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 Table of Contents  
EDITORIAL
Year : 2018  |  Volume : 2  |  Issue : 1  |  Page : 1-2

Prescribing errors and the need for prescription separation in Libya


Department of Anesthesia and Intensive Care, Faculty of Medical Technology, Tripoli University, Tripoli, Libya

Date of Web Publication27-Mar-2018

Correspondence Address:
Dr. Ahmed E Atia
Department of Anesthesia and Intensive Care, Faculty of Medical Technology, Tripoli University, Tripoli
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_48_17

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How to cite this article:
Atia AE. Prescribing errors and the need for prescription separation in Libya. Libyan J Med Sci 2018;2:1-2

How to cite this URL:
Atia AE. Prescribing errors and the need for prescription separation in Libya. Libyan J Med Sci [serial online] 2018 [cited 2018 Aug 15];2:1-2. Available from: http://www.ljmsonline.com/text.asp?2018/2/1/1/228681



The policy of prescription practice mandates the separation of pharmaceuticals prescribing by physicians and dispensing by pharmacists. In Libya, both dispensing and prescribing is practiced by community pharmacists (CPs) in private pharmacies. This practice is hypothesized to have caused prescription error of drugs and widespread use of antibiotics.[1] The separation of the prescription and dispensation of medicines had been long overdue, and concerns have risen with this issue, due to potential conflict of interest, as medicine prescription is a professional duty of GPs that shall not be shared with CPs. There is a call for the need of “prescription separation” for CPs so that they can focus on professional services and ensure rational use of medicines. The idea of prescription separation is not new and has been debated for many years with obvious refusal from several organizations, including the medical associations. Nowadays, more discussions on this matter and many debates still remain around reduced suitability and raised medication error and an inappropriate pharmacist practice.[2],[3]

Separation of dispensing and prescribing is beneficial in enhancing the quality of medical care by separating the mission of physicians and pharmacists based on their specialty in that doctors will issue prescriptions to patients and the pharmacists will then dispense the prescription accordingly. Nowadays, at private community pharmacies in Libya, no one checks for the safety and suitability of drug dispensing and any possibility for medication-related problems. The individual who dispenses medications in these pharmacies generally does not have sufficient knowledge on illness management and prescription practice and sometimes may not have any medical background or health-related certifications. This is of great concern as patient safety may be put at risk due to medication errors that could simply occur during pharmaceutical prescribing and dispensing. Most of these medication errors are possibly preventable and as consequence severe adverse events and even death are present.

There are controversies that patients may not want to first visit the general practitioner and they prefer to directly visit pharmacy to have their medications dispensed. However, this will not be a major concern if pharmacies are located in area nearby clinics and would be a slight barrier (if any) in return for patient safety. In addition, many questioner-based studies had reported the need to implement dispensing separation policy.[4] Alternative models to pharmacy services in rural areas and whether incorporating a pharmacist into prescription services in rural areas may be convenient options to consider in order to overcome difficulties with accessibility and suitability.

Despite disagreement against dispensing separation is that it may raise costs to the patients due to the need to visit two health-care professionals, this may not essentially be the case. In Libya, visiting general practitioners at primary health-care centers are made free and widely accessible. Patients gain access to secondary and tertiary care through referral from primary care centers. However, patients can seek medical services and consultation in private hospitals and clinics. On the contrary, the profits gained by CPs from both the prescribing and dispensing of medicines, mean there is a possible for overprescribing of drugs and this is additional discussed by a previous local study in Libya.[5]

Nonexistence of general practitioner in the primary health centers in Libya is one of the frequently quoted arguments by those against the separation of prescribing and dispensing. Over the years, the health authorities have tried to overcome this by employing enough medical graduates. Currently, Libya has sufficient number of GPs that would be able to serve residents in the nearby area, and the argument on the shortage of physicians should no longer be valid. Conversely, we currently have a prospective situation available with graduates incapable to acquire employment due to the absence of request for them in the lack of dispensing separation.[6] Our graduates today facing difficulty to find employment, and it took for them almost 1 year after graduation to get employed. With this lack of chance to get job in public sector, there is a plenty of private pharmacies available. We may face a problem with an overflow of pharmacies if the supply exceeds existing demand.

The issue has been continuing for years, and the debates against prescription separation used nowadays are similar from those highlighted a years ago nevertheless proof of benefits from the separation of these roles. Progressive researchers and scientific society were the driving forces behind the opinion of the separation of medication prescribing and dispensing. It is time for policy-makers to keep patient safety as their top priority and need for better enforcement of pharmacy laws. Drug use and prescribing must also be rationalized, especially in self-medication and misuse of antibiotics.

Acknowledgment

We acknowledge Tripoli University for their support.



 
  References Top

1.
Atia AE, Abired AN. Antibiotic prescribing for upper respiratory tract infections by Libyan community pharmacists and medical practitioners: An observational study. Libyan J Med Sci 2017;1:31-5.  Back to cited text no. 1
  [Full text]  
2.
Abduelkarem AR. Extending the role of pharmacists in patient care: Are pharmacists in developing nations ready to change? Pharmacol Pharm 2014;5:865-75.  Back to cited text no. 2
    
3.
ElOakley RM. Consultation on the Libyan health systems: towards patient-centred services. Libyan J Med 2013;8:1-9.  Back to cited text no. 3
    
4.
Hassali MA, Saleem F, Aljadhey H. Public perceptions towards implementation of dispensing separation: results from a cross sectional analysis. J Pharm Care Health Syst 2015;2:143.  Back to cited text no. 4
    
5.
Sherif FM. An evaluation of the prescribing patterns of drugs in Libya. Libyan J Med 2008;1:3.  Back to cited text no. 5
    
6.
Health Services in Libya and Trails for Change. Available from: http://www.leebya.com/2013/01/blog-post_19.html. [Last accessed on 2017 Nov 26].  Back to cited text no. 6
    




 

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