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LCQ12: Disposal of waste medicine from households
     Following is a question by Dr the Hon David Lam and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (November 2):
     Currently, there is no law in Hong Kong regulating the disposal of waste medicine from households, nor are there services for the collection of waste medicine from households in the market. There are views pointing out that, with an ageing population, the number of elderly people taking medicine on a long-term basis has increased and such elderly people are often prescribed medicine of an amount lasting for over half a year, and once they need to have their medications adjusted or be hospitalised again before their next follow-up medical appointments, their existing medicine will become useless right away, resulting in a large amount of medicine being wasted. In this connection, will the Government inform this Council:
(1) whether it knows if the Hospital Authority (HA) has reviewed the existing mechanism for dispensing of medicine in public hospitals and has taken effective measures to reduce the generation of residual or surplus medicine requiring disposal; if HA has, of the details of the relevant measures, and whether HA has assessed the effectiveness of such measures;
(2) whether it knows if HA has considered introducing the following measures to reduce the amount of medicine which patients need to keep at home:
(i) extending the current service targets of the General Outpatient Clinic Public-Private Partnership Programme (PPP Programme) to cover patients suffering from diseases other than hypertension and diabetes mellitus, so as to make it more convenient for them to attend follow-up medical appointments at locations closer to their homes in the district; and
(ii) collaborating with pharmacists in the community so that patients of specialist outpatient clinics who are not the service targets of the PPP Programme can regularly refill their medicine in pharmacies closer to their homes in the district; if HA has, of the details; if not, the reasons for that; and
(3) whether it has considered providing members of the public with dedicated channels for discarding residual medicine, such as setting up medicine disposal boxes in the community, so as to properly collect and handle waste medicine from households, thereby avoiding the pollution of the environment by medicine such as antibiotics as a result of waste medicine from households being handled together with general domestic solid wastes; if so, of the details; if not, the reasons for that?
     In relation to Dr the Hon David Lam’s question, the reply in consultation with the Hospital Authority (HA) and the Environmental Protection Department (EPD) is as follows.
(1) The HA has been continuously optimising the current drug prescribing procedures in public hospitals with a view to ensuring medication safety and enhancing drug compliance of patients while avoiding excessive drug storage at patients' home to reduce risk of inappropriate medication use. As such, the HA has been implementing the "E-Fill" Drug Refill Service progressively in public hospitals since December 2017. Prescriptions for patients participated in the programme are split by hospitals' pharmacy into smaller and manageable quantities for dispensing by phases. HA pharmacists will review the prescriptions and reaffirm the latest conditions of the patients before each refill. At present, the "E-Fill" Drug Refill Service is available in 12 public hospitals and benefitting around 60 000 patients.
     Besides, the HA pharmacy has been providing drug education and information service to patients and their carers through the drug compliance clinics to enhance their knowledge on proper use of medication conducive to drug compliance. Patients in need may directly request service arrangement with the clinics, and doctors may also refer suitable patients to this service, the core of which is drug safety management to address the issue of drug wastage at the root cause.
     The HA has also allocated additional resources in recent years to set up pharmacist clinics to proactively provide clinical pharmacy service to those specialist outpatients in need, such as providing comprehensive drug counselling and assessment for patients to assist them or their carers in the selection and proper use of medication, so as to improve drug compliance and reduce the risk of drug wastage.
     The HA will continue to engage and exchange views with the relevant departments, patient groups, professional pharmacist bodies and various stakeholders to continuously optimise the drug dispensing system and reduce drug wastage through education, publicity and administrative measures.
(2) (i) Through the General Outpatient Clinic Public-Private Partnership Programme (GOPC PPP) launched by the HA, the Government provides choice to outpatients for receiving primary healthcare services from the private sector in the community. The outpatient consultation quota so released can then be available to other patients more in need.
     Under HA's GOPC PPP, participating patients may choose a family doctor from the list of Participating Service Providers (PSPs) in any districts of Hong Kong to attend clinical consultations, and collect medications directly from the private clinics.  Each participating patient may receive up to 10 subsidised visits per year, including medical consultations covering both chronic and episodic illnesses. As at end of September, more than 600 PSPs have participated in the Programme, providing consultation service to over 40 000 participating GOPC patients. Amidst the COVID-19 epidemic in the past year, apart from providing more convenient medical consultation or drug refill services options for participating patients, the participating PSPs had also provided two extra service quotas during the winter surge.
     The "Co-care Service Model" has been introduced under GOPC PPP since August 2021 to extend coverage from patients of GOPCs to those clinically stable patients of Specialist Outpatient Clinics (SOPCs). Piloting from Internal Medicine SOPCs, the Service Model has been subsequently extended to Orthopaedics and Traumatology and Psychiatry SOPCs.
     The Government will also launch a three-year "Chronic Disease Co-Care Pilot Scheme" within next year. Under the Pilot Scheme, those who are diagnosed with hypertension or diabetes mellitus will be arranged to receive treatment provided by family doctors and allied health professional teams in the community to help them better manage their chronic diseases and prevent complications, with a view to enhance accessibility to primary healthcare services in the community and promote the family doctor concept so as to alleviate the pressure on the public healthcare system.
     When devising any new PPP programme, the Government and the HA will take into account relevant factors including service demand, suitable patient category, potential programme complication, capacity and adaptability of the private sector, etc. The HA will continue to liaise with the public and patient groups, and collaborate with stakeholders to explore other possible PPP programmes in order to meet the medical service needs of the general public.
(ii) In a bid to shift the emphasis of the present healthcare system and people's mindset from treatment-oriented to prevention-focused, the Health Bureau is setting up District Health Centres (DHCs) across all 18 districts progressively. DHCs provide Government subsidised primary healthcare services in a multi-disciplinary team approach. As part of the DHC team, DHC's on-site pharmacists are responsible for providing free medication consultation and drug compliance counselling service to members.
     Under the steer of the Steering Committee on Primary Healthcare Development, the Government has established a working group to review and provide advice to the Health Bureau on matters relating to the demand for and development of community pharmacy service and its role in primary healthcare; as well as consider proposals on enhancing the training for pharmacists in support of primary healthcare development.
     On the other hand, the HA is closely monitoring the drug collection and other support services currently offered by community pharmacies. The service model and workflow are also under review for formulation of development strategies and plans to optimise HA's pharmacy service.
(3) According to the EPD, from the perspective of environmental pollution, given the small quantities of unwanted medicines and injections disposed of from households, they are currently treated together with municipal solid waste. The EPD has set tight standards for treatment and discharge of leachate from local landfills. The findings of a scientific study on environmental waters have suggested that environmental pollution caused by residual medicines (including antibiotics, etc.) is insignificant. The EPD will continue to keep in view international research on environmental pollution caused by residual medicines and their findings.
Ends/Wednesday, November 2, 2022
Issued at HKT 12:14
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