What’s in a role?
The word ‘role’ can be defined as “the function assumed or part played by a person or thing in a particular situation”. Further expansion on this definition includes the “socially expected behavioural pattern usually determined by an individual’s status in society”. A role statement can be used to describe what is required in terms of attributes and abilities. Such statements can distil how a profession perceives its own situation — to understand the knowledge, skills and behaviours that are expected of the person performing the role. Furthermore, a role statement also identifies the unique contributions of a profession to society and can be used to establish an agreed set of expectations, to enable policy formulation and assess performance.
It could be argued that the role of the pharmacist and other health professions has been devalued by the demarcation of boundaries and a wide application of the word ‘professionalism’ beyond established disciplines. Targets, monitoring and performance management are challenges faced by all professionals and there is a question about how much autonomy an individual has when taking up a role. Many entered the profession of pharmacy as a vocation but often end up pursuing organisational objectives that may not be congruent or inspire personal commitment to the work they do on a day-to-day basis. There may have been a loss of a sense of craft.
Fundamentals of the role
Are the fundamentals of the role of the pharmacist well understood? In an environment of increasing public expectations, workforce pressures, and significant scientific and technological advances, it is important to define the contribution the pharmacist makes not only to the healthcare team but more widely. Without clarity on the pharmacist’s role, we cannot effectively select, educate and train pharmacists, or plan for the future pharmacy workforce.
Attempting to create a generic definition of what it means to be a pharmacist is fraught with difficulties. Much seems to depend on context — the sector of work, the pharmacist’s career stage and experience. Furthermore, a role cannot be defined in isolation without considering the inter-relationships with other professionals. However, the drive for a flexible, adaptable workforce that can meet the health demands of an increasingly older population with multiple long-term conditions means that there is greater working across professional boundaries, and professional roles inevitably become more homogenous. Although taking on new roles can be enriching, there is also a danger that a profession can lose its way, or worse, lose its identity. Poorly defined professional role boundaries can also become a source of conflict and there is a risk that the best interests of patients and public are not served. The role of the pharmacist must be congruent with the roles of others such as doctors, nurses, pharmacy technicians etc. The nature of authority and responsibility between these relationships should be clear as should what the formal and informal expectations of one another are.
Reaching a consensus
Agreeing a statement on the role of the pharmacist is a difficult balancing act. But by defining the fundamental qualities of the pharmacist we create an anchor point for the profession. Changing patient and service needs will describe how these qualities are applied over time. As an example, science must be a fundamental part of the role so it can then be applied in, for example, clinical problem solving. Other fundamentals need to be agreed and patients, the public and other professionals made aware of the depth and breadth of pharmacists’ training as well as the skills they can expect from them.
If the pharmacist’s role is too narrowly defined, we risk impoverishment. If the definition is too wide, it will become meaningless. The prize of truly understanding our role is that we each feel like a pharmacist (rather than just a position in an occupational hierarchy) and are recognised as being dedicated to our craft for the benefit of others.
Pharmacists' responsibilities for providing rational use of medicine
To promote rational drug use the pharmacist requires to be part of all the decisions regarding medicines and their use. The changing role of the pharmacist as patient counselor/educator and as an intermediate to improve patient outcome in the ambulatory settings is essential for promoting rational use of drugs (RUD). The way drugs are procured, stored, distributed, and dispensed and the information given by the pharmacist/dispensers dictates the quality of their use, thus in terms influencing the rational use of medicines. According to World Health Organization (WHO), RUD requires that the patients receive "medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community". Thus to promote rational drug use, pharmacist requires to dispense right drug to the right patient in right dose, route and time of administration. One of the ways to achieve this is the training of pharmacist and allied health professionals during their academic training. Different countries have taken such initiatives like Pakistan where WHO rational drug module has been incorporated in final year Doctor of pharmacy curriculum.
Pharmacy ethics
Only general principles, based on accepted values in Western society, lead to guidelines for ethical behavior. The ethical problem appears to be the unequal access to the health care system. An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of non-maleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within the pharmacy profession. A definition of target groups for pharmaceutical care will facilitate this task. Pharmacists should obey the code of ethics guidelines.
Pharmaceutical care
The concept of pharmaceutical care evolves through a systematic comprehensive approach, which requires that the pharmacist should work in collaboration with the health care team and identify and resolve the actual and potential drug-related problems and prevent the patients from the potential harm of medicines. The pharmaceutical care concept was first introduced in the US by Hepler and Strand in the 1990s. The process revolves around the patient, and is continuous in its delivery with the strategy to anticipate and improve the patient outcome of the drug therapy as compared with the traditional pharmacy where the focus is usually the order (prescription/OTC), which is fulfilled on demand, and the pharmacist, who is oriented to the drug product, obeys the order that he/she receives. The concept of care emphasizes on establishing the pharmacist-patient relationship and putting an additional value of the clinical outcome by being actively involved in the treatment procedure. The delivery of pharmaceutical care by the pharmacist is a hub around process known as pharmacist's workup of drug therapy (PWDT), which starts by collecting relevant information of the patient, developing CORE pharmacotherapy plan, identifying PRIME pharmacotherapy problems of the patient, and formulating the FARM (F = Finding, A = Assessment, R = Regimen and M = Monitoring) progress notes. With the emergence of this concept the academics and training programs are promoting the philosophy of pharmaceutical care in all areas of pharmacy practice. For delivery of pharmaceutical care the training of the pharmacist should be in line for the development of skills in patient assessment, education and counseling, in the development of patient-specific pharmacist care plans, treatment protocols, dosage adjustments, selection of therapeutic alternatives, and preventive therapies. However, the concept is new to many of the community pharmacists working in many of the developing countries. Moreover, there are many barriers to adoption/adaptation of pharmaceutical care concept in practice including lack of understanding of pharmaceutical care concept in professionals, lack of training, resource constraints, and above all the political will to implement. At times, the curriculums are not sensitive toward the new developments in the field of pharmacy practice. Every region and country will have to come up with their own model of practice while considering their local scenario, and identifying the clear steps and actions required for having a start so as to help their nations in improving their millennium development goals and commitments through pharmacists' contributions.
Evidence-based pharmacy
Moving from perception to evidence in pharmacy practice is mandatory in providing optimal pharmaceutical care. The concept of evidence for clinical decision making got recognition in the early 1990s and poses a major challenge for its introduction and implementation of clinical guidelines in daily practice in most of the settings including the pharmacy. Evidence suggests that the patients receive unnecessary and harmful care, which is at times beyond the scope of the providers. One of the challenges is to keep oneself abreast with the latest developments in the field of medical science with so many new specialties and sub specialties. The basic principle of evidence-based practice is to make all practical decisions based on research studies, which are selected according to the specific standards pertaining quantitative, qualitative, and theoretical studies. It is believed that the evidence-based medicine is difficult to practice and one of the ways is to bridge the gaps in the knowledge of the practitioners by enhancing information systems in order to provide decision support, which will help in preventing decision errors. There is a need to develop a curriculum that is sensitive to the skill development in the area of evidence-based pharmacy.
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