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 21^st 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 22^th 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 21^st 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 13^th 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 13^th 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.

Time	Major regulations relating to clinical pharmacy	Remarks
December 2012	Legal 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 2013	Regulation 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 2014	The 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 2016	Law 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 2019	Competency 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 2020	Regulations 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].

Content	Circular 31/2012/TT-BYT	Decree 131/2020/NĐ-CP
Scope of application	Hospitals with pharmacy departments	Clinical settings where medicines are used with or without pharmacy
Person-in-charge of clinical pharmacy	No specific requirements	Specific requirements for pharmacists who will work as clinical pharmacist
Number of pharmacists	No	1 pharmacist
Clinical pharmacist	Graduate pharmacist (university level)	Graduate pharmacist (university level)
	Specific requirements for continuing training	Specific requirements for traditional medicines
Number of clinical pharmacists	No	1 clinical pharmacist/200 beds
		1 pharmacist/1000 prescriptions
		<200 beds or without pharmacy department: 1 pharmacist responsible for clinical pharmacy
Roadmap	No	To 2026 and 2031
Clinical activities	Activities at pharmacy department and clinical wards	Hospitals and clinics
		Activities at pharmacy department and clinical wards
Pharmacies inside hospital area	No	Addressed by Article 80, The Law on Pharmacy 2016
Responsibility of the head of hospitals, clinics	Recruit, train pharmacists and direct/guide the clinical pharmacy services	Must organize and responsible for the outcome of clinical pharmacy activities
Responsible of person-in-charge of clinical pharmacy	No	Regulated in Article 82, Law on Pharmacy 2016
Responsible of clinical pharmacist	Implementation under the direction and authorization of the head of hospital/clinic and pharmacy departments	Regulated 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.

Not applicable.

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