CHALLENGING ROLE OF PHARMACIST IN HEALTH CARE THE FUTURE PROSPECTS

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MODERN PHARMACIST:
One who is able to provide the patient oriented services as in developed countries is called as a modern pharmacist. Such services start from obtaining patients medication history to the feedback from the same after discharge. The componential characteristics that a modern hospital pharmacist must possess include:
1. Professional knowledge
2. Computer / IT acquaintance & skill
3. Counseling and communication skills

COMPUTER / IT ACQUAINTANCE & SKILL:
The modern pharmacist has to be adequately skilled in such an area for storing data of patient medication history to drug profile, drug stock to its expiry date details, analytical calculations to research programs etc. The use of computer in pharmacy is imminent and important. The hospital pharmacy practice involves informative interactions of in-house and distant persons to meet out the clinical emergencies.

COUNSELING AND COMMUNICATION SKILLS:
A modern pharmacist in order to perform patient oriented services, needs to perform “Therapeutic Drug Monitoring” and consequently to individualization of dosage regimen. Hospital pharmacists are involved in the treatment process of the patients from the beginning viz; from taking medication history to selection, dispensing and monitoring of drug therapy.

ENDEAVOURS, CHALLENGES & MISPERCEPTIONS OF PHARMACY PROFESSION:
During the concurrent professional scenario, the community pharmacists provide only dispensing services within pharmacies. Many opine that the presence of pharmacists in community pharmacies is merely to satisfy the current legal requirements. They only count and pack tablets and capsules and distributes these to consumers.There is need to adopt new concepts of clinical & patient oriented practices. There is requirement to make medicines safe for patients by providing counseling than for proper use, clarifying correct dosages and right application. It involves checking new treatments that are compatible with other medicines that the patients might be taking. The future of pharmacy does not seem to lie merely in dispensing of medication batter in provision of relevant drug information and drug therapy recommendation to patients. A clinical pharmacist is an important source for furnishing clinical aspects of the drugs and delivery system particularly with respect to the safety and efficacy parameters.

AN ANTIBIOTIC PHARMACIST:
Endeavours to become a source of peculiar aspects of antibiotic therapy, monitoring of antibiotic consumption, participation in infection control, formulary development and appraisal of new antimicrobials. The addition of a dedicated antibiotic pharmacist to a counseling team may be beneficial to patients to reduce medication errors and time spent at hospitals.

RETAIL PHARMACISTS: may check the probable harmful effects of self medication by imparting relevant drug information to the consumers.

ACADEMIC PHARMACISTS: help the general public by creating awareness on safe use and administration of drugs.

PHARMA JOURNALISTS:  provide drug information in various print media like journals, magazines, bulletins, newspapers etc. which may play a crucial role in making the patients familiarised and comfortable with the drug used and proper mode of administration.

CHALLENGES & PROBLEMS: these include understanding of the technical complexities, gross assessment of physico chemical aspects, ensuring appropriate administration and reckoning use of the drug, making the patient ready, comfortable and compatible with the health care delivery system.

STRATEGIES FOR PHARMACISTS:
various aspects in determining the professional strategies include:

1. Appropriate patient counseling:  The patient's choice of medicine could be lost unless a mechanism be found for rewarding professional advice rather than just dispensing of medicines.
2. Communication: An essential tool delivering drug information i.e. dose, dosing schedule/dosing regimen, adverse and side effects, drug-drug interaction etc
3.  Inculcation of helping attitude:It focuses principally on patience, cooperation, helpful and compassionate attitude to achieve the target of counseling of OTC consumers successfully.
4.  A vital triangular relationship: It included establishment of relationship between pharmacist, doctor, a patient to improve patient's use of medicines simplifying various complexities.

COMMUNITY PHARMACY A GROWING NEED:
Community pharmacists serve as a major source of information to the over the counter users residing in the rural and backward areas, to convey his message to the OTC consumers via various modes like verbal discussions, presentations through charts, video clippings and provide explanations of significant pictograms to them and motivating people to increase their awareness about the OTC medications. Community pharmacy is the most structured and advanced, in developed countries such as USA, UK and other European countries, in fulfilling responsibilities such as sale of medicine, medication information, patient record keeping, running health promotion activities such as smoking cessation services, giving advice on health services, family planning, drug misuse and abuse. Community pharmacist strives for most effective, appropriate, safe and economic treatment of the patient. Adoption of Community Pharmacy Practice Technologies such as use of patient care databases, software for identification of ADRs / DI specific to patient medication history, medication therapy management modules, electronic direct prescribing, telephonic/web based prescription / non-prescription drug and/or information requests, digitally secured confidential patient data, has enhanced customer care services.

OVER THE COUNTER MEDICATIONS, SELF MEDICATION AND COMMUNITY PHARMACY:
1. SELF MEDICATION: Self medication is defined as consumption of medication on self behalf without professional supervision on medicinal products.

2. USE OF OTC DRUGS: Commonly used OTC drugs such as decongestants, expectorants, antihistamines, cough suppressants and analgesics (pain relievers) can lead to various adverse effects such as respiratory depression, cardiac arrest, serious central nervous system (CNS) related problems etc. These drugs also pose possibility of various drug interactions for prescription drugs.

3. INCREASING DEMAND IN CHRONIC CARE: Chronic diseases like asthma, diabetes, cardiovascular diseases such as hypertension, Chronic obstructive pulmonary disease etc. Need expertise and prompt care till the end of medication or, throughout the entire life of a patient.

4. LIFESTYLE CHANGES AND PHARMACEUTICAL DEMANDS: The rapidly changed life style of the community requires special category of drugs to treat lifestyle illnesses. There is increasing demands for therapies such as anti-obesity drugs, anti-ageing cosmetic interventions, erectile dysfunction disorders, anti-oxidants etc., isolated protein and dietary supplements. People access to these lifestyle drugs and nutraceuticals at community pharmacy.

5. ROLE OF PHARMACISTS INVOLVING MEDICATION  MANAGEMENT:
a) Pharmacists are skilled at analysing complex systems serving as the best source of information about the institution's medication use system.
b) Pharmacists have core knowledge of medications including their adverse effects, interactions, proper dosing and monitoring parameters.
c) Pharmacists manage the institution's drug budget and are cognisant of drug costs.
d) Pharmacists understand the risks inherent in the medication management process, consequently can identify areas of weakness and are able to create or redesign systems to improve risk areas.
e) Pharmacists continuously monitor medication related literature and are comfortable in patient counseling.
f) Medication safety continues to be a challenge within health care to monitor patients on more complex drug therapy regimens to thereby improved therapeutic outcomes.

PHARMACIST AND HEALTH AWARENESS:
The awareness and approach of each unit towards various problems is mandatory needed. Such burning areas include-
1. Malnutrition, weakness and anaemia, hygiene and sanitation. 
2. Commonly occurring diseases like diabetes, hypertension, tuberculosis, infective diseases etc.
3. Gynaecological problems.
4. Immunization schedule.
5. Skin and contagious diseases.
6. General tendency of self medication and purchase of OTC products.

PHARMACISTS AND GERIATRIC CARE:
Geriatric care requires-
1) Caring elderly -The pharmacist's way.
2) Dosing drugs in elderly.
3) Pharmacists manage and improve drug therapy and quality of life of geriatric patients
4) Pharmacists can provide a variety of small but important services to make them taking prescription medication easier for the elder patient. A prudent clinical monitoring of drug therapy by a pharmacist can limit adverse drug reactions and polypharmacotherapy due to a prescribing cascade.

RURALISING HEALTHCARE:
The health care awareness needs to be proliferated to the grass root level i.e. rural areas.
1. Pharmacists are primary custodians of drug and ensure safety and suitability.
2. Checking drug-drug and drug-food interactions.
3. Identification and reporting of adverse drug reactions.

Assuring the medication adherence by patient counseling.

About Authors:
Nishant Verma
Department of Pharmaceutical Chemistry, Teerthanker Mahaveer College of Pharmacy,
Teerthanker Mahaveer University, Moradabad, India-244001
nishantvermamiet@gmail.com

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