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 healthcare 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 healthcare technology. Recently, however, a striving for economy engendered by the ever burgeoning costs of healthcare 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 healthcare 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 healthcare 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.
Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, sell them without a prescription. In addition to ensuring an accurate supply of appropriate products, their professional activities also cover counselling of patients at the time of dispensing of prescription and non-prescription drugs, drug information to health professionals, patients and the general public, and participation in health-promotion programmes. They maintain links with other health professionals in primary health care.
Today, an increasingly wide range of new and analogous products are used in medicine, including high-technology biological products and radio-pharmaceuticals. There is also the heterogeneous group of medical devices, which includes some products analogous to medicines, some of which demand special knowledge with regard to their uses and risks (e.g., dressings, wound management products, etc.).
Hospitals and other institutions and facilities, such as outpatient clinics, drug-dependency treatment facilities, poison control centres, drug information centres, and long-term care facilities, may be operated by the government or privately. While many of the pharmacist’s activities in such facilities may be similar to those performed by community pharmacists, they differ in a number of ways. Additionally, the hospital or institutional pharmacist:
- Has more opportunity to interact closely with the prescriber and, therefore, to promote the rational prescribing and use of drugs;
- In larger hospital and institutional pharmacies, is usually one of several pharmacists, and thus has a greater opportunity to interact with others, to specialize and to gain greater expertise;
- Having access to medical records is in a position to influence the selection of drugs and dosage regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and report adverse drug reactions;
- Can more easily than the community pharmacist assess and monitor patterns of drug usage and thus recommend changes where necessary;
- Serves as a member of policy-making committees, including those concerned with drug selection, the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and thereby influences the preparation and composition of an essential-drug list or formulary;
- Is in a better position to educate other health professionals about the rational use of drugs;
- More easily participates in studies to determine the beneficial or adverse effects of drugs, and is involved in the analysis of drugs in body fluids;
- Can control hospital manufacture and procurement of drugs to ensure the supply of high-quality products;
- Takes part in the planning and implementation of clinical trials.
Statutory provisions in some countries including Nigeria may require that certain positions be held by pharmacists. The main activities of industrial pharmacists are described below.
Research and development
Pharmacists contribute to research, and their expertise in formulation development is of particular relevance to the biological availability of active ingredients.
Manufacture and quality assurance
The pharmacist’s broad knowledge of the pharmaceutical sciences ensures an integrated approach to quality assurance (including good manufacturing practice) through the validation of the various stages of production and the testing of products before release.
The pharmacist has the knowledge and expertise to provide detailed information on medicines to members of the health professions and the public. Also, pharmacists provide an information service within the company.
Patent applications and drug registration
The pharmacist is ideally qualified to understand and collate the diverse information required for patent and authorization submissions.
Clinical trials and post-marketing surveillance
The pharmacist has the knowledge of drugs and health care provision required to facilitate collaboration between companies, health professionals and governments in relation to clinical trials and surveillance.
Sales and marketing
The pharmacist, whose professional ethics demand a concern for the interest of patients, can make a contribution to proper marketing practices related to health care and to the provision of appropriate information to health professionals and the public.
The inclusion of pharmacists in all levels of management promotes an ethical approach within management policies.
Academic pharmacists engage in education, pharmaceutical practice, and research in schools of pharmacy. These three aspects of academic activity are interrelated, and at the same time connected with manpower planning and management. Undergraduate, postgraduate and continuing education require the educators to have expertise in the various pharmaceutical sciences, but, in view of the professional and vocational goals of pharmacy education and the necessary interaction of education and research with service, the academic staff must also include a substantial component of pharmacists with appropriate postgraduate education.
General/Training other health care workers
Training provided by pharmacists may include efforts to optimize drug therapy, by promoting the rational use and storage of drugs and methods of reducing drug abuse, and is directed to medical and other prescribers or suppliers of drugs, including community health workers who handle drugs. Pharmacists with training responsibilities should receive some training in the planning and management of training programmes in relation to the educational and health goals being served.
Medicine is the heart of the health care profession. Pharmacists are committed to improve global health by advancing pharmacy practice and science to enable better discovery, development, access to and safe use of appropriate, cost-effective, quality medicines in the best interest of the patient. Pharmacists believe that patient is the king and the epicenter of the healthcare delivery system. The well-being of the patient (The King) is paramount to pharmacists and the pharmacy profession.
Your pharmacist truly cares for you. Talk to him, ask him questions about your health, befriend him and he will care for you and your wellbeing.
On behalf of the National Executive Council and the Council members of Pharmaceutical Society of Nigeria, I wish all Nigeria Pharmacists, Pharmaceutical scientists and the general public happy World Pharmacists Day.
Pharmacists: Caring for you.
PHARM. AHMED I. YAKASAI, FPSN, FPCPharm, FNAPharm, FNIM
PHARMACEUTICAL SOCIETY OF NIGERIA (PSN)