EMERGENCE OF PHARMACY PRACTICE- A PROGNOSTIC VIEW WORLD WIDE
The complexity of health care has made one to categorize and develop algorithms for standard practice. Variety of diseases drugs and non availability of proper guidelines to be fallowed in disease conditions has created confusion among healthcare providers and patients. The lack of time and abundance in health care customers has pushed the primary care givers into great stress and confusion. The pharmacy practice has emerged out of necessity to address this demand by developing the pharmacotherapeutics as major discipline of clinical practice. The pharmacotherapeutics practice is carried out by well trained clinical pharmacist who, along with doctors and nurses involve themselves in activities of ward rounds participation , drug and poison information practice, clinical and medication order review, therapeutic drug monitoring medication history interview, patient safety and education.1,2
The Remington Pharmaceutical Sciences which is considered as bible of pharmacy has been updating the development of pharmacy profession and attempts to highlight the latest developments of pharmacy and its relevance to health care. The earlier edition of Remington Pharmaceutical Sciences in their introduction to pharmacy profession have explained major streams of pharmacy as manufacturing, quality control, marketing, distribution and retail business which are major industrial practices.3 The Academics who were responsible for advancing the profession were training the pharmacists in skills as per the demands of the patients. The socioeconomic issues assuming the importance in patient care delivery led to the development of new area called Pharmacy practice.
The main theme of pharmacy practice is the holistic approach in which total patient wellness, safety with improved quality of life.
In the history of pharmacy in India, till recently the much importance was given to the development of industrial practices and related activities. Hence much development has occurred in Industrial pharmacy with good manufacturing practices leading to quality product. So in their over enthusiasm along with ignorance of government and regulators industry was successful in establishing a product, brand oriented market. The popular brands were sold in the market like hot cakes and blockbusters. In this process the patients were grossly ignored and are made to believe that 'for every ill there is a pill. The golden line of prescription writing like mandatory calculation of risk versus benefits were grossly ignored leading to unnecessary prescribing and leading to hazardous exposure of drugs with a burden of drug injury.
The rampant increase in prescription of brand medicines and its impact on health was soon realized by regulators, government and patients. Patients became aware regarding nexus of Pharm industry and prescribers. This public activism was very much instrumental in bringing the misuse of public trust. There were many court cases against pharmaceutical industries regarding unethical marketing practice leading to court orders directing the industry to compensate the patients and governments .payment The realization that every drug carries known and hidden risks on health which is quite unpredictable has necessitated development of a system, pharmacovigilance. In Pharmacovigilance the evidence of drug injuries while in use were documented and communicated to practioners, patients, regulators and governments who get alerted and guides them to take appropriate steps in the interest of patient safety.
Figure 1: Collaborative care
The prescriber, pharmacist, and nurse work as a team to assure error free medication management (See Fig.1). Doctors being experts in diagnosis are natural leaders who are the prescribers. The prescription is hands over to pharmacists by patients, for dispensing the prescription. Pharmacists who are experts in medicine for checks drug- drug interactions (DDIs) and duplications of medicines in the prescriptions along with patient safety matters to patients. Pharmacists in consultation with the doctor would dispense the medicines by updating the patient regarding how to use, store, and special precautions patients should fallow while using medicines. He will also consult the nurse and pass on special instructions to be follow while administrating medicines.
The above model of collaborative practice is highly successful worldwide as this accommodates space for each professional to excel in their domain and as the area of practice are not overlapping and hence little confrontation but more mutual dependence. The collaborative care is so much useful and convenient for all the health care providers as it has demarked the area of expertise and offers opportunities to acquire specific skills of practice which is conducive for patient centric care. The patient centric care is the new buzz word which gives the guidelines overall practice and develops protocols of practice making as guidelines. There are several guidelines which are established and practiced in healthcare delivery.