INTRODUCTION TO COMMUNITY PHARMACY

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INTRODUCTION TO COMMUNITY PHARMACY

• BAREERA RANA
• M PHIL PHARMACEUTICS

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The role of the pharmacist

• Pharmacists are allied health professionals who
  practice in pharmacy, the field of health science
  focusing on safe and effective medication use
• The role of the pharmacist has shifted from the
  classical "lick, stick, and pour" dispensary role
  to being an integrated member of the health care
  team directly involved in patient care.

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Specialities of Pharmacists

• Expert in Science Clinical use of medications.
• Knowledge about Composition Properties of drug
• Various categories of diseases Classification
  of drugs
• Therapeutic dose of drug
• Structure Activity Relationship of drug

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• Understand the Pharmacological Mechanism of
  Action of Drug
• Have analytical skills clinical knowledge
• Information about Adverse Drug Reaction toxic
  effects of Drug
• Familiar with Medical terminologies

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More common roles

• The most common pharmacist positions are
• A community pharmacist (also referred to as
  "retail pharmacist" or dispensing chemist"),
• Or
• A hospital pharmacist (also known as a clinical
  pharmacist).

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The breakdown (2006)
76 community 15 hospital 9 others
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What is Community Pharmacy?

• Practice of pharmacy based within the community
• Primarily located within a retail setting
• Centre for healthcare

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• Retail Business
• Income comes from
• dispensing
• retail sales
• Average distribution is 70 Rx / 30 retail
• services under Community Pharmacy Agreements eg.
  Medschecks, Clinical Interventions
• A MedsCheck provides an in-pharmacy review of a
  patient's medicines
• Miscellaneous - aged care homes, medical
  certificates

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Quality Care Pharmacy Program

• Quality assurance program for community pharmacy
• Community Pharmacy Quality Assurance analysis
  and establishment of a patient-specific
  adherence program 
• Aim to provide quality professional services
  and customer care
• Re-assessed every 2 years

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Community pharmacy definition

• Interface between public/consumer/patient and a
  retail facility from where consumer can access
  his/her pharmaceutical and health related needs
  (supplies/services) from a team of trained
  personnel working under direct/indirect
  supervision of a pharmacist.
• Patient pharmacist interface
• An inevitable interaction in health care
• An overwhelming number and reach in masses
• An ideal area for designing PHA (public Health
  awareness)

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ALSO CALLED

• Chemist and druggist shop
• Drug store
• Pharmacy
• Medical store
• Retail pharmacy

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THE TWO DRUG AREAS IN SOCIETY

• PHARMACY PRACTICE

• Pharmacist
• Physician
• Other health care professionals
• Patients

Health Systems Pharmacy
Community Pharmacy

• Pharmacist
• Patient/Consumer

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BUSINESS CONCEPT

• Distributors
• Wholesaler
• RETAILER
• Direct interaction
• An advanced role
• And greater responsibility
• More than a business transaction

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The Community Pharmacy

• Joining the professional transformation
• SERVICE
  CARE

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COMMUNITY PHARMACY

• A lot more than prescription filling
• Compounded pharmaceuticals
• Pharmaceutical care
• A recent advancement in pharmacy practice
• Research and documentation is what makes us see
  things happen.

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COMMUNITY PHARMACY

• A hybrid concept
• Well developed professional skills
• Clinical knowledge
• Management skills
• Communication skills
• Queries , advice, education
• Prescription drugs
• OTC (over the counter) drugs
• Health Care supplies and medical equipment

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The CONFLICT

• INVESTOR CONCEIVES
• PHARMACIST AS MANAGER
• PHARMACIST CONCIEVES HIS ROLE AS
• SERVICE PROVIDER

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THE MANAGEMENT OF PHARMACY

• INVENTORY MANAGEMENT
• HUMAN RESOURCE MANAGEMENT THE INVESTOR
• FINANCIAL MANAGEMENT
• QA/DOCUMENTATION THE REGULATORY
  INSPECTORS
• THE PROFESSIONAL ROLE PROFESSIONAL
  SATISFACTION
• 
  
  SOCIETAL ROLE OF PHARMACY
• 
  
  ETHICAL CONCERNS
  

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PHARMACIST AT THE COMMUNITY PHARMACY

• The qualified person/license
• The manager
• The shift manager
• The intern/apprentice
• The observer
• The owner/investor
• The more your interest is at stake the better you
  understand functioning and sustainability of the
  pharmacy

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COMMUNITY PHARMACY

• Is the most important tool for improving health
  indicators of the country
• Health promotion
• Disease management state and drug monitoring
• Public health awareness
• Drug information
• Poison control

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THE COMMUNITY PHARMACY

• CREDIBLE
• A relation more than a business transaction
• A concept that can change the face of health
  system in Pakistan

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PROFESSIONAL SERVICES
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Compounding

• Why and who needs it most
• Art and science of compounding
• Good compounding practices
• Diverse dosage form
• For special drugs and population

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PHARMACEUTICAL CARE IN COMUNITY

• COMPOUNDING
• DUR (DRUG UNILIZATION REVIEW)
• Disease stage management
• Drug monitoring
• Collaborative practice agreements
• OBRA 90 (Omnibus Budget Reconciliation Act of
  1990) requires that minimum pharmaceutical care
  can be performed with every prescription.

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CLASSICAL PARADIGM

• Appropriate drug and dose for the patient
• Drug allergies
• Drug interaction
• Contraindications
• Dose scheduling

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ADDITIONALLY

• Assurance of efficacy in dispensing and labeling
• Provide storage information
• Potential risk and benefits
• What to do when dose is missed?
• What to do when ADRs (adverse drug reactions)
• Assessment of patients understanding

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CONTEMPORARY

• Appropriateness of entire pharmacotherapy care
  plan
• Pharmacogenomic considerations
• Monitoring of results of pharmacotherapy care
  plan

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ASHEVILLE PROJECT

• 12 pharmacies
  
• 85 diabetes patients
• Started in march 1997
• Include pharmacy services
• Patients education and training
• clinical assessment
• Monitoring
• Follow-up
• referal

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ASHEVILLE PROJECT

• Better than comparison group
• Lower health cost
• Missed few days of school
• Required less intensive care

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ImPACT Project

• Impact Persistence and Compliance with Therapy
• 26 pharmacies
• 469 patients with dyslipidemias
• 30 minute counseling session
• RESULTS
• Explain lab reports
• Life style changes
• Importance of following prescription

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ImPACT Project

• IV. Attainment of clinical goals was demonstrated
  by pharmaceutical care
• 84 patients showed compliance
• VI. 50 has achieved their cholesterol lowering
  goals

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DISEASE STATE MANAGEMENT

• Pharmacist monitor
• Disease progression
• Drug related problems
• Screening clinics
• Blood pressure
• Blood glucose
• Lipid testing
• Advice in co administration of
• Nutritional supplements
• Immunization
• OTC preparation

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COLLABORATIVE PRACTICE

• Pharmacist is driving force in decision making
• Pharmacist run clinic
• Medication care planning, follow up and
  monitoring under the limits of collaborative
  agreement
• Here physicians refers patients to pharmacist
  clinic.

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THE LOYALTY ISSUES
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PHARMACIST

• Fails to visualize the drug sale outlet as a
  commercial venture
• Does not take retail pharmacy as his willing
  full opted career
• Escapes from the responsibilities as manager

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Limitations for the improvement of professional
services

• Law
• Current practice absence of model settings
• Level of autonomy in decision making
• Fear of professional/career development

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Silence needs to be broken

• The curriculum
• The law
• The practice model

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Way to go forward

• Learn at student age
• Hands on experience
• Paid apprenticeship
• Documentation , SOPs and SOP based system
• Focus viability offer professional services, aim
  for credibility and positive change norms.

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Grey areas..

• Drug shortages-Black marketing, over pricing
• The refills (Rx)
• Stamp of prescription dispensed
• Ambiguous prescriptions
• Absence of prescriber identity on Rx order, no
  PMDC Reg. no. is given
• Legal rights to prescription checking
• Prescribers knowledge of legal issues of
  prescription order.