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Role of a Pharmacist in Health Care System

The foremost parts of this issue are—


1. Pharmacist
2. Position of a Pharmacist
3. Health care system
Pharmacist: A Pharmacist in one who is well-informed & certified to prepare &
dispensing drugs & to afford drug & associated information to the community.
There has never been a better time to consider a rewarding career in pharmacy.
The demand for trained pharmacy professionals has dramatically increased in recent
years due the rapid growth of the health care and pharmaceutical industries,
especially for the growing elderly population. The number of Pharmacists in health
care services also is escalating as Pharmacists become more actively involved in drug
therapy decision-making for patients of all ages.
Role of a Pharmacist: Role of a Pharmacist means, in which fields a Pharmacist can
perform.
The ideal frontline Pharmacist of the future has been described as a seven star
Pharmacist-some one who is equal in excellence to a five star hotel yet accessible to
everyone from the richest to the poor. The future 7 star Pharmacists will have seven
principal roles to play:
--Care giver;
-- Decision-maker;
-- Communicator;
-- Leader;
-- Manager;
-- Life long learner and
-- Role model.

A Pharmacist with the above skills and attitudes should make himself an indispensable
partner in health care system of a nation.
Health care system: Pharmacists play a vital role in health care system through the
medicine and information they provide.
While responsibilities vary among the different areas of pharmacy practice, the
bottom line is that Pharmacists help patients get well. Pharmacist responsibilities
include a range of care for patients, from dispensing medications to monitoring patient
health and progress to maximize their response to the medication. Pharmacists
educate consumers and patients on the use of prescriptions and over-the-counter
medications, and advise physicians, nurses, and other health professionals on drug
selection and utility. Pharmacists also provide expertise about the composition of
drugs, including their chemical, biological, and physical properties and their
manufacture and use. They ensure drug purity and strength and make sure that drugs
do not interact in a harmful way. Pharmacists are drug experts ultimately concerned
about their patients’ health and wellness.
The World health organization (WHO) report on “The role of the Pharmacist in
the health care system” states that the competence of the Pharmacist is already
proven and control.
- In health promotion and social responsibilities;
- In the direction and administrative of pharmaceutical services;
- In drug regulation and control;
- In the formulation and quality control of pharmaceutical products;
- In the inspection and assessment of drug manufacturing facilities;
- In the assurance of product quality through the distribution chain;
- In drug procurement agencies and
- In National and institutional formulary & therapeutics committees.
In health promotion and social responsibilities: - A Pharmacist has an important
role to play in health promotion and primary, secondary and tertiary prevention,
especially in relation to the management of chronic diseases. Discussed below in
details-----
Sexually Transmitted Diseases-AIDS: - India has 3.5 million HIV positive cases,
which is about 10% of the global HIV cases and barely second to South Africa. HIV
drugs are expensive and beyond the reach of common man. Huge resource of
community Pharmacist can educate people in the prevention and information of
HIV/AIDS. For this, Federation of Indian Pharmacists project in India on involvement of
Pharmacist in fight against AIDS is very relevant.
Another sensitive issue is the increasing number of women patients suffering
from AIDS. The number rose from 7% in 1985 to 18% in 1995. Although many classes
of antiretroviral are available like protease inhibitors, nucleoside reverse transcriptase
inhibitors and non-nucleoside reverse transcriptase inhibitors, patients need close
monitoring and strict dietary regimen. Explaining to what HIV is, its transmission, risk
reduction, patient counseling are the components of the counseling that a community
Pharmacist can provide.
Pneumococcal disease and influenza: - The role of a Pharmacist in immunizing
adults against pneumococcal disease and influenza is discussed. Pneumococcal
disease and influenza each cause up to 40,000 deaths annually in the United States.
Vaccination against these diseases is encouraged for all people 65 years of age or
older and for those with certain chronic diseases or immunosuppressant. Influenza
virus vaccine should also be given to residents of long-term-care facilities, many
pregnant women, and health care workers. Pneumococcal vaccine is usually given
once in a lifetime; influenza virus vaccine is given annually in the fall. Advocacy of
immunization is consistent with the precepts of pharmaceutical care, and Pharmacists
can promote immunization by assuming the roles of educator, facilitator, and
immunizer. Despite lack of specific mention of it in accreditation standards, health-
system personnel have a duty to vaccinate adults, just as they do pediatric patients.
Pharmacists should review immunization records with patients periodically and at the
time of immunization. As with other drug products, formulary decisions and the
distribution, storage, and handling of vaccines are important Pharmacist
responsibilities. Pharmacoeconomic studies have demonstrated the value of
pneumococcal and influenza virus vaccines. Medicare covers these vaccines under
Part B. Pharmacists have an important role to play in promoting adult immunizations
against pneumococcal disease and influenza.
Chronic disease management: - A Pharmacist’s role in the control of the chronic
disease can range from the support of proven community programs such as screening
and disease management clinics for diabetes etc.
Nutrition Counseling: - Community Pharmacist can make, significant
contributions in assuring adequate nutrition by advising his patients about basic food
needs, keeping to correct improper food habits in children, advising on special
requirements, suggesting special diet instructions for diabetic patients and people with
food allergy and participating in school lunch programs and schemes like mid-day
meals etc. in rural areas.
There are certain facts such as women who often eat fish or omega-3-fatty acids
are less likely to suffer stroke, symptoms of hyper vitaminosis result in irregular
menstrual cycle and excessive intake during pregnancy may cause birth defects. The
Pharmacist can tell these facts to people to ensure better health. Now a days designer
foods i.e. nutraceuticals/ dietary supplements have not only gained considerable
acceptance but also have newfound use and applications. They are considered to
provide medical or health benefits. The community Pharmacist could explain these
new innovative products and their standardization.
Oral health: - A report of the surgeon Generas (May 2000) and the healthy
people 2010 focus area on oral health. The call to action seems expand on these
efforts by enlisting the expertise of individuals, health researchers and cure providers
communities and policymakers at all levels of society. A Pharmacist has numerous
opportunities on a daily basis to positively affect his trend.
The American dental association has published pamphlets for dentists and
Pharmacists that cover oral structures and diseases prevention to caries, OTC and
prescription dental drugs and how these two professions can collaborate
Environmental health: - About this a Pharmacists should adapt his methods of
health educations.
A Pharmacist role in environmental health is related primarily to being alert to
the conditions prevailing in the community and of working with others to adequately
control any of the attendant hazards
All elements of the natural environment can be altered, some time with harmful
results. Air, food, water and the earth can all become sources of illness in the home,
public or work environments. Such as Food remains a significant vehicle of disease
organisms. Al through pasteurization has eliminated milk as a medium for disease
distribution.
Mental health: - A Pharmacist should be aware of their local community mental
health services, especially those catering to ambulatory patients. The timely referral of
patients exhibiting unusual behavior to these facilities may be life saving, especially in
those persons who demonstrate suicidal tendencies.
Epidemilogy: - Epidemilogy is the study of the distribution and determination of
health related events in specific population and the application of this field in the
control of these events. Epidemilogy relates to the interaction of hosts and their
environment with attention to those particular agents in the environment that are
causal factors of disease. The alert Pharmacist who can apply the basic principal of
Epidemiology in their community will become a significant member of the health
team.
Health measurement: - A Pharmacist in the health professional in the most
frequent contact with the general public and this function as a community health
education makes the Pharmacist role unique. By staying abreast of local health
statistics Pharmacist can function as a valuable resource person to researchers
conduction epidemiological studies in the community.
Health education: - The objective of health education is to provide the
individualized information necessary for patients to modify their behavior, all in an
effort to live a healthier life. Pharmacists actively promote good health practices
through their own personal example and by reaching out to provide professional
information to the public. Many Pharmacists participate in patient health education
through the use of pamphlets & bulletins that cover every medical subject imaginable.
Participation of a Pharmacist in community health education programs must be
recommended but it is in the every person to person contact that the Pharmacist
serves most effectively.
Alcohols, Drug Abuse and Smoking Cessation: - The diseases of alcoholism and
drug abuse also come under the preview of the community Pharmacist. The
Pharmacist has a key role to help individuals who become dependent upon alcohol.
Drug abuse is similar to alcoholism yet different because it has been gaining more
acceptances among young people. Annual mortality from tobacco use exceeds that
from all other causes combined. Smoking is the greatest single preventable cause of
morbidity and mortality in India. It is the responsibility of a community Pharmacist to
take an active role in helping the smokers to stop smoking. Following a number of
smoking policies through out the pharmacy, by written information and posters, can
do this. The Pharmacist can advise on the products available to assist the patient in
giving up smoking. Counseling sessions can be made by the community Pharmacist to
stop smoking.

Vaccinations: - Administering vaccines to patients and health care workers is


enabling some health-system Pharmacists to assume a prominent role in public health.
Pharmacists have noticed that immunization needs were not being met and, through
their advocacy, increased the numbers of patients and employees of health systems
who have been vaccinated.

Family planning: - Although pharmacies now dispense primarily modern products


originating in large multinational corporations, the community Pharmacist has not
been replaced by any ultramodern technological advance. Many thousand persons
acquire family planning products in pharmacies. The Pharmacist works many hours a
day, is always available, and provides free advice to his clients. Pharmacists are
consulted daily on numerous topics, especially on family planning. Many parsons in
rural areas are without the services of a physician and rely on Pharmacists all the
more. Pharmacists could orient the public on family planning in general, help in
choosing the most appropriate of available methods, and refer patients to physicians
in case of problems. Participants at the recent International Conference on the Role of
Retail Pharmacists in Family Planning, held in Alexandria, Egypt, concluded that
Pharmacists should cooperate with physicians and other health professionals to
provide family planning services and should participate in elaboration of laws
regulating the manufacture, storage, prices, and distribution of contraceptives. The
prices of contraceptive supplies to the consumer could be reduced if taxes and import
duties were removed, if supplies were produced locally, or if supplies were subsidized
by some donor organization.

Cholesterol Risk Management:- A randomized controlled trial conducted in 54


community pharmacies (1998-2000) included patients at high risk for cardiovascular
events (with atherosclerotic disease or diabetes mellitus with another risk factor).
Patients randomized to Pharmacist intervention received education and a brochure on
risk factors, point-of-care cholesterol measurement, referral to their physician, and
regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care
physician identifying risk factors and any suggestions. Usual care patients received the
same brochure and general advice only, with minimal follow-up. The primary end point
was a composite of performance of a fasting cholesterol panel by the physician or
addition or increase in dose of cholesterol-lowering medication.

As a result the external monitoring committee recommended early study


termination owing to benefit. Of the 675 patients enrolled, approximately 40% were
women, and the average age was 64 years. The primary end point was reached in 57%
of intervention patients vs, 31% in usual care.

Finally, A community-based intervention program improved the process of


cholesterol management in high-risk patients. This program demonstrates the value of
community Pharmacists working in collaboration with patients and physicians.

Women Welfare-Pregnancy and Infant Care: - A famous Sanskrit Shloka from


Manusmriti scriptures goes as “Yatra Nariyastu Poojayanta, Ramante Tatra Deva”
which means, “where women are worshipped Gods preside there”.
Women are the corner stone for effective public health and investing in women
translate into investing in family, community and the Nation. Against the backdrop of a
hectic and demanding schedule, women’s health receives the least priority when it
should be the first. A woman goes through different stages throughout her life, each of
which has specific need and the presence of a counselor is needed in each one of
them. The Pharmacist who understands the normal course of pregnancy and infancy is
at a distinct advantage as he or she can guide the mother in simple matters of
hygiene and management. The community Pharmacist can encourage breastfeeding
and can play a major role by guiding the mother for the protection of the child by
following proper immunization schedule. Efforts are definitely underway in this area.

Individualization of Drug Therapy: - Today the latest concept in medicine is


towards individualization of drug therapy. Where judicious patient care is needed
individualization of drug therapy becomes a need, and a Pharmacist can play a vital
role in this. A physician who is preoccupied with patient diagnosis and treatment may
not spare time for patient counseling regarding pharmaco-economics, drug
information, alternative therapy, moral supporting etc. A Pharmacist can set up a
separate consultation room and provide counseling to the patient. He can store the
details of patient history, allergies and other details necessary for therapy so that the
concept of individualization of drug therapy could be implemented.

Radio pharmacy: - This is a specialized area of pharmacy, where radio active


materials are produced as drugs for the diagnostics of certain diseases like Thyroid
problem by Iodine isotope. Here a Pharmacist has a significant role to play.

Consultancy service: - It’s another area in where a Pharmacist can play a role
directly in public health.

For independent career & business consultancy in pharmacy profession is


challenging & demanding & has got a good scope of successful career build up.

Disease prevention: - Three levels of prevention exist. Here pharmacists play a


great role.
1) Primary: - Primary prevention is helping people maintain their
health or improve the quality of their lives through a health lifestyle. An example of
primary prevention is the control of infection through immunization.
2) Secondary: - Secondary prevention in the early diagnosis and
treatment of an already existing disease the use of penicillin in the treatment of a
streptococcal infection prevent the onset of rheumatic fever. Thus a pharmacist can
perform a vital service by advising patients, who present a febrile illness characterized
by a sore throat to see a physician.
3) Tertiary prevention: - Tertiary prevention largely consists of
rehabilitation. Most chromic disease can not be cured but their progress can be re-
tarded with maximum benefit to the patient. Much can be done for instance with
rheumatoid arthritis to make patients more comfortable and more productive in their
daily lives.

In the direction & administrative of pharmaceutical services: - In this


branch there are opportunities to a Pharmacist of all education levels. The largest
numbers of Pharmacists are involved in marketing & administration. There marketing
people (Pharmacists) educate physicians & community Pharmacists, hospital
Pharmacists etc. about manufactures product. This can be a rewarding career for a
Pharmacist with right personality & motivation. Pharmacist with master degree in
business or additional LLB degree find opportunities in the marketing sales &
regulatory affairs departments. Production & quality control supervisory positions are
held by Pharmacists with bachelor or master degree. Pharmacist with higher like
pharm D or PhD degree serve the industry as top post executive or research
scientist.

In Hospital management: - A Pharmacist has a great role to play in hospital


administration. The governing body has total accountability within the organization’s
structure in most hospitals. This board commonly hires a CEO to lead the organization
& make recommendations to the board. This offer is commonly referred to as the CEO,
president or superintendent. In the case of the federal hospitals, there is usually a
federal structure through which local hospitals are organized & report. State, county &
city hospitals often have a governing board appointed by the designated political
officer. In the nonprofit, nongovernmental hospital, there is usually a governing board,
board of trustees, board of governors or other titled group that assumes over all
responsibility for the proper operation of the hospital so that adequate service can be
rendered to the sick & injured at as low a cost as is compatible with efficiency. All this
posts are restricted for only physicians & Pharmacists.
The responsibilities of a hospital Pharmacist is to develop a high quality
comprehensive pharmaceutical service, properly coordinate & meet the needs of the
numerous diagnostic & therapeutic departments, the nursing service, the medical
staff, medical equipments of hospital & the hospital as a whole in the interest of
community improving patient care.
In health maintenance organizations: - In health maintenance organizations
(HMO) is a public or private organization that provides & manages comprehensive
health services to individuals enrolled win the HMO of the health plan. Here a
Pharmacist can play a role in the administration of this kind of organization or give
direction.
In drug regulation & control: A Pharmacist in government drug regulatory affair
department plays his role by regulating the quality of medications, price of the
medications, applying the ethics & law about medications & industries.
In the formulation & quality control of pharmaceutical products: The
formulation of any medication is only depended on Pharmacist. It is one of the
important roles of a Pharmacist.
The physical, chemical & biological quality of a pharmaceutical product intended
for administration to patients in the home must be of the highest quality attainable.
This quality must be built in to the product in each step of the aseptic compounding
process, that is, in the starting components, the design & operation of the
compounding facilities, the control of the environment & the qualifications of operators
all contribute to the final quality of the product, either in a positive or negative
manner. Therefore, the control of quality is a continuous process through out the
compounding of the product. Testing of the finished product can only confirm the
quality built in to the product during its preparation. Here only a Pharmacist can play
his role.
In the inspection & assessment of drug manufacturing facilities: The another
important duty of a Pharmacist (by joining the government testing laboratory &
medicine regulatory service) is inspect the pharmaceutical industries, their
environment, quality of medications, facilities & assesses the medications.
In the assurance of product quality through the distribution chain:
Distribution of medication is two types—
1. From industry to market
2. From hospital to the patient (through prescription)
From industry to market: - After produced, before sending to the market
ensuring the quality of pharmaceutical products is must, because it is directly related
with life. Here only a Pharmacist plays a significant role.
From hospital to the patient (through prescription): - The medication distribution
system in hospitals is very complex & involves in several health care professionals.
The usual flow is physician prescribes, Pharmacist dispenses & nurses administer
medication. Here the Pharmacist who dispenses, has the right to change the medicine
which is prescribed by the physician to ensure the quality of that medicine.
In drug procurement agencies: The work of drug procurement agencies is to
supply the medication & find out the possible customer in home & abroad. Here a
Pharmacist plays a great role.
In national & intuitional formulary & therapeutics committees: During recent
years, with the development of the clinical pharmacy movement, a number of clinical
Pharmacists on the staff of some departments have developed expertise in specific
therapeutic specially areas. Therefore, it was a logical development under the
pharmacy & therapeutics committee.
The formulary system has attempted to outline the scientific data on a
medication, including its toxicities, untoward side effects, safety profile & beneficial
effects- has been a controversial method of appraising medication therapy. All these
are provided by a formulary committee of a nation & this formulary committee is
constructed by the Pharmacists.
Except these a Pharmacist has important role to play as an Academic
Pharmacist, Chain Drug Store Pharmacist, Compounding Pharmacist, Critical Care
Pharmacist, Drug Information Specialist, Grocery Chain Pharmacist, Home Care
Pharmacist, Hospice Pharmacist, Hospital Staff Pharmacist, Infectious Disease
Pharmacist, Long-Term Care Pharmacist, Managed Care Pharmacist, Military
Pharmacist, Nuclear Pharmacist, Oncology Pharmacist, Operating Room Pharmacist,
Pediatric Pharmacist, Pharmacist in Non-traditional Settings, Pharmacy Benefits
Manager, Poison Control Pharmacist, Primary Care Pharmacist, Psychiatric Pharmacist,
Veterinary Pharmacist.

Conclusion: From the above consideration, it is clear that the Pharmacists have
definite beneficial roles regarding health matters. A Pharmacist is the legally qualified
and professionally competent person to handle drugs and allied supplies required for
the patients within and outside the hospital. It is a matter of regret that the
government of our country is taking very little effort to employ highly skilled pharmacy
personnel in different sectors of the health services. But in the developed countries,
Pharmacists are in unique position in this regard. So, the governmental health policy
should be modified by incorporation Pharmacist in different sectors to improve and
ensure the health service for the well being of people of our country.

[References: -
1. Remington (The science and practice of Pharmacy)
21st edition
2. Article: Pharmacists' Involvement with Vaccinations Leads to Preventive Health
Care Role
BY: Krysten. A. Modrzejewski
American society of health – System Pharmacists.
3. Article: Smoking Cessation Guidelines for Health Professionals - A guide to
effective smoking cessation interventions for the health care system
By: MARTIN RAW, PhD Freelance Consultant; Honorary Senior Lecturer in Public
Health
King's College School of Medicine and Dentistry, University of London, London,
UK
4. Article: A Randomized Trial of the Effect of Community Pharmacist Intervention on
Cholesterol Risk Management
The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)
By: Ross T. Tsuyuki, BSc(Pharm),PharmD,MSc; Jeffrey A. Johnson, BSP,PhD;
5. Article: Health-system pharmacists' role in immunizing adults against
pneumococcal disease and influenza
By: JD Grabenstein and J Bonasso
American Journal of Health-System Pharmacy, Vol 56, Issue suppl_2, S3-S22
6. Article: The pharmacist should play an active role in family planning
NCBI, a service of the National Library of Medicine and the National Intuition of
Health
7. Article: Role of community pharmacist in ensuring better healthcare
By: Harish Dureja and Deepak Kaushik
Lecturers at Department of Pharmaceutical Sciences
M. D. University, Rohtak (Haryana)
8. Article: New role for pharmacists
By: Jessica Whiteside
University of Toronto
9. Article: Role of the pharmacist in healthcare system
By: S S Bhise
The author is principal, Government College of Pharmacy, Osmanpura,
Aurangabad
10. Article: Community pharmacy in Australia
NCBI, a service of the National Library of Medicine and the National Intuition of
Health
11. Article: SIUE school of Pharmacy
Board of Trustees, Souther Illinols University
12. http://www.pubmed.gov
13. http://www.pubmed.gov