COMMUNITY

PHARMACY

history and scope Submitted to: Sir

of community Irfan
pharmacy

Submiited by: Syeda shehr Bano

70059443
6th A
.
Department of Pharmacy
UNIVERSITY OF LAHORE
 History of community pharmacy:
Community pharmacists are the largest and most accessible group of health care
providers in the health care system. .No longer responsible solely for the provision of
drug products, community pharmacists play an integral part in community health and
wellness through expanded services such as medication management and
reconciliation, educational and behavioral counseling, and preventative health
services.Patient care services in specialty areas such as heart failure medication
management and point-of-care testing in pharmacies have been described in the
literature.he conventional role of pharmacist is to manufacture and supply medicinal
products. Recently, however, there is a significant change in the pharmacy profession
in terms of professional services delivery due to increase in demand of
pharmacists.Complexities due to increase in range of medicines and poor compliance
have shifted the focus of pharmacist toward patient centered approach.

Evolution of community pharmacy:

Pharmacy profession has evolved from its conventional and traditional drug focused
basis to an advanced patient focused basis over the years. In the past century the
pharmacists were more involved in compounding and manufacturing of medicines,
but this role has significantly reduced over time. This advancement in the role of
pharmacist calls for them to be the part of the broader health care team working for
providing better health care for the patients, thus contributing in achieving the global
millennium development goals. To match up, the role of today's pharmacists needs to
be expanded to include pharmaceutical care concepts, making the pharmacist a health
care professional rather than a drug seller in a commercial enterprise. Therefore,
pharmacy schools should prepare a program that has competence with the changing
role of the pharmacist. The education should provide ability for critical thinking,
improve problem-solving skills and decision making during pharmacotherapy. The
student should be trained to create, transmit, and apply new knowledge based on
cutting-edge research in the pharmaceutical, social, and clinical sciences; collaborate
with other health professionals and learn to enhance the quality of life through
improved health for the people of local society and as well as the global community.

Community pharmacy and public health before 1948:

The modern history of pharmacy in Great Britain can be traced to the foundation of
the Pharmaceutical Society in 1841.The nineteenth century was a period of gradual
professionalisation for pharmacy, with the introduction of examinations and
registration. Pharmacy practice largely involved the making and selling of medicines,
and occasionally dispensing prescriptions; but for people unable to afford a doctor the
local pharmacist was a ready source of advice about a whole range of issues.

At that time public health was also in its infancy. It largely meant sanitation and
housing, with its focus on clean water and efficient sewers. These were areas where
there was little scope for involvement by the pharmacist. But by the early twentieth
century public health was developing a broader definition concerned with the
establishment and maintenance of health, and by the end of that century it had come
to embrace individual lifestyle and advice.4 These areas offered far greater scope for
pharmacy involvement.

By the 1930s the role of the community pharmacist was still much as it had been for
generations.
Pharmacists usually spent much of their time dealing with customers and giving
advice. They often spent their working lives in the same place, and became respected
members of the community. A pharmacist who owned a shop in Nottingham in the
mid-1930s recalls that “we became father confessors, giving advice on all sorts of
subjects. The public expected a great deal from myself and my contemporaries.”
At its meeting in October 2005, the Council of the Royal Pharmaceutical Society of
Great Britain resolved to increase pharmacy’s public health role further,44 following
a presentation suggesting that current interactions between pharmacists and the public
were not maximising the opportunities that existed to improve public health. Reasons
included a poor understanding of pharmacy’s role in public health, little emphasis on
public health in pharmacy training and difficulties in coming to terms with the
multidisciplinary approach of public health initiatives.

Pharmacy has traditionally been an isolated profession: its ability to break out of its
isolation will largely determine the success or otherwise of its public health role in the
future. This will test both its adaptability and its flexibility. Although pharmacy is
changing fast, so too is public health.
This advisory role was both informal and unpaid, and was to change significantly over
the following decades. Post-war changes in the pharmacist’s education led to different
expectations by newly qualified pharmacists; and the founding of the NHS in 1948
led to significant changes in practice

Important aspect in Pakistan:

Community pharmacy is an important aspect of the pharmacy profession as it is easily
accessible for the society. The major responsibilities of the pharmacist are to maintain
all ethical requirements regarding the dispensing of medicines. The activities also
involve counseling of patients regarding the disease and the medicines. They also
remain in contact with the physician and work as a health care team to facilitate the
patient at best. However, the involvement of community pharmacists in such activities
is not well known in Pakistan. This paper tries to explore the education, experience
and main activities undertaken by pharmacists at local medical stores in Karachi – the
metropolitan city of Pakistan. The study also determines the potential of these
functional pharmacies or medical stores to play role in contributing to health care
provision to local public

Pakistan and community pharmacy:

Pharmacy services in Pakistan have experienced both evolutionary and revolutionary
changes since 1947. With time the pharmacists interest increased at community level
but the quality of services are still not up to the mark. While in comparison with the
developed countries like U.K and U.S.A, where community pharmacists are
expanding patient care services and have enhanced their role as pharmaceutical care
providers, the pharmacy profession in Pakistan is continuously evolving. This study is
carried out to explore history for evolutionary and revolutionary changes in
community pharmacy practice in Pakistan and to highlight the current scenario in
Pakistan. The aim of this research work is to bring forward the ground realities and to
analyze the factors that can overcome the barriers thus making community pharmacy
practice in Pakistan a success. The healthcare services in community pharmacies,
currently insignificant, must undergo reforms to meet the changing needs of modern
medicines users. Although pharmacists' contributions to health care are not
recognized yet, there is every reason to be optimistic toward making patient care in
community pharmacy setting a success

Current scenario of community pharmacy practice in pakistan:

There are relatively a few studies articulating the situation with community pharmacy
services in Pakistan. The Licensed premises in Pakistan include the medical stores,
the retail pharmacies and also the Wholesale Distribution Setups. Among the total no.
of pharmacists in Pakistan, 55 % join industrial sector, 15% works at public sector,
15% in sales marketing, 5 % in teaching and research, and 10 % in community
pharmacies.
About more than 1000 students are passed out each year now. The health care
services at community pharmacies must undergo reforms to meet the international
standards. Most of the personnel (dispensers) in pharmacies have minimum training.
Even if the license is displayed the pharmacy, the professional is seldom present . The
dispensers working at retail outlets (so-called community pharmacies) are mostly
untrained, non-qualified but have experience in years. Retail outlets in developing or
low income countries sell Prescription Only Medicines without a Prescription on
patient’s demand.
The doctors are receptive to the pharmacists expanded roles in Pakistan but their
expectations do not match with their actual experiences . 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 In current scenario, Pakistani pharmacists are seeking foreign
opportunities as this profession has a much higher demand worldwide as compared to
Pakistan. In Pakistan there is less recognition and lesser opportunities

Conclusion
The changing face of pharmacy practice requires that the pharmacy schools should
intervene with their programs with the competence to take up the challenge of
changing role of the pharmacy profession. The education should provide ability for
critical thinking, improve problem-solving skills, and decision making during
pharmacotherapy. The student should be trained to create, transmit, and apply new
knowledge based on cutting-edge research in the pharmaceutical, social, and clinical
sciences; collaborate with other health professionals and to enhance the quality of life
through improved health for the people of our society and as well as the global
community.
The diversity of the legal and regulatory framework also reflects the specificities of
the development of
pharmacies and the health care system as a whole, including the challenges they have
encountered in
the past and what the framework aimed to correct. In some countries, especially those
outside the EU, it may also reflect the limited capacity for oversight and regulation of
the sector. The legal and regulatory

framework usually covers the following fields:

• the pharmacy workforce (pharmacists and, in most cases, pharmacy technicians and
other pharmacy
staff in contact with patients);
• the pharmacy licence, including ownership requirements;
• pharmacy operations (in terms of premises, processes, workforce and so on);
• the types of service and activities provided in a community pharmacy and the
associated remuneration

Scope of community pharmacy:

1. Role of Community Pharmacist in Traditional and Alternative Medicines

In some countries, pharmacists provide traditional medicines and dispense
homeopathic prescriptions. W.H.O. promotes the safe and effective use of traditional
medicines. WHO’s role is to assist those countries where traditional medicine is
widely practiced to incorporate it into their national health systems and encourages
their potential in health care system. Its aims to enhance national program
development, operational research, clinical and scientific investigations, education
and training

2. Role of Community Pharmacist in Smoking Cessation

‘Health is wealth’. As is known to all, this simple English sentence explain how
important ‘Our health is’. Yes, health is a pre-requisite to human productivity and
development process. A good health encompasses physical, mental, social and
economic well-being. But man by the influence of media, T.V, Internet had cultivated
a habit that had caused a hazardous effect on his health as well as his surrounding
environment i.e., Consuming of Tobacco [Smoking].Tobacco, botanically called as
‘nicotina tobacum’. It mainly consists of a liquid substance which is colorless called
as ‘Nicoitne’ (1-methyl-2-[3-pyridyl] pyrolidine and 19 Carcino-genic substances
(collectively called TAR) and other 4000 chemicals, which have created a drastic
change in human health.
Typically various smoking forms of tobacco are available in the market today, among
whicht he commonest used by a high class and middle class society is the ‘Cigarette’
and ‘Bedees’ by a low class society. Cigarette normally consists of a tobacco
processed a thousand of chemicals. Often these are fitted in a ‘filters’. Many people
believed that these ‘filters’ are lifeguard as these prevent the entry of tobacco particles
in to the respiratory tract while smoking. But they are not aware that these ‘filters’
almost prevent the microparticles, but not the entry of microparticles and other
chemicals. Similarly, ‘Bedees’ besides their smaller size delivers higher concentration
of chemicals in mouth as it requires a harder puff than the cigarette. But common man
in the society doesn’t know this factor due to lack of education, poverty, and wrong
advertisements by the manufacturers. Even today people in north India, practice the
use of special device called ‘water pipes’ (‘shisha’) for smoking the
tobacco.reconstructive and replacement of surgical measures

3. Role of Community Pharmacists in Oral Health

Community pharmacists have several potential roles in oral health:
 They may be asked questions about oral and dental problems (e.g. toothache,
mouth ulcers, candida, gingivitis). The outcome of such an encounter may be
sale of a treatment (e.g. a simple analgesic) or referral to another professional
(e.g. dentist or doctor).
 They can give information on nutritional issues in relation to oral health (e.g.
sugar in foods, medicines and drinks) and oral hygiene (e.g. brushing, use of
toothpastes and mouthwashes).
 They can give information about the side effects of medicines in relation to the
mouth. Some medicines can alter taste or result in a dry or sore mouth. The
pharmacists take a more proactive approach to maximize opportunities in oral
health. Moreover, pharmacist training on oral health is variable and needs to
be improved.

4. Patients health care

Pharmacist plays an important role in patient healthcare. Clinical pharmacists posses

in-depth knowledge of new knowledge of medications that is integrated with a
fundamental understanding of the biomedical, pharmaceutical, socio bio-behavioral
and clinical sciences, he also assumes the responsibility and accountability for
managing medication therapy in direct Parkinson’s patient care setting whether
practicing independently or in consultation with other health care, due to free
accessibility and friendly approach, pharmacists are placed at first point of contact.
The practice of clinical pharmacy embraces the philosophy of pharmaceutical care as
a discipline; clinical pharmacy also has an obligation to contribute to the generation of
new knowledge that advances health and quality of life. Pharmacists are uniquely
positioned and most easily accessible healthcare professionals in the community.
Even in developing countries like India, most of the people communicate and take
treatment advice on minor ailments from pharmacist only. In India large number of
patient pool goes directly to pharmacies and depends on pharmacist to tell them what
medicines to take. Major role of community pharmacist is to educate consumers on
preventive measures and disseminate concise and up-to-date information to the public.
5. Role of Pharmacist in Sexually Transmitted Diseases-AIDS
India has approx., 3.5 million HIV positive cases, which is about 10% of the global
HIV cases and barely second to South Africa. HIV drugs are expensive and beyond
the reach of common people. Huge resource of community pharmacist can educate
people in the prevention and information of HIV/AIDS. For this, Federation of Indian
Pharmacists project in India on involvement of pharmacist in fight against AIDS is
very relevant. Another sensitive issue is the increasing number of women patients
suffering from AIDS.
The number rose from 7% in 1985to 18% in 1995. Although many classes of
antiretroviral are available like protease inhibitors, nucleoside reverse transcriptase
inhibitors and non-nucleoside reverse transcriptase inhibitors, patients need close
monitoring and strict dietary regimen. Explaining to what HIV is, its transmission,
risk reduction, patient counselling are the components of the counselling that a
community pharmacist can provide
6. Role of Community Pharmacist in Racial/Ethnic Barriers to Breast Cancer
Screening
Breast cancer is the most frequently diagnosed cancer in women in the United States,
and it accounts for 1 out of 3 diagnoses of cancer26. In the recent past, various studies
have consistently shown poor breast cancer screening rates in the racial and ethnic
minority populations, including African Americans, Native Indians, Asians, and
Hispanics.
It clearly indicates that the current strategies to increase awareness regarding breast
cancer screening methods in the minority groups have not been up to the mark.
Therefore, it becomes essential to highlight this issue and design effective strategies
to increase the screening rates in the women belonging to minority groups. Aside
from the direct out-of-pocket costs of breast cancer examinations, poor screening rates
in minority groups can be attributed to two main reasons:
i. A lack of awareness about the importance of breast cancer screening and
screening methods available
ii. Culture-based embarrassment about screening methods such as mammography.
Due to existing social and cultural barriers, many minority women feel reluctant to go
for breast cancer screening. Language barriers further worsen the issue. Jacob set al.
have reported that the language barriers act as a hindrance to breast cancer screening
by impeding adequate health communication30.It is important to influence the social
and cultural beliefs of these women and also decrease the existing language barriers in
order to decrease their reluctance and, hence, increase the screening rates. Pharmacists
can play an important role in increasing awareness of breast cancer screening among
minority women. Pharmacists working in both community and hospital settings are
the key drug information providers to patients since they are the ones who interact
most frequently with them. They should provide more information to these women
regarding mammography, clinical breast examination (CBE), and breast self
examination (BSE). This can be done by either providing individual counselling or by
organizing community-based education programs. Culturally targeted interventions
can prove helpful in increasing aware-ness and screening rates.
REFERNCES:
https://www.researchgate.net/publication/235698661_Community_Pharmacy_Practic
e_in_Pakistan

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758081/

https://jech.bmj.com/content/61/10/844

https://www.researchgate.net/publication/222711966_Professional_Scopes_And_Role
s_of_Community_Pharmacists_In_Various_Health_Care_Services_An_Updated_Rev
iews
https://www.news-medical.net/health/Community-Pharmacy.aspx