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.