Access to health data by Pharmacists ( APEF, Portugal Pharmacy-Based Intervention of Covid-19 Vaccine Acceptance Among Indonesian People ( BEM KMFA UGM, Indonesia) ……………………………………………………………………....................................................................................................19

ACCESS TO HEALTH DATA BY PHARMACISTS AMBASSADOR: CAROLINA SIMÃO APEF, PORTUGAL

According to the guidelines on Good Pharmacy Practice Standards for Quality of Pharmacy Services, developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organisation (WHO), ''Pharmacists should have access to, contribute to and use all necessary clinical and patient data to coordinate effective medication therapy management, especially when multiple health-care are involved in the patient's medication therapy, and intervene if necessary'' . [1] Additionally, the FIP recommends in its eighth development objective entitled ''Working with Others'' , the need to continue and integrate care through communication systems, data sharing, co-decision, and co-accountability, [2] in order to contribute to the development of health care of better quality and centred on the patient.

On the legislative scope, in Portugal, access to health data by health professionals is facilitated. This is necessary as a way to promote more and better health care to the population. Thus, safeguarding access to data only by professionals who have a duty of professional secrecy, such as pharmacists. [3]

Evidence points to the need to share health data with Pharmacists at different levels of patient care, however, in Portugal, this is not always the case. Community Pharmacists, as community outreach professionals, still do not have access to users' health data, therefore, are prevented from making decisions based on accurate and complete information. This limitation hinders the work of the professionals, who are often the user's first contact with health care, reducing the quality of counselling and monitoring of the user's medication.

The Portuguese Pharmacists' Association and the Shared Services of the Ministry of Health (SPMS), in 2019, signed an agreement defining the access of Hospital Pharmacists to the electronic clinical record of users of the National Health System. [4] This was an important step and is now also required for other areas of action such as Community Pharmacies.

Why is it so important for Community Pharmacists to have access to health data? In Portugal, a large percentage of the population is polymedicated. A European study called SYMPATHY, which involved the Faculty of Pharmacy of the University of Coimbra and Lisbon, and which aimed to study the impact of polymedication on the elderly population, estimates that 40% of people who are polymedicated do not do it properly [5], This leads to a high percentage of hospitalizations and health complications that could be avoided.

The access by the Community Pharmacists to the patient's health data and to the medication that they administers would be useful information that allows the professionals to understand if the dispensing of the medication requested by the user was safe and, in the last case, act on drug-drug or drug-pathology interactions.

In a reality where patients are unaware of the true impact of the drugs they administer and where they sometimes hide the information about the drugs they have acquired in other Pharmacies, it has never been so urgent to extend the sharing of health data to the Community Pharmacists. Such a decision would lead to substantial gains in health, as it would not only make taking the medication by the patient a safer process, reduce hospitalizations triggered by drug interaction phenomena in polymedicated patients, but also allow the Community Pharmacists to provide more targeted, reasoned, and personalised counselling. Thus, allied to the technical-scientific knowledge of a pharmacist, the sharing of information regarding the patient's pathology and therapy would ultimately lead to a more fruitful and efficient pharmaceutical intervention as well as great gains in health.

A concerted effort involving health regulators, representatives of the pharmaceutical sector and the Patient Associations is needed to reach an agreement that is practical, safe, and comfortable for everyone. For the moment, the object of discussion and advocacy by the stakeholders of the pharmaceutical sector has been the authorization to share the patient's health data with the Pharmacists during the period in which the patient is in the Pharmacy.

The Portuguese Pharmacists' Association has been working in this area since 2017, not only by continued work with the Shared Services of the Ministry of Health but also, by sharing the Pharmacists’ view on the possibility of accessing health data in several hearings and meetings between this Association and the National Data Protection Commission.

Additionally, stakeholders in the pharmaceutical sector have developed several workshops for Pharmacists, with the aim of raising awareness and promoting the development of digital and cybersecurity.

The truth is, there are several challenges and barriers underlying this theme. From the need to adapt all information systems, to concerns about data protection and reduced digital literacy among healthcare professionals.

Access to Pharmacists for health data has been at the forefront of the demands of stakeholders in the pharmaceutical sector and we know that step by step, we will make the actual process and contribute to the improvement of health care.

[1]https://www.who.int/medicines/areas/quality_ safety/quality_ assurance/FIPWHOGuideline

sGoodPharmacyPracticeTRS961Annex8.pdf

[2]https://www.fip.org/fip-development-goal-8

[3]Access to health data -working document. National Council of Ethics for the Life sciences.

[4]https://www.ordermfarmaceuticos.pt/pt/noticias/farmaceuticos-hospitalares-com-acesso-a electronic-clinical-registry of users/

[5]https://www.dn.pt/lusa/estudo-considera-urgente-plano-nacional-de-polimedicacao-nos-id osos-emportugal-8538765.html

PHARMACY-BASED INTERVENTION OF COVID-19 VACCINE ACCEPTANCE AMONG INDONESIAN PEOPLE AMBASSADORS: NI MADE LALITA GITA GAYATRI & RIZKI AMEILIA PUTRI BEM KMFA UGM-INDONESIA

Indonesia is going through critical times because of the Covid-19 pandemic. Many big income resources like tourism have been shut down causing the economy during the year 2020 to decline. This may affect other life aspects as well, such as health and social. To overcome this problem, Indonesia should stop SARS-CoV-2 from spreading and infecting people. One of the most effective ways is through achieving herd immunity. Herd immunity could happen if most of the population is immune to Covid-19 thus it can provide indirect protection to others who aren’t immune. Immunity can be developed if a substantial part of the population either gets infected or vaccinated. But, to let a large number of people get infected is quite risky as it can increase the death rates and allow the virus to mutate. Therefore, vaccination is the best way to reach herd immunity.

Since SARS-CoV-2 is a new virus hence no vaccine is available to fight its spreadability in the early pandemic. Several countries including Indonesia started their research to develop vaccines against this virus. As a response to the emerging situation, the former Health Minister, Terawan Agus Putranto, initiated Nusantara and Merah Putih (Red and White, Indonesia’s national flag reference) vaccines research. However, the Nusantara vaccine is facing controversy as the Food and Drugs Agency (BPOM) stated that it doesn’t meet the requirements, thus the vaccine wouldn’t be commercialised and its development is only for research purposes. Yet, the massive production of Merah Putih vaccine is expected in early 2022 after it is granted Emergency Use Authorization (EUA) on the completion of its clinical trials. As it takes a long time to wait for homegrown vaccines to be available in Indonesia, we have to import some vaccines from other countries. BPOM holds a crucial role in making sure which vaccines are suitable to be distributed and pass the clinical trials.

In the meantime, the government had made health protocols such as the obligation to wear masks, wash hands, avoid crowded gatherings, and physical distancing. But these health protocols aren’t well promoted in some areas and some people don’t even want to trust the virus’ existence, causing Covid-19 cases in Indonesia to reach its peak before the widespread execution of the vaccination program. The first batch of the Covid-19 vaccine arrived in Indonesia on December 6, 2020 with the launch of the first vaccination program on January 13, 2021, As of August 2021, there are five vaccines approved for use in Indonesia, these are Sinovac, Sinopharm, AstraZeneca, Pfizer, and Moderna.

In fact, there are some problems with increasing the Coronavirus vaccination rate, such as , the number of the first dose of vaccines is not enough. In the beginning, the elderly patients, with an age range of at least 60 years, were prioritised to get the first and second doses of Coronavirus vaccination. However, based on the new mutation of the Covid-19, called Delta, the government pushes the adult and the children to get the vaccines. Also, the amount of vaccines has run out. The first vaccine in Indonesia is Sinovac which ran out in May 2021. Then, the existence of AstraZeneca vaccine is targeted to adults with a minimum age range of 18 years . The other problem is the non-compliance of people towards vaccination.

Furthermore, some local groups of Indonesian have rejected the Covid-19 vaccinations. There is a lack of trust from the society towards the Indonesian government in the arrangements for distributing and developing COVID-19 vaccines. On the other hand the lack of trust in the vaccine industry because of pharmaceutical companies’ long-standing negative reputation, mostly contributed to the anti-vaccine movement and vaccine hesitancy. There are some hoaxes about conspiracy theories through the online chatting app that are promoted by anti-vaccine groups. To manage those who are hesitant for vaccination, the government restricts people’s mobility and would give passes to only those with vaccine certificates even if they want to get into malls and other tourist attractions. Hence the anti-vaccine movement slowly decreases.

At least, all health actors work together to build an understanding of Indonesian people to get themselves vaccinated for Covid-19. The most important thing is to simplify the registration of vaccines by facilitating an application and increasing public places used for mass vaccines. There is an application called SpeedID to sort the queue digitally. Until this article has been written, the vaccination rate of the second dose of Coronavirus vaccine in Indonesia is at 7.56 percent. It is a very small number of the Indonesian population. However, one of Indonesia's provinces has successfully accomplished the Coronavirus vaccination. Based on the latest data from the official website of the Ministry of Health of the Republic of Indonesia on August 1st, 2021 regarding COVID-19 vaccination, Bali became the province with the highest number of first doses of vaccination, which was 102.43 percent of the initial target. We hope the vaccination rate would increase rapidly so herd immunity can be achieved and people can manage to live their pre-pandemic lives and build the economy stronger.

References:

Anonim. 2021. The First COVID-19 Vaccine Arrives in Indonesia. Retrieved from URLhttps://kemlu.go.id/chicago/en/news/9864/the-first-covid-19-vaccine-arrives-in-indonesia Anonim. 2021. 5 Vaccines Approved for Use in Indonesia. Retrieved from URL https://covid19.trackvaccines.org/country/indonesia/. Anonim. 2021. Vaksinasi COVID-19 Provinsi. Retrieved from URL https://vaksin.kemkes.go.id/#/provinces. D’souza, Gypsyamber., & Dowdy, David. 2021. What is Herd Immunity and How Can We Achieve It With COVID-19? Retrieved from URL https://www.jhsph.edu/covid-19/articles/achieving-herd-immunitywith-covid19.html. Oktavia, Maria Helen. 2021. Indonesia Gearing Up to Produce Homegrown Covid-19 Vaccines. Retrieved from URL https://go.kompas.com/read/2021/04/20/162812474/indonesia-gearing-up-to-producehomegrown-covid-19-vaccines?page=all#page2. Oktavia, Maria Helen. 2021. BPOM: Indonesia's Merah Putih Vaccine to Kick Off Production in 2022. Retrieved from URL https://go.kompas.com/read/2021/04/17/074443674/bpom-indonesias-merahputih-vaccine-to-kick-off-production-in-2022?page=all#page2.

DIGITAL HEALTH: HEALTH INEQUALITY AND THE LAW FOR PHARMACEUTICAL OF IT IN INDONESIA AMBASSADORS: GUSTI AYU MADE WIDIARI, VICTORYA BASULE BEMF USD, INDONESIA

The COVID-19 pandemic has resulted in many changes in the world's health system, as well as in Indonesia. The treatment environment is also changing rapidly and more and more health professionals such as doctors and pharmacists, one of which is practising health services by maintaining social distance and not meeting face-to-face, are working to slow the spread of the virus , In 2020, the Indonesian Ministry of Health issued a Circular Letter of the Minister of Health HK.02.01/MENKES/303/2020 which stated that telemedicine services are health services carried out by doctors using information and communication technology to provide quality health services. In addition to providing medical consultation services, telemedicine also includes teleradiology, tele-electrocardiography, telepathology, and telepharmacy performed by other health professionals . Telepharmacy is the telecommunications of patients and pharmacists without direct interaction that provides pharmaceutical services such as monitoring, patient counselling, prior authorization and authorization of refills for prescription drugs, and monitoring of formulary compliance with the help of teleconferencing or video conferencing. This service is provided through a retail pharmacy website or through a hospital, nursing home, or other medical care facilities.

Telepharmacy has the potential to expand access to pharmacy care from cities to villages. The implementation of this system can also provide pharmaceutical services to remote areas that were previously difficult to obtain, improve patient safety through counselling, reduce transportation costs, and several other pharmaceutical services. The application of this technology is closely related to the quality of technology, medical procedures, decision making, and human interaction in a holistic integrated manner. . However, looking at Indonesia's geography for people who still live in disadvantaged areas, borders and islands, it is difficult to get optimal services. In these areas, there are still many basic health facilities that do not meet service standards, lack of standard health service guidelines, availability of facilities, completeness of facilities, drugs, medical devices, and health workers. This creates an increasingly large gap in society because in strategic areas the community can easily access health services and even accelerate technology to optimise them, but in the non strategic area, the community is further away from adequate health services due to limited facilities so they are unable to apply technology and communicate with the internet to get optimal service .

As mentioned above, telemedicine services have been regulated from the beginning in Permenkes No. 20 of 2019 which updated as Circular Letter of the Minister of Health HK.02.01/MENKES/303/2020, namely before the pandemic, but until now there has been no regulation for telepharmacy, especially for buying drugs in marketplaces such as Shopee, Tokopedia, Blibli and other marketplaces that are available in Indonesia. Suboptimal use of the internet can be described by the provision of various types of drugs in uncontrolled marketplaces such as in offline pharmacies, where buyers can easily get drugs that should require a doctor's prescription to be redeemed, such as hard drugs, narcotics class drugs, and Psychotropic drugs. Abuse of the drugs mentioned above is easier to happen because of the difficulty of monitoring both during promotions, purchases, and or transactions.

Due to the absence of good monitoring and regulation, several cases are rife, such as the circulation of hard drugs that are sold freely and can be easily purchased by buyers. This is also accompanied by weak laws regarding restrictions on product sales in the marketplace which are written in the Circular Letter of the Minister of Communication and Information No. 5 of 2016, because judging from the position of this regulation, it has not been entered into legislation that can be a strong guideline for being able to trade drugs in the marketplace (Ariyulinda, 2018). The legislation that will be issued is also expected to help pharmacists protect consumers, namely providing consumer rights: submit a drug; ensuring the fulfilment of the rights of consumers of drugs: ensuring the dosage, labelling, monitoring of drugs; protects consumers from inappropriate drugs: prescription screening, packaging, counselling; hep to increase her/his (consumers) awareness of rights: to provide information about drug.

Therefore, a regulation that can provide solutions to both parties is needed, both for the seller (registered pharmacist) and the buyer, it should be published together with the regulation for online treatment or telemedicine. For a long time, the Pharmaceutical Law Draft has existed to be used as a guide to pharmaceutical law in Indonesia. However, until now, there is no certainty that the draft will become a valid law. In fact, in the era of the pandemic, telepharmacy is very much needed to be able to provide drug preparations more safely, more easily, and save more time and energy to go directly to the pharmacy. Therefore, many activities that encourage the advancement of the draft of pharmaceutical practice law are carried out to preserve the name of the pharmaceutical profession in Indonesia and tighten supervision laws by the Indonesian FDA. The escort activities to guide that the draft law can be ratified are carried out by various parties concerned with the pharmaceutical profession, both by IAI (Indonesian Pharmacists Association) and by Pharmacy Students Federation of Indonesia.

References:

Ariyulinda, N., 2018. Urgensi Pembentukan Regulasi Penjualan Obat Melalui Media Online. Jurnal Legislasi Indonesia, 15(1), 37-48. Elson, E. C., et al., 2020. Use of telemedicine to provide clinical pharmacy services during the SARS-CoV-2 pandemic. American Journal of Health-System Pharmacy, 77, 1005–1006, https://doi.org/10.1093/ajhp/zxaa112 Sari, N., 2015. Protecting Consumer Medicine in Indonesia: Examining the Role of Pharmacist. Jurnal Hukum IUS QUIA IUSTIM, 22(1), 95-115. Sianipar, B. H., 2015. Kebijakan pengembangan telemedicine di Indonesia. Kajian Kebijakan dan Hukum Kedirgantaraan, 1(1), 42-62. Wikipedia, 2021. Telefarmasi - Telepharmacy Ensiklopedia, https://id.wikiqube.net/wiki/Telepharmacy, accessed on August 3, 2021. Yulianti, 2020. Pendekatan Telemedicine Dalam Rangka Menekan Penyebaran Covid-19, https://www.mutupelayanankesehatan.net/3500-pendekatan-telemedicine-dalam-rang kamenekan-penyebaran-covid-19, accessed on August 3, 2021.

THE OPIOID CRISIS IN CANADA AND THE PHARMACIST’S ROLE IN TACKLING THIS ISSUE AMBASSADOR: RITA HUANG CAPSI-CANADA

The federal government of Canada has announced that Canada is in the midst of an opioid crisis and that the growing number of overdoses and deaths caused by opioids is a public health crisis. (1) The Canadian Centre on Substance Abuse and Addictions reported that there were more than 11,500 opioid related deaths between January 2016 and December 2018. (2) The Covid-19 pandemic has worsened the opioid crisis. In 2020 alone, there were 6,214 apparent deaths related to opioid toxicity, of which 96% were unintentional. Since the onset of the pandemic, 5,148 apparent deaths related to opioid toxicity have occurred in the period between April to December 2020. This represents an 89% increase from the same time period in 2019, when 2,722 opioid related deaths were reported. (3)

Commonly prescribed for pain, opioids have the potential to cause problematic use due to the production of a euphoric feeling of well-being after their consumption. The current opioid crisis is the result of multiple complex factors. First, patients who are prescribed opioid analgesics may have a misunderstanding or lack of awareness of their addictive risk. Oftentimes, they have a lack of awareness or inability to access other medications to help manage pain. When patients seek treatment for pain, physicians are often prescribing opioids more frequently and for larger amounts. For individuals who may become addicted through the use of prescription opioids, they often turn to illicit opioid use when they cannot get prescriptions anymore. Often, these illicit opioids are laced with fentanyl and its analogues, which dramatically increases the risk of overdoses due to its potency, even in trace amounts. Physiological, social and biological factors can predispose individuals to addictions. These risk factors include genetics, mental health, trauma, and social determinants of health such as poverty or lack of stable housing. Those who are suffering from opioid addiction, they are often faced with stigma from the public and from health care providers when they try to seek help. There is also a lack of comprehensive care to respond to all the mental and physical needs of the individual that occur concomitantly with the addiction. (2) The pandemic has contributed to the worsening opioid crisis. Several factors include being cut off from the normal drug supply, an increasingly toxic illicit drug supply, limited accessibility to services, and feelings of stress, isolation and loneliness that can exacerbate mental illnesses. (3)

Previous to and since the announcement of the opioid crisis in Canada, federal and provincial governments have been working closely with health care providers and the public to raise awareness of and solve this issue. Here, pharmacists have played an important role. As the final point of contact when a patient is prescribed an opioid analgesic, pharmacists educate patients about their medication and the risks associated with it - including addictions and overdose. To provide further education to patients, Health Canada requires pharmacists to place a warning

sticker on all dispensed narcotic prescriptions, warning patients that opioids have the potential to cause dependence, addictions, and overdose. This is accompanied by a pamphlet that includes information such as recognizing the signs of an overdose, side effects of opioids, not sharing opioids, and keeping them out of the reach of children. (4) Pharmacies across the country also promote the returning of unused narcotic prescriptions to the pharmacy for safe disposal. This provides assurance that the medication does not fall into the wrong hands.

Pharmacists are actively involved in harm reduction strategies aimed at reducing the negative consequences of drug use. One of the strategies is through dispensing of long -acting opioid agonist treatment - methadone and buprenorphine/naloxone (Suboxone). Both medications are long-acting agonists of the μ opioid receptors and act to reduce cravings and signs and symptoms of withdrawal. They allow patients to regain stability and work towards recovery. Pharmacists that dispense these medications to patients often develop close relationships with them and are able to guide them to other community resources. Another harm reduction strategy is through education and provision of naloxone, a complete μ opioid antagonist that can temporarily reverse an opioid overdose to allow time for the individual to reach a hospital.

The Canadian Pharmacists Association (CPhA) has released the Opioid Action Plan with recommendations to improve how pharmacists help prevent prescription opioid misuse and abuse before it begins. There are three main recommendations in the plan. The first recommendation is to: Accelerate the implementation and integration of drug information systems (DIS) with electronic health records (EHRs) in every province and territory. This electronic drug information system would allow pharmacists to monitor opioid prescribing and dispensing no matter where the patient receives the prescription and identify patterns of misuse and abuse. The second recommendation is to: Support the creation and adoption of collaborative professional practice tools and guidelines. These guidelines would provide evidence based recommendations to prescribers on how to prescribe opioids and promote inter collaborative care. The final recommendation is: Designate pharmacists as practitioners under the Controlled Drugs and Substances Act. Often pharmacists are presented with opioid prescriptions where the dose or quantity is above what is recommended. Implementation of this recommendation will allow pharmacists to adapt opioid prescriptions, such as reducing the dose, or prescribing non-opioid alternatives. (5) Currently, CPhA is advocating the government to implement this plan to allow pharmacists to better help their patients.

Through providing education and care to patients and advocating for increased support, pharmacists are playing an essential role in combating the opioid crisis in Canada. In Canada, the scope of pharmacy practice is constantly expanding. Pharmacists and pharmacy students are also receiving more education about the opioid crisis and what they can do to help their patients and their community.

References:

1. Responding to Canada’s Opioid Crisis. [Internet]. Government of Canada; May 2021 [cited 2021 Jul 17]. Available from: https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis .html 2. King S, Katan C, Pana P. Opioids. [Internet]. Canadian Centre on Substance Use and Addictions [cited 2021 Jul 17]. Available from: https://www.ccsa.ca/opioids 3. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid and Stimulant Related Harms in Canada. [Internet]. Public Health Agency of Canada; Jun 2021 [cited 2021 Jul 17]. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/ 4. Opioid Warning Sticker and Patient Information Handout, and Risk Management Plans. [Internet]. Government of Canada; Mar 2019 [cited 2021 Jul 17]. Available from: https://www.canada.ca/en/health-canada/services/drugshealth-products/drug-products/ap plications-submissions/policies/warning-sticker-opioid-patientinformation-handout.html 5. Opioid Crisis. [Internet]. Canadian Pharmacists Association; Nov 2018 [cited 2021 Jul 18]. Available from: https://www.pharmacists.ca/advocacy/issues/opioid-crisis/