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• A community pharmacist is the health professional who focuses on the patient’s drug therapy.

• While a physician prescribes drugs and a nurse administers them, the pharmacist is the drug expert.

• Pharmacists’ expertise lies in – How medications should be used?– How to maximize benefits and

minimize adverse effects of drug therapy?

– How prescription drugs interact with other medications.

• The pharmacist’s primary role is – “To ensure that the medications

used by a patient are the most effective and are used in the most appropriate manner”

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• In general:– They can recommend an over-the-counter (OTC) product for a cold, – Demonstrate the proper use of an asthma inhaler, and – Help patients manage their diabetes. – Clients can also talk to their pharmacist about

• How to store and take medication?• What foods or activities to avoid, and • what to do if a dose is missed.

– Working with patients, physicians and other health care providers to help patients achieve their health goals by improving the quality of their drug therapy

– Ensuring safe, secure and effective distribution of medications – Taking medication histories and maintaining patient drug profiles– Monitoring adverse drug reactions and patients’ adherence with their

drug treatment

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– Assessing patients’ drug therapy for possible interactions with current medications and health conditions

– Making recommendations to prescribers and other health care professionals for adjustments to patients’ drug regimens to enhance the quality of care

– Providing education to patients and caregivers on proper use of medications and medical devices

– Managing minor illnesses by providing information to patients on self-care and nonprescription medications

– Providing referrals and advice on health promotion and wellness

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• In their current role, pharmacists contribute to the health care system by:

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• Role of physicians is prescribing and the pharmacists dispensing– Developed countries– Rural India

• Reasons– Unqualified doctors– Qualified doctors prescribe and dispense medicines in their clinics

• Historically, the General Practitioners and community pharmacist have a common ancestor in the apothecary, an adviser on health and dispenser of medicines.

• Hence their is necessity to improve the pharmacy practices on professional scales in India– India is becoming a fast developing nation in the world.– Major exporters to European countries and in USA, in generics

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• In India there is major transformation in Research and Development, production, marketing etc. – how ever the trend has not penetrated down the line to:

• The vital link in supply chain • The pharmaceutical Trade.

• In this chain - the ultimate and vital link is Community Pharmacy.

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Rural India

• Illiterate rural masses• Non-availability of basic quality

medical health care• Quackery practice in rural areas

• Vast number of drug• Non availability of qualified

pharmacists• Mainly focused by Indian pharma

companies• Weak regulatory control

Urban India

• Educated progressive consumers.• Emerging quality medical health

care in urban centers• Highly competent medical

profession• Good awareness• Large turnout of qualified

pharmacists. • Focused by Indian/MNC pharma

companies. • efficient State level Drug agencies

in control

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• In this context it is crucial that we take bold initiative to :– educate the practicing pharmacists, – change their mind set and – prepare them as Community Pharmacists by introducing refresher

courses at State and district Head quarters with a time frame• Recently Indian Pharmaceutical Association has taken some intiatives to

improve the health care practices

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• Everyday, the pharmacist is asked by customers for advice about minor ailments. – They may require advice on symptoms– May ask for a medicine by brand name; – May require general health advice e.g. about dietary supplements,

precautions etc. – Management of the sale of over-the-counter (OTC) medicine

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• There is need to educate and advice the consumers on proper and safe use of medicines, because– There is growing OTC segments of products– Lay press advertisements– Self medication– Drug abuse– Non-compliance of dosage regimen– Mixing of OTC medicines with prescription medicines– Changing life style and food habits– Prevalence of diseases like asthma, tuberculosis, diabetes etc.,

• Hence it requires regular refresher courses to prepare the community pharmacists in patient care and counseling.

• With the advent of IT, a wealth of information is available through web sites and Drug Information Centers which can be used by the community pharmacists

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• It is in the interest of pharmacists that they buy the medicines from authorized sources with proper purchase records.

• Maintain sales memos with patients name and address, batch number of the medicines sold, as a legal requirement and to safeguard themselves in the event of any drug found substandard or unsafe requiring recall etc.

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• Pharmaceutical associations, manufacturers can provide brochures to be distributed to patients at the counters on disease like asthma, diabetes, hypertension, epilepsy even common cold and cough, with Dos and Don'ts etc,.

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• For Immunization and • If space permits, vaccination programs can be organized with the help of

manufacturers in the pharmacies.

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• Elderly patients tend to get confused or forget to take medicines properly. • Complementary packs for keeping each medication separately with dosage

marked will help them to take medicines as prescribed.

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• In the counseling area pharmacists can – Provide BP apparatus, – Devices that are available to test blood sugar etc

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• All medicines are temperature sensitive and to retain their potency and efficacy proper storage is essential, protected from sunlight and heat.

• While it is recommended that all Community Pharmacies are air conditioned, there is a proposal to amend D&C Rules to provide air conditioners compulsorily.

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• To – Drug Information centres– reference books– web-sites on drug information

• This is possible by providing Computers and Inter-net connectivity.

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• As pharmacists, to understand customer needs, it is necessary to develop – listening skills, – Questioning skills.

• To develop a positive mind set for ethical pharmacy practices, evolving all professional, legal and moral obligations to the society.

• These should be basic parameters on which we must introduce a practical approach to Community pharmacy environment in India.

• Community Pharmacy Division of IPA with All India Organization of Chemists & Druggists with State Pharmacy Councils as nodal centers, can organize jointly, structured programs to train practicing pharmacists in every major towns so that, we can bring a perceptible change in pharmacy practices in India.

• As a supplementary activity, a Journal dedicated to Community Pharmacy is necessary to constantly update their knowledge on new molecules, and this should reach all leading pharmacies in India.

• Such professional Journals can be sponsored by manufacturers.

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• The practice of pharmacy is continuing to undergo a paradigm shift from a dispensing-focused to a patient-care-focused profession.

• Pharmacists have more time to provide clinical services• Pharmacists have the opportunity to become involved in patient care is

disease management

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• “aspects of case and outcomes management, but the approach focuses on specific diseases, looking at what creates the costs, what treatment plan works, educating patients and providers, and coordinating care at all levels: hospital, pharmacy, physician, etc.”

• DM has also been defined as a “systematic management tool applied to specific diseases with an emphasis on prevention and ‘best practices’ to provide high quality care at a reasonable cost with an ongoing process of monitoring and continuous improvement.”

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• Device and laboratory companies, • Medical product wholesalers and distributors, • Physician groups, and • Community pharmacies

• There are now companies that specialize in selling DM services to health care providers who choose not to develop programs with their own staff.

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• The origin of pharmacists’ involvement in DM can be traced back to the hospital environment.

• In the late 1960s and early 1970s, clinical pharmacy practice began to discuss– direct patient contact and – clinical involvement of the pharmacist.

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• Hence the concept of pharmaceutical care was started.• Pharmaceutical care means “the responsible provision of drug therapy for

the purpose of achieving definite outcomes that improve a patient’s quality of life.”

• “pharmaceutical care targets those with risk factors for drug-related problems, a history of non-adherence, and frequent changes in medication regimens.”

• In practicing pharmaceutical care, a pharmacist is expected to assume greater responsibility for patients’ medication-related outcomes.

• For example,– pharmacists have taken on roles to help assess patients’ therapeutic

needs, – prevent adverse drug reactions, – individualize drug therapy, manage chronic disease, and – monitor follow-up care.

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• Research suggests that the potential impact of a pharmacist’s intervention in patient care is significant.

• In a follow-up project, it is estimated that pharmacist intervention and pharmaceutical care could reduce the annual expense of drug-related problems by $45.6 billion making a great difference.

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• Patient access• Consistency between sites:

– Organization and structure of pharmacies (e.g., chain drug stores), which allow the administration of a program through pharmacists practicing at different locations.

• Expanding the role of pharmacy technicians– Greater use of technicians might allow pharmacists to devote more time to

patient care.– It is expected that advanced training of technicians will reduce the amount of

time that pharmacists typically devote to medication dispensing and allow more time for pharmacists to provide pharmaceutical care.

• Governmental efforts– Under this legislation, pharmacists with appropriate training can be

reimbursed for providing cognitive services for patients with • diabetes, • asthma, • lipid disorders, and • anticoagulation under patient-specific treatment protocols approved by a

physician

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• Targets specific patient populations suffering from a disease.• Integrates health care services directed toward the chosen disease by various

components of the health care system, providing a seamless system of prevention and care.

• Support health care services on consistent application of:– the best scientific information available on treatment and – evaluation of care, – constant updating and improvement through use of quality improvement

techniques.• Links care to the outcomes of interest to consumers of health care,

– This takes into account • clinical, • economic, and • humanistic outcomes.

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• Most DM efforts have focused on chronic conditions that are common or have high associated treatment costs, or both.

• Some specific disease states for which the impact of the pharmacists has been demonstrated are – asthma,– cardiovascular conditions (hypertension, hyperlipidemia, and

anticoagulation),and – diabetes.

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• Educate patients about the role of each medication.• Instruct patients about the proper techniques for inhaling medications.• Monitor medication use and refill intervals to help identify patients with

poorly controlled asthma.• Encourage patients purchasing nonprescription asthma inhalers or tablets to

seek medical care.• Help patients use peak-flow meters appropriately.• Help patients discharged from the hospital after an asthma exacerbation to

understand their asthma management plan.

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• Pharmacist can provide:– Diabetes education, – medication counseling, and – evaluation and adjustment of the medication – regimen in noninsulin-dependent diabetes mellitus (NIDDM) patients

• This has significance in – lowering average weekly blood glucose levels, – a decreased incidence of hyperglycemic events, and – significant increase in their understanding of diabetes medications as

well as a positive difference in their perception and attitude toward communication with the pharmacist.

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• In summary, the results of studies assessing DM with pharmacist involvement demonstrate that pharmacists are capable of improving patient outcomes and reducing health care costs.

• Pharmacists’ expertise has been shown to be particularly beneficial for diseases in which outcomes heavily rely on medications.

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• Dramatic changes over the past decade. • The DM movement, along with technological improvements in prescription

processing, has fostered pharmacist involvement in patient care.• Pharmacists in a variety of practice settings are participating in DM and are

beginning to demonstrate their value in the management of several high-cost diseases, including asthma, cardiovascular disease, and diabetes.

• For the movement to be sustainable, pharmacists will have to demonstrate that the costs of developing and administering DM services do not exceed the benefits of improved patient outcomes.

• Opportunity:– As employers and government purchasers continue to face pressures to

reduce the cost of prescription benefits, pharmacists will be presented with opportunities to demonstrate their impact in providing DM.

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• It has been estimated that traditional prescription processing utilizes only about 10% of the technological potential that computers offer to pharmacists.

• Software applications to assist pharmacists in DM have been developed and will continue to be improved.

• Pharmacy information systems will support the processes of – drug dispensing; – prescription processing; and – the task of outcomes data collection, documentation, and monitoring

• An educational curriculum aimed at educating community pharmacists on how to “provide an expanded level of patient care” related to disease management and wellness activities

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