British pharmacist
Hannah Weekes worked as a pharmacy intern in the US. In this article, she
explains the main differences she has found in the profession between the two
countries.The fundamental principle of “do no harm” is shared by the healthcare
systems in both the UK and the US and achieving sustainable healthcare outcomes
as an appropriate percentage of gross domestic product (GDP) is important.1
Funding healthcare
Perhaps the most obvious difference between healthcare models in the UK and US is the national, publicly funded system paid for by taxation in the UK, versus a predominantly private scheme in the US. The current system in the US means that, in some situations, those who cannot afford healthcare insurance or cannot pay fully for their treatment receive limited care. Various insurance plans often require a “co-pay” or “excess” to supplement each episode of care.
You may have heard about healthcare reform in the US. ‘Obamacare’ or the ‘Affordable Care Act’ is in the process of being implemented. This has the ultimate aim of ensuring everyone has access to healthcare.2
My interpretation of this is as follows:
Funding healthcare
Perhaps the most obvious difference between healthcare models in the UK and US is the national, publicly funded system paid for by taxation in the UK, versus a predominantly private scheme in the US. The current system in the US means that, in some situations, those who cannot afford healthcare insurance or cannot pay fully for their treatment receive limited care. Various insurance plans often require a “co-pay” or “excess” to supplement each episode of care.
You may have heard about healthcare reform in the US. ‘Obamacare’ or the ‘Affordable Care Act’ is in the process of being implemented. This has the ultimate aim of ensuring everyone has access to healthcare.2
My interpretation of this is as follows:
·
It will be mandatory for those who do not have healthcare insurance and
can afford it to acquire it — financial penalties will otherwise ensue.
·
For those who fall below the poverty line and cannot afford insurance,
there will be subsidies. Essentially the system will be more scaled and
somewhat means tested, according to earnings.
·
Insurance companies will be forced to cover pre-existing conditions and
there will be more of a ‘quality’ over ‘quantity’ aim and more ‘healthcare
bundles’. This will mean streamlining and negotiating costs in advance, and
preventing unnecessary tests from being performed to generate profit.
Healthcare insurance marketplaces will be available to allow people to search
for the best insurance policy to suit their needs.
Everyone in the US is
currently entitled to receive emergency treatment and delivery in pregnancy,
regardless of their insurance status, under the Emergency Medical Treatment and
Labor Act”. The aftercare can vary considerably depending on insurance, the
state the patient resides in and, in the case of perinatal services, the
facilities available in the hospital because some are equipped differently and
may include management of complicated pregnancies.3 Long-term
care and high-cost treatments create the greatest issue.
For general medical care, there is a confusing multitude of different insurance plans available and eligibility varies for each. Pre-existing conditions may not be covered and healthcare entitlement may also vary from state to state. Depending on which state you reside in, there may be more or less state tax invested in Medicaid and Medicare, which provide free coverage for low-income families and the elderly, respectively. For example, in Massachusetts, health coverage is already mandatory. Financial penalties exist and are set to rise for those who are not covered, with the exception of those individuals for whom healthcare insurance is free because their income is below the federal poverty level.
In addition to the way the systems are funded, there are other substantial differences in the ways UK and US hospital pharmacies operate.
24 hour service
Pharmacies in busy, large hospitals in the US can operate 24 hours a day. The day is often divided into three shifts — morning, afternoon and evening, and overnight. Pharmacists generally rotate between shifts, although a minority of jobs are exclusively overnight. This 24-hour operation is necessary given that they aim to verify 100 per cent of prescriptions before administration. In contrast, the UK currently has an “out-of-hours” on-call emergency-only system.
The role of the technician
Much of a technician’s job relates to the various electronic systems (see below). In the US, by law, technicians cannot perform patient counselling or medicines reconciliation, although pharmacy interns may be involved in the former. In hospital, technicians are primarily involved in the preparation of medicines, which can include compounding, delivery to the appropriate floors and checking for expiry dates. Other tasks include audit or project work, and maintaining accurate records of refrigerator temperatures and, if this is out of range, quarantining medicines accordingly. Reports can be produced to look at user activities.
Automated dispensing and distribution
Probably the most notable difference in the US compared with the UK is the use of advanced, automated machines and systems for drug dispensing and distribution. In large hospitals, almost all unit-dose medicines such as tablets, capsules, liquids, and other small items such as creams and enemas may be stocked in a drug carousel within the inpatient pharmacy (see figures 1a and 1b).
For general medical care, there is a confusing multitude of different insurance plans available and eligibility varies for each. Pre-existing conditions may not be covered and healthcare entitlement may also vary from state to state. Depending on which state you reside in, there may be more or less state tax invested in Medicaid and Medicare, which provide free coverage for low-income families and the elderly, respectively. For example, in Massachusetts, health coverage is already mandatory. Financial penalties exist and are set to rise for those who are not covered, with the exception of those individuals for whom healthcare insurance is free because their income is below the federal poverty level.
In addition to the way the systems are funded, there are other substantial differences in the ways UK and US hospital pharmacies operate.
24 hour service
Pharmacies in busy, large hospitals in the US can operate 24 hours a day. The day is often divided into three shifts — morning, afternoon and evening, and overnight. Pharmacists generally rotate between shifts, although a minority of jobs are exclusively overnight. This 24-hour operation is necessary given that they aim to verify 100 per cent of prescriptions before administration. In contrast, the UK currently has an “out-of-hours” on-call emergency-only system.
The role of the technician
Much of a technician’s job relates to the various electronic systems (see below). In the US, by law, technicians cannot perform patient counselling or medicines reconciliation, although pharmacy interns may be involved in the former. In hospital, technicians are primarily involved in the preparation of medicines, which can include compounding, delivery to the appropriate floors and checking for expiry dates. Other tasks include audit or project work, and maintaining accurate records of refrigerator temperatures and, if this is out of range, quarantining medicines accordingly. Reports can be produced to look at user activities.
Automated dispensing and distribution
Probably the most notable difference in the US compared with the UK is the use of advanced, automated machines and systems for drug dispensing and distribution. In large hospitals, almost all unit-dose medicines such as tablets, capsules, liquids, and other small items such as creams and enemas may be stocked in a drug carousel within the inpatient pharmacy (see figures 1a and 1b).
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This machine is operated by a computer system (eg,
Talyst) and is linked to the floor dispensing machines (eg, Pyxis). It rotates
like a conveyor belt to the required row and compartment. One major role for
technicians is to ensure that newly delivered medicines are rapidly received
into their designated location and added to the inventory. To avoid human
error, and to check for expired drugs, there may be cyclical checks of
medicines. Larger items, bulk liquids and excess stock are stored on shelves
organised by compartments. Several refrigerators and freezers also have
designated compartments to store medicines.
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