Activities of Pharmacy Practice

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Pharmacy Practice Types

The pharmacy practice has branched out into clinical, hospital and community pharmacy. These areas of practice are based on the setting of pharmacy practice. The pharmacy practice essentially involves the following activities as shown in the Table 1.

Table 1: Activities of Pharmacy Practice

Clinical Pharmacy

Hospital Pharmacy

Community Pharmacy

Patient Education

Manufacturing and Dispensesing

Patient Counseling

Drug and Poisons Information

Formulary development

Chronic Disease Management

Management of DDIs and Adverse drug reactions (ADRs)

Purchase and sale of Medicines

Home medication Review

Ward rounds participation

Inventory control

Ambulatory care

Medication History Interview

Drug store management

Medication therapy management

Drug therapy monitoring

Prescription monitoring

Pharmaceutical care

The pharmaceutical care is a recent phenomenon with history five decades, emerging in the parts of the world simultaneously in different styles.

In American/Canadian model, the focus of pharmacy practice is based on health insurance, reimbursement and consumers activism. Here the patients visits the pharmacists and learn from him how to use medicines

whereas in UK and Europe, the pharmacists are encouraged to educate patients on a fee for services paid by reimbursements by governments to the pharmacist

In Australia and New Zealand, pharmacists are supposed to interact with patients and give necessary information which can be viewed as a hybrid of American and European model of practice.

The global guidelines of pharmaceutical care were brought in by WHO and FIP jointly with an aim to make encourage the pharmacy care as a integral part of healthcare delivery in 2006. A focus on patient care. This document has contributed by representatives of leaders in pharmacy with a hope to develop universal model of practice. Pharmacy practice in 20th Century

In their foreword:-- "Pharmacists should move from behind the counter and start serving the public by providing care instead of dispensing pills only. There is no future in the mere act of dispensing. That activity can and will be taken over by the internet, machines, and/or hardly trained technicians. The fact that pharmacists have an academic training and act as health care professionals puts a burden upon them to better serve the community than they currently do."4

The document introduces the concept of seven star pharmacists which was introduced by WHO and adopted by FIP 2000 in its policy statement as good education pharmacy practice. The pharmacists are supposed to assume the new roles of caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager. This was again in addition having pharmacists as researcher.5

The improvements in information technology and disease management with help of big data are the recent things which are offering new avenues for patient education backed with effective counseling. The technology based educational protocols for disease specific and patient centric counseling are the offering in the prospect. However, The patient prefers a human interface in care rather than a machine. The human touch and communication skills of humans are ahead of machine delivered instructions. Hence the patient chooses a lively human being to share and interact rather being instructed by non human devices lacking in human interactions. This limitation of the machines and technology has not been able to replace the pharmacist who is easily accessible and can deliver the customized care for the patient. As the number aging population increases and the demand for wellness with preventive care preferences over the critical care takes the prominence, there will be huge demand for pharmacist, especially the community pharmacist. It requires proper monitoring and fallow up to achieve the optimum outcomes with aim of good risk benefit ratio while using any medicine. All the prescription needs to be thoroughly worked out in terms of drug drug interactions, drug food interactions and patient safety issues with customized individualized therapy. Hence there is promising prospects for pharmaceutical care in future which is continuously getting accepted by patients, doctors and nurses who support and practice the model of collaborative care .

References:

  1. Micheal D, Antun D, Margaret C, Sylvia C, Galbraith K, Matthews H. SHPA Standards of Practice for Clinical Pharmacy. J Pharm Pract Res 2005;35:122-46.
  2. Mateti UV, Rajesh V, Laddha A, Sharma S, Nagappa AN. Activities of Pharm D Students in Indian Hospital. The Pharma Review 2011; 7(2)133-135.
  3. Graffon DC, Aratt DM, Stewart CH, Thomas M. Remington the Science and Practice of Pharmacy. 18th Edition 1990. Indian Edition, BI Publication Pvt. LTD, Lippincott Williams Wilkins.
  4. Van Mil JW, Schulz M, Tromp TF. Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review. Pharm World Sci. 2004 Dec; 26(6):303-11.
  5. The role of the pharmacist in the health care system. Preparing the future pharmacist: Curricular development. Report of a third WHO Consultative Group on the role of the pharmacist, Vancouver, Canada, 27-29 August 1997. Geneva: World Health Organization; 1997. WHO/PHARM/97/599. Available at: http://www.who.int/medicinedocs/

About the Author

Anantha Naik Nagappa's picture

I am professor, intrested in developing the community pharmacy services in India, We have an association called ASSOCIATION OF COMMUNITY PHARMACISITS OF iNDIA. CHECK AT www.acpi.in for further detials

Comments

A.R.Khan's picture

I never heard pharmacist has a role Ambulatory care,.. Would you please explain me pharmacist role?

Anantha Naik Nagappa's picture

will you please visit these links for

http://www.pharmacist.com/sites/default/files/files/Profile_04%20Ambulat...

https://www.google.co.in/search?q=role+of+pharmacist+in+ambulatory+care&...

there is board of pharmacy speciailst as ambulatory care pharmacist in USA, Canada

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

A.R.Khan's picture

Thanks for the links Sir. Is it in theory or Jobs available for pharmacists in this speciality ?

Ph. Bhagavan P S RPh's picture

Sir, with due regards and respect, I beg to differ from the narration out of involved and observed experience in the hospital.

This was the puzzling issue for me when I was assigned to teach Hospital pharmacy in GCP Bangalore on deputation from the hospital service.

The question paper invariably carries questions like: Role of pharmacists in (1) ambulatory patients, (2) Emergency and casualty services (3) CSSD etc. Students just write the mugged up irrelevant answer from the guide and get not less than 70% of the marks alloted!

The scope and limitations of pharmacists role being logistics management irrespective of the area of service all explanations and details that the student fills the page with is just packing materials than the content!

Thats how the hospital pharmacy is being taught.

I will be happy if at least the students are taught about the maintenance of 'Crash cart'.

As regards the insurence claims, the pharmacists are assigned the job of verification of claims even in India in ESIS Hospitals.

The global guidelines brought out by WHO and FIP are difficult to catch up by the pharmacists comming out of the pharmacy colleges in India, as the prescriptions addressed are standardized and obsolete ones on the one hand and they are taught within 4 walls of class rooms with no filed exposure.

Students have to see and feel the community and its problem through windows like TV shopping.

Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India
Anantha Naik Nagappa's picture

Dear sir,

true as you have commented regarding the status of hospital pharmacy and practice are concerned. Our aim is to inform the overall objective of hospital pharmacy accroos the globe. not to concentrate on Indian hospital pharmacy practice, which is not fully developed and yet with hopes of development off coarse with snail speed.

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

Eswar GsnkRao's picture

Dear Sir,

First of all, I would like to appreciate your good work in presenting the Pharmacy Practice in a very informative and understandable manner.

May I know the thin line difference between Patient Education and Patient Counselling?

Regards

ESWAR :-) 

Ph. Bhagavan P S RPh's picture

You are right Eswar, the line difference is quite thin and subjective also.

I define them as under:

Patient education is a general advisory applicable to all patients with common health problems and symptoms.

ThePatient counselling is patient specific advise with respect to the medication and health problem under consideration in the prescription

Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India
Anantha Naik Nagappa's picture

Dear Sir,

The patient education is a passive where as counselling is an active process informing the patient on one to one basis. The patient education is prepared protocol where as counselling is a customized extemporaneous effort in an interactive manner.

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

A.R.Khan's picture

Would you please explain difference betwen these pharmacists with examples, For me from your article all three looks same American , EU and Australian models . My understading is

1) In USA , Patient brings prescription to the pharmacist.

2) Pharmacist dispenses medication and Patient Insurance company pays Pharmacist dispensing fee

3) Pharmacist Counsels patients

4) In addition , Pharmacists reviews patient medications and provide advise to the patient , For that he get paid by insurance company (Medication Therapy Management fees)

Appreciate if you could explain scenarios in UK and Australia like above and high light the major difference.

Thanks again for your time.

Anantha Naik Nagappa's picture

Dear Sir,

The major difference in North America vs UK and Australia stem from the flow of patients.

In America it is the patients themselves approch the pharmacist and ask for Pharmacuetical care.

http://www.acpi.in/interview_padmasundareshan.pdf

whereas in UK and Australia the government/ insurance companies encourage pharmacist to involve with patient engagement. There are incentives paid for the pharmacist by the govt in UK, whereas in Australia the pharmacist volunteer to advice the patient and submit the bill for either insurance/Health Agency for remuneration for patient counselling.

Please visit the interview put on website www.acpi.in given by pharmacist Ina Donnet from UK and Sridhar Bhat from Australia and USA.

http://www.acpi.in/Pre%20-%20final%20report.pdf

http://www.acpi.in/Interview%20of%20%20an%20Australian%20Community%20Pha...

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

Srinivas's picture

sir,

in an Indian scenario, where you see most of the pharmacies crowded, is patient counselling practically possible?

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