Pharmacy concerns: Patients

The Health Services Authority operates a main pharmacy located within the Cayman Islands Hospital in George Town as well as dispensaries at each of the district health centres. Residents have the option of getting prescriptions filled at either the HSA pharmacies or any private pharmacy in the Cayman Islands.

The main difference between private sector and HSA pharmacies, as far as patients are concerned, is that private pharmacies tend to sell a range of personal care products and over the counter medications, as well as filling prescriptions. HSA pharmacies do carry non-prescription items but patients are not able to simply pick them up and pay for them. “The way the government hospital system is set up, everything has to be dispensed under prescription, whether it’s an OTC medication or not. A prescription is needed for everything,” said Chief Pharmacist Colin Medford.

Unlike some private sector pharmacies where ancillary services such as blood pressure and diabetes testing or flu jabs are offered, because HSA pharmacies are located within clinics and hospitals, the pharmacies do not offer such services as there are nurses and doctors on hand to perform them.

HSA pharmacies are staffed by a team of highly trained clinical pharmacists, pharmacy technicians and pharmacists and medications are sourced from reputable pharmaceutical manufacturers in the United Kingdom, United States, Central America and the Caribbean.

Prescriptions and refills

Once patients have seen the doctor and been issued with a prescription they can present this at any pharmacy to have it filled. HSA pharmacies are working to reduce waiting time for prescriptions from 30 minutes to 20 minutes or less.

Prescription refills represent the bulk of the workload of pharmacists and because of this there is a one day waiting time for refills. In an effort to streamline the process and reduce waiting time, HSA offers patients three ways to obtain their refills. The first is to bring the empty, labelled container into a pharmacy. The second is to call in with one’s prescription number and/or medical record number and details of the prescription. The third is to complete the refill request form online at www.hsa.ky.

Putting one’s refill request in in good time takes a lot of pressure off the pharmacists.

“Often patients don’t think about ordering refills until they are down to the last pill,” Mr. Medford said. “They should really be ordering them when they still have a week’s supply left.”

Hurricane preparedness

Particularly now, during hurricane season, it’s important to think ahead, Mr. Medford advised. “People usually wait until there is an impending weather system, and then everyone comes in at once to get their meds.”

Before Hurricane Ivan, he says, they gave out three months’ worth of medications to patients. Most people lost them all during the storm, so in the aftermath they had to replace all of these as well as covering for all those pharmacies that had not yet reopened.

“Now we ask patients to come and get a month’s supply of their prescription and put it in a ziploc bag with the rest of the their hurricane supplies and not use it. You want to be doing this now, well in advance, not leaving it to the last minute,” he said. This way people have an extra month’s supply, and if it is not used by the end of hurricane season, then patients can use this as their December refill.

Specialist clinics

In addition to the day-to-day work of dispensing medications, the clinical pharmacists and pharmacy technicians oversee a number of specialist activities including the anticoagulant clinic and the chemotherapeutic clinic (in collaboration with the Ambulatory Care Unit) for outpatients receiving chemotherapy.

The anticoagulant clinic exists to monitor those on anticoagulant medications such as Warfarin. Pharmacists monitor patients’ INR to ensure their doses are at safe levels and there is no risk of haemorrhage. This clinic means patients can get checked without having to make a doctor’s appointment and even be issued prescriptions by pharmacists, although they will always be referred to the doctor if there are complications.

In the chemotherapeutic clinic the oncologist and a clinical pharmacist work together to essentially tailor the drug regimen to the individual patient, based on their individual profile and the protocol. The pharmacists will then reconstitute the regimen and calculate the dosage for each patient. A clinical pharmacist also counsels new patients and provides advice during their chemotherapy course.

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