Just think, how long does it take for a drug to travel from the pharmacy to a patient’s hands?
In a fishing village in Taiwan’s New Taipei City, Mrs. Zhang suffered from Parkinson’s disease. She lived there alone for many years, accompanied day and night by only the roaring sea breeze.
Every time she needed to visit the hospital, she had to arrive at the coastal road early in the morning to wait for the bus. After a long journey, she would arrive at the hospital, where she would need to register, wait, pick up her medicine, and finally take the bus home. In this way, one whole day would pass.
This is a story common among many remote residents, especially patients of chronic disease, for whom the hospital is not for treatment but is instead just a place to pick up a packet of prescription medication. But needing to spend so much energy travelling can often leave them tossing and turning in endless frustration.
Fortunately, iHealth Express, established in 2010, is the first service to provide personal home-visits from pharmacists. Since its establishment, the sound of a doorbell has come to signal the delivery of their medication for those living in remote places. And all this came from two pharmacists who were not able to accept the limitations of the physical store, Johnny Wang and Chen Wen-chih.
Escaping the shackles of the physical store, pharmacists take the initiative
After Johnny Wang graduated as a pharmacist, he opened first one pharmacy and then another before hitting a wall. Up to approximately 70% of people in Taiwan tend to trust hospitals and are used to immediately picking up their medication at the hospital after seeing a doctor. As a result, community pharmacies dare not prepare too much medication in case it expires, leaving the population distrustful of community pharmacies.
So, if pharmacists cannot dispense medicine, then what can they do? “Sell health food, medical equipment and maternal and infant supplies, just as though they are convenience store clerks who only need to sell and operate the till. But the less that pharmacists use their professionalism, the more customers will wonder, ‘is this thing you are selling really good for me?’” said Johnny Wang.
He was in the grips of a dilemma. He puzzled, Japanese pharmacies dispense multiple months’ worth of medication in one go, American pharmacies mail medication home on time, community pharmacists personally make home- visits in Germany. Suddenly the idea came, “If pharmacies cannot wait any longer for customers, then why don’t pharmacists take the initiative?”
Today, chronically ill patients need only call up, fax or send a photo of their prescription to iHealth, and pharmacists will make up the prescription within a specified time before personally delivering it to the patient’s home to give guidance on using the medication, as well as other health advice.
For example, many people repeat medication without knowing. “Some people see a dentist for toothache and a doctor for a headache, resulting in them taking a whole bunch of similar painkillers. Some might take western medicine first, and then take traditional Chinese medicine.” Johnny Wang points out, “Drugs may conflict with each other, so our very important task is to check cross- medication.”
Another example is if a patient has dizziness symptoms, pharmacists will take the initiative to check whether the passageways in his or her house are blocked by any obstacles in order to avoid the patient tripping. Another example is if they see a table filled with chocolate, pharmacists will promptly remind patients about the importance of correct eating habits.
Surprisingly, such a thoughtful service is completely free, a fact which the public has often questioned, and that the government has been troubled by. “Many people cannot figure it out, how can a community pharmacy be located on the 15th floor?” Johnny Wang explains that the health insurance system in Taiwan allocates a service charge of NT $60 per chronic prescription to pharmacists, so iHealth is able to accumulate operational resources from this.
Using urban resources to help remote areas and build an integrated long-term care platform
Yet, in its first month of opening, there were no more than five or six prescriptions to complete. Following this, there were only around 30 prescriptions per month, and iHealth was making losses over and over again. Faced with this, Johnny Wang turned to cooperating with nursing homes, where servicing one institution was the equivalent of caring for 49 patients. Today, in a single month, iHealth can service 500 nursing homes, which is the equivalent of 40% of institutions in Taiwan. Together with a number of individual customers, it distributes a total of 10,000 prescription drugs per month.
But Johnny Wang and Chen Wen-chih did not forget their original intention and continued to advance towards remote areas. Once, an indigenous person living in the mountainous area of New Taipei City sent in a prescription. Johnny Wang calculated that driving to the foot of the mountain from Taipei before climbing 25 kilometres to reach the patient would only earn NT $100 yuan for iHealth. Despite this, the partners decided in unison: “Let’s go!”
Following this, iHealth received successive requests for prescriptions from the depths of the Alishan Range and the Central Mountain Range. They did not hesitate, taking their medicine box, they immediately set out. Today, apart from the outlying islands and outer islands, all of Taiwan has been included in its service area.
Besides delivering medication, iHealth also actively integrates long-term care information, such as by providing a 24-hour drug counselling line, so that pharmacists can be consulted at any time. In addition, pharmacists can quickly query cross- medication side effects using the “COCO Drug Storehouse”. The “Subsidy Pass” allows people to easily browse and apply for government grants. “CareJob Smile Nursing” matches nurses with home care, institutions and hospitals. And “Mum and Dad Home” recommends appropriate care agencies according to clients’ needs.
Standing on its foundation of providing a prescription home delivery service, Johnny Wang looks forward to creating a care network with a full range of operations. “In the future, doctors can follow our path and go to patients’ homes to provide care, dietitians can consult on nutrition, rehabilitation professionals can deliver their expertise, as can providers of services such as meal-delivery, bathing, cleaning and repairing. We can achieve all these at once.”