Drug Prescription Reform
Why THRF Advocate This?
Drug scripts in Taiwan generally lacks of detail information and clear format. It is a common practice that the doctors would give the drug script directly to the pharmacist, and the patient would only receive an informal instruction on how to use the drugs prescribed.
The roles of clinic and pharmacy have never been clearly defined in Taiwan. It is not unusual to see clinics performing pharmacy’s functions simultaneously. Though by 2001, BNHI established a ban on clinic dispensing drugs not by pharmacists, the practice persisted in different forms. Most of pharmacies still opened within doorstep of a clinic ran by the same clinic (under different name). Such phenomenon has make drug safety extremely difficult to supervise, which in result undermined the drug safety in Taiwan.
According to surveys done by various scholars, the average medical centers in Taiwan had around 11 - 14 prescription mistakes per day. 63% of those mistakes were due to inaccurate script, while another 37% were mainly caused by typos. The anti-diabetic therapy was the area suffered most from the prescription errors. The Taiwan Journal of Public Health in one of their 2006 researches stated that the problematic prescription had reached 48% for the anti-diabetic medications. The Bureau of National Health Insurance’s own investigation also revealed that about 27.75% anti-diabetic prescriptions were unsafe to the patients. The investigation showed that most of prescription errors were mainly the results of careless diagnosis, lack of understanding to the drugs, and other human errors. Another BNHI investigation showed that 23.21% clinics had prescribed anti-hypertensive drugs that were dangerous to the fetus to the pregnant women.
To address the problems caused by the substandard drug scripts, the Department of Health ordered all the local clinics must give patients detailed prescriptions began from October 2006. DOH also urged the public refrain from taking prescriptions to the pharmacies operated by the same clinics. The prescription should be taken to the independent pharmacy, which could provide more effective double check and supervisions.
In October 2006, the Taiwan Healthcare Reform Foundation hosted a press conference to push for the drug prescription reform. Prior to that, we already received numerous complaints about the substandard scripts and the reports of obscure prescription being used to make false NHI reimbursement claims.
In order to improve medical prescriptions in Taiwan, it is crucial to keep the process of drug prescription and distribution disclosed to the public supervision. The following are various practices that we observed that might degrade the prescription quality and the drug safety in Taiwan:
1. Drug scripts could be written in obscure abbreviations and private codes. And often times the script simply lacks essential information such as the name and quantity of the drug, the instruction and frequency of usage, refill quotas and indications. In certain cases, the information on prescriptions is too blurry to decipher even by the professional pharmacists.
2. There existed a drug information disparity/inconsistency between local clinic and the Bureau of National Health Insurance. Given the subtle hostility persisted between Taiwan’s clinics and independent pharmacies, some clinics would use this information disparity to prescribe the drugs that were not on the average pharmacy’s list, so the patients would be force to buy drugs from the pharmacies operated by the clinics.
3. On the other side of the coin, some pharmacies would also take advantage of the drug information disparity between the BNHI and the local healthcare facilities by simply not following the clinic’s prescriptions. For example, pharmacist could replace drugs on the prescription at will, even when it was noted on the script that the drug should not be changed. In more blatant cases, pharmacists would try sell non-medical related products to the patients, which in result damaged the professional image of the independent pharmacy, and made the process of separating the role of clinic and pharmacy more difficult.
The Taiwan Healthcare Reform Foundation believes it is important for the public to join the clinics and the pharmacies in drug safety supervision. We also suggest the Department of Health need to improve its 2001 regulation on drug prescription by taking the following actions:
1. The Department of Health should create a list of essential information that needed to be included on the drug scripts, such as names of the patient, physician and clinic, the name, type, and quantity of the drug, direction and frequency of usage, refill quota, and the NHI registered drug code.
2. DOH and medical unions should cooperate in order to establish a universal drug information database shared by both clinics and pharmacies. Locations of pharmacies should also be accessible to the public, so that the patients would be able to have more choices on where to fill their prescriptions.
3. The pharmaceutical union needs to take more assertive role in regulating its members. Disciplinary actions must be taken against any substandard services in order to improve public’s trust toward the independent pharmacies.
 許茜甯、郭虹君、戴慶玲：藥師介入對醫院用藥品質初期分析 ── 某醫學中心「異常處方」執效益。醫療品質雜誌，2002年4月
 高淑真、李玉春、黃文鴻、李龍騰：全民健保糖尿病門診問題處方之分析──以北台灣為中心之研究。台灣衛誌 2006, Vol. 25, No. 1
 「高血壓病患用藥安全管理已具成效」, Bureau of National Health Insurance, Press Release, 10 May 2006
 Bureau of National Health Insurance, 2006