داروساز به دسترسیسالمت به دسترسی

راسخ رضا حمید دکتربهشتی شهید داروسازی دانشکده

Introduction Pharmacy in Healthcare Timelines/Evolution in Pharmacy Issues in Pharmacy Emerging Opportunities Summary Conclusion

Key Considerations in Effective Healthcare Delivery

Access Quality Affordability

Pharmacy in Healthcare Role of Pharmacy in Healthcare

Traditionally.. regarded as a transitional discipline

between the health and chemical sciences Seen as a profession charged with ensuring

the safe use of medication

Pharmacy in Healthcare Role of Pharmacy in Healthcare

Traditionally.. Some aspects of the profession have been

constant, unchanged over centuries – the focus on helping patients deal with

maladies, the ability to apply contemporary

understanding of science and technology to health-related issues, and

the ethical mandate to place the patient at the center of all we do as pharmacists.

Pharmacy in Healthcare Role of Pharmacy in Healthcare

Contemporary.. Pharmacists are currently recognized as drug

experts whose role is to work in collaboration with patients, physicians and other health care professionals to optimize medication management to produce positive health outcomes.

Pharmaceutical Care embodies a patient-centered, outcomes-oriented practice of pharmacy. This practice model promotes the Pharmacist as a key member of the healthcare team, with responsibility for the outcomes of medication therapy.

Pharmacy in Healthcare Role of Pharmacy in Healthcare

Contemporary.. The ability of pharmacists to provide true

"pharmaceutical care“ hinges on: the redesign of the traditional pharmacy environment and

services, "revolutionary changes" such as private consulting areas in

pharmacies "adding value" to the pharmacist license via expanded

patient services. Immunization clinics, emergency contraceptives, and

collaborative practice provisions for optimal medication therapy management.

Pharmacy in Healthcare Role of Pharmacy in Healthcare

Contemporary.. Need to raise the profile of the

Pharmacist from a quiet but valuable member of the Healthcare team to a more visible and vital component of patient care.

Pharmacy in Healthcare Linkages through the National Health Policy

(NHP) Goal of NHP: Comprehensive Healthcare System

based on Primary Healthcare (PHC)-Promotive, Protective, Preventive, Restorative & Rehabilitative

Key PHC Elements: Education about prevailing Health problems

and methods of prevention/control Prevention and Control of locally endemic

and epidemic diseases Provision of Essential Drugs and Supplies

Pharmacy in Healthcare Linkages through the National Drug Policy

(NDP) Goals of NDP:

Improve Quality of Healthcare through the Rational Use of Drugs

Make available (Access) at all times, Drugs which are Effective, Affordable, Safe and of Good Quality throughout the Healthcare System

Key Success Factor For NDP: Qualified & Duly Registered Pharmacists in

ALL Community Pharmacies & Hospital/Health Systems

Pharmacy in Healthcare Linkages through the National Health

Insurance Scheme (NHIS) Goal of NHIS:

Improve the Health of All at an Affordable Cost

Key Success Factor For NHIS: Re-Classify Pharmacist as Primary

Healthcare Providers with direct payment from NHIS for Services Rendered

Time-lines in Pharmacy Practice Early 1900s- Pharmacists fulfilled the

role of Apothecary —preparing drug products secundum artem

(according to the art) for medicinal use. At a point there was an Apothecary-General

By the 1950s, Large-scale manufacturing of medicinal products Introduction of prescription-only legal status for most

therapeutic agents Consequence: limited the role of Pharmacists to

compounding, dispensing and labelling prefabricated products.”

Time-lines in Pharmacy Practice

Mid-1960s- Clinical Pharmacy: Evolution toward a more patient-oriented practice rapid transition characterized by an

expansion and integration of professional functions,

increased professional diversity and closer interaction with physicians and other health care

Time-lines in Pharmacy Early 1990s - Pharmaceutical Care Model

adopted to emphasize that the role of the Pharmacist involves “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.”

Evolution in Nomenclature Apothecaries: Dates back to 1600’s. legally ratified

members of the medical profession, able to prescribe as well as dispense medicines.   Still in use in USA

Pharmaceutical Chemist/Chemist in Australia, New Zealand, and the UK, a pharmacy is

often referred to as “the chemist.” 19th Century. Druggist

A druggist was a pharmacist who owned a pharmacy, Pharmacist: Dates back to 18th Century in UK

Pharmacy Training Apprenticeship

Pharmacy Extern Pharmacy Intern

Academic Diploma Degree

B.Sc B.Pharm Pharm. D

Specialisation Continuing Professional Education

Evolution in Training

Apprenticeship an aspiring apothecary, would work side-

by-side with the established professional practitioner,

learning by observing and doing medication-related activities

under the tutelage of the master craftsman or “master”

Evolution in Training…Apprenticeship

Student Pharmacist required to complete a period of practical experience under a Practitioner approved by the Pharmacy Board

“Pharmacy Extern”: hours, usually totalling nearly a year overall, could be completed during the summers between terms of enrollment in classes.

“Pharmacy Intern”: Total hours completed following graduation.

Evolution in Training…University Degree USA

1820’s to 1860’s: Private Pharmacy Schools operating as Independent Colleges were the Pioneers of University Education for Pharmacists

1940s (WW2 era): Schools/Colleges became affiliated with Universities (many of which were Public Uni’s)

academic health centres began to emerge at U.S. universities as clusters of schools of the health professions assembled with a university hospital

Evolution in Training…University Degree USA

1820’s to 1860’s: Private Pharmacy Schools/Colleges

1940s (WW2 era): Schools/Colleges became affiliated with Universities

Academic Health Centres (schools of the health professions assembled with a university hospital) providing patient care educating future professionals. Many of

these operations included colleges of pharmacy.

Evolution in Training…University Degree USA

1821: First college to train Pharmacists in the U.S.-Philadelphia College of Pharmacy.

1823: Second college was the Massachusetts College of Pharmacy, now the Massachusetts College of Pharmacy and Health Sciences

1860’s: First Pharmacy program in a public institution at the University of Michigan

Evolution in Training…University Degree USA: Curriculum (1)

In the 1800s, colleges of pharmacy offered the

academic degree Graduate in Pharmacy (Ph.G.).

For an additional year of study the student would be awarded the degree Pharmaceutical Chemist (Ph.C.)

even further study could earn the student the degree Doctor of Pharmacy (Phar.D.).

Evolution in Training…University Degree USA: Curriculum (2)

1940s: B.Sc (4 years) B.S.Pharm (5 years) Professional Degree 1990s: Pharm.D (6 years)

Evolution in Training…University Degree USA: Focus

1800s: Chemistry- Prepare & Dispense Medications

Early 1900’s: Prepare & Dispense Medications + Clinical Chemistry eg Urinalysis

1960’s: The Chemical focus gradually transferred over to a biological focus during the with increasing emphasis on pharmacology

1970’s: A Clinical focus moving the emphasis from the product to the patient.

1990’s: Pharmaceutical care- A new philosophy of Pharmacy Practice was advanced by Helper and Strand.

Evolution in Training: Licensure USA: Exams designed to assess whether the

licensure applicant possesses the minimum competence to be admitted to practice as well as to assess the licensure candidate’s knowledge in the areas of Pharmacy Laws.

Issues

Rapid Change in Healthcare Delivery Significant Growth & Development

Opportunities for Pharmacy Expansion of the scope of Pharmacy

Practice and, in some jurisdictions, the assumption of the

authority to prescribe medications in defined situations.

Considerable Ambiguity & Uncertainty by Outsiders

Issues Rapid Change in Healthcare Delivery

Significant Growth & Development Opportunities for Pharmacy Assumption of the authority to prescribe

medications in defined situations. USA: Collaborative Drug Therapy Management

by Pharmacists UK: Independent & Dependent Prescribing

Rights for Pharmacists Canada: Alberta—“adapting a prescription”— &

“initiating/managing drug therapy.” Nigeria: National Prescription Drug Policy (work

in progress) to include Pharmacists as Prescribers of “Safe Medicines” (20 Categories)

Issues Prominence in Community Health Systems Pharmacy vs Hospital

Pharmacy IT in Pharmacy

E-Prescribing E-Patient Health Records E-Dispensing

Veterinary Pharmacy

Services you can get from your Pharmacist:

Counselling

Medication Therapy Management (MTM)

Disease prevention strategies

Immunization

Rapid tests (Cholesterol, Blood Pressure, Sugar, Malaria, Hepatitis, etc.)

HIV counselling and testing

Family planning

Services you can get from your Pharmacist:

Family wellness

Pharmaceutical care for chronic conditions like (Hypertension, Diabetes, etc)

Medication Use Review (MUR)

Drug Information (DI)

Documentation of your medical matters for continuum of care

Online consulting.

Services you can get from your Pharmacist:

Home delivery

Home visits

Referral to other Healthcare Providers

Public health Services and Campaign

First Aid kits

Training

Primary Health Care Development

• Goal 1: Control preventable diseases • Goal 2: Improve access to basic health

services • Goal 3: Improve quality of care • Goal 4: Strengthen the Institution • Goal 5: Develop a high-performing and

empowered health workforce • Goal 6: Strengthen partnerships • Goal 7: Engage communities

What does the future look like for Pharmacy & Pharmacists? (1)

The future is limited only by the imaginations and abilities of those entering and leading the profession.

 Change is a certainty – will you be positioned to capitalize on opportunities as they emerge and evolve?  

 “It is not the strongest of the species that survives, nor the most intelligent that survives, but the one most responsive to change.” Charles Darwin.

What does the future look like for Pharmacy & Pharmacists? (2)

Globally Bright and Rewarding very highly regarded by individual

patients and the public collectively Locally

Community > Hospital Need to reposition Pharmacy as Central

to Healthcare by offering more Value Added Services to the Consumer

What does the future look like for Pharmacy & Pharmacists? (3) Do Pharmacists have knowledge and abilities to

provide services valued by others? Can their services have a positive impact on others? Are they accessible so people can avail themselves

of these services? 24 hrs Call Centre

Can Pharmacists recognize emerging trends and opportunities to advance the profession and themselves? Chain Pharmacies? Public Health?

What does the future look like for Pharmacy & Pharmacists? (4)

“As the leading healthcare authority on medication, the pharmacist is the most logical member of a total healthcare management team to gauge the usage and efficacy of medication, patients’ medication use patterns and alternative therapies,”

 Plus, no one is better equipped to keep costly medication mistakes from happening than Pharmacists.

What does the future look like for Pharmacy & Pharmacists? (5) The potential for a medication error is

particularly high when a patient leaves the hospital with new medications and has old ones at home.

Add to that the mix of prescriptions with over-the-counter medications and supplements – often from a variety of doctors:

It’s a “prescription” for trouble that has a simple remedy: Increased ACCESS to the One Healthcare

Professional overseeing it all:

The Pharmacist.

Summary The Future of Pharmacy

Depends to a great extent on: the Pharmacists ability to INNOVATE ETHICS, INTEGRITY & PROFESSIONALISM Pharmacy’s ability to demonstrate its

RELEVANCE by creating VALUE for Patients/Consumers/Customers/Chain members

ALERTNESS, COHESION, ARTICULATION, & POLITICAL SAVVY to institute Friendly Laws & Policies as well as to pre-empt and counteract unfriendly laws

Conclusion

“Those that are creative, entrepreneurial and able to develop a value-added “Win-Win” approach will find more opportunities.”

ACCESS TO PHARMACISTS IS ACCESS TO HEALTH!

What will Success Look Like?

I Really Do...

When the Patient/Consumer Says...