Redefinition of pharmacists’ role to boost healthcare services
Nowhere is the need for essential drugs more evident in the day-to-day management of patients than in the provision of this unique specialized commodity. Indeed, effective medicine can be practiced only where there is efficient drug management. This is an axiom that applies with equal validity to both developed and developing countries.
Yet, time and again, in less affluent settings, inadequacies in the provision of primary health care are attributable to shortcomings within the drug distribution chain. Only when the pharmacist has been accepted as a vital member of the health care team can the necessary supporting services be organized with the professionalism that they demand.
In highly industrialized countries, acceptance of the need for professionalism in the supply and dispensing of drugs and health appliances has long since been indispensable because of the complexity of modern health care technology.
Recently, however, a striving for economy engendered by the ever-burgeoning costs of health care within the public sector has lent much credence and immediacy to arguments that a redefinition of the role of the pharmacist could serve the interests of both individual patients and the public at large.
The day-to-day activities of the pharmacist in these two starkly different settings may appear, superficially, to be very different. Everywhere, the call for pharmaceutical expertise is founded upon the same precepts. Pharmacists are uniquely qualified because:
•They understand the principles of quality assurance as they are applied to medicines;
•They appreciate the intricacies of the distribution chain and the principles of efficient stock-keeping and stock turnover;
•They are familiar with the pricing structures applied to medicinal products that obtain within the markets in which they operate;
•They are the custodians of much technical information on the products available on their domestic market;
•They are able to provide informed advice to patients with minor illnesses and often to those with more chronic conditions who are on established maintenance therapy;
•And not least, they provide an interface between the duties of prescribing and selling medicines and, in so doing, they dispose of any perceived or potential conflict of interest between these two functions.
This inventory of activities identifies the dispensing of medicines as the pivotal responsibility of the pharmaceutical services. This is, without question, destined to remain the case in virtually every national setting. However, the distinctive expertise of the pharmacist provides members of the profession with a suitable background to assume diverse responsibilities in both public administration and drug manufacture and supply. The competence of the pharmacist is already proven and evident:
•In the direction and administration of pharmaceutical services;
•In drug regulation and control;
•In the formulation and quality control of pharmaceutical products;
•In the inspection and assessment of drug manufacturing facilities;
•In the assurance of product quality throughout the distribution chain;
•In drug procurement agencies;
•And in national and institutional formulary committees.
In these activities, the pharmacist serves as a member of a multidisciplinary team rather than in an autonomous capacity; but in any particular country the profession can only be an efficiently organized element of the health care system when it has gained representation within the senior ranks of administration in both government and industry, and when pharmaceutical education has become established at university level.
Similarly, the pharmacist has indisputable functions at various levels in national drug registration and regulation. The responsibilities of the regulatory authority are to ensure that all products subject to its control conform to acceptable standards of quality, safety and efficacy; and that all premises and practices employed to manufacture, store and distribute these products comply with requirements to assure the continued conformity of the products to these standards, until such time as they are delivered to the end user. A small regulatory authority will rarely, if ever, undertake independent, comprehensive assessments of the safety and efficacy of individual products. In this case, the administrative and technical responsibilities that fall within its ambit are largely of a pharmaceutical nature and they are directed primarily to quality assurance.
Wherever pharmacy establishes its roots as a profession, it is within the health care institutions and in the community itself that pharmacists will serve in greatest numbers and with the most immediate effect on patient welfare.
Pharmacists’ specialized knowledge of the management and properties of medicines in an increasingly sophisticated health care environment brings them closer to prescribing doctors as a source of independent information about therapeutic options and about the consequences – both positive and negative – of treatment. It also brings them closer to patients in the community as readily accessible dispensers not only of medicines but also of health-related information. Their basic training should aim to confer upon them competence to offer skilled advice on the treatment of minor illness and the adoption of healthy lifestyles, and it should endow them with the insight necessary to recognize when the best interests of the patient are served by prompt referral to a medical practitioner.
The contribution of pharmacists to health care is based, in most countries, upon a body of knowledge and expertise acquired from a university degree (or equivalent) education, followed by a formally designated period of supervised pre-registration practical experience. Basic professional education is reinforced by a professional obligation to observe both statutory and professional measures related to control of safety and quality of drugs and procedures, and increasingly by continuing education, which in some places is required as a condition of continuing registration or licensure.
From their basic education and pre-registration training, students acquire a broad understanding of the scientific principles and techniques of the pharmaceutical sciences and the ability to keep pace throughout their careers with developments in pharmacy. Their knowledge and expertise extends to all aspects of the preparation, distribution, action and uses of drugs and medicines, and they should have acquired sufficient scientific discipline of mind to enable them to be efficient self-learners and to benefit from continuing education, as well as to enable those who wish to continue their studies to undertake postgraduate training or research.
With the development of specific and potent synthetic drugs, the emphasis of the pharmacist’s responsibility has moved substantially towards the utilization of scientific knowledge in the proper use of modern medicines and the protection of the public against dangers that are inherent in their use.
Pharmacists are employed in regulatory control and drug management, community pharmacy, hospital pharmacy, the pharmaceutical industry, academic activities, training of other health workers, and research. In all these fields, their aim is to ensure optimum drug therapy, both by contributing to the preparation, supply and control of medicines and associated products, and by providing information and advice to those who prescribe or use pharmaceutical products.
Finally, on this occasion of the 2016 World Pharmacy Day, I want to enjoin consumers of health to continue if they have and if not begin to maximally utilize the peculiar expertise of their pharmacists at community, hospital, industrial or academic levels. Your pharmacist is an invaluable source of information on all medicines. It is your right to top this huge reserve and potential.
*Ahmed Yakasai is the President of Pharmaceutical Society of Nigeria (PSN)
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