Pharmacy Practice - Introduction PDF

PHARMACY PRACTICE -I BY, Mr.Elias A(Msc, in Clinical pharmacy)  Learning Objective Upon completing the course, students will be able to Describe and identify the broad range of pharmacy practice settings Perform the basic functions and/or skills assigned in various practice settings...

PHARMACY PRACTICE -I BY, Mr.Elias A(Msc, in Clinical pharmacy)  Learning Objective Upon completing the course, students will be able to Describe and identify the broad range of pharmacy practice settings Perform the basic functions and/or skills assigned in various practice settings Describe the role and function of pharmacy professionals at different practice settings Conduct public health educational program for the community Course Outline This course covers: Introduction to Pharmacy Practice The Pharmacist as a health care professional Community pharmacy Hospital pharmacy Other areas of pharmacy practice Pharmacy health education  1. Introduction to Pharmacy Practice Pharmacy is a very old profession that has been changed profoundly over the years. The word derives from Greek “pharmakon”, meaning "drug" or “remedies" It is the health profession that links the health science with the chemical science and it is charged with ensuring the safe and effective use of 4  1. Introduction… The practice of pharmacy is a vital part of a complete health care system. The number of people requiring health care services has steadily increased, and this trend will likely continue. Pharmacy will face new challenges, expanded responsibilities, and an ever-increasing growth and opportunities. 1. Introduction … Pharmacists are health care professionals who use their expertise in medicine to help people understand what the medications they are taking are how they will help, and how they will react  1. Introduction…..  Pharmacy practice: is the discipline within pharmacy that involves developing the professional roles of the pharmacist.  It can also be described as the application of the knowledge and skills acquired as part of the other related disciplines to actual patient care’.  Pharmacy Practice is vital, since it facilitates and enables pharmacists to fully exploit their substantial knowledge and expertise in areas such as:  Pharmacology  Pharmaceuticss  Pharmacognosy  Chemistry and  Therapeutics within a clinical context e.t.c.  1. Introduction…. Pharmacists represent the 3rd largest healthcare professional group globally. Pharmacist to population ratios vary widely globally (FIP, 2012): < 0.02 pharmacists per 10,000 (1:500,000) population (Somali) >25.07 pharmacists per 10,000 (1:399) population (Malta) Egypt (18 pharmacists per 10,000 /1.8:1000 population) Germany (10 pharmacists per 10,000/1:1000 population) Uganda (1 pharmacist per 100,000 population) Ethiopia: (2.38 pharmacists per 100,000/ 1:42,000 population) (B/Mariam and Gedif, 2010) Regional and rural imbalances WHO recommends ratio of 1:2000  1. Introduction Aim of Pharmacy Practice The practice of pharmacy aimed at providing and promoting the best use of drugs and other health care services and products, by patients and members of the public.  1. Introduction… Traditionally, the mission of pharmacy practice is to provide medications and other health care products and services However, in recent years the term “pharmaceutical care” has established itself as a philosophy of practice. Pharmaceutical care: is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”. (Hepler and Strand, 1990) The principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication that improves patients' quality of life. 1. Introduction… These outcomes include:  cure of a disease  elimination or reduction of symptoms arresting or slowing a disease process  prevention of disease  diagnosis of disease 1. Introduction… In general, Eight Star Pharmacists are: Caregiver Communicator decision-maker Teacher Lifelong learner leader Manager Researcher 1. Introduction… 1. Caregiver Pharmacists provide caring services. They must view their practice as integrated and continuous with those of the health care system and other health professionals. So as, services must be of the highest quality. 1. Introduction… 2. Communicator The pharmacist is in an ideal position to provide a link between prescriber and patient, and to communicate information on health and medicines to the public. He or she must be knowledgeable and confident while interacting with other health professionals and the public. Communication involves verbal, non-verbal, listening and writing skills  1. Introduction… 3. Decision-maker The appropriate, efficacious, safe and cost-effective use of resources (e.g., personnel, medicines, chemicals, equipment, procedures, and practices) should be the foundation of the pharmacist’s work. At the local and national levels, pharmacists play a role in setting medicines policy. Achieving this goal requires the ability to evaluate, synthesize data and information and decide upon the most appropriate course of action.  1. Introduction… 4. Teacher The pharmacist has a responsibility to assist with the education and training of future generations of pharmacists and the public. Participating as a teacher not only imparts knowledge to others, it offers an opportunity for the practitioner to gain new knowledge and to fine-tune existing skills. 1. Introduction….. 5. Life-long-learner It is impossible to acquire in pharmacy school all the knowledge and experience needed to pursue a life-long career as a pharmacist. The concepts, principles and commitment to life-long learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to keep their knowledge and skills up to date. 1. Introduction… 6. Leader In multidisciplinary (e.g., team) caring situations or in areas, the pharmacist is obligated to assume a leadership position in the overall welfare of the patient and the community Leadership involves compassion and empathy as well as vision and the ability to make decisions, communicate, and manage effectively. A pharmacist whose leadership role is to be recognized must have vision and the ability to lead. 1. Introduction… 7. Manager Pharmacists must be able to manage resources (human, physical and financial) and information effectively. They must also be comfortable being managed by others, whether by an employer or the manager/leader of a health care team  1. Introduction… 8. Researcher The pharmacist must be able to use the evidence base (e.g., scientific, pharmacy practice, health system) effectively in order to advise on the rational use of medicines in the health care team By sharing and documenting experiences, the pharmacist can also contribute to the evidence base with the goal of optimizing patient care and outcomes As a researcher, the pharmacist is able to increase the accessibility of unbiased health and medicines-related information to the public and other health care professionals  1. Introduction…. Areas of Pharmacy Practice  Community Pharmacy  Pharmacy Associations  Hospital pharmacy  Clinical Pharmacy (Recent)  Pharmaceutical Industry  Long-term Care Facilities  Drug regulatory body  Academia Research institutes  Government Drug supply and distribution  Armed services agencies  Mail order/Internet pharmacy  2. The pharmacist as a health care professional 2.1. Evolution of Professional Pharmacy Practice  How was sickness or disease thought to be in early civilizations? ….bad sprit/evil, disasters  The use of drugs in healing is as old as civilization itself.  Modern archaeologists have unearthed clay tablets listing hundreds of medicinal preparations.  In the Ancient civilizations periods, different expertise contribute a lot for the foundation of Pharmacy Practice.  The Babylonians, the Egyptians, the Greeks, the Romanians, the Arabs, the Chines civilizations e.t.c are the front listed ones.  Early inhabitants used the trial-and-error method to compile lists of drugs, pharmacopeias or dispensatories.  Modern day formularies are based on these drug lists.  2.1. Evolution of Professional Pharmacy Practice Important People of the Ancient Era Chinese pharmacy traces its origins to the emperor Shen Nung in 2000 BC. He investigated medicinal value of several hundred herbs, and wrote the first Pen T’sao, or native herbal, containing 365 drugs Egyptian medicine dates from around 2900 BC, the most important Egyptian pharmaceutical record, the Papyrus Ebers, was written much later, in about 1500 BC. This is a collection of around 800 prescriptions, in which some 700 different drugs are mentioned.  2.1. Evolution of Professional Pharmacy Practice Important People of the Ancient Era  It was more than another thousand years before the early Greek philosophers began to influence medicine &Pharmacy.  They sought to explain what they saw, gradually transforming medicine into a science.  Hippocrates : Considered to be the father of medicine.  He is associated with a number of documents known collectively as the Hippocratic Corpus dating to 420–370 BC, which list 200–400 drugs of vegetable origin and describe the method of preparation of gargles, ointment and pessaries.  His works placed emphasis on treating the patient with minimal reference to magical and religious powers.  2.1. Evolution of Professional Pharmacy Practice Important People of the Ancient Era Dioscorides: boosted the transition of pharmacy into a science in the first century AD. In his Materia Medica he describes nearly 500 plants and remedies prepared from animals and metals gives precise instructions for preparing them Galen (130 to 201 AD): practiced and taught both pharmacy and medicine. He introduced many previously unknown drugs was the first to define a drug as anything that acts on the body to bring about a change –Father of Pharmacy His principles for preparing and compounding medicines remained dominant in the Western world for 1,500 years, and he gave his name to pharmaceuticals prepared by mechanical means (Galenicals)  2.1. Evolution of Professional Pharmacy Practice Important People of the Ancient Era  The first privately owned drug stores were established by the Arabs in Baghdad in the 18th century  They built on knowledge acquired from both Greece and Rome  develop a wide range of novel preparations, including syrups and alcoholic extracts  One of the great Arab physicians was Rhazes(865–925 AD)  His principal work, Liber Continens, was to play an important part in Western medicine  He wrote ‘if you can help with foods, then do not prescribe medicaments; if simples are effective, then do not prescribe compounded remedies’  2.1. Evolution of Professional Pharmacy Practice Important People of the Ancient Era Early nineteenth century: retail pharmacies developed a separate manufacturing area, which included an area for extraction and purification, necessary for extraction of plant alkaloids such as quinine from cinchona bark used for malaria Late nineteenth century: separation of the manufacturing business from the retail community pharmacy  2.1. Evolution of Professional Pharmacy Practice The role of the pharmacist, during the 20th century, has changed dramatically to keep pace with medical and scientific advances. There are five distinct eras since the beginning of 20th Century: The Traditional Era The Scientific Era The Clinical Era The Pharmaceutical Care Era The Biotechnology and Genetic Engineering Era (Now to the future)  2.1. Evolution of Professional Pharmacy Practice 1. Traditional Era Beginning of the 20th century, pharmacists formulated and compounded medications from natural sources. Prescriptions were compounded by hand, using a mortar and pestle, ingredients and dosages tailored to individual patients. Less than 1% of all prescriptions today are compounded. Pharmacists-in-training served as apprentices, learning the trade in pharmacies rather than sitting in a classroom. Pharmacognosy – the knowledge of the medicinal functions of natural products from animal, plant, or mineral origins was a piece of the limited education pharmacist focused on at this time.  2.1. Evolution of Professional Pharmacy Practice 2. Scientific Era Post WWII period, pharmaceutical manufacturers, like Eli Lilly, Merck and Pfizer, developed and tested new drugs and dosage forms. Synthesized, developed and mass-produced these medications were more economical and better quality. Educational institutions increased the emphasis on the sciences and expanded the pharmacy curriculum. Pharmacology – the scientific study of drugs and their mechanisms of action, was a required course of study. 1960, a five-year BS degree was required.  2.1. Evolution of Professional Pharmacy Practice 3. Clinical Era Combining the traditional role of pharmacist with a dispenser of drug information to the patient and physician. Pharmaceutics – the study of how drugs are introduced to the body, was added to the pharmacy curriculum. There was a feeling that training had shifted too far into the sciences, away from the actual practice of pharmacy. 1973, the American Association of Colleges of Pharmacy (AACP) reevaluated the mission of the pharmacy profession. Development of clinical- or patient-oriented pharmacy resulted in a change to the pharmacy curriculum and the adoption of the PharmD degree program.  2.1. Evolution of Professional Pharmacy Practice 3. Clinical Era New courses were also developed: Pharmacokinetics – individualizing doses of drugs based on absorption, distribution, metabolism, and excretion from the body. Therapeutics – the study of applying pharmacology to the treatment of illness and disease states Pathophysiology – the study of disease and illnesses affecting the normal function of the body.  2.1. Evolution of Professional Pharmacy Practice 4. Pharmaceutical Care Era Pharmaceutical care – expands the mission of the pharmacy profession to include responsibility for ensuring positive outcomes for drug therapy. “Medication therapy management” (MTM):s may include recommending a less costly drug to a physician, identifying a potential serious drug-drug interaction, or counseling a patient.  2.1. Evolution of Professional Pharmacy Practice 5. Biotechnology and Genetic Engineering Era (Now to the future) DNA and Genetic Technology  Gene Therapy is being conducted.  Some diseases are linked to genetics.  Modifying the genetic make up of people may prevent or cure diseases. Recombinant DNA Technology:  is a form of synthetic DNA that is engineered through the combination or insertion of one or more DNA strands, thereby combining DNA sequences that would not normally occur together.  2.1. Evolution of Professional Pharmacy Practice Read further on Evolution of Pharmacy Practice Assignment 1. Discuss in detail the development of Pharmacy Practice in Ethiopia (Past, Present and Future)? 2. Which is the first Pharmacy that was opened in Ethiopia? Who is the first Pharmacist in Ethiopia? Who is also the first Ethiopian Pharmacist? 2.2.Concepts of profession and professionalism What is profession? Can we say anyone who makes his or her living in some occupation as a “professional”?  2.2.Concepts of profession and professionalism Profession: is a form of employment or a field that is respected in the society and that requires study and mastery of specialization in knowledge. Some of the characteristic of a profession are: 1. Requires extensive training of an intellectual character. 2. Its services are vital to society’s well being. 3.Its practitioners usually have a high degree of autonomy in deciding how to carry out their job. 2.2.Concepts of profession and professionalism 4. Requires certification or licensing by the state.  Licensing gives practitioners an exclusive legal right to provide those services. 5.Professionals are usually organized in “societies” the EPA for Ethiopian Pharmacist, the EMA for Ethiopian physicians, the EPHA for Ethiopian public health  2.2.Concepts of profession and professionalism Is Pharmacy a true profession? Yes, b/c it assists the public and individuals make the best use of medication Professions exist to serve society. Hence the mission of the pharmacy profession must address the needs of society and individual patients. At one time, the acts of deciding on drug therapy and implementing it were relatively simple, safe and inexpensive. The physician prescribe and the pharmacist dispense.  2.2.Concepts of profession and professionalism However, there is evidence that the traditional method of prescribing and dispensing medication is no longer appropriate to ensure safety, effectiveness and adherence to drug therapy. B/c the consequences of medicine-related errors are costly in terms of hospitalizations, physician visits, laboratory tests and remedial therapy. In developed countries, 4%–10% of all hospital in-patients experience an ADR – mainly due to the use of multiple drug therapy, especially in the elderly and patients with chronic diseases. That situation is changing in rapidly evolving health systems. The practice of pharmaceutical care assumes the pharmacist to be responsible for patients under their care. 2.3. Relationship with other health care professional Health care is a collaborative effort between physicians, nurse practitioners, dentists, vets, nurses, and pharmacists. Paraprofessionals like pharmacy technicians, physician assistants, dental assistants, hygienists, vet assistants, and licensed practical nurses assist professionals in routine but necessary tasks. Pharmacy technicians assist pharmacists allowing pharmacists more time to meet the mission of the profession: to ensure positive outcomes for drug therapy in the patient population.  2.3. Relationship with other health care professional They will need to adapt their knowledge, skills and attitudes to this new role They should integrate traditional pharmaceutical science with clinical aspects of patient care, clinical skills, management and communication skills, active collaboration with medical teams and solving of medicine-related problems  2.3. Relationship with other health care professional Pharmacist as health care professional is involved mainly in drug therapy, controlling & supervising its comprehensive applications The contributions of the pharmacist as a health care professional is so diversified and can be observed in various areas. The main one to be emphasized as health care professional is the clinical pharmacy services and some of such activities are: Verifies prescription order for the dose, frequency, and duration of therapy Verifies prescription order for compatibility Checks patient record for pertinent patient information before dispensing prescription medication Maintains a record file of current prescription orders including pertinent patient information and renewal data  2.3. Relationship with other health care professional Use effective communication techniques in accomplishing the following: Obtain history of prior and present medical problems Obtain history of drug usage (including prescription) Obtains history of patient compliance with drug regimen Obtain history of drug allergies or sensitivities i.e. dose, root of administration, type of reaction Confirm & further clarifies patient’s understanding of medication dosages, dosage frequency & methods of administration Advises patient of potential drug-related or health related conditions which my develop from the use of the medications which patient should seek other medical care Requirements to provide Clinical Pharmacy services Knowledge of drug therapy Knowledge of Knowledge of nondrug therapy the disease Therapeutic Knowledge of planning laboratory skills and diagnostic skills Patient care Drug Information Communication Skills skills Physical Patient assessment monitoring skills skills  Level of Action of Clinical Pharmacists Clinical pharmacy activities may influence the correct use of medicines at three different levels: Before the prescription During the prescription After the prescription is written.  1. Before the prescription Clinical trials Formularies Drug information Drug-related policies  2. During the prescription Counselling activity Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments. The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring. The clinical pharmacist monitors, detects and prevents the medication related problems  Medication-related Problems Untreated indications. Improper drug selection. Sub-therapeutic dosage. Medication Failure to receive Medication Over dosage. Adverse drug reactions. Drug interactions.  3. After the prescription Counselling Preparation of personalised formulation Drug use evaluation Outcome research Pharmaco-economic studies  Summary The use of drugs in healing is as old as ancient civilization itself. The practice of pharmacy is a vital part of a complete health care system. The practice of pharmacy aimed at providing and promoting the best use of drugs and other health care services and products, by patients and members of the public. The contributions of the pharmacist as a health care professional is so diversified and can be observed in various practice areas. Thank You