Retail medicine supply (to patients)

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Retail medicine supply (to patients)
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Some terms

• POM prescription-only
• NP OTC
• Wrong term! American and European meanings
• Europe NP medicines
• USA anything sold in the pharmacy without
  prescription
• Is there a counter? Also under the counter?
• GSL General Sales List NP that can be sold not
  only in pharmacies (if such exists)

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The first issue PHARMACIESand other places for
retail medicine supply
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In your opinion how old are the pharmacies?

• i.e. establishments where drugs are
  compounded/sold

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Medicines were already compounded also in the
Prehistoric Age
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Pharmacies - traditions
Pharmacy in ancient Egypt
Pharmacy in ancient China
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Pharmacies traditions 2
ancient Arabic pharmacy
Pharmacy in ancient Babylon
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Pharmacy traditions 3
Galen
Pharmacy in ancient Greece
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Pharmacy traditions 4
Pharmacy in a medieval European Monastry
Avicenna (ibn Sina?) Persian? Middle East Asian?
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Pharmacy traditions 4
Late 19th Century pharmacy laboratory
Pharmacy in the 18th Century USA
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Contemporary pharmacies
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Drugs to patients

• Retail drug sales
• Community pharmacies
• Some specialised/ordinary shops
• Hospital pharmacy
• By medical doctors (is at called also pharmacy?)

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Retail drug selling - various modelsEthical
model

• Pharmacy is mostly a health-care institution,
  different from shops
• Mostly medicines sold
• Pharmacists run the pharmacy, mostly they are the
  owners
• Profession overcomes profit-orientation (no
  owner-investors who take away the profit)

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Retail drug selling - various modelsBusiness-ori
ented model

• (or liberal model) pharmacy is one of the
  specialised shops (drug-store)
• Any product sold that makes profit cosmetics,
  some food, but also cakes and whisky in the USA
• some OTCs sold also outside pharmacies

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OTC retail selling - various models

• From
• any drug is pharmacy only
• through
• GSL (shops, fuel stations, department stores)
• to
• distant/Internet sellings

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Drugs sold not only in pharmacies GSL

• In the recent Member States of the EU, it is
  possible, e.g. in
• B, DK, GE, GR, IR, NL, UK (phyto products AT,
  PO!), CZ, PL, SVN, SW
• also in Hungary
• Norway

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Self-service pharmacy for NP drugs

• DK, FI, SW, UK (GR only a few products, NL under
  discussion)

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Internet-, TV-, distant selling

• DK, FI, GE, UK, NL, also in Hungary (from
  pharmacies only)

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Owner of pharmacy not only pharmacist

• In these countries chain pharmacies also possible

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Magistral drug compounding in pharmacies

• Not available in many EU Member States
• The meaning of
• pharmacy (Canadian example)

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Other provisions, easy to misunderstand

• Austria 7741 inhabitants/pharmacy
• but 1086 community pharmacies plus 1009
  drug-seller physicians!
• the Netherlandes 10.000 inhab./pharmacy
• but 1600 community pharmacies plus 4190
  drugstores, among them 430 outlets in common
  shops (also at groceries)
• Russia the translation of pharmacist

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Thus...

• when discussing retail pharmacy affairs, be
  careful to identify what pharmacy and
  pharmacist mean in the given country!

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What is a pharmacy? 1

• What kind of goods sold?
• Mostly drugs, no open shelves
• Mostly drugs, also self-service from open shelves
  (to pharmacist or to the cassier)
• Boots in the UK (many cosmetics, also a
  pharmacy inside
• USA every kinds of goods open shelves window
  for prescriptions
• Canada department-store pharmacy

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What is a pharmacy? 2

• Is a pharmacist needed in it?
• even the owner must be
• at least one pharmacist is available all time
• pharmacist director, not all time
• physician-handled pharmacy, too
• pharmacy technician for OTCs
• satellites, outlets at normal shops
• OTCs at fuel stations, etc.

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What is a pharmacy?

• Is there magistral drug production on the spot?
• yes, both acc. to physicians individual
  prescripitons and official formulae
  individual prescriptions
• no, only ready drug products (manufactured in
  factories) sold

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The core of the issue

• Is the community pharmacy a health-care
  institution or a shop?
• ex factory price margins - Governments want to
  decrease consumer prices by avoiding pharmacists
  services plus drug price competition among drug
  retailers

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Establishment of a new pharmacy

• Private - State-owned?
• No limitation (competition driven) or even
  distribution (WHO! Remote areas, islands, per
  inhabitants, distance between)
• Magistral compounding? injection in post-Soviet
  pharmacies vs. factories, dialysis solutions

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Magistral injections?

• As a rule, industrial level manufacture gives
  higher assurance
• In some post-Soviet countries the pharmacies had
  better corcumstances!
• Otherwise, simple dosage-forms are compounded in
  pharmacies

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Story preparation of solutions for dialysis

• Preparation mean survival time of dialysed
  patients
• In a Central Asian post-Soviet country (in 1995)
  in a bath-tube, with a paddle
• Hungary 20 years ago in hospital pharmacies
• Hungary nowadays dialysis centres (GMP-level
  manufacture)

3 years
6-7 years
10 years
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Authorisation of a new pharmacy

• Should it be authorised? (WHO requirement)
• By whom?
• Any conditions (e.g. personnel requirements,
  facilities, equipment)?

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Authorisation of a retail pharmacy

• No authorisation?
• Ministry of Health?
• Local Governments (municipality)?
• Other?

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Any limitation of new retail pharmacy
establishment?

• Absolutely free (new pharmacy in the same
  building)?
• Area limitation? (e.g. one pharmacy per square
  kilometer, given number per village, etc.)
• Inhabitant limitation? (e.g. 5.000 inhabitants to
  each pharmacy)

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Premises-equipment requirements?

• None?
• Minimum area (square meters)?
• List of equipments (applicable when there is
  magistral compounding)
• If any, where and by whom is it specified? MoH
  Decree, oether?

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Inspection of pharmacies

• Is it available? By whom? Ministry, local health
  authority, consumer protection
• Inspection of drugs sold outside the pharmacies?

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Pharmacies on duty?

• (E.g. during night, on holidays)
• Regulated? By whom? Who (if any) appoints on-duty
  pharmacies and sets the time-frames for
  operation?
• Or regulated by the business?

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The second issuethe PHARMACISTWhat is his/her
role?
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The evolving role of a pharmacist (WHO) 1

• Physician prescribes medicines
• Nurse administers medicines
• Pharmacist?

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The evolving role of a pharmacist (WHO) 2

• The role of the Pharmacist?
• Expert of medicines!
• how the medication should be used
• interaction with other (e.g. OTC) products
• maximise benefits and minimise Adverse Drug
  Reactions

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The evolving role of a pharmacist (WHO) 3

• The role of the Pharmacist? contd
• How to use medicines in the most effective and
  appropriate manner
• NP e.g. pain relief advising patients
• how to use an asthma inhaler
• how to store medicines at home

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The evolving role of a pharmacist (WHO) 4

• The role of the Pharmacist? contd
• what foods to avoid during this medication
• what to do if a dose is missed
• compounding, preparing, dispensing medicines
• Evolving role roboting in dispensing

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Information provided

• Is there any mandatory/advised information the
  pharmacist must/should provide when selling
  drugs?
• Two misconcepts
• - natural safe
• - non-prescription (OTC) no adverse
  effect like other commodities

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The evolving role of a pharmacist (WHO) 5

• Pharmaceutical care
• Blood sugar measurement
• Blood pressure measurement
• Etc.

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Special issue complementer/alterna-tive/tradition
al medicine

• Is it recognised?
• Traditional medicine pharmacies or mixed ones or
  only traditional healers?
• Homeopathic pharmacies?

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Hospital pharmacies
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Hospital

• What is hospital? Is there a legal definition?
• any that has in-patient facilities?
• minimum number of beds?
• named wards (e.g. internal disease, surgery)
• Public, private, both?

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Different hospitals may exist
Hospital in Africa
Mayo Clinic in the USA
Hospital in Bangladesh
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Physicians, treatments
Doctor in Europe
Consulting and treatment in Malaysia
acupuncture in Asia
Chief physician in former Soviet Central Asia
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Hospital pharmacy

• Is there a definiton?
• E.g. establishment to serve in-patients in
  hospital wards
• Mandatory in every hospital?
• If not, what is the requirement? (E.g. No of
  beds, town/regional hospitals, etc.)
• May existing hospital pharmacies serve other
  hospitals?
• Instead, community pharmacies serve hospitals?

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Establishment of a hospital pharmacy

• Is there an authorisation system, or it is the
  decision of the hospital administrator?
• If authorisation
• by whom?
• Are there criteria for the facilities and
  personnel?
• Is there any rule where could it be placed within
  the hospital (e.g. not in the cellar)

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Hospital pharmacy categories

• Are there different categories? E.g.
• only distributing registered medicines
• also magistral preparations
• also compounding sterile parenterals
• Also mixed infusions (citostatic?)
• unit dose distribution
• clinical pharmacy
• also working as a community pharmacy

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These are the issues you should identify first
when going home or target country and starting
the practice!
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Exam topic!
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Retail drug supply

• The meaning of retail drug supply
• Prescription and supply categories
• Retail drug selling models
• Pharmacy as health-care institution or a shop
• Establishment of a new community pharmacy
  possibilities
• Magistral (in-pharmacy) compounding
• Products a pharmacy may sell
• Inspection of pharmacies
• The roles of a pharmacist
• (In all cases detail the situation in your
  country!)

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Hospital pharmacies

• Definition hospital, hospital pharmacy
• Different organisation of drug supply of hospital
  patients
• Establishmentof a hospital pharmacy
• Possible categories of a hospital pharmacy