Feature

Developing Pharmacy Practice
…A Focus on Patient Care

Mithilesh Kumar Jha

PHARMACEUTICAL care is a ground-breaking concept in the practice of pharmacy which emerged in the mid-1970s. It stipulates that all practitioners should assume responsibility for the outcomes of drug therapy in their patients. The fields of pharmacy and pharmacotherapy are areas of rapid change, with new techniques, new products and new information about old products constantly being introduced. All health care professionals, including pharmacists, are faced with the constant challenge of new information, which they are required to 'filter', assimilate and use to improve their practice.

The term 'clinical pharmacy' was coined to describe the work of pharmacists whose primary job is to interact with the health care team, interview and assess patients, make specific therapeutic recommendations, monitor patient responses to drug therapy and provide medicines information. Clinical pharmacists work primarily in hospitals and acute care settings and provide patient-oriented rather than product-oriented services.

Clinical pharmacy requires an expert knowledge of therapeutics, a good understanding of disease processes and knowledge of pharmaceutical products. In addition, clinical pharmacy requires strong communication skills with solid knowledge of the medical terminology, drug monitoring skills, provision of medicines information, therapeutic planning skills and the ability to assess and interpret physical and laboratory findings. Pharmacokinetic dosing and monitoring is a special skill and service provided by clinical pharmacists. Clinical pharmacists are often active members of the medical team and accompany ward rounds to contribute to bedside therapeutic discussions. In some countries, the pharmacy profession has evolved to the point at which clinical pharmacy with patient-focused practice is no longer the exception but the rule for most pharmacists. Yet clinical pharmacy is still practiced exclusively in in-patient settings and hospitals, where access to patient data and the medical team is available.

The role of the pharmacist takes different forms in various parts of the world. The pharmacist's involvement with pharmaceuticals can be in research and development, formulation, manufacturing, quality assurance, licensing, marketing, distribution, storage, supply, information management, dispensing, monitoring or education. Supply and information management activities have been termed 'pharmaceutical services' and continue to form the foundation of pharmacy practice. Pharmacists practice in a wide variety of settings. These include community pharmacy (in retail and other health care settings), hospital pharmacy (in all types of hospital from small local hospitals to large teaching hospitals), the pharmaceutical industry and academia. In addition, pharmacists are involved in health service administration, in research, in international health and in nongovernmental organizations (NGOs).

The knowledge base of pharmacy graduates is changing. As these graduates move into practice, so pharmacy practice is developing beyond the horizon. The number of medicines on the market has increased dramatically over the last few decades, bringing some real innovations but also considerable challenges in controlling the quality and rational use of medicines.

The forces behind the changes in pharmaceutical education are many and varied, and increasing in both number and intensity. In developing and industrialised countries alike, efforts to provide health care, including pharmaceutical care, are facing new challenges. These include the rising costs of health care, limited financial resources, a shortage of human resources in the health care sector, inefficient health systems, the huge burden of disease, and the changing social, technological, economic and political environment which most countries face. While globalisation has brought countries closer together in trade of products and services and in recognition of academic degrees and diplomas, for example, it has led to rapid changes in the health care environment and to new complexities due to increased travel and migration.

Access to medicines of assured quality remains a major concern worldwide. One third of the world's population does not yet have regular access to essential medicines. For many people, the affordability of medicines is a major constraint. Those hardest hit are patients in developing and transitional economies, where 50%90% of medicines purchased are paid for out-of-pocket.

Rational use of medicines remains the exception rather than the rule. These challenges both to access to medicines of assured quality and to their rational use underscore the urgency of the need for global health sector reform. Against this backdrop of ongoing and profound changes in health care delivery systems, a paradigm shift in pharmacy practice is occurring. Over the past 40 years, the pharmacist's role has changed from that of compounder and dispenser to one of 'drug therapy manager'. This involves responsibilities to ensure that wherever medicines are provided and used, quality products are selected, procured, stored, distributed, dispensed and administered so that they contribute to the health of patients, and not to their harm. The scope of pharmacy practice now includes patient-centered care with all the cognitive functions of counseling, providing drug information and monitoring drug therapy, as well as technical aspects of pharmaceutical services, including medicines supply management. It is in the additional role of managing drug therapy that pharmacists can now make a vital contribution to patient care. Pharmacy practice does not take place in a vacuum, but in the health care environment. It aims to improve health. Health is a broad concept which can embody a wide range of meanings from technical to moral and philosophical. It is perhaps the most important human resource.

Health is a human right and access to health care, including essential medicines, is a derived right. Health is essential for sustainable economic and social development. For example, in many parts of the world, the HIV/AIDS pandemic reduces economic achievements and national health outcomes. Health is thus a very precious resource.

In view of the constantly expanding choice of medicines on the pharmaceutical market, pharmacists need to keep up to date with information and new developments in order to help patients make informed treatment choices. Pharmacists are well positioned to assume responsibility for the management of drug therapy.

(The writer is a student of University of Asia Pacific)