Around the world a vast majority of pharmacists are employed in community settings. Community pharmacy is the first level of contact of individuals of a community with health care and thus bringing health care as close as possible to where people live. The community pharmacist plays a critical role in most health care systems worldwide. The organization of the practice of community pharmacy varies between developed and developing countries.
The role and responsibilities of the community pharmacist has been and continues to undergo major change across the world. The direction of this change has been a path towards focusing not on the medicine (ready made dosage form) itself but on the user (patient). In the recent years the ‘pharmaceutical care’ has established itself a philosophy of practice, with the patient and the community as the primary beneficiaries of the pharmacist actions and activities. There has been ample debate on the pharmaceutical care concept due to differences in the pharmacy systems and health care structures across countries. With the influx of new generation of powerful and potent medicines, the role of community pharmacist in providing effective medication therapy management (MTM) is more vital today than ever. Thus pharmaceutical care describes greater involvement in MTM and other cognitive services by the community pharmacist beyond the physical dispensing of medicinal products.
Cognitive pharmaceutical services
Cognitive pharmaceutical services can be considered as a strategy to improve the quality of drug therapy and health care delivery system. This concept is relatively a new task in community pharmacy practice. Cipolle et al. formulated an integrated definition of cognitive pharmaceutical services (Source: Cipolee RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York, McGraw-Hill Companies; 1998). Cognitive pharmaceutical services, according to Cipolle et al. is the use of specialized knowledge by the pharmacist for the patient or health professionals for the purpose of promoting effective and safe drug therapy. Different activities are included in this broad definition; some of these activities of cognitive pharmaceutical services are listed in table 1.
Table 1: Activities of cognitive pharmaceutical services | Category | Activities | | Health promotion | Smoking cessation | | | Emergency hormonal contraception | | | Dealing with infestations | | | Dietary advice | | | Sun and skin protection | | | | | Medicine therapy management | Medicine review | | | Provision of drug information | | | Improving adherence | | | Detecting adverse drug events | | | Providing education | | | | | Preventive care services | Diabetes prevention | | | Osteoporosis screening/prevention | | | Weight management | | | CHD prevention and management | | | Immunizations |
In the recent past, community pharmacists have made significant advances in the development and implementation of pharmaceutical care or pharmaceutical cognitive services. The cognitive pharmaceutical service concept has added a new dimension to the interpretation of the pharmaceutical care. Community pharmacies in some countries have started implementing cognitive pharmaceutical services in their organization; payment for such services comes primarily from government sources. Pharmacists in Australia receive remuneration from government for conducting comprehensive home medicine review. They developed many programmes, including one called “pharmacist home visits” in which community pharmacists make house calls and are reimbursed by the government. The Pharmacy Guild of Australia has proposed medication continuance practice where community pharmacists could approve ongoing low-complexity areas of drug therapy rather than sending the patient back to the physician. In Canada, pharmacists are remunerated by their government for expanded services such as medicine review. They have developed a variety of programmes very similar to medication therapy management services for which they receive government reimbursement. In UK, community pharmacists can prescribe certain classes of medicines. They also can provide certain health promotion programmes such as smoking cessation and weight control management and be paid for these services under the government national health system. Other countries across the globe are moving in a similar direction. Community pharmacy is now being recognized by the government of many developed nations as a mainstream contributor to primary health care and public health.
Indian situation
Community pharmacies can be considered an important player affecting drug use owing to their placement in the health care delivery system. Their potential is to be utilized to promote involvement in medicines management and other cognitive roles. The opportunity always exists, but needs to be optimized. If Indian community pharmacists are to contribute to cognitive pharmaceutical services effectively, they need to be given the opportunity to acquire the new knowledge and skills required for their role. More research is required to identify the local, social and cultural factors that may be prerequisites for enhanced contribution through cognitive pharmaceutical services by community pharmacists to primary health care. It remains a tremendous challenge for the policy makers, academia, regulators and pharmacy profession in India to recognize trends in the pursuit by community pharmacists of the goals of cognitive pharmaceutical services and pharmaceutical care and to identify the direction for the future of the profession.
(Author is associate professor,
Department of Pharmacy, Annamalai University, Annamalainagar 608 002, Tamil Nadu) |