance abuse among patients and professionals Little collaboration between professionals in different healthcare professions Little collaboration between professionals in different healthcare professions Negligence and responsibility Negligence and responsibility Unsynchronized insurance industry Unsynchronized insurance industry Shortage of healthcare professionals Shortage of healthcare professionals

The Use of Technology in the US

Almost all medical records are kept electronically Almost all medical records are kept electronically Pharmacies and other professions maintain current patient profiles in order to provide more efficient care Pharmacies and other professions maintain current patient profiles in order to provide more efficient care Easier to monitor therapies and track compliance Easier to monitor therapies and track compliance

We hope to overcome many of our barriers through international collaboration with other professionals.

Thank you

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References WHO website for Vietnam: ( Adams, Susan. Vietnam’s Healthcare System: A Macroeconomic Perspective. International Monetary Fund, Tran, Tuan. Community-based Evidence About the Health Care System in Rural Vietnam. PhD Dissertation, Nguyen, Thi. “Doi moi” and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam. Pharmacoepidemiology and Presciption, Larsson, M, et al. Antibiotic medication and bacterial resistance to antibiotics:a survey of children in a Vietnamese community. Tropical Medicine and International Health, Olsson, E, et al. Health professionals’ and consumers’ views on the role of the pharmacy personnel and the pharmacy service in Hanoi, Vietnam-a qualitative study. Journal of Clinical Pharmacy and Therapeutics, 2002.