Oct 19, 2015
All sections to appear here
Githa Fungie Galistiani
....Historically a pharmacy has been the place for:
storing drugs making medicines supplying and distributing drugs to customers
The first known pharmacy was established in the year 766 in Baghdad. In Europe the pharmacies date back to the 11th Century
In ancient times the same person acted as both doctor and pharmacist.
In 1231 the German emperor and king of Sicily, Frederick II, legally separated the professions of medicine and pharmacy.
Frederick also gave rules about the education of health professionals.
These and other provisions have been the basis of legislation and
practice of pharmacy in many European countries until the 20th century.
Physicians were to diagnose and prescribe drugs
Pharmacists were to be responsible for making the drugs and providing
these to the patients
In some other countries the distinction between the medical and pharmaceutical profession has not been so clear and today we still find
dispensing doctors.
In most countries pharmacists have acted as the poor mans doctor diagnosing and prescribing.
Pharmacy workforce data in 10 countries
Factors influencing supply of, and demand for, pharmacists
Pharmacy practice is moving toward a model that intergrates patient-focused care and drug distribution services. Today, the primary role of the pharmacist in contemporary practice is the delivery of ...
Mikeal and others (1975) as the care that a given patient requires and receives which assures rational drug usage
Strand and others, in 1992, stated:
Pharmaceutical care is that component of pharmacy practice which
entails the direct interaction of the pharmacist with the patient for the
purpose of caring for that patients drug-related needs.
The American Society of Health-System Pharmacists (ASHP), in 1993, had
statement about pharmaceutical care:
The mission of pharmacist is to provide pharmaceutical care.
Pharmaceutical care is the direct, responsible provision of medication-
related care the purpose of achieving definite outcomes that improve a
patients quality of life.
Dispensing Pharmacy
(Old Paradigm)
Pharmaceutical Care
(New Paradigm)
Product business
Objective is to bring product to the
customer
Decisions focus on the business
Inventory generates revenue
Available service supports the product
Success measured as number of
prescriptions
Space is organized to display and sell
products
Records are kept primarily to meet
legal requirements concerning the drug
product
Schedule for refill determined by
customer supply of drug product
Business is passively sought through
the generation of prescriptions
Service (people) business
Objective is to bring the pharmacist to the
patient
Decisions focus on the patient
Patient care generates revenue
Available product supports the service
Success is measured as patient outcomes
Space is organized to meet patients needs
Documentation supports patient care
Schedule for follow-up determined by risk
and benefit of drug therapies and needs of
the patient
Business is actively sought through the
recruitment of patients
What Will You Learn?
Hospital and Community Practice PC Concept
Patient and Prescription monitoring Assessment Care Plan and Follow up Method
Patient and Prescription monitoring by PAM method
Evidence Based Medicine
Formularium Development
PC Application Strategy
Health Care Systems
Pharmaceutical Care in Health Care Systems
Pharmaceutical care is a patient-centered practice in which the practitioner assumes
responsibility for a patient's drug-related needs and is held accountable for this commitment (Helper & Strand,1990)
The Function of Pharmaceutical Care
Indetification of potential and actual DRPs
Solve the Actual DRPs
Prevent potential DRPs
Medical problems are disease states; that is, problems related to altered physiology that result in clinical evidence of damage.
Drug therapy problems are patient problems that are either caused by a drug or may be treated with a drug.
Drug Therapy Problem Description of the Drug Therapy Problem
Unnecessary drug therapy
The drug therapy is unnecessary because the patient does not have a clinical indication at this time.
Needs additional drug therapy
Additional drug therapy is required to treat or prevent a medical condition.
Ineffective drug The drug product is not effective at producing the desired response.
Dosage too low The dosage is too low to produce the desired response.
Adverse drug reaction The drug is causing an adverse reaction.
Dosage too high The dosage is too high resulting in undesirable effects.
Noncompliance The patient is not able or willing to take the drug regimen appropriately.
Categories of Drug Therapy Problems
Outcomes of Pharmaceutical Care
Cure of disease
Elimination of reduction symptomps
Arrest or slowing of a disease process
Prevention of disease or symptoms
1. A competent pharmacist is one who is able to confer with
a physician about the care and treatment of his or her
patient. The pharmacist should appreciate the essentials
of the clinical diagnosis and understand the medical
management of the patient. He or she should also be
informed about the drugs that may be used in the
treatment of the patient. The pharmacist should know
various things about the drugs include:
a. their mechanisms of action;
b. their combinations and dosage forms;
c. the fate and disposition of the drugs (if known);
d. the factors that may influence the physiological
availability and biological activity of the drugs from
their dosage forms;
e. how age, sex, or secondary disease states might
influence the course of treatment;
f. How other drugs, foods, and diagnostic procedures
may interact to modify the activity of the drugs.
2. A competent pharmacist is one whose overall function is to ensure
optimum drug therapy. He or she should know the appropriate
indications and dosage regimen for the drug therapy being
undertaken as well as the contraindications and potential untoward
reactions that may result during therapy. He or she should be
informed as to the proprietary products that might interact adversely
with or be useful adjuncts to drug therapy, facilitating administration
or improving overall patient care.
3. A competent pharmacist must be aware of the proposed therapeutic
actions of proprietary medications, their composition, and any unique
applications or potential limitations of their dosage forms. He or she
should be able to objectively appraise advertising claims. At the
patients request, he or she should be able to ascertain the probable therapeutic usefulness of a certain drug in resolving the patients complaints.
4. A competent pharmacist should be able to review a scientific
publication and summarize the practical implications of the findings
as they may relate to the clinical use of drugs. He or she should be
able to analyze a published report of a clinical trial in terms of the
appropriateness of the study design and the validity of the statistical
analysis, and should be able to prepare an objective summary of the
significance of the data and the authors conclusions.
5. A competent pharmacist is a specialist as to the stability
characteristics and storage requirements of drugs and drug products,
the factors that influence the release of drugs from dosage forms, and
the effect of the site of administration or its environment within the
body on the absorption of a drug from the administered dosage form.
Most importantly, the pharmacist understands the effect of the
interaction of all these factors on the onset, intensity or duration of
therapeutic action.
6. A competent pharmacist should be precisely informed as to the legal
limitations on procurement, storage, distribution, and sale of drugs;
the approved use of a drug as specified by federal authorities and
acceptable medical practice; and his or her legal responsibilities to
the patient when drugs are used in experimental therapeutic
procedures.
7. A competent pharmacist should be able to recommend the drug and
dosage-form that are most likely to fulfill a particular therapeutic need,
supporting his or her choice objectively with appropriate source
material. In addition, he or she should be capable of identifying a
drug, within a reasonable period of time, on the basis of its color,
shape, and proposed use, as described in reference books or other
sources.
8. On the basis of symptoms described in an interview with the patient, a
competent pharmacist should know what additional information he or
she must obtain from the patient. Based on this information, he or she
should be able to refer the patient to the proper medical practitioner,
specialist, or agency that would be of most help.
9. A competent pharmacist should be aware of drug toxicities, as well as
the most effective means of treatment for them.
10. A competent pharmacist should be able to instruct patients on the
proper administration of prescription and proprietary drugs. He or she
should know which restrictions should be placed on food intake,
other medication, and physical activity.
11. A competent pharmacist should be able to communicate with other
healthcare professionals or laymen on appropriate subjects, ensuring
that the recipient understands the contents of the message being
communicated.
12. A competent pharmacist should be capable of compounding
appropriate drugs or drug combinations in acceptable dosage forms.
13. A competent pharmacist is a person who takes appropriate measures
to maintain his or her level of competency in each of the areas
described above.
an expert knowledge of therapeutics
a good understanding
of disease processes
knowledge of drug
products
strong communication
skills
drug monitoring,
drug information,
and therapeutic planning skills
ability to assess and interpret physical
assessment findings
Basic Skill (in a network era)
English Language Skill
Internet Skill
Computer Skill
Communication Skill
1. Rovers, J.P., Currie, J.D., Hagel, H.P., McDonough, R.P., Sobotka, J.L., 2003, A Practical Guide to Pharmaceutical Care, 2nd Eddition, AphA, Washington, D.C.
2. Cipolle, R.J., Strand, L.M., and Morley, P.C., 1998, Pharmaceutical Care Practice, McGraw Hill, New york.
3. Tindall, W.N., and Millonig, M.K., 2003, Pharmaceutical Care: Insight from Community Pharmacists, CRC Press, Boca Raton.
4. Tietze, K.J., 2004, Clinical Skill for Pharmacists A patient-Focused Approach, 2nd Edition, Mosby, St. Louis.
5. Ritschel W.A. and Kearns, G.L., 2004, Handbook of Basic Pharmacokinetics ... Including Clinical Applications, 6th Edition, American Pharmaceutical Association, Washington, D.C.
6. Williams, R.L., Brater, D.C., and Mordenti, J., 1990, Rational Therapeutics A Clinical Pharmacologic Guide for Health Professional, Marcel Dekker Inc, New York.
7. Dipiro, J.T., et al., 2005, Pharmacotherapy A Pathophysiologic Approach, 6th Edition, McGraw Hill, New York.
Useful Reference Handbooks
Facts and Comparisons Handbook of Clinical Drug Data Drug Information Handbook Therapeutic Choices Griffith's 5-minute Clinical Consult Geriatric Dosage Handbook Pediatric Dosage Handbook Laboratory Test Handbook Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs
and Related Remedies The Top 100 Drug Interactions: A Guide to Patient
Management.