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R Clin Pharm 2023; 1(1): 49-56

Published online June 30, 2023 https://doi.org/10.59931/rcp.23.007

Copyright © Asian Conference On Clinical Pharmacy.

Pharmacy and Patient Care: Evolution of Its Practice and Education in Vietnam Since 2012

Nguyen Van Hung1 , Ngo Thi Quynh Mai2 , Cao Duc Tuan3 , Pham Thi Anh4 , Tran Thi Ngan5 , Nguyen Thi Thu Phuong1

1Department of Pharmacology, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
2Department of Herbal and Traditional Medicine, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
3Department of Medicinal Chemistry and Quality Control, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
4Deparment of Pharmaceutical Management and Economics, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
5Department of Pharmacy Practice, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam

Correspondence to:Nguyen Van Hung
E-mail nvhung@hpmu.edu.vn
ORCID
https://orcid.org/0000-0002-6830-5279

Received: March 20, 2023; Revised: June 7, 2023; Accepted: June 9, 2023

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Since the early 21st Century, pharmacy practice has experienced critical changes diversely worldwide. This paper reviewed studies aimed at the development of pharmacy education and practice during the last 10 years in Vietnam.
Methods: Analyse data from official sources including Pubmed, Government website, University’s website and books.
Results: The results showed that Vietnam has taken great strides in the legal regulation of clinical pharmacy operations, which are considered a patient-centered pharmacy activity. However, the practice of clinical pharmacy in hospitals, especially direct patient care services, is very limited. Although patient-centered subjects have been added in teaching curricula, the clinical practice experiences of pharmacist students in hospitals have not been addressed.
Conclusion: Vietnam has built a favorable environment for clinical pharmacy practice and education; however, the pharmaceutical services provided by pharmacists remain very limited, especially in the hospital setting.

KeywordsPharmacy; Patient; Education; Practice; Vietnam

Clinical pharmacy was introduced to Vietnam since the late of 1990s and it started to be a formal teaching subject at the two pharmacy schools in Vietnam, Hanoi University of Pharmacy and Ho Chi Minh (HCM) University of Medicine and Pharmacy in early 2000s [1]. Though pharmacist’s involvement in promoting rational use of medicines had been practiced sometimes earlier, patient centered pharmacy practice and education in Vietnam have been slowly developed in the first decade of 21st century. After the “booming” in newly established pharmacy education programs since 2011; together with the “Clinical pharmacy activities in hospitals Guideline” issued in 2012 (31/2012/TT-BYT, Vietnam Ministry of Health), clinical pharmacy in Vietnam has experienced a critical movement toward patient centered care [2,3].

This paper aims to review key developments of patient centered pharmacy practice and education in Vietnam since 2012 and summarized lessons learned.

English literature searches in the PubMed database were conducted for period of January 2012 through December 2022 using the following search terms alone or in combination: trends, pharmacy practice, education. A search in the Vietnamese database (Vietnamese government policies and journals) was also conducted, focused in the development and evolution of clinical pharmacy practice in Vietnam. Besides, information published on the official websites of Vietnamese universities and Government/Ministries during 2012–2022 was screened. The acquired relevant data then used for analyzing the evolution of patient centered pharmacy education in Vietnam.

Trends in Pharmacy Practice and Education Worldwide

During the last two decades, pharmacy practice has experiencing critical changes with diversity worldwide [4-9]. A global survey was conducted between January and May 2015 to collect country-level data from member organizations of the International Pharmaceutical Federation (FIP), and national-level contacts from regulatory, with full data sets from 48 countries and territories. The study found that there are variations within terminology and definitions, frameworks for specialization and advanced practice, professional recognition mechanisms and benefits across countries. Despite the variances, it is clear that professional advancement and the recognition of advancement in practice are developing around the world and this could be due to the increasingly complex nature of pharmaceutical care delivery and a consequent need to be able to endorse professional capabilities [10].

Patient centered pharmacy education initiated in the USA with PharmD model has partially replicated in some other countries, and the largest changes occurred after graduation. Pursuit of residencies has increased steadily, more than doubling between 2009 and 2018 and the percentage of students pursuing residencies increasing from 21.8% to 29.0% [7]. After the successful introduction of clinical pharmacy concepts and services, pharmaceutical services have been transforming and pharmaceutical care was introduced [2,11,12].

In 2022, a cross-sectional web-based survey led by the Education Committee of the European Society of Clinical Pharmacy (ESCP) was conducted and comprised three domains focusing on: (1) undergraduate education, (2) postgraduate education and (3) practice. Results Data from 40 European countries were included and most respondents (86.8%) agreed with the ESCP’s definition of clinical pharmacy. Almost every country (94.9%) reported clinical pharmacy topics at the undergraduate level. At postgraduate level, 92.5% of countries reported PhD programs including clinical pharmacy and 65.0% of that mentioned the existence of specific clinical pharmacy master/diploma degrees. Continuous professional development courses were also reported by 63.9% of respondents. More than half the countries (52.5%; n=21) recognized clinical pharmacy as an area of specialization, of which, 60.0% of participants was applied solely in the hospital setting. The survey concluded that although clinical pharmacy is embedded in education and practice in European countries, there are wide variability in education and practice patterns [13].

There are two major forums in Asia relating to the development of clinical pharmacy education and practice. Asian Conference on Clinical Pharmacy, started in 1996 and the coming 22th Conference in Haiphong Vietnam on July 2023, is the leading force in initiating and promoting clinical pharmacy practice, education and research in Asia. The other forum, Asian Association of Schools of Pharmacy (AASP) was established in April 2001 to promote cooperative advancement of pharmacy education and research amongst pharmacy schools in Asia by organizing conferences and dean’s forums every 2 years.

In addition, pharmaceutical care and pharmacy education via digital technologies have significantly increased and will be incorporated into patient care and the teaching-learning process, respectively. Thus, pharmacy curricula should promote the development of specific competencies for the cognitive, conscious, and effective use of digital tools. This requires the training of “disruptive” educators, who are capable of using teaching-learning methods adapted to the digital environment and educational processes suitable for stimulating the use of effective disruptive technologies. This commentary argues that the pharmacy profession can no longer wait for the slow integration of digital technologies into pharmacy practice and education [14].

Patient centered or product-oriented pharmacy involves two new definitions that need to be clarified. Clinical pharmacy is the term that is most commonly used in the context of hospital pharmacy, where the focus is on pharmacotherapy and advanced subspecialties within this sector. Clinical pharmacy could be carried out in the community pharmacy, but there is a distinction between advanced clinical practice in the primary, secondary and tertiary care (hospital clinical pharmacists), and clinical activities that are undertaken within a community pharmacy. Pharmaceutical care involves a defined process and warrants consideration as it crosses boundaries by being able to be implemented in hospital pharmacy and also in the context of the community pharmacy setting [11,15].

The Development of Patient Centered Pharmacy Education in Vietnam

Pharmacy education programs at university level in Vietnam are complex and offer 5 main career pathways: (1) drug management and supply, (2) drug development and production, (3) pharmacology and clinical pharmacy, (4) medicinal plants and traditional pharmacy and (5) drug quality control. In 2012, the Vietnam Ministry of Education and Training issued the latest regulations for the health sector programs which include pharmacy education (Circular 01/2012/TT-BGDĐT). The pharmacy program outline includes theory and laboratory modules in general, foundation, and pharmaceutical knowledge; placements in health facilities and a final examination. Patient centered subjects and practices were not yet addressed. Based on this outline, all universities develop their curricula. As such, pharmacy programs in Vietnam are 5-year program with similar core subjects. Pharmacy education remains product oriented and clinical pharmacy training has not received adequate attention [1,16].

The basic concepts of clinical pharmacy were introduced in Vietnam in 1990s and staring at Hanoi University of Pharmacy, and then HCM University of Medicine and Pharmacy. These pharmacy faculties began adapting their curricula to focus on the patient and on clinical practice. The master’s and doctoral degree programs in pharmacology and clinical pharmacy started in 1998 and 2006. Government authorities, academics, and pharmacy professionals recognized that the development of clinical pharmacy is essential to improve the safety, effectiveness, and efficiency of drug therapy. It’s also necessary to note that in Vietnam, clinical pharmacy is used in the Law and regulations as an area of patient centered pharmacy practice and education.

With the implementation of the Law on University Education (No: 08/2012/QH13) from January 1 of 2013, the Program Outlines issued by the Vietnam Ministry of Education and Training (Circular 01/2012/TT-BGDĐT) is no longer mandatory. Universities have the rights to develop their own curricula and programs. Learning from the development of clinical pharmacy and/or pharmaceutical care worldwide and from the actual needs, patients centered subjects were added to pharmacy curricula of universities at different levels.

The pharmacy curricula/programs of major universities in Vietnam, including Hanoi, HCM, Hue, Haiphong, Cantho and Thainguyen were reviewed based on their official websites. The acquired data (Fig. 1) showed that the duration and total credits of these pharmacy program is somewhat similar: 5 years, 155 to 170 credits, respectively. However, there are big variations in the number of learning outcomes. For examples, Haiphong University of Medicine and Pharmacy [2] designed its pharmacy program with 9 learning outcomes but there are 57 of that in Hue University of Medicine and Pharmacy (2020).

Figure 1. Number of learning outcomes on knowledge, skills and attitude in curricula.

Besides, credit hours of major components of pharmacy programs also allocated differently from university to university (Fig. 2). Pharmaceutical knowledge (also called professional knowledge) is accounted for the biggest credit hours in pharmacy programs. Compared to “The program outline” issued by Vietnam Ministry of Education and Training in 2012, the general knowledge tends to be reduced in most of universities, and patient care related subjects were added to pharmacy program, such as pathology, immunology, pharmacotherapy, hospital pharmacy and clinical rotation experiences. Importantly, there are only a few patient-centered education activities, such as clinical rotation, bedside teachings appeared in pharmacy curricula.

Figure 2. Percentage of credit hours allocated for key components in curricula of major pharmacy programs.

In 2019, the Vietnam Ministry of Health issued the Competency Standards for Vietnam Pharmacist (Decision 4815/QĐ-BYT), this document mainly focused on the rational use of medicines. For the first time, Vietnam set up the competency standards of pharmacists which will be the basics for universities to develop their curricula and programs [15,17].

The Evolution of Pharmaceutical Care in Vietnam Since 2012

The pharmacist’s roles in primary care have been reported in Vietnam since early of 21st Century [18]. In December 2012, the Vietnam Ministry of Health introduced a legal regulation of clinical pharmacy services (Circular 31/2012/TT-BYT) [19]. This regulation provides regulations for clinical pharmacy operation in hospitals with qualified hospital pharmacies. This is the first time the term “clinical pharmacy” officially introduced into Vietnam hospitals. Since then, all patient centered pharmacy practices in hospitals and/or community pharmacies in Vietnam are considered as clinical pharmacy activities while pharmaceutical care is not yet mentioned in official regulations.

From 13 to 15 of September, 2013, the 13th Asian Conference on Clinical Pharmacy organized by Haiphong University of Medicine and Pharmacy in Haiphong City. More than 1,000 participants (pharmacists, pharmacy educators, researchers, managers) from 24 countries participated this conference. Half of these are Vietnamese pharmacists, pharmacy educators, managers from hospitals, provincial health bureau and ministry level departments [20]. The 13th conference was a great opportunity for our educators, managers, pharmacists to learn, exchange and network on clinical pharmacy with colleagues worldwide.

Table 1 showed the fast movement in clinical pharmacy related regulations from ministry level up to the Law on Pharmacy and Government Policies since 2012 [21].

Table 1 Major regulations relating to patient centered pharmacy since 2012

TimeMajor regulations relating to clinical pharmacyRemarks
December 2012Legal regulation of clinical pharmacy services (Circular 31/2012/TT-BYT, Vietnam Ministry of Health)For the first time in Vietnam, clinical pharmacy in hospitals is officially addressed, guided and regulated by the Ministry of Health.
August 2013Regulation on Organization and Operation of Drugs and Treatment in the Hospital (Circular 21/2013/TT-BYT, Vietnam Ministry of Health)The reinforcement of drug and treatment committee addressing the roles of pharmacists in these committees.
January 2014The national strategy on development of Vietnam pharmaceutical industry up to 2020, with
a vision toward 2030 (Decision No. 68/QĐ-TTg, Vietnam Prime Minister)
Specific objectives up to 2020: attain rate of 2.5 pharmacists/ 1 ten thousand people, in which clinical pharmacists shall occupy 30% (for the first time, Vietnam decided
on the number of clinical pharmacists).
April 2016Law on Pharmacy (Law No. 105/2016/QH13, Vietnam National Assembly) [22]Clinical pharmacy is the first time addressed in the Vietnam Law. Chapter IX on clinical pharmacy with 4 articles Article 80, 81, 82 and 83, addressed the contents, activities, rights and responsibilities of pharmacists and government policies on clinical pharmacy. Clinical pharmacy officially regulated at the highest policy level.
October 2019Competency Standards for Vietnam Pharmacist (Decision 4815/QĐ-BYT, Vietnam Ministry of Health)Its main responsibility is relating to the rational use of medicines. For the first time in Vietnam, national competency standards for pharmacists recognized and addressed capacity to provide clinical pharmacy services.
November 2020Regulations on clinical pharmacy organization and activities of medical examination and treatment in healthcare establishments (Decree No. 131/2020/NĐ-CP, Vietnam government)For the first time, Vietnam government officially regulates the clinical pharmacy practice in hospitals and clinics. It replaced the Circular 31/2012/TT-BYT by Vietnam Ministry of Health.

Following the Law on Pharmacy 2016, the Decree 131/2020/NĐ-CP of the Vietnam government has set-up a strong commitment and enforcement on the implementation of clinical pharmacy in hospitals and clinics. This is actually the recognition of patient centered pharmacy practice and the pharmacist’s roles in patient examination and treatment.

Table 2 showed that, in comparison to Circular 31/ 2012/TT-BYT, there were many changes in Decree 131/2020/NĐ-CP. The decree was issued to accommodate a better position for clinical pharmacists in hospitals and clinics, with or without pharmacy departments. The leaders of hospitals now are required to implement clinical pharmacy activities in their clinical settings. The number of clinical pharmacists is also regulated.

Table 2 Main advancement in decree 131/2020/NĐ-CP [23]

ContentCircular 31/2012/TT-BYTDecree 131/2020/NĐ-CP
Scope of applicationHospitals with pharmacy departmentsClinical settings where medicines are used with or without pharmacy
Person-in-charge of clinical pharmacyNo specific requirementsSpecific requirements for pharmacists who will work as clinical pharmacist
Number of pharmacistsNo1 pharmacist
Clinical pharmacistGraduate pharmacist (university level)Graduate pharmacist (university level)
Specific requirements for continuing trainingSpecific requirements for traditional medicines
Number of clinical pharmacistsNo1 clinical pharmacist/200 beds
1 pharmacist/1000 prescriptions
<200 beds or without pharmacy department: 1 pharmacist responsible for clinical pharmacy
RoadmapNoTo 2026 and 2031
Clinical activitiesActivities at pharmacy department and clinical wardsHospitals and clinics
Activities at pharmacy department and clinical wards
Pharmacies inside hospital areaNoAddressed by Article 80, The Law on Pharmacy 2016
Responsibility of the head of hospitals, clinicsRecruit, train pharmacists and direct/guide the clinical pharmacy servicesMust organize and responsible for the outcome of clinical pharmacy activities
Responsible of person-in-charge of clinical pharmacyNoRegulated in Article 82, Law on Pharmacy 2016
Responsible of clinical pharmacistImplementation under the direction and authorization of the head of hospital/clinic and pharmacy departmentsRegulated in the article 82, Law on Pharmacy (more details, and by Law)

Although, the supportive environment for implementation of patient centered pharmacy practice and education was established, the direct patient care was limited [22]. A recent survey in Hanoi, including 22 provincial and 17 district hospitals using online questionnaires and in-depth interviews pharmacists, showed that most clinical pharmacy activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were only available in 8/39 hospitals (21%). The most common non-patient-specific clinical pharmacy activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific clinical pharmacy activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists [6].

A national survey in 2022 with total of 560 Heads of Pharmacy and 574 clinical pharmacists, representing a response rate of 41.2%. Among the participating hospitals, non-patient specific clinical pharmacy activities were implemented widely across all hospital classes, with pharmacovigilance, medication information, and standard operating procedures development implemented in over 88% of all hospitals. In contrast, there was a significant variation in the level of implementation of patient-specific clinical pharmacy activities among hospital classes. With activities such as medication counselling, monitoring of adverse drug reactions, and obtaining patient’s medication histories provided at a considerably lower level in between 49 and 57% of hospitals [10].

Pharmacy is on the brink of transforming the profession, and patient centered practice and education is a trend with variation in countries. Vietnam has made great movement with relevant policies and regulations for the operation of clinical pharmacy which is considered patient centered pharmacy practice and education. However, the implementation of clinical pharmacy services in hospitals, especially the direct patient care services are very limited. Patient-centered subjects were added in teaching curricula while clinical practice experiences are still not yet addressed in pharmacy education. It’s necessary to encourage pharmacist spending more time for direct patient care and to allocate more time for clinical experiential practices for pharmacy students.

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  3. Bates I, Bader LR, Galbraith K. A global survey on trends in advanced practice and specialisation in the pharmacy workforce. Int J Pharm Pract. 2020 Apr; 28(2):173-81.
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  9. National Assembly of Vietnam. Law on pharmacy. Law No. 105/2016/QH13 [Internet]. Hanoi: National Assembly of Vietnam; 2016 Apr 6 [cited 2023 Apr 8]. Available from: https://thuvienphapluat.vn/van-ban/The-thao-Y-te/Luat-Duoc-2016-309815.aspx
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  14. Hai Phong University of Medicine and Pharmacy. Undergraduate Programs [Internet]. Hải Phòng: Hai Phong University of Medicine and Pharmacy; 2022 Oct [cited 2023 Mar 15]. Available from: http://hpmu.edu.vn/hpmu/news/Chuong-trinh-chi-tiet-cac-nganh-dao-tao-dai-hoc/CHUONG-TRINH-DAO-TAO-DAI-HOC-3080/
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  17. Nguyen VH. [Xu hướng trong đào tạo và thực hành dược: sách chuyên khảo]. Hanoi: Nhà xuất bản Y học; 2022. Vietnamese
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  19. Asian Conference on Clinical Pharmacy. The 13th Asian Conference on Clinical Pharmacy. The clinical pharmacist and patient care: opportunities and challenges; 2013, Sep 13-15; Haiphong, Vietnam.
  20. Nguyen VH, Nguyen TTP. Study the role of drug sellers in primary care services in selected urban areas in Vietnam. Vietnam Med J 2007; 1(340):195-204.
  21. Vietnam Government. Decree. Providing regulations on clinical pharmacy organization and activities of medical examination and treatment establishments. No. 131/2020/ND-CP [Internet]. Hanoi: Vietnam Government; 2020 Nov 2 [cited 2023 Mar 4]. Available from: https://english.luatvietnam.vn/decree-no-131-2020-nd-cp-dated-november-02-2020-of-the-government-on-providing-regulations-on-clinical-pharmacy-organization-and-activities-of-medic-193333-doc1.html
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    CrossRef

Article

Original Article

R Clin Pharm 2023; 1(1): 49-56

Published online June 30, 2023 https://doi.org/10.59931/rcp.23.007

Copyright © Asian Conference On Clinical Pharmacy.

Pharmacy and Patient Care: Evolution of Its Practice and Education in Vietnam Since 2012

Nguyen Van Hung1 , Ngo Thi Quynh Mai2 , Cao Duc Tuan3 , Pham Thi Anh4 , Tran Thi Ngan5 , Nguyen Thi Thu Phuong1

1Department of Pharmacology, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
2Department of Herbal and Traditional Medicine, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
3Department of Medicinal Chemistry and Quality Control, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
4Deparment of Pharmaceutical Management and Economics, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam
5Department of Pharmacy Practice, Hai Phong University of Medicine and Pharamacy, Haiphong, Vietnam

Correspondence to:Nguyen Van Hung
E-mail nvhung@hpmu.edu.vn
ORCID
https://orcid.org/0000-0002-6830-5279

Received: March 20, 2023; Revised: June 7, 2023; Accepted: June 9, 2023

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Since the early 21st Century, pharmacy practice has experienced critical changes diversely worldwide. This paper reviewed studies aimed at the development of pharmacy education and practice during the last 10 years in Vietnam.
Methods: Analyse data from official sources including Pubmed, Government website, University’s website and books.
Results: The results showed that Vietnam has taken great strides in the legal regulation of clinical pharmacy operations, which are considered a patient-centered pharmacy activity. However, the practice of clinical pharmacy in hospitals, especially direct patient care services, is very limited. Although patient-centered subjects have been added in teaching curricula, the clinical practice experiences of pharmacist students in hospitals have not been addressed.
Conclusion: Vietnam has built a favorable environment for clinical pharmacy practice and education; however, the pharmaceutical services provided by pharmacists remain very limited, especially in the hospital setting.

Keywords: Pharmacy, Patient, Education, Practice, Vietnam

Body

Clinical pharmacy was introduced to Vietnam since the late of 1990s and it started to be a formal teaching subject at the two pharmacy schools in Vietnam, Hanoi University of Pharmacy and Ho Chi Minh (HCM) University of Medicine and Pharmacy in early 2000s [1]. Though pharmacist’s involvement in promoting rational use of medicines had been practiced sometimes earlier, patient centered pharmacy practice and education in Vietnam have been slowly developed in the first decade of 21st century. After the “booming” in newly established pharmacy education programs since 2011; together with the “Clinical pharmacy activities in hospitals Guideline” issued in 2012 (31/2012/TT-BYT, Vietnam Ministry of Health), clinical pharmacy in Vietnam has experienced a critical movement toward patient centered care [2,3].

This paper aims to review key developments of patient centered pharmacy practice and education in Vietnam since 2012 and summarized lessons learned.

METHODS

English literature searches in the PubMed database were conducted for period of January 2012 through December 2022 using the following search terms alone or in combination: trends, pharmacy practice, education. A search in the Vietnamese database (Vietnamese government policies and journals) was also conducted, focused in the development and evolution of clinical pharmacy practice in Vietnam. Besides, information published on the official websites of Vietnamese universities and Government/Ministries during 2012–2022 was screened. The acquired relevant data then used for analyzing the evolution of patient centered pharmacy education in Vietnam.

RESULTS AND DISCUSSION

Trends in Pharmacy Practice and Education Worldwide

During the last two decades, pharmacy practice has experiencing critical changes with diversity worldwide [4-9]. A global survey was conducted between January and May 2015 to collect country-level data from member organizations of the International Pharmaceutical Federation (FIP), and national-level contacts from regulatory, with full data sets from 48 countries and territories. The study found that there are variations within terminology and definitions, frameworks for specialization and advanced practice, professional recognition mechanisms and benefits across countries. Despite the variances, it is clear that professional advancement and the recognition of advancement in practice are developing around the world and this could be due to the increasingly complex nature of pharmaceutical care delivery and a consequent need to be able to endorse professional capabilities [10].

Patient centered pharmacy education initiated in the USA with PharmD model has partially replicated in some other countries, and the largest changes occurred after graduation. Pursuit of residencies has increased steadily, more than doubling between 2009 and 2018 and the percentage of students pursuing residencies increasing from 21.8% to 29.0% [7]. After the successful introduction of clinical pharmacy concepts and services, pharmaceutical services have been transforming and pharmaceutical care was introduced [2,11,12].

In 2022, a cross-sectional web-based survey led by the Education Committee of the European Society of Clinical Pharmacy (ESCP) was conducted and comprised three domains focusing on: (1) undergraduate education, (2) postgraduate education and (3) practice. Results Data from 40 European countries were included and most respondents (86.8%) agreed with the ESCP’s definition of clinical pharmacy. Almost every country (94.9%) reported clinical pharmacy topics at the undergraduate level. At postgraduate level, 92.5% of countries reported PhD programs including clinical pharmacy and 65.0% of that mentioned the existence of specific clinical pharmacy master/diploma degrees. Continuous professional development courses were also reported by 63.9% of respondents. More than half the countries (52.5%; n=21) recognized clinical pharmacy as an area of specialization, of which, 60.0% of participants was applied solely in the hospital setting. The survey concluded that although clinical pharmacy is embedded in education and practice in European countries, there are wide variability in education and practice patterns [13].

There are two major forums in Asia relating to the development of clinical pharmacy education and practice. Asian Conference on Clinical Pharmacy, started in 1996 and the coming 22th Conference in Haiphong Vietnam on July 2023, is the leading force in initiating and promoting clinical pharmacy practice, education and research in Asia. The other forum, Asian Association of Schools of Pharmacy (AASP) was established in April 2001 to promote cooperative advancement of pharmacy education and research amongst pharmacy schools in Asia by organizing conferences and dean’s forums every 2 years.

In addition, pharmaceutical care and pharmacy education via digital technologies have significantly increased and will be incorporated into patient care and the teaching-learning process, respectively. Thus, pharmacy curricula should promote the development of specific competencies for the cognitive, conscious, and effective use of digital tools. This requires the training of “disruptive” educators, who are capable of using teaching-learning methods adapted to the digital environment and educational processes suitable for stimulating the use of effective disruptive technologies. This commentary argues that the pharmacy profession can no longer wait for the slow integration of digital technologies into pharmacy practice and education [14].

Patient centered or product-oriented pharmacy involves two new definitions that need to be clarified. Clinical pharmacy is the term that is most commonly used in the context of hospital pharmacy, where the focus is on pharmacotherapy and advanced subspecialties within this sector. Clinical pharmacy could be carried out in the community pharmacy, but there is a distinction between advanced clinical practice in the primary, secondary and tertiary care (hospital clinical pharmacists), and clinical activities that are undertaken within a community pharmacy. Pharmaceutical care involves a defined process and warrants consideration as it crosses boundaries by being able to be implemented in hospital pharmacy and also in the context of the community pharmacy setting [11,15].

The Development of Patient Centered Pharmacy Education in Vietnam

Pharmacy education programs at university level in Vietnam are complex and offer 5 main career pathways: (1) drug management and supply, (2) drug development and production, (3) pharmacology and clinical pharmacy, (4) medicinal plants and traditional pharmacy and (5) drug quality control. In 2012, the Vietnam Ministry of Education and Training issued the latest regulations for the health sector programs which include pharmacy education (Circular 01/2012/TT-BGDĐT). The pharmacy program outline includes theory and laboratory modules in general, foundation, and pharmaceutical knowledge; placements in health facilities and a final examination. Patient centered subjects and practices were not yet addressed. Based on this outline, all universities develop their curricula. As such, pharmacy programs in Vietnam are 5-year program with similar core subjects. Pharmacy education remains product oriented and clinical pharmacy training has not received adequate attention [1,16].

The basic concepts of clinical pharmacy were introduced in Vietnam in 1990s and staring at Hanoi University of Pharmacy, and then HCM University of Medicine and Pharmacy. These pharmacy faculties began adapting their curricula to focus on the patient and on clinical practice. The master’s and doctoral degree programs in pharmacology and clinical pharmacy started in 1998 and 2006. Government authorities, academics, and pharmacy professionals recognized that the development of clinical pharmacy is essential to improve the safety, effectiveness, and efficiency of drug therapy. It’s also necessary to note that in Vietnam, clinical pharmacy is used in the Law and regulations as an area of patient centered pharmacy practice and education.

With the implementation of the Law on University Education (No: 08/2012/QH13) from January 1 of 2013, the Program Outlines issued by the Vietnam Ministry of Education and Training (Circular 01/2012/TT-BGDĐT) is no longer mandatory. Universities have the rights to develop their own curricula and programs. Learning from the development of clinical pharmacy and/or pharmaceutical care worldwide and from the actual needs, patients centered subjects were added to pharmacy curricula of universities at different levels.

The pharmacy curricula/programs of major universities in Vietnam, including Hanoi, HCM, Hue, Haiphong, Cantho and Thainguyen were reviewed based on their official websites. The acquired data (Fig. 1) showed that the duration and total credits of these pharmacy program is somewhat similar: 5 years, 155 to 170 credits, respectively. However, there are big variations in the number of learning outcomes. For examples, Haiphong University of Medicine and Pharmacy [2] designed its pharmacy program with 9 learning outcomes but there are 57 of that in Hue University of Medicine and Pharmacy (2020).

Figure 1. Number of learning outcomes on knowledge, skills and attitude in curricula.

Besides, credit hours of major components of pharmacy programs also allocated differently from university to university (Fig. 2). Pharmaceutical knowledge (also called professional knowledge) is accounted for the biggest credit hours in pharmacy programs. Compared to “The program outline” issued by Vietnam Ministry of Education and Training in 2012, the general knowledge tends to be reduced in most of universities, and patient care related subjects were added to pharmacy program, such as pathology, immunology, pharmacotherapy, hospital pharmacy and clinical rotation experiences. Importantly, there are only a few patient-centered education activities, such as clinical rotation, bedside teachings appeared in pharmacy curricula.

Figure 2. Percentage of credit hours allocated for key components in curricula of major pharmacy programs.

In 2019, the Vietnam Ministry of Health issued the Competency Standards for Vietnam Pharmacist (Decision 4815/QĐ-BYT), this document mainly focused on the rational use of medicines. For the first time, Vietnam set up the competency standards of pharmacists which will be the basics for universities to develop their curricula and programs [15,17].

The Evolution of Pharmaceutical Care in Vietnam Since 2012

The pharmacist’s roles in primary care have been reported in Vietnam since early of 21st Century [18]. In December 2012, the Vietnam Ministry of Health introduced a legal regulation of clinical pharmacy services (Circular 31/2012/TT-BYT) [19]. This regulation provides regulations for clinical pharmacy operation in hospitals with qualified hospital pharmacies. This is the first time the term “clinical pharmacy” officially introduced into Vietnam hospitals. Since then, all patient centered pharmacy practices in hospitals and/or community pharmacies in Vietnam are considered as clinical pharmacy activities while pharmaceutical care is not yet mentioned in official regulations.

From 13 to 15 of September, 2013, the 13th Asian Conference on Clinical Pharmacy organized by Haiphong University of Medicine and Pharmacy in Haiphong City. More than 1,000 participants (pharmacists, pharmacy educators, researchers, managers) from 24 countries participated this conference. Half of these are Vietnamese pharmacists, pharmacy educators, managers from hospitals, provincial health bureau and ministry level departments [20]. The 13th conference was a great opportunity for our educators, managers, pharmacists to learn, exchange and network on clinical pharmacy with colleagues worldwide.

Table 1 showed the fast movement in clinical pharmacy related regulations from ministry level up to the Law on Pharmacy and Government Policies since 2012 [21].

Table 1 . Major regulations relating to patient centered pharmacy since 2012.

TimeMajor regulations relating to clinical pharmacyRemarks
December 2012Legal regulation of clinical pharmacy services (Circular 31/2012/TT-BYT, Vietnam Ministry of Health)For the first time in Vietnam, clinical pharmacy in hospitals is officially addressed, guided and regulated by the Ministry of Health.
August 2013Regulation on Organization and Operation of Drugs and Treatment in the Hospital (Circular 21/2013/TT-BYT, Vietnam Ministry of Health)The reinforcement of drug and treatment committee addressing the roles of pharmacists in these committees.
January 2014The national strategy on development of Vietnam pharmaceutical industry up to 2020, with
a vision toward 2030 (Decision No. 68/QĐ-TTg, Vietnam Prime Minister)
Specific objectives up to 2020: attain rate of 2.5 pharmacists/ 1 ten thousand people, in which clinical pharmacists shall occupy 30% (for the first time, Vietnam decided
on the number of clinical pharmacists).
April 2016Law on Pharmacy (Law No. 105/2016/QH13, Vietnam National Assembly) [22]Clinical pharmacy is the first time addressed in the Vietnam Law. Chapter IX on clinical pharmacy with 4 articles Article 80, 81, 82 and 83, addressed the contents, activities, rights and responsibilities of pharmacists and government policies on clinical pharmacy. Clinical pharmacy officially regulated at the highest policy level.
October 2019Competency Standards for Vietnam Pharmacist (Decision 4815/QĐ-BYT, Vietnam Ministry of Health)Its main responsibility is relating to the rational use of medicines. For the first time in Vietnam, national competency standards for pharmacists recognized and addressed capacity to provide clinical pharmacy services.
November 2020Regulations on clinical pharmacy organization and activities of medical examination and treatment in healthcare establishments (Decree No. 131/2020/NĐ-CP, Vietnam government)For the first time, Vietnam government officially regulates the clinical pharmacy practice in hospitals and clinics. It replaced the Circular 31/2012/TT-BYT by Vietnam Ministry of Health.


Following the Law on Pharmacy 2016, the Decree 131/2020/NĐ-CP of the Vietnam government has set-up a strong commitment and enforcement on the implementation of clinical pharmacy in hospitals and clinics. This is actually the recognition of patient centered pharmacy practice and the pharmacist’s roles in patient examination and treatment.

Table 2 showed that, in comparison to Circular 31/ 2012/TT-BYT, there were many changes in Decree 131/2020/NĐ-CP. The decree was issued to accommodate a better position for clinical pharmacists in hospitals and clinics, with or without pharmacy departments. The leaders of hospitals now are required to implement clinical pharmacy activities in their clinical settings. The number of clinical pharmacists is also regulated.

Table 2 . Main advancement in decree 131/2020/NĐ-CP [23].

ContentCircular 31/2012/TT-BYTDecree 131/2020/NĐ-CP
Scope of applicationHospitals with pharmacy departmentsClinical settings where medicines are used with or without pharmacy
Person-in-charge of clinical pharmacyNo specific requirementsSpecific requirements for pharmacists who will work as clinical pharmacist
Number of pharmacistsNo1 pharmacist
Clinical pharmacistGraduate pharmacist (university level)Graduate pharmacist (university level)
Specific requirements for continuing trainingSpecific requirements for traditional medicines
Number of clinical pharmacistsNo1 clinical pharmacist/200 beds
1 pharmacist/1000 prescriptions
<200 beds or without pharmacy department: 1 pharmacist responsible for clinical pharmacy
RoadmapNoTo 2026 and 2031
Clinical activitiesActivities at pharmacy department and clinical wardsHospitals and clinics
Activities at pharmacy department and clinical wards
Pharmacies inside hospital areaNoAddressed by Article 80, The Law on Pharmacy 2016
Responsibility of the head of hospitals, clinicsRecruit, train pharmacists and direct/guide the clinical pharmacy servicesMust organize and responsible for the outcome of clinical pharmacy activities
Responsible of person-in-charge of clinical pharmacyNoRegulated in Article 82, Law on Pharmacy 2016
Responsible of clinical pharmacistImplementation under the direction and authorization of the head of hospital/clinic and pharmacy departmentsRegulated in the article 82, Law on Pharmacy (more details, and by Law)


Although, the supportive environment for implementation of patient centered pharmacy practice and education was established, the direct patient care was limited [22]. A recent survey in Hanoi, including 22 provincial and 17 district hospitals using online questionnaires and in-depth interviews pharmacists, showed that most clinical pharmacy activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were only available in 8/39 hospitals (21%). The most common non-patient-specific clinical pharmacy activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific clinical pharmacy activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists [6].

A national survey in 2022 with total of 560 Heads of Pharmacy and 574 clinical pharmacists, representing a response rate of 41.2%. Among the participating hospitals, non-patient specific clinical pharmacy activities were implemented widely across all hospital classes, with pharmacovigilance, medication information, and standard operating procedures development implemented in over 88% of all hospitals. In contrast, there was a significant variation in the level of implementation of patient-specific clinical pharmacy activities among hospital classes. With activities such as medication counselling, monitoring of adverse drug reactions, and obtaining patient’s medication histories provided at a considerably lower level in between 49 and 57% of hospitals [10].

CONCLUSION

Pharmacy is on the brink of transforming the profession, and patient centered practice and education is a trend with variation in countries. Vietnam has made great movement with relevant policies and regulations for the operation of clinical pharmacy which is considered patient centered pharmacy practice and education. However, the implementation of clinical pharmacy services in hospitals, especially the direct patient care services are very limited. Patient-centered subjects were added in teaching curricula while clinical practice experiences are still not yet addressed in pharmacy education. It’s necessary to encourage pharmacist spending more time for direct patient care and to allocate more time for clinical experiential practices for pharmacy students.

INSTITUTIONAL REVIEW BOARD STATEMENT

Not applicable.

INFORMED CONSENT STATEMENT

Not applicable.

DATA AVAILABILITY STATEMENT

Not applicable.

FUNDING

None.

ACKNOWLEDGMENTS

None.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Fig 1.

Figure 1.Number of learning outcomes on knowledge, skills and attitude in curricula.
Researh in Clinical Pharmacy 2023; 1: 49-56https://doi.org/10.59931/rcp.23.007

Fig 2.

Figure 2.Percentage of credit hours allocated for key components in curricula of major pharmacy programs.
Researh in Clinical Pharmacy 2023; 1: 49-56https://doi.org/10.59931/rcp.23.007

Table 1 Major regulations relating to patient centered pharmacy since 2012

TimeMajor regulations relating to clinical pharmacyRemarks
December 2012Legal regulation of clinical pharmacy services (Circular 31/2012/TT-BYT, Vietnam Ministry of Health)For the first time in Vietnam, clinical pharmacy in hospitals is officially addressed, guided and regulated by the Ministry of Health.
August 2013Regulation on Organization and Operation of Drugs and Treatment in the Hospital (Circular 21/2013/TT-BYT, Vietnam Ministry of Health)The reinforcement of drug and treatment committee addressing the roles of pharmacists in these committees.
January 2014The national strategy on development of Vietnam pharmaceutical industry up to 2020, with
a vision toward 2030 (Decision No. 68/QĐ-TTg, Vietnam Prime Minister)
Specific objectives up to 2020: attain rate of 2.5 pharmacists/ 1 ten thousand people, in which clinical pharmacists shall occupy 30% (for the first time, Vietnam decided
on the number of clinical pharmacists).
April 2016Law on Pharmacy (Law No. 105/2016/QH13, Vietnam National Assembly) [22]Clinical pharmacy is the first time addressed in the Vietnam Law. Chapter IX on clinical pharmacy with 4 articles Article 80, 81, 82 and 83, addressed the contents, activities, rights and responsibilities of pharmacists and government policies on clinical pharmacy. Clinical pharmacy officially regulated at the highest policy level.
October 2019Competency Standards for Vietnam Pharmacist (Decision 4815/QĐ-BYT, Vietnam Ministry of Health)Its main responsibility is relating to the rational use of medicines. For the first time in Vietnam, national competency standards for pharmacists recognized and addressed capacity to provide clinical pharmacy services.
November 2020Regulations on clinical pharmacy organization and activities of medical examination and treatment in healthcare establishments (Decree No. 131/2020/NĐ-CP, Vietnam government)For the first time, Vietnam government officially regulates the clinical pharmacy practice in hospitals and clinics. It replaced the Circular 31/2012/TT-BYT by Vietnam Ministry of Health.

Table 2 Main advancement in decree 131/2020/NĐ-CP [23]

ContentCircular 31/2012/TT-BYTDecree 131/2020/NĐ-CP
Scope of applicationHospitals with pharmacy departmentsClinical settings where medicines are used with or without pharmacy
Person-in-charge of clinical pharmacyNo specific requirementsSpecific requirements for pharmacists who will work as clinical pharmacist
Number of pharmacistsNo1 pharmacist
Clinical pharmacistGraduate pharmacist (university level)Graduate pharmacist (university level)
Specific requirements for continuing trainingSpecific requirements for traditional medicines
Number of clinical pharmacistsNo1 clinical pharmacist/200 beds
1 pharmacist/1000 prescriptions
<200 beds or without pharmacy department: 1 pharmacist responsible for clinical pharmacy
RoadmapNoTo 2026 and 2031
Clinical activitiesActivities at pharmacy department and clinical wardsHospitals and clinics
Activities at pharmacy department and clinical wards
Pharmacies inside hospital areaNoAddressed by Article 80, The Law on Pharmacy 2016
Responsibility of the head of hospitals, clinicsRecruit, train pharmacists and direct/guide the clinical pharmacy servicesMust organize and responsible for the outcome of clinical pharmacy activities
Responsible of person-in-charge of clinical pharmacyNoRegulated in Article 82, Law on Pharmacy 2016
Responsible of clinical pharmacistImplementation under the direction and authorization of the head of hospital/clinic and pharmacy departmentsRegulated in the article 82, Law on Pharmacy (more details, and by Law)

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Asian Conference On Clinical Pharmacy

Vol.1 No.2
December 2023

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