community pharmacy

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Community Pharmacy:

Community Pharmacy 16 March 2013 1

Who is a community Pharmacist?:

Who is a community Pharmacist? A community pharmacist is the health professional who focuses on the patient’s drug therapy. While a physician prescribes drugs and a nurse administers them, the pharmacist is the drug expert . Pharmacists’ expertise lies in How medications should be used? How to maximize benefits and minimize adverse effects of drug therapy? How prescription drugs interact with other medications. The pharmacist’s primary role is “To ensure that the medications used by a patient are the most effective and are used in the most appropriate manner” 16 March 2013 2

Who is a community Pharmacist?:

Who is a community Pharmacist? In general: They can recommend an over-the-counter (OTC) product for a cold, Demonstrate the proper use of an asthma inhaler, and Help patients manage their diabetes. Clients can also talk to their pharmacist about How to store and take medication? What foods or activities to avoid, and what to do if a dose is missed. Working with patients, physicians and other health care providers to help patients achieve their health goals by improving the quality of their drug therapy Ensuring safe, secure and effective distribution of medications Taking medication histories and maintaining patient drug profiles Monitoring adverse drug reactions and patients’ adherence with their drug treatment 16 March 2013 3

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Assessing patients’ drug therapy for possible interactions with current medications and health conditions Making recommendations to prescribers and other health care professionals for adjustments to patients’ drug regimens to enhance the quality of care Providing education to patients and caregivers on proper use of medications and medical devices Managing minor illnesses by providing information to patients on self-care and nonprescription medications Providing referrals and advice on health promotion and wellness 16 March 2013 4

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In their current role, pharmacists contribute to the health care system by: 16 March 2013 5

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Community Pharmacy in India:

Community Pharmacy in India Role of physicians is prescribing and the pharmacists dispensing Developed countries Rural India Reasons Unqualified doctors Qualified doctors prescribe and dispense medicines in their clinics Historically, the General Practitioners and community pharmacist have a common ancestor in the apothecary, an adviser on health and dispenser of medicines. Hence their is necessity to improve the pharmacy practices on professional scales in India India is becoming a fast developing nation in the world. Major exporters to European countries and in USA, in generics 16 March 2013 8

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In India there is major transformation in Research and Development, production, marketing etc. how ever the trend has not penetrated down the line to: The vital link in supply chain The pharmaceutical Trade. In this chain - the ultimate and vital link is Community Pharmacy . 16 March 2013 9

Health care needs to the rural and urban masses to be viewed from some of the strange situations are as listed below::

Health care needs to the rural and urban masses to be viewed from some of the strange situations are as listed below: Rural India Illiterate rural masses Non-availability of basic quality medical health care Quackery practice in rural areas Vast number of drug Non availability of qualified pharmacists Mainly focused by Indian pharma companies Weak regulatory control Urban India Educated progressive consumers. Emerging quality medical health care in urban centers Highly competent medical profession Good awareness Large turnout of qualified pharmacists. Focused by Indian/MNC pharma companies. efficient State level Drug agencies in control 16 March 2013 10

Role of professional & trade associations::

Role of professional & trade associations: In this context it is crucial that we take bold initiative to : educate the practicing pharmacists, change their mind set and prepare them as Community Pharmacists by introducing refresher courses at State and district Head quarters with a time frame Recently Indian Pharmaceutical Association has taken some intiatives to improve the health care practices 16 March 2013 11

Scope for training:

Scope for training Everyday, the pharmacist is asked by customers for advice about minor ailments. They may require advice on symptoms May ask for a medicine by brand name; May require general health advice e.g. about dietary supplements, precautions etc. Management of the sale of over-the-counter (OTC) medicine 16 March 2013 12

Basic knowledge about the drugs and diseases:

Basic knowledge about the drugs and diseases There is need to educate and advice the consumers on proper and safe use of medicines, because There is growing OTC segments of products Lay press advertisements Self medication Drug abuse Non-compliance of dosage regimen Mixing of OTC medicines with prescription medicines Changing life style and food habits Prevalence of diseases like asthma, tuberculosis, diabetes etc., Hence it requires regular refresher courses to prepare the community pharmacists in patient care and counseling. With the advent of IT, a wealth of information is available through web sites and Drug Information Centers which can be used by the community pharmacists 16 March 2013 13

Need to maintain proper statutory records:

Need to maintain proper statutory records It is in the interest of pharmacists that they buy the medicines from authorized sources with proper purchase records. Maintain sales memos with patients name and address, batch number of the medicines sold, as a legal requirement and to safeguard themselves in the event of any drug found substandard or unsafe requiring recall etc. 16 March 2013 14

Need to provide patient information brochures::

Need to provide patient information brochures: Pharmaceutical associations, manufacturers can provide brochures to be distributed to patients at the counters on disease like asthma, diabetes, hypertension, epilepsy even common cold and cough, with Dos and Don'ts etc,. 16 March 2013 15

To provide information:

To provide information For Immunization and If space permits, vaccination programs can be organized with the help of manufacturers in the pharmacies. 16 March 2013 16

Geriatric care:

Geriatric care Elderly patients tend to get confused or forget to take medicines properly. Complementary packs for keeping each medication separately with dosage marked will help them to take medicines as prescribed. 16 March 2013 17

Need to provide basic monitoring/test devices:

Need to provide basic monitoring/test devices In the counseling area pharmacists can Provide BP apparatus, Devices that are available to test blood sugar etc 16 March 2013 18

Proper Storage:

Proper Storage All medicines are temperature sensitive and to retain their potency and efficacy proper storage is essential, protected from sunlight and heat. While it is recommended that all Community Pharmacies are air conditioned, there is a proposal to amend D&C Rules to provide air conditioners compulsorily. 16 March 2013 19


Access To Drug Information centres reference books web-sites on drug information This is possible by providing Computers and Inter-net connectivity. 16 March 2013 20

Communication skills:

Communication skills As pharmacists, to understand customer needs, it is necessary to develop listening skills, Questioning skills. To develop a positive mind set for ethical pharmacy practices, evolving all professional, legal and moral obligations to the society. These should be basic parameters on which we must introduce a practical approach to Community pharmacy environment in India. Community Pharmacy Division of IPA with All India Organization of Chemists & Druggists with State Pharmacy Councils as nodal centers, can organize jointly, structured programs to train practicing pharmacists in every major towns so that, we can bring a perceptible change in pharmacy practices in India. As a supplementary activity, a Journal dedicated to Community Pharmacy is necessary to constantly update their knowledge on new molecules, and this should reach all leading pharmacies in India. Such professional Journals can be sponsored by manufacturers. 16 March 2013 21

The role of the pharmacist in disease management :

The role of the pharmacist in disease management 16 March 2013 22


Introduction The practice of pharmacy is continuing to undergo a paradigm shift from a dispensing-focused to a patient-care-focused profession. Pharmacists have more time to provide clinical services Pharmacists have the opportunity to become involved in patient care is disease management 16 March 2013 23

Definition of disease management:

Definition of disease management “aspects of case and outcomes management, but the approach focuses on specific diseases, looking at what creates the costs, what treatment plan works, educating patients and providers, and coordinating care at all levels: hospital, pharmacy, physician, etc.” DM has also been defined as a “systematic management tool applied to specific diseases with an emphasis on prevention and ‘best practices’ to provide high quality care at a reasonable cost with an ongoing process of monitoring and continuous improvement.” 16 March 2013 24

Organizations that offer disease management programs:

Organizations that offer disease management programs Device and laboratory companies, Medical product wholesalers and distributors, Physician groups, and Community pharmacies There are now companies that specialize in selling DM services to health care providers who choose not to develop programs with their own staff. 16 March 2013 25

History of pharmacists’ involvement in patient care:

History of pharmacists’ involvement in patient care The origin of pharmacists’ involvement in DM can be traced back to the hospital environment. In the late 1960s and early 1970s, clinical pharmacy practice began to discuss direct patient contact and clinical involvement of the pharmacist. 16 March 2013 26

Pharmaceutical care:

Pharmaceutical care Hence the concept of pharmaceutical care was started. Pharmaceutical care means “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.” “pharmaceutical care targets those with risk factors for drug-related problems, a history of non-adherence, and frequent changes in medication regimens.” In practicing pharmaceutical care, a pharmacist is expected to assume greater responsibility for patients’ medication-related outcomes. For example, pharmacists have taken on roles to help assess patients’ therapeutic needs, prevent adverse drug reactions, individualize drug therapy, manage chronic disease, and monitor follow-up care. 16 March 2013 27

PowerPoint Presentation:

Research suggests that the potential impact of a pharmacist’s intervention in patient care is significant. In a follow-up project, it is estimated that pharmacist intervention and pharmaceutical care could reduce the annual expense of drug-related problems by $45.6 billion making a great difference. 16 March 2013 28

Factors influencing pharmacist involvement in disease management:

Factors influencing pharmacist involvement in disease management Patient access Consistency between sites: Organization and structure of pharmacies (e.g., chain drug stores), which allow the administration of a program through pharmacists practicing at different locations. Expanding the role of pharmacy technicians Greater use of technicians might allow pharmacists to devote more time to patient care. It is expected that advanced training of technicians will reduce the amount of time that pharmacists typically devote to medication dispensing and allow more time for pharmacists to provide pharmaceutical care. Governmental efforts Under this legislation, pharmacists with appropriate training can be reimbursed for providing cognitive services for patients with diabetes, asthma, lipid disorders, and anticoagulation under patient-specific treatment protocols approved by a physician 16 March 2013 29

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Characteristics of a Disease Management Program:

Characteristics of a Disease Management Program Targets specific patient populations suffering from a disease. Integrates health care services directed toward the chosen disease by various components of the health care system, providing a seamless system of prevention and care. Support health care services on consistent application of: the best scientific information available on treatment and evaluation of care, constant updating and improvement through use of quality improvement techniques. Links care to the outcomes of interest to consumers of health care, This takes into account clinical, economic, and humanistic outcomes. 16 March 2013 31

Impact of the pharmacist in managing specific diseases:

Impact of the pharmacist in managing specific diseases Most DM efforts have focused on chronic conditions that are common or have high associated treatment costs, or both. Some specific disease states for which the impact of the pharmacists has been demonstrated are asthma, cardiovascular conditions (hypertension, hyperlipidemia, and anticoagulation),and diabetes. 16 March 2013 32

Responsibilities in Asthma Disease Management:

Responsibilities in Asthma Disease Management Educate patients about the role of each medication. Instruct patients about the proper techniques for inhaling medications. Monitor medication use and refill intervals to help identify patients with poorly controlled asthma. Encourage patients purchasing nonprescription asthma inhalers or tablets to seek medical care. Help patients use peak-flow meters appropriately. Help patients discharged from the hospital after an asthma exacerbation to understand their asthma management plan. 16 March 2013 33

Diabetes mellitus:

Diabetes mellitus Pharmacist can provide: Diabetes education, medication counseling, and evaluation and adjustment of the medication regimen in noninsulin-dependent diabetes mellitus (NIDDM) patients This has significance in lowering average weekly blood glucose levels, a decreased incidence of hyperglycemic events, and significant increase in their understanding of diabetes medications as well as a positive difference in their perception and attitude toward communication with the pharmacist. 16 March 2013 34


Summary In summary, the results of studies assessing DM with pharmacist involvement demonstrate that pharmacists are capable of improving patient outcomes and reducing health care costs. Pharmacists’ expertise has been shown to be particularly beneficial for diseases in which outcomes heavily rely on medications. 16 March 2013 35


Conclusion Dramatic changes over the past decade. The DM movement, along with technological improvements in prescription processing, has fostered pharmacist involvement in patient care. Pharmacists in a variety of practice settings are participating in DM and are beginning to demonstrate their value in the management of several high-cost diseases, including asthma, cardiovascular disease, and diabetes. For the movement to be sustainable, pharmacists will have to demonstrate that the costs of developing and administering DM services do not exceed the benefits of improved patient outcomes. Opportunity: As employers and government purchasers continue to face pressures to reduce the cost of prescription benefits, pharmacists will be presented with opportunities to demonstrate their impact in providing DM. 16 March 2013 36

Future directions:

Future directions It has been estimated that traditional prescription processing utilizes only about 10% of the technological potential that computers offer to pharmacists. Software applications to assist pharmacists in DM have been developed and will continue to be improved. Pharmacy information systems will support the processes of drug dispensing; prescription processing; and the task of outcomes data collection, documentation, and monitoring An educational curriculum aimed at educating community pharmacists on how to “provide an expanded level of patient care” related to disease management and wellness activities 16 March 2013 37

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