Universal Journal of Pharmacy Take Research to New Heights

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1 Universal Journal of Pharmacy Take Research to New Heights Review Article ABSTRACT THE KEY ROLE OF COMMUNITY PHARMACISTS IN HEALTH CARE SYSTEM; AN OVERVIEW Krishnagoudar Bhimaray* 1, Mahadevamma L 1, Yoganand R 1, Shaik Shafiya Begum 2 1 Department of Pharmacy Practice, SJM College of Pharmacy, Chitradurga , Karnataka, India. 2 Department of Pharmacy Practice, KC Reddy Institute of Pharmaceutical Science, Jangamguntla, Guntur , Andhrapradesh, India Received ; Revised ; Accepted Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, dispense them without a prescription. Community pharmacists are in a distinctive position to identify, prevent, and resolve drug-related problems in ambulatory patients, and data suggests that community-based pharmacy services can improve health outcomes. India is a global face of rapidly changing developing nations, which requires strengthening its professional aspects of community pharmacy. With changing demands from educated and urbanized mass, there needs a reform in the policies and structure of the present community pharmacy setup. Community Pharmacy and Pharmacy Practice are yet to be established strongly and pharmacists working in community pharmacies do not provide patient counseling in the usual situation. We need to work closely with the pharmacist associations and share our common experiences and frame appropriate guidelines, so that community pharmacist who plays a major role in providing better health care s. Keywords: Community Pharmacy, Health care professional, Patients, Prescriptions, and Pharmacy Practice. INTRODUCTION Health is a word very familiar to us but it also carries a lot of complications and problems. According to the World Health Organization, health is a state of complete physical, mental and social well-being and not merely absence of any illness. To make the above definition of health practical we have to depend upon a "health care team". A health care team is the group of people who share a common health goal and common objectives determined by community needs. Corresponding Author: Bhimaray Krishnagoudar Lecturer and Clinical Pharmacist SJM College of Pharmacy Chitradurga Karnataka. India. Ph No: bsk.lkp@gmail.com The need of the hour is to make community pharmacist a key towards better health care. The community pharmacist can take part in health promotion campaigns, locally and nationally, on a wide range of drug related and health related topics. A community pharmacist involvement could play an important role in the following areas of health care. Community pharmacy practice evolved in the post Second World War period. A pharmacist not only began to perform functions that were new to pharmacy, but they began to innovate functions and make original contribution to literature. The popular motto of "patient oriented practice" and "drug use control" came into practice. But unfortunately the role of community pharmacist is not so much recognized till today. Although community pharmacist is of key importance in providing better healthcare, it is the matter of shame for us that the patient does not find any difference between the grocer and the pharmacist. Despite of major role of community pharmacy, the situation and Universal Journal of Pharmacy, 01(01), Nov-Dec

2 condition of the community pharmaceutical service has stood where it was like a man walking on a treadmill. He walks and walks and sweats, but remains in the same place. Until and unless the link between the people and physician i.e. the pharmacist does not get its proper recognition any dreams of making a healthier nation cannot be fulfilled 1. Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, dispense them without a prescription. In addition to ensuring an accurate supply of appropriate products, their professional activities also cover counseling of patients at the time of dispensing of prescription and non-prescription drugs, drug information to health professionals, patients and the general public, and participation in health promotion programmers. He dispenses medicines with a prescription and in certain cases without a prescription where applicable (OTC drugs). As he is the person who will be in direct contact with the public, he has to play an important role in decreasing the mortality and morbidity in the public. They maintain links with other health professionals in primary health care. Today, an increasingly wide range of new analogous products are used as medicinal, including high technology biological products and radiopharmaceuticals 1, 2. Community pharmacists are in a distinctive position to identify, prevent, and resolve drug-related problems in ambulatory patients, and data suggests that communitybased pharmacy services can improve health outcomes. The pharmaceutical care framework assumes a patient pharmacist professional relationship that is based upon caring, trust, communication, cooperation, and mutual decision making in which the pharmacist works very closely with the patient to promote health, to prevent disease, and to insure that drug therapy is safe and effective. Because of this close relationship, the successful implementation of the pharmaceutical care framework in community pharmacies requires that patients appropriately understand the pharmacist s professional role especially with respect to consultation with patients, monitoring the appropriateness of drug regimens, and other pharmaceutical care activities. Problems in pharmacist consultation can occur when patients and pharmacists have different expectations about the pharmacist s role and pharmacy services 3. Chronic diseases such as asthma, diabetes, cardiovascular diseases such as hypertension, chronic obstructive pulmonary disease (COPD) needs long term medical and pharmaceutical care. There has been alarming increase in the cases of these chronic diseases in India. Many of these clinical conditions are co-existing and needs multiple drug interventions and continued medical and pharmaceutical care. The drugs in these categories pose both clinical and pharmacoeconomic challenges. Community pharmacy is an ideal place where patient's and retailer's business aspirations can be matched. Community pharmacies can run various health care programs, patients' disease / medication education programs for its clients where in patients will be benefited for their health and pharmacy would built business through its medication sale. There is tremendous scope for such type of initiatives in community pharmacy 11. It is well known that the most prevalent chronic diseases are strongly linked to specific behaviors such as smoking, diet, sedentary lifestyle, intravenous drug abuse etc. Prevention and effective treatment of these diseases require behavior changes. Community Pharmacists familiarize themselves with recent developments in the scientific study of the behavior change. Moreover, chronic diseases in many cases are life-long. It damages the patients biography and self-image and usually has a more severe impact than acute diseases on quality of life. When providing medication counseling to patients with chronic diseases, pharmacists must be sensitive to the broad array of challenges the patients face. For the patients with chronic diseases, home is the central site of managing diseases and these patients also require more knowledge on the management of their diseases. Since chronic diseases move through different phases and these phases of diseases require different kinds of managing strategies these patients are primarily concerned with quality of life. In this article the authors make an attempt to emphasize some of the commonly seen chronic diseases where community pharmacists can play an active role through patient s healthcare 4. Community pharmacist is in a best position to perform these main activities: Direct patient care DUR Extemporaneous preparations Respond to minor ailments Drug information Health promotion Counseling 5 1. DIABETES Diabetes is a group of metabolic disorder in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of increased hunger, increased thirst and frequent urination. The chronic complications of diabetes are known to affect the quality of life of diabetic patients. The role of pharmacists in diabetes management is essential for identifying patients, assessment, education, referral and continuous monitoring. Pharmacists can help identify patients with diabetes through regular screening procedures. Patient education Universal Journal of Pharmacy, 01(01), Nov-Dec

3 should be provided immediately after a diagnosis of diabetes or any other diseases. Later on, patient assessment can be performed, and the patient can be educated to reinforce concepts and provide a motivational boost 7. Lifestyle measures: The pharmacist can explain about diabetes, stress, family involvement and social support, nutrition, exercise and activity, monitoring and use of results, relationship between nutrition, exercise, medication, and blood glucose level. Advice regarding the prevention, detection and treatment of acute / chronic complications, foot, skin and dental care, behavior change strategies, goal setting, risk factor reduction, and problem solving, preconception, pregnancy and postpartum management 7. Therapeutic measures: Tight glycemic control depends upon the patients adherence towards drug therapy as well as on diet and exercise. Educating the patients on the use of Sulfonylureas Taken 30 mins before food and also the awareness of hypoglycemia during insulin therapy etc HYPERTENSION High blood pressure is designated as either essential (primary) hypertension or secondary hypertension and is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg. In essential hypertension (95% of people with hypertension), no specific cause is found, while secondary hypertension (5% of people with hypertension) is caused by an abnormality somewhere in the body, such as in the kidney, adrenal gland, or aortic artery. The management of hypertension requires nonpharmacotherapeutic as well as pharmacotherapeutic methods. Lifestyle measures: In many occasions non pharmacotherapeutic treatment alone may suffice in the Management of hypertension. A pharmacist can counsel the patient s regarding 8 : Patients should stop smoking (offer help ± nicotine replacement therapy). Weight reduction should be suggested if necessary, to maintain ideal body mass index (BMI) of kg/m2. Offer a diet sheet and/or dietetic appointment. Dietary self-help, e.g. dieting clubs, may be appropriate 10. Reduce their salt, total fat, saturated fat and cholesterol intake, while increasing consumption of polyunsaturated, monosaturated fats and oily fish. Encourage fruit, vegetables, legumes and whole grains; and low-fat (or zero-fat) dairy, poultry meat, fish and shellfish products as in the Dietary Approaches to Stop Hypertension (DASH) eating plan. Cut alcohol intake to no more than 21 units (male) or 14 units (female) of alcohol per week. Encourage and training sessions on regular dynamic exercise per week for a young adult, or brisk walking for 30 minutes most days for the older individuals. Therapeutic measures: Educating the patients on the use of Antihypertensives is one of the important roles of pharmacists 11, ASTHMA Asthma is a chronic condition requiring lifelong drug therapy. Pharmacist can play an active role in educating the patient regarding self monitoring of drug therapy, other life style modifications and usage of specialized dosage forms such as metered dose inhalers, dry powder inhalers, spacers 7 etc. Lifestyle measures: Safety measures while traveling, prophylactic use of drugs before exercise, avoidance of allergens, stopping cigarette smoking 5 etc. Therapeutic measures: Patient involvement in management of asthma is very important. Specific counseling on drug therapy should concentrate on three areas; drugs to relieve symptoms, drugs used to prevent asthma attack and those drugs which are given only as reserve treatment for severe attacks. Training regarding use of the metered dose inhaler is one of the important roles of the community pharmacist. Many times the patients fail to take the inhaled steroids, as they do not produce any immediate effects PROCESSING OF PRESCRIPTIONS The pharmacists verifies the legality, safety and appropriateness of the prescription order, checks the patient medication record before dispensing the prescription (when such records are kept in the pharmacy). The community pharmacist also ensures that the quantities of medication are dispensed accurately, and decides whether the medication should be handed to the patient, with appropriate counseling. In many countries, the community pharmacist is in a unique position to be fully aware of the patient's past and current drug history administration and, consequently, can provide essential advice to the prescriber 2. CLINICAL PHARMACY/CARE OF PATIENTS The pharmacists seeks to collect and integrate information about the patient s drug history, clarify the patient's understanding of the intended dosage regimen and method of administration, and advises the patient of drug-related precautions, and in some countries, monitors and evaluates the therapeutic response. Pharmacist has al-ways played a vital role in a therapeutic committee established for the proper health care system 2. RATIONAL USE OF DRUGS A community pharmacist can also advice on the administration of the medication, provide information on the storage of the medication and wherever necessary he can counsel the patient. Education Universal Journal of Pharmacy, 01(01), Nov-Dec

4 regarding the disadvantage of polypharmacy can also be given to the patient. Drug information system should be set up and access to adverse drug reaction system should be made. A community pharmacist should do therapeutic drug monitoring and he should have a sound knowledge of genotype reporting i.e. predictive pharmacology. Drug information awareness programmes should be conducted to make people aware of side effects of certain OTC drugs e.g. Aspirin - a wonder drug also has many side effects like gastric ulceration; asthma and large doses may cause tinnitus. Regular use of paracetamol can cause harm to the liver. Considering the above examples, in the best interest of public health a community pharmacist can provide counseling to common people unaware of these side effects. Moreover the definition of an OTC product should be that "which does not require the prescription of a registered medical practitioner but which can be sold only under the supervision of a pharmacist". In a nut shell there should be rational use of drug i.e. right drug in right patient in right dose at right time. A community pharmacist is one of the inevitable members of the health care team who can help to achieve the goal of rational use of drugs by following good pharmacy practices. It is found that interventions by pharmacists in explaining the patients about medicines prescribed to them can significantly enhance patient knowledge of correct use of medicines from 56 per cent to 90% 1. 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 throughout 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. The ideal frontline pharmacist of the future has been described as a seven star pharmacist-someone 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, Lifelong learner, and Role model. The community pharmacist with the above skills and attitudes should make himself an indispensable partner in health care system of a nation 1. COUNSELING In a number of countries, the pharmacist provides advisory services as well as supply information to residential homes for the elderly, and other long-term patients. In some countries, policies are being developed under which pharmacists will visit certain categories of house-bound patients to provide the counseling service that the patients would have received, had they been unable to visit the pharmacy 2. 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 day s 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 1. FUTURE NEED AND SCOPE OF COMMUNITY PHARMACY With a population of billion, the community pharmacy in India is in demand for its various services. India is a global face of rapidly changing developing nations, which requires strengthening its professional aspects of community pharmacy. With changing demands from educated and urbanized mass, there needs a reform in the policies and structure of the present community pharmacy setup. Professional and educational development of the community pharmacist can make an important place in the health delivery network. Their needs lot of initiatives from the community pharmacy, which should cater the needs of the increasing demand of the health and drug information support to the local community. This will enhance the public health, leading to more healthy society. However, there also needs a input from the society and other medical practitioners towards reorganization of the community pharmacy services, which should compliments the efforts made by the pharmacist towards betterment of the patient care. Lot is talked about the factors that are responsible for the Universal Journal of Pharmacy, 01(01), Nov-Dec

5 non-recognition of pharmacy as a profession. However, the fact is, we all need better community pharmacy. Their needs a overall efforts from government, regulatory agencies, manufacturers, pharmacy THE DAILY LIFE OF A COMMUNITY PHARMACIST The daily life of a community pharmacist is hugely varied, drawing on a wide range of clinical and nonclinical competencies and skills. Every pharmacy is required to be operated under the control of a Responsible Pharmacist'. Daily tasks undertaken by community pharmacists include: clinical scrutiny of prescriptions; oversight of safe dispensing processes; providing patients with advice about medicines and treatments; provision of public health information to patients and customers and promotion of wellness; signposting people to other services, self-care organisations or information resources; assessment and treatment for minor ailments; professional oversight of the sales of over the counter (OTC) medicines; liaison with other healthcare professionals; clinical review services for specific patient groups in GP practices, e.g. asthma, diabetes, hypertension; medicines management support for GP practices, e.g. supporting practice formulary and clinical guideline implementation, repeat prescription management; and Providing locally commissioned Enhanced services such as supply of Prescription Only Medicines (POMs) under Patient Group Directions (PGDs), screening services, public health interventions and treatments 14. CONCLUSION Community Pharmacy and Pharmacy Practice are yet to be established strongly and pharmacists working in community pharmacies do not provide patient counseling in the usual situation. We need to work closely with the pharmacist associations and share our common experiences and frame appropriate guidelines, so that community pharmacist who plays a major role in providing better health care s. Pharmacist in the health care system is like circumcenter of a triangle with physicians, patients and nurses at the corners of the triangle. He has direct contact with all health care professionals and patients. It is really important to appreciate the fact that a patient finds himself to be much more comfortable in a drug store than in a physician s dispensary. The role of community pharmacist is indispensable in providing better health care. Steps should be taken by the government and the pharmacist himself to make his recognition in the community as a better health care provider. The commonwealth pharmacist association, The pharmaceutical society of India, World Health organization etc. will have to be committed to change and use their influence to convince community and the government that pharmacists can play a significant role in national health care programmers. REFERENCES 1. Number One Pharmacy The Health Booster. Role of community pharmacist in ensuring better healthcare 2010;2. 2. Alam TM. Concept and Scope of Community Pharmacy, Pakistan Journal of Pharmaceutical Sciences 1995;8(2): Hajj ME. Public s attitudes towards community pharmacy in Qatar: a pilot study. Patient Preference and Adherence 2011; 5: Venkat MUA. Nagesh, R. Thiyagu, V. Rajesh, Naik AN. Role of community pharmacist in patient s healthcare - a growing need in chronic diseases. International Journal of Research in Pharmacy and Chemistry 2011; 1(3): Alam TM. Concept and Scope of Community Pharmacy, Pakistan Journal of Pharmaceutical Sciences 1995;8(2): R Venkatesan. Role of community pharmacists in improving knowledge and glycemic control of type 2 diabetes ICSR2012 Vol : 3 (1 ): Muaed JA, Shareef Q, Hanan MA, Dima MM, Claire C. Evaluation of the community pharmacist s behavior towards a prescription of Antidiabetic and antiasthma drugs. Pharmacy Practice (Internet) 2011; 9(1): Diabetes Blue Circle Symbol". International Diabetes Federation2006; Avaible from: URL: 9. Joseph D, Robert L. Talbert, Gary Y, Gary M, Barbara W, Michael LP. Hypertension. Editors. In Pharmacotherapy Hand Book. 7 th ed. New York: MC Graw-Hill; 2008; Appel LJ, Moore TJ, Obarzanek E. A clinical trial of the effects of dietary patterns on blood pressure. N Engl JMed. 1997; 336: Gerald KM, Elaine KS, Linda K, Katarzyna J, Laura AB al. AHFS Drug Information. Bethesda, Maryland, Ahmed JH, Aitken JM, Badminton M, Clarke CE. British National Formulary. 57th edition. British medical association; London; Universal Journal of Pharmacy, 01(01), Nov-Dec

6 13. Kole PL. Community pharmacy - A growing need, pharmabiz.com. 2007; rmacy.html. Source of support: Nil, Conflict of interest: None Declared Universal Journal of Pharmacy, 01(01), Nov-Dec