What are the roles and responsibilities of a Pharmacist?

 

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.