Role of community pharmacist

BY:
MD. MYNUL HASAN
SOUTHEAST UNIVERSITY
 Contents
 Introduction

 The main activities of community pharmacists

 Processing of prescriptions

 Care of patients or clinical pharmacy

 Extemporaneous preparation and small-scale manufacture of medicines

 Traditional and alternative medicines

 Monitoring of drug utilization

 Responding to symptoms of minor ailments

 Informing health care professionals and the public

 Health promotion

 Domiciliary services

 Rational Use of Drugs

 Individualization of Drug

 Community Pharmacists Play Key Role in Improving Medication Safety

 Pharmacists as a Community Resource

 Conclusion
  reference

Role of community pharmacist

Introduction
Community pharmacists are the health professionals most accessible to the public. They supply
medicines in accordance with a prescription or, when legally permitted, sell them without a
prescription. In addition to ensuring an accurate supply of appropriate products, their professional
activities also cover counselling 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 programs. They maintain links with other health professionals
in primary health care.

Today, an increasingly wide range of new and analogous products are used in medicine, including
high-technology biological products and radio-pharmaceuticals. There is also the heterogeneous
group of medical devices, which includes some products analogous to medicines, some of which
demand special knowledge with regard to their uses and risks (e.g., dressings, wound management
products, etc.).
Pharmacists have progressively undertaken the additional task of ensuring the quality of the
products they supply.

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 especially in Bangladesh and needs strong efforts.
Although community pharmacist is of key importance in providing better healthcare, it is the
matter of shame for us that patient does not find any difference between the grocer and the
pharmacist. Despite of major role of community pharmacy, the situation and 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 Bangladesh,
a healthier nation cannot be fulfilled.

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.

The main activities of community pharmacists are described below:

Processing of prescriptions:
The pharmacist 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), ensures that the quantities of medication are dispensed accurately, and decides whether
the medication should be handed to the patient, with appropriate counselling, by a pharmacist. In
many countries, the community pharmacist is in a unique position to be fully aware of the patient’s
past and current drug history and, consequently, can provide essential advice to the prescriber.

Care of patients or clinical pharmacy:

The pharmacist 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.

Monitoring of drug utilization:

he pharmacist can participate in arrangements for monitoring the utilization of drugs, such as
practice research projects, and schemes to analyse prescriptions for the monitoring of adverse drug
reactions.

Extemporaneous preparation and small-scale manufacture of medicines:

Pharmacists everywhere continue to prepare medicines in the pharmacy. This enables them to
adapt the formulation of a medicine to the needs of an individual patient. New developments in
drugs and delivery systems may well extend the need for individually adapted medicines and thus
increase the pharmacist’s need to continue with pharmacy formulation. In some countries,
developed and developing, pharmacists engage in the small-scale manufacture of medicines, which
must accord with good manufacturing and distribution practice guidelines.

Traditional and alternative medicines:

In some countries, pharmacists supply traditional medicines and dispense homoeopathic

prescriptions.

Responding to symptoms of minor ailments:

The pharmacist receives requests from members of the public for advice on a variety of symptoms
and, when indicated, refers the inquiries to a medical practitioner. If the symptoms relate to a self-
limiting minor ailment, the pharmacist can supply a non-prescription medicine, with advice to
consult a medical practitioner if the symptoms persist for more than a few days. Alternatively, the
pharmacist may give advice without supplying medicine.

Informing health care professionals and the public:

The pharmacist can compile and maintain information on all medicines, and particularly on newly
introduced medicines, provide this information as necessary to other health care professionals and
to patients, and use it in promoting the rational use of drugs, by providing advice and explanations
to physicians and to members of the public.

Health promotion:

The pharmacist can take part in health promotion campaigns, locally and nationally, on a wide
range of health-related topics, and particularly on drug-related topics (e.g., rational use of drugs,
alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent abuse,
poison prevention) or topics concerned with other health problems (diarrhoeal diseases,
tuberculosis, leprosy, HIV-infection/AIDS) and family planning. They may also take part in the
education of local community groups in health promotion, and in campaigns on disease prevention,
such as the Expanded Programme on Immunization, and malaria and blindness programmes.

Domiciliary services:

In a number of countries, the pharmacist provides an advisory as well as a supply service 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 counselling service that the patients would have received had they been able to visit
the pharmacy.

Agricultural and veterinary practice:

Pharmacists supply animal medicines and medicated animal feeds.

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.

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.

The US FDA's office of women's health has created "women's health: take time to care", a national
public awareness campaign, where apart from giving information about safe medicine use, they
also hold local interactive sessions led by pharmacists and other health care professionals.

Rational Use of Drugs:

A community pharmacist can also advise on the administration of the medication, provide
information on the storage of the medication and wherever necessary he can counsel the patient.
Education 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. How many amongst the common people know that drugs such as Action 500, Coldarin
can increase blood pressure in patients having hypertension. Even pain shows difference between
men and women. Where women respond better to the opiods such as morphine, pentazocine and
pethidine men respond better to the non-steroidal anti-inflammatory drug, ibuprofen. 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% per cent.

There is yet another role of the community pharmacist in India and that is enhancing the
availability of essential drugs. Nearly 70% population in Bangladesh is deprived of essential drugs
for a variety of reasons including non-availability of health professionals and improper
professional advice about the usage of drugs.

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. 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. Counselling sessions can be made by the community pharmacist
to stop smoking.

Family Planning:
One of the greatest needs of the hour is to control the tremendously increasing population in
Bangladesh. A community pharmacist is the one who can control this rising population by
counseling with people and doing programmers which exhibit the problems related with large
families. He can tell the various families planning measures that are available in the market at
affordable prices. He can educate the people and convince them about the advantages of having
small families. So, like all other aspects community pharmacist plays a very important role in this
case also.
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.

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.

The community pharmacist with the above skills and attitudes should make himself an
indispensable partner in health care system of a nation.

Community Pharmacists Play Key Role in Improving Medication Safety:

Americans rely on prescriptions to manage their health issues. In fact, according to health care
market intelligence from IMS Health, prescription sales in 2009 grew by 5.1% versus 1.8% in
2008. Consequently, as more medications are prescribed to patients, the more likely it is that those
patients will experience medication interactions if they don’t receive proper education from their
health care professionals. Sadly, it appears that adverse interactions, medication overuse, and
errors are a perennial problem. A recent study by researchers at the University of California, San
Diego, and the University of California, Los Angeles, found that fatal medication errors rise in the
month of July, just when new medical residents arrive at hospitals.
There is a powerful tool that can be employed to help patients avoid dangerous drug interactions
and adverse health effects—that tool is the pharmacists themselves. The pharmacist often interacts
with patients more often than the prescribing medical professional. Helping patients understand
their medication regimens certainly improves health outcomes, but it also strengthens pharmacist–
patient relationships and helps reinforce the role of the pharmacist as a trusted health advisor.
Pharmacists are in a unique position to improve medication safety because:

 Pharmacists have the time and clinical expertise to make a difference in the way patients
manage chronic conditions for which they may be taking multiple medications.
 Pharmacists are an affordable and accessible health care resource. For many patients, it is
probably easier to consult with a pharmacist than with a physician.
 The community pharmacy often becomes the de facto community health center, with
pharmacists acting as the first point of care.
 Pharmacists already play an active role in coaching patients on potential side effects of
their medications and why it is important to take them exactly as prescribed.

For patients with chronic conditions, pharmacists have an opportunity to monitor their patients’
use of combined medications and pass along information about possible interactions. However,
to increase the effectiveness of these ongoing interactions, pharmacists need a plan for how
best to communicate with their patients, because an ad hoc approach does not yield success.

Ongoing Counseling and Education

A structured framework for patient consultations can improve the way patients monitor their
medications and prevent potential problems with medication safety or drug interactions. In
general, such programs include the following steps:

Screen for any issues: Ask patients about existing health issues, such as high blood pressure
or diabetes, that might worsen due to medication interaction.

Discuss all medications: Schedule oneon- one time with patients to go over all their
medications. This step can help prevent side effects or drug interactions resulting from
prescriptions from multiple doctors.

Educate patients: Remind patients of the role and importance of each medication in their
regimen.

Emphasize adherence: Stress the importance of adherence for better outcomes.

Pharmacists as a Community Resource:

Medication errors and interactions have a financial cost as well as an impact on the well-
being of an individual. When patients become ill due to safety issues, recovery time
increases. As the health care industry and patients look at ways to reduce health care costs,
community pharmacists can be part of the solution.

Pharmacists play a vital role connecting patients and medical professionals. They are
specially trained to help manage side effects and counsel patients on taking multiple
medications effectively and safely, and they are also more easily accessible than physicians.
Community pharmacists offer a trusted environment in which to reduce medication errors
and improve safety, while reducing costs and improving the quality of care.

Conclusion
In a nutshell, 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 physicians 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. Every community pharmacist should always remember, the
following lines:

"Do all the good you can, In all the ways you can;
In all the places you can, At all the times you can;
To all the people you can, As long as ever you can".

References

 http://www.srmuniv.ac.in/sites/default/files/downloads/Role_of_commun
it_pharmacist_in_ensuring_better_healthcare.pdf
 https://www.pharmacytimes.com/publications/issue/2010/november2010/
communitypharmacists_medsafety
 http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.2.html
 https://www.researchgate.net/publication/222711966_Professional_Scop
es_And_Roles_of_Community_Pharmacists_In_Various_Health_Care_S
ervices_An_Updated_Reviews
 Obe SG. Public Health a practical guide for community
pharmacists. Available at www.pharmacyhealthlink.org.uk