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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 medicationrelated care the purpose of achieving definite outcomes that improve a patients quality of life.

Dispensing Pharmacy (Old 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

Pharmaceutical Care (New Paradigm) 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 Unnecessary drug therapy Needs additional drug therapy Ineffective drug

Dosage too low

Adverse drug reaction Dosage too high Noncompliance

Description of the Drug Therapy Problem The drug therapy is unnecessary because the patient does not have a clinical indication at this time. Additional drug therapy is required to treat or prevent a medical condition. The drug product is not effective at producing the desired response. The dosage is too low to produce the desired response. The drug is causing an adverse reaction. The dosage is too high resulting in undesirable effects. 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

ability to assess and interpret physical assessment findings

a good understanding of disease processes

drug monitoring, drug information, and therapeutic planning skills

knowledge of drug products strong communication skills

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.