Pharmacy Practice Lecture 1 PDF

Pharmacy Practice What we as pharmacist believe our profession to be determines what it is Wendell T.Hill,Jr. Pharmacist are experts on the actions and uses of drugs, including their chemistry, their formulation in to medicines and the ways in which they are used to m...

Pharmacy Practice What we as pharmacist believe our profession to be determines what it is Wendell T.Hill,Jr. Pharmacist are experts on the actions and uses of drugs, including their chemistry, their formulation in to medicines and the ways in which they are used to manage diseases. The principal aim of the pharmacist is to use this expertise to improve patient care. Top priority for all pharmacists are right drug right route right dose right patient right time  Good Pharmacy Practice requires that a pharmacist's first concern must be the welfare of the patients in all settings. The core of the pharmacy activity is the supply of medication and other health care products, of assured quality, appropriate information and advice for the patient, and monitoring the effects of their use. An integral part of the pharmacist's contribution is the promotion of rational and economic prescribing and appropriate medicine use. The objective of each element of pharmacy service is relevant to the individual, is clearly defined and is effectively communicated to all those involved. Changing role of Pharmacy ◼ The traditional role of pharmacists is to manufacture and supply medicines. ◼ More recently, pharmacists have been faced with increasing health demands which change their direction and focus to PATIENTS instead of the Product. Three pillars for service delivery in health care system Professional Prospects ◼ 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 in opportunities. Issues that our Profession will face ◼ increases in average life span ◼ the increased incidence of chronic diseases; ◼ new infectious diseases have emerged ◼ the increased complexity, number, and sophistication of medications and related products and devices; ◼ increased emphasis on primary and preventive health services, ◼ In addition, more and more so-called “life-style medicines” – treatments for ailments like baldness, dry skin, wrinkles or erectile dysfunction– are being marketed. Increasingly medicines can be purchased in new settings, and are handled by non- pharmacists. Compounding has been largely replaced by the commercial manufacture of nearly all formulations. Medicines can be bought in supermarkets, in drug stores or at markets. They can also be obtained by mail order or over the Internet, they are sold by medical practitioners and dispensed by computerized dispensing machines. Issues that our Profession will face ◼ Under these circumstances it is pertinent to ask the following questions: ◼ Do we still need pharmacists? ◼ What is the value of pharmacy services? Because of the large role that medications and their proper use play throughout these issues, pharmacists will play an important part in the future of health care. 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 prescribed and the pharmacist dispensed. During the twentieth century, the pharmacy profession has evolved through four stages. ◼What Was A Pharmacist? n From Earliest Recorded History (1500’s BC) Until Early 1900’s - Pharmacists Were Gathers & Compounders Of Medications - Chemists ◼What Was A Pharmacist? n From Early 1900’s Until 1940’s and 1950’s, Chemical Companies Began Making Raw Drugs Available For Pharmacist To Compound Medications. ◼What Was A Pharmacist? n From Late 1950‘s through 1960’s and 1970’s, Chemical Companies Became Pharmaceutical Firms, Making Pre-formulated Dosage Forms Available For Pharmacist To Dispense. ◼What Was A Pharmacist? n During 1970’s and 1990’s Pharmacists Were Almost ◼Take 2 Exclusively Dispensers Of ◼Tablets Medication, But New ◼At Bed Duties To Counsel Patients Were Added To The Pharmacist’s Job.  ◼Clinical Pharmacist ◼Clinical Pharmacist serves 60 beds ◼integratesinto ◼medical specialties ◼Pharmacist ◼Emergence as of the ◼ward visitor ◼ Variety of ◼serves 120 Teacher- Practitioner models ◼ beds ◼Pharmacy Patient ◼Computer Records ◼Primary Care ◼and Services to ◼ Pharmacy ◼Community Pharmacy ◼ Elderly Nursing ◼Targeted Services ◼Patient ◼ Homes ◼Medication Records ◼ Innovations in Pharmacy Services 1970s 1980s 1990s 2000s 20 ◼ Evolutionary change in Pharmacy Practice  Why this change in focus? Age-old role of pharmacists as compounders is disappearing; pharmacists looking for new roles ◼ Dispensing has become more simple: robots do it! ◼ Drug related problems become more manifest because of a malfunctioning medication use process. Causes: ◼ Pharmacotherapy is an increasingly complex technology ◼ Inappropriate prescribing/ dispensing/ administration or use of medicines. ◼ Chronic shortage of other health care providers such as nurses and doctors in most countries  ◼Why this change in focus? o multiple practitioners writing prescriptions for a single patient, often without coordination and communication. o 4 in 5 people over 75 y prescriped ≥ 1 drug, with 36% taking ≥4 medicines. o the large number of medications and overwhelming amount of drug information presently available to patient. o an increase in self-care through alternative and complementary medicine. o a high level of drug-related morbidity and mortality which results in significant human and financial costs. ◼Why this change in focus? improper medication use is expensive! and no one is responsible for that. Society has a great unmet need for safe and effective drug therapy. The focus of pharmacy practice must change from products to ensuring the best drug therapy and patient safety.  ◼Why this change in focus? ◼ Pharmacists can and do make a unique contribution to improving patient care. Medicines are the most common of all the steps taken by clinicians to help patients. And of all the healthcare professions, pharmacists have the widest knowledge in the science and use of medicines. ◼Whether in the community, in hospitals or specialist units, pharmacist focuses on empowering and protecting patients. ◼Pharmacists have a key role to play in ensuring health gain wherever medicines are used. ◼Pharmacy students and practitioners must be educated to assume the responsibility for managing drug therapy, so that they can maintain and expand their position in the health care system. Definition Pharmacy Practice is the discipline within Pharmacy that involves developing the professional roles of the pharmacist. ◼ Pharmacy Practice is vital, since it facilitates and enables pharmacists to fully exploit their substantial knowledge and expertise in areas such as pharmacology, pharmaceutics, chemistry and therapeutics within a clinical context. Pharmacy Practice Aim ◼ 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. ◼ It requires that the welfare of the patient is the pharmacist's prime concern at all times. Why become a Pharmacist? How do you become a Pharmacist in Bangladesh UNDERLYING PHILOSOPHY ◼ 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. Eight Star Pharmacist The ideal frontline pharmacist of the future has been described as a eight star pharmacist-some one who is equal in excellence to a five star hotel yet accessible to everyone from the richest to the poor. The future 8 star pharmacists will have eight principal roles to play: 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. Services must be of the highest quality 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 Decision-maker: The appropriate, efficacious, safe and cost-effective use of resources (e.g., personnel, medicines, chemicals, equipment, procedures, 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 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. More and more, information and its related technology will provide challenges as pharmacists assume greater responsibility for sharing information about medicines and related products and ensuring their quality 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. 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. Leader: In multidisciplinary (e.g., team) caring situations or in areas where other health care providers are in short supply or non-existent 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. 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. Pharmacy Practice Settings Community Pharmacy Clinical Pharmacy Mail-Order Pharmacy Pharmacy Benefit Managers & Managed Care Hospital Pharmacy Home Health Care Long-Term Care Specialty Pharmacy Services Community Pharmacy Any place under the direct supervision of a pharmacist where the practice of pharmacy occurs or where prescription orders are compounded and dispensed Local retail or grocery store pharmacy chain or independently owned Pharmacist in community settings – prepare prescription labels – verifies the legality, safety and appropriateness of the prescription order – ensures that the quantities of medication are dispensed accurately – order & maintain drug inventory – process insurance claims – operate a cash register Clinical Pharmacy Clinical pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, and disease prevention. What do clinical pharmacists do? ◼ Assess the status of the patient’s health problems and determine whether the prescribed medications are optimally meeting the patient’s needs and goals of care. ◼ Evaluate the appropriateness and effectiveness of the patient’s medications. ◼ Recognize untreated health problems that could be improved or resolved with appropriate medication therapy. ◼ Follow the patient’s progress to determine the effects of the patient’s medications on his or her health. ◼ Consult with the patient’s physicians and other health care providers in selecting the medication therapy that best meets the patient’s needs and contributes effectively to the overall therapy goals. ◼ Advise the patient on how to best take his or her medications. ◼ Support the health care team’s efforts to educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization. ◼ Refer the patient to his or her physician or other health professionals to address specific health, wellness, or social services concerns as they arise. Mail-Order Pharmacy ◼ Mail-order pharmacy is a pharmacy that operate over the internet and sends the orders to customers through the mail or shipping companies. ◼ Prescriptions filled & refilled through the mail ◼ No face-to-face contact with patients Pharmacy Benefit Managers Oversees prescription medication programs. Processes & pays prescription medication insurance claims. Develops & maintains a medication formulary. Pharmacist who work in a PBM environment do not have direct patient contact They work to ensure lower costs and better health outcomes through affordable access to medicines that patient need Managed Care Type of health insurance program – Patients pay a blanket fee for their health care services “The application of management principles to achieve maximum health outcomes at the lowest cost” Managed care programs often operate ambulatory clinics & hospitals Hospital Pharmacy Pharmacists are directly involved with patient care – daily interactions with physicians, nurses, & other s – develop plans of pharmaceutical care – monitor the patients’ drug therapy – may provide specialized services – pediatrics – oncology – infectious diseases – nutrition support – drug information Hospital Pharmacy ◼ Pharmacists ❑ evaluate trends in medication use ❑ develop guidelines for medication use ❑ educate patients & health care professionals, ❑ implement & maintain drug distribution systems ❑ interdisciplinary work within & outside pharmacy department Home Health Care ◼ Home health care is a practice that specializes in treating patients in their homes or other residential facilities, such as assisted living communities. ◼ Home care pharmacists ❑ assess patient for the appropriateness of home medication administration ❑ develop a medication management plan to educate & monitor the patient ❑ medications administered may be oral tablets or capsules or continuous infusions of pain medications or total parenteral nutrition (TPN) Long-Term Care Includes nursing homes psychiatric or behavioral health institutions intermediate care facilities for mentally disabled patients skilled nursing facilities A long-term care pharmacist is engaged by a long-term care pharmacy to provide pharmacy, infusion, education, consulting, and related services for a specific patient population. There are two general career paths in long- term care pharmacy: one focuses on dispensing/management operations and the other on consultant services Long-Term Care Hospice care – patients with incurable diseases – not expected to live more than six months Hospice care may be offered – long-term care settings – hospitals – patients’ own homes Provides dying patients with best possible quality of life – focus on relief of symptoms rather than on treating disease Pharmaceutical Care ◼ Pharmaceutical care ❑ “the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life” Pharmaceutical Care The principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication that improves patients' quality of life. These outcomes include: ◼ 1) cure of a disease; ◼ 2) elimination or reduction of symptoms; ◼ 3) arresting or slowing a disease process; ◼ 4) prevention of disease; ◼ 5) diagnosis of disease; ◼ 6) desired alterations in physiological processes, all with minimum risk to patients. MTM Medication therapy management (MTM) is medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. Medication Therapy Management includes ❑ assessment of a patient’s health status ❑ formulation of a medication treatment plan ❑ selection, initiation, modification, or administration of medication therapy ❑ monitoring of the patient’s response to therapy ❑ review of medications for medication-related problems Primary Care Pharmacy Primary care pharmacists play a significant part in managing medicines. They have a strategic role to focus on maximizing benefit and minimizing risk associated with medicines as well as making the best use of resources allocated for medicines. Primary care pharmacists work in the local community supporting GPs, nurses, community pharmacists and other healthcare professionals. The level of patient contact varies depending on role. They will play a significant role in the management of medicines use, and will be involved in developing services for the local population, implementing national health priorities at a local level, arranging funding and access to health services (commissioning), and designing treatment pathways. They will also be involved in conducting audits and research. Secondary and Tertiary care pharmacist Medical care that is provided by a specialist or facility upon referral by a primary care physician and that requires more specialized knowledge, skill, or equipment than the primary care physician can provide. Pharmacist working with specialist are known as secondary/tertiary care pharmacist.