Role of Community Pharmacists in Healthcare

INTRODUCTION

Community pharmacists may be regarded as the health professionals most accessible to the public¹ and whose services are coveted by the public and patients. Round the world, millions of people visit community pharmacies for their daily health care requirements. Pharmacists are placed as the first point of contact in the healthcare system because of their ease of approach2. They dispense medications in accordance with a prescription or without prescription when permitted, as in the case of OTC medicines. In addition to the supply of medicines the professional services of a community pharmacist should also cover patient counselling, drug information to healthcare professionals, patients and public, participation in healthcare programmes.³

The main activities of community pharmacists include: ^{3, 4, 5}

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• Processing of prescriptions

The pharmacist checks for the legality, safety and appropriateness of the prescription order and decides whether the medication should be handed to the patient with appropriate counselling, by a pharmacist. The community pharmacist is in a unique position to be fully aware of the patient’s past and current drug history and, consequently, can provide essential advice to the prescriber.

• Care of patients or clinical pharmacy

The pharmacist seeks to collect and integrate information about the patient’s drug history, clarifies the patient’s understanding of the intended dosage regimen and method of administration, and advises the patient of drug-related precautions.

• Monitoring of drug utilization

The pharmacist can participate in arrangements for monitoring the utilization of drugs, such as practice research projects, and schemes to analyze prescriptions for the monitoring of adverse drug reactions.

• Extemporaneous preparation and small-scale manufacture of medicines

New developments in drugs and delivery systems may well extend the need for individually adapted medicines and thus increase the pharmacist’s need to continue with pharmacy formulation. Pharmacists engage in the small-scale manufacture of medicines, which must accord with good manufacturing and distribution practice guidelines.

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• Traditional and alternative medicines

In some countries, as in India, pharmacists supply traditional medicines and dispense homoeopathic prescriptions.

• Responding to symptoms of minor ailments

The pharmacist receives requests from members of the public for advice on a variety of symptoms and, when indicated, refers the inquiries to a medical practitioner. If the symptoms relate to a self-limiting minor ailment, the pharmacist can supply a non-prescription medicine, with advice to consult a medical practitioner if the symptoms persist for more than a few days. Alternatively, the pharmacist may give advice without supplying medicine.

• Informing health care professionals and the public

The pharmacist can compile and maintain information on all medicines, and particularly on newly introduced medicines, provide this information as necessary to other health care professionals and to patients, and use it in promoting the rational use of drugs, by providing advice and explanations to physicians and to members of the public.

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• Health promotion

The pharmacist can take part in health promotion campaigns, locally and nationally, on a wide range of health-related topics, and particularly on drug-related topics (e.g., rational use of drugs, alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent abuse, poison prevention) or topics concerned with other health problems (diarrheal diseases, tuberculosis, diabetes care, leprosy, HIV-infection/AIDS), nutritional counselling and family planning. They may also take part in the education of local community groups in health promotion, and in campaigns on disease prevention, such as the Expanded Programme on Immunization, and malaria and blindness programmes.

• Domiciliary services

In a number of countries, the pharmacist provides an advisory as well as a supply service to residential homes for the elderly, and other long-term patients. In some countries, policies are being developed under which pharmacists will visit certain categories of house-bound patients to provide the counselling service that the patients would have received had they been able to visit the pharmacy.

• Agricultural and veterinary practice

Pharmacists supply animal medicines and medicated animal feeds.

Global setting of Community Pharmacy

Community pharmacy practice evolved in a period after Second World War. A pharmacist began to perform functions that were new to pharmacy. The popular motto of “patient oriented practice” and “drug use control” came into practice.⁶

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Around the world there are community pharmacists who are drug experts providing patient care in their community pharmacies. In many countries community pharmacies are places where individuals may obtain health advice & assistance with managing their disease status with medication.

In UKpharmacist have role in primary care & public health. In community pharmacies the concept of “responsible pharmacist” is adopted from 2005. In Canada community pharmacies offer professional services like home delivery of prescription, in store blood pressure monitoring device, in store screening/risk assessments, patient library, in store educational seminar/programs, trial prescriptions, patients call back system, in store disease management, home visits, out of store educational seminars/program & documented care plans.

InBrazilcommunity pharmacies provide pharmaceutical services like drug dispensing, blood pressure measurement, capillary glucose test, cholesterol/triglyceride test, nebulization, administration o injectables & compounding. In Germany community pharmacists contributes to health promotion & promote rational prescribing and appropriate use of medicine along with this they provide drug information, pharmaceutical care& preventive care services.

In Finlandmedication counseling by community pharmacists was made mandated by law in 1983. In Australia, disease state management in asthma & diabetes is being considered for reimbursement & in Portugal, programs exists for diabetes, asthma & hypertension. In Sweden all pharmacies have an information technology-based drug related problem documentation system & a new national drug related problem database.⁸

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Community Pharmacy in India

The genesis of community pharmacy practice in India can be traced back to the Colonial period when allopathic drugs were introduced and were made available through drug stores towards the end of the nineteenth century. The pharmacy practice scenario and especially community pharmacy practice during pre-independence era was highly unregulated and there were no restrictions on the practice of pharmacy in India.⁷

When we look into our country, as compared with the global setting, things are totally different and honestly it is quite disturbing. More or less, with very few exceptions, pharmacies are the drug selling shops and not yet healthcare settings. The true community pharmacy concept is not developed yet. Although community pharmacist is of key importance in providing better healthcare, the situation and condition of the community pharmaceutical service has stood where it was in its commencement.⁶

Today, community pharmacists play an important role in any country as they take responsibility for patient’s medicine related needs for access to healthcare. However, in India only the supply of medicines remains the core activity of the community pharmacist. Most community pharmacists in the country still hardly offer patient-oriented service. The role of the pharmacists in the community, and with it their medicine management, may change in the wake of the rapid growth of domestic medicine output and national healthcare expenditure.⁷

The profession of pharmacy in India can seize the opportunity and respond to changes in the health care system, in part, by making pharmaceutical care its mission. Good Pharmacy Practice Guidelines aim to set standards for practice of pharmacy as a profession in India. It is also an affirmative statement conveying that we ourselves control our profession’s standards, not anyone else. These guidelines aim to provide the framework to meet the criteria that has the potential to make pharmacy profession relevant to the society. Hence it is necessary that every individual pharmacist should be aware of the guidelines and uplift their profession.

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Prevalence of diabetes and the role of community pharmacist in diabetes care

According to recent estimates, approximately 285 million people worldwide (6.6%) in the 20–79 year age group will have diabetes in 2010 and by 2030, 438 million people (7.8%) of the adult population, is expected to have diabetes⁹. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries.¹⁰

It is estimated that the total number of people with diabetes in 2010 to be around 50.8 million in India, rising to 87.0 million by 2030. According to the World Health Organization (WHO) criteria, the prevalence of known diabetes was 5.6% and 2.7% among urban and rural areas, respectively. India is ranked first among the top10 countries for estimated numbers of adults with diabetes, 2010 and 2030 ¹¹.

Several studies have reported the role of pharmacists in diabetes care. Community Pharmacists for diabetes patients intervention study in Japan showed a marked increase in HbA1C levels.¹² A Study conducted in Tamil Nadu has turned out to show that community pharmacists are in a unique position to monitor and counsel rural patients with diabetes. This study demonstrates the positive impact that the community pharmacist can have in achieving the primary therapeutic goal in diabetes patients of overall diabetes control. ¹³

It is evident that community pharmacy in its broad meaning has not yet come into practice and the community pharmacist has a major role to play in diabetes care. An evaluation will reflect how far our pharmacists are aware of their role and will help to improve themselves in their profession. Hence our study aims at assessing the knowledge, attitude and practice of the community pharmacist towards Good Pharmacy Practice and diabetes with an objective of imparting academic and professional updation through professional development initiatives.

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References

1. Krishna Goudar Bhimaray, Mahadevamma C, Yoganada R, Shaik Shafiya Begum. The key role of community pharmacist in Health care system. An over view.
2. Adepu R, Nagavi BG. General practitioner’s perceptions about the extended roles of the community pharmacist in the state of Karnataka: A study. Indian J Pharm Sci. 2006; 68(1): 36-40.
3. Report of WHO Consultative Group; New Delhi, India. The role of the pharmacist in the health care system; N- December 1988; p 10-12.
4. Stephen Greenwood, Australian Health Consumer number one 2005–2006; Value of the current system of community pharmacy; p 10 – 13
5. Rai Awani Kumar, Saini Rakesh, A Textbook of Community Pharmacy; Roles and responsibilities of community pharmacist; p 2 – 3
6. Ishita, Deepak Kaushik & Harish Dureja ; Role of community pharmacist in ensuring better healthcare http://www.pharmabiz.com/article/detnews.asp?articleid=22582&sectionid=46
7. Subal Chandra Basak, Dondeti Sathyanarayana; Community Pharmacy Practice in India: Past, Present and Future, Southern Med Review: Volume 2 | Issue 1 | April 2009 p 11 – 14
8. International Scenario Community Pharmacy http://www.pharmainfo.net/vijayaratna/blog/community-pharmacy-india-and-some-issues
9. IDF Diabetes Atlas, 4th edition. International Diabetes Federation, 2009.
10. J.E. Shaw , R.A. Sicree, P.Z. Zimmet, Diabetes Atlas; Global estimates of the prevalence of diabetes for 2010 and 2030
11. A Ramachandran, AK Das, SR Joshi, CS Yajnik, S Shah, KM Prasanna Kumar Current Status of Diabetes in India and Need for Novel Therapeutic Agents; Supplement to japi • june 2010 • vol. 58
12. Okada H, Nakagawa Y, Onda M, Shoji M, Fukuoka K, Ishii Y, Sakane N; Community Pharmacists for Diabetes Patients Intervention Study in Japan – Compass Project
13. R Venkatesan, AS Manjuladevi , S Sriram; Role of community pharmacist in improving glycemic control, Perspectives in clinical research