Pharmacy Practice Fields
Fields of Pharmacy Practice:
A pharmacy
(commonly the chemist in Australia, New Zealand
and the UK; or drugstore in North
America; retail pharmacy in industry terminology; or Apothecary,
historically) is the place where most pharmacists practice the profession of
pharmacy. It is the community pharmacy where the dichotomy of the profession
exists—health professionals who are also retailers.
Community
pharmacies usually consist of a retail storefront with a dispensary where
medications are stored and dispensed. The dispensary is subject to pharmacy
legislation; with requirements for storage conditions, compulsory texts,
equipment, etc., specified in legislation. Where it was once the case
that pharmacists stayed within the dispensary compounding/dispensing
medications; there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist
spends more time communicating with patients.
All
pharmacies are required to have a pharmacist on-duty at all times when open. In
many jurisdictions, it is also a requirement that the owner of a pharmacy must
be a registered pharmacist (R.Ph.). This latter requirement has been revoked in
many jurisdictions, such that many retailers
(including supermarkets and mass merchandisers) now include a pharmacy as a
department of their store.
Likewise,
many pharmacies are now rather grocery store-like in their design. In addition
to medicines and prescriptions, many now sell a diverse arrangement of
additional household items such as cosmetics, shampoo, office
supplies, confectionary, and snack foods.
Pharmacies
within hospitals
differ considerably from community pharmacies. Some pharmacists in hospital
pharmacies may have more complex clinical medication management issues whereas
pharmacists in community pharmacies often have more complex business and
customer relations issues.
Because
of the complexity of medications including specific indications, effectiveness
of treatment regimens, safety of medications (i.e., drug interactions) and
patient compliance issues ( in the hospital and at home) many pharmacists
practicing in hospitals gain more education and training after pharmacy school
through a pharmacy practice residency and sometimes followed by another
residency in a specific area. Those pharmacists are often referred to as
clinical pharmacists and they often specialize in various disciplines of pharmacy.
For example, there are pharmacists who specialize in haematology/oncology,
HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy,
pain management, psychiatry, anticoagulation clinics, herbal medicine,
neurology/epilepsy management, paediatrics, neonatal pharmacists and more.
Hospital
pharmacies can usually be found within the premises of the hospital. Hospital
pharmacies usually stock a larger range of medications, including more
specialized medications, than would be feasible in the community setting. Most
hospital medications are unit-dose, or a single dose of medicine. Hospital
pharmacists and trained pharmacy technicians compound sterile products for
patients including total parenteral nutrition (TPN), and
other medications given intravenously. This is a complex process that requires
adequate training of personnel, quality
assurance of products, and adequate facilities. Several hospital pharmacies
have decided to outsource high risk preparations and some other compounding
functions to companies who specialize in compounding.
Clinical pharmacy
Clinical pharmacists provide direct patient
care services that optimizes the use of medication and promotes health,
wellness, and disease prevention. Clinical pharmacists care for patients in all
health care settings but the clinical pharmacy movement initially began inside Hospitals and
clinics. Clinical pharmacists often collaborate with Physicians
and other healthcare professionals to improve pharmaceutical care. Clinical
pharmacists are now an integral part of the interdisciplinary approach to
patient care. They work collaboratively with physicians, nurses and other
healthcare personnel in various medical and surgical areas. They often
participate in patient care rounds and drug product selection. In most
hospitals in the United
States
Compounding
is the practice of preparing drugs in new forms. For example, if a drug
manufacturer only provides a drug as a tablet, a compounding pharmacist might
make a medicated lollipop that contains the drug. Patients who have
difficulty swallowing the tablet may prefer to suck the medicated lollipop
instead.
The formal definition of compounding is the
preparation, mixing, assembling, packaging of a drug in the course of
professional practice. Qualified pharmacists make medications from
scratch using raw materials, powders to blend up a customized drug that suits a
particular individual or a particular need.
Compounding
pharmacies specialize in compounding, although many also dispense the same
non-compounded drugs that patients can obtain from community pharmacies.
Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly branching into other institutions and non-institutional settings. A consultant pharmacist is a specialized pharmacist. Consultant Pharmacists give consultation on various issues.
Traditionally
consultant pharmacists were usually independent business owners, though in the
United States many now work for several large pharmacy management companies
(primarily Omnicare,
Kindred Healthcare and PharMerica).
This trend may be gradually reversing as consultant pharmacists begin to work
directly with patients, primarily because many elderly people are now taking
numerous medications but continue to live outside of institutional settings.
Some community pharmacies employ consultant pharmacists and/or provide
consulting services.
The
main principle of consultant pharmacy is Pharmaceutical care developed by Hepler and
Strand in 1990.
Since
about the year 2000, a growing number of Internet
pharmacies have been established worldwide. Many of these pharmacies are
similar to community pharmacies, and in fact, many of them are actually
operated by brick-and-mortar community pharmacies
that serve consumers online and those that walk in their door. The primary
difference is the method by which the medications are requested and received.
Some customers consider this to be more convenient and private method rather
than traveling to a community drugstore where another customer might overhear
about the drugs that they take. Internet pharmacies (also known as Online
Pharmacies) are also recommended to some patients by their physicians if they
are homebound.
While
most Internet pharmacies sell prescription
drugs and require a valid prescription, some Internet pharmacies sell
prescription drugs without requiring a prescription. Many customers order drugs
from such pharmacies to avoid the "inconvenience" of visiting a
doctor or to obtain medications which their doctors were unwilling to
prescribe. However, this practice has been criticized as potentially dangerous,
especially by those who feel that only doctors can reliably assess
contraindications, risk/benefit ratios, and an individual's overall suitability
for use of a medication. There also have been reports of such pharmacies
dispensing substandard products.
Of
particular concern with internet pharmacies is the ease with which people,
youth in particular, can obtain controlled substances (e.g., Vicodin,
generically known as hydrocodone) via the internet without a prescription
issued by a doctor/practitioner who has an established doctor-patient
relationship. There are many instances where a practitioner issues a
prescription, brokered by an internet server, for a controlled substance to a
"patient" s/he has never met. In the United States
Canada
is home to dozens of licensed Internet pharmacies, many of which sell their
lower-cost prescription drugs to U.S. consumers, who pay one of the world's
highest drug prices. In recent years, many consumers in the US and in other countries with high drug costs,
have turned to licensed Internet pharmacies in India ,
Israel and the UK , which often have even lower prices than in Canada
In the
United
States, there has been a push to legalize importation of medications from Canada and other
countries, in order to reduce consumer costs. While in most cases importation
of prescription medications violates Food and Drug Administration (FDA)
regulations and federal laws, enforcement is generally targeted at international
drug suppliers, rather than consumers. There is no known case of any U.S.
Veterinary pharmacy
Veterinary
pharmacies, sometimes called animal pharmacies may fall in the category
of hospital pharmacy, retail pharmacy. Veterinary pharmacies stock different
varieties and different strengths of medications to fulfill the pharmaceutical
needs of animals. Because the needs of animals as well as the regulations on veterinary medicine are often very different
from those related to people, veterinary pharmacy is often kept separate from
regular pharmacies.
A veterinary pharmacist can make a valuable contribution to the welfare of
animals by supplying a professional service to pet owners. Pharmacists are
closely involved in the supply of animal medicines and the dispensing of
veterinary prescriptions.
Pharmacists in rural settings are often involved in helping the farming
industry by supplying medicines for farm livestock.
Nuclear pharmacy
Nuclear
pharmacy focuses on preparing radioactive materials for diagnostic tests and
for treating certain diseases. Nuclear pharmacists undergo additional training
specific to handling radioactive materials, and unlike in community and
hospital pharmacies, nuclear pharmacists typically do not interact directly
with patients.
Nuclear medicine involves the use of radioactive
substances (radionuclides), to assess the metabolic, structural, and functional
details of various organs in the body. The radionuclides are used mainly for
diagnostic purposes, and also for therapeutic purposes in certain conditions.
The specialized nature of the radiopharmaceuticals, which require manufacturing
and handling of regulated and potentially hazardous radioactive material, has
also made ˜nuclear pharmacy" an essential ally in the growth of this
multidisciplinary, challenging,
Military pharmacy
Military
pharmacy is an entirely different working environment due to the fact that
technicians perform most duties that in a civilian sector would be illegal.
State laws of Technician patient counseling and medication checking by a
pharmacist do not apply.
The pharmacists
working in the military sector can deploy their services at short notice
anywhere in the world to provide medical support to the Armed Forces in war,
during conflict or during peacekeeping operations worldwide.
In peacetime
The Pharmacist Officer's main roles are in the distribution of medical
supplies to support current operations and overseas units; the provision of
pharmaceutical care within Service hospital units working alongside their
civilian colleagues; and in the provision of pharmacy support to GPs at primary
care level.
During conflict
In the medical logistic role, the Pharmacist is responsible for the timely
distribution of drugs, dressings and medical equipment in general to all units
in the theatre of operations. In Field Hospitals, they provide pharmacy support
and advice to the Commanding Officer. Depending on the number of
pharmacists deployed at any one time, any one pharmacist could be required to
provide advice to other unit commanders on all pharmaceutical matters including
storage, distribution, security and the prescribing, dispensing and supply of
drugs. As commissioned officers, they also undertake military duties as
required by the Commanding Officer and will expected to develop their
leadership and management skills.
Pharmacy informatics
Pharmacy
informatics is the combination of pharmacy practice science and applied
information science. Pharmacy informaticists work in many practice areas of
pharmacy, however, they may also work in information technology departments or
for healthcare information technology vendor companies. As a practice area and
specialist domain, pharmacy informatics is growing quickly to meet the needs of
major national and international patient information projects and health system
interoperability goals. Pharmacists are well trained to participate in
medication management system development, deployment and optimization.
The
pharmacy informaticist focuses on application of technology for pharmacists in
supporting, streamlining, improving workflow, increasing patient safety with
best practices and reliable systems. After recognizing the rapidly increasing
role of the pharmacist in the use of healthcare information and management
systems
Academic Pharmacy:
Academic pharmacy means the practice of pharmacy which deals with the pharmacy education.
There are many full-time faculty members work in
the nation's colleges and schools of pharmacy and also in the University. They
are involved with teaching, research, public service, and patient care. Others
serve as consultants for local, state, national, and international
organizations. Becoming a member of the faculty at a college of pharmacy
usually requires a postgraduate degree and/or training (e.g., Ph.D. degree or
residency or fellowship training following the professional degree program).
While some pharmacists who complete graduate school exercise the option to
teach, there currently exists a shortage of faculty, creating an array of
excellent professional opportunities.
Pharmacy practice faculty have significant
responsibility for patient care, in addition to their work in teaching and
research. These academicians often are called educator/ practitioners, and they
serve as role models for pharmacy students and residents in many
education/practice settings. Faculty in disciplines other than pharmacy
practice usually are involved in pharmaceutical sciences research. The
pharmaceutical scientists are mainly concerned with research that includes
sophisticated instrumentation, analytical methods, and animal models that study
all aspects of drugs and drug products. Moreover, social, economic, and
behavioral science research often uses survey methods and statistical analyses
to solve complex problems of drug utilization management, health care delivery,
marketing, management, and other practice issues. To paraphrase one current
pharmacy faculty member, "Perhaps no other job in pharmacy has such
far-reaching effects on the profession as that of an educator. It is in
academia that one can excite individuals about pharmacy and lay the groundwork
for continuing advances in the field."
Pharmaceutical
Industry:
Pharmaceutical industry produces
chemicals, prescription and on prescription drugs, and other health products.
Pharmacists do such things as marketing, research and product development,
quality control, sales, and administration. Many pharmacists go on to obtain
postgraduate degrees in order to meet the technical demands and scientific
duties required in pharmaceutical manufacturing. Pharmacists with an interest
in sales and administration can combine this with their technical background in
pharmacy by serving as medical service representatives. These representatives
call on a variety of health care professionals to explain the uses and merits
of the products their firms produce. Experienced and successful medical service
representatives with administrative abilities often rise to supervisory or
executive posts in the pharmaceutical industry. Pharmacists are also employed
as sales representatives, supervisors, and administrators in wholesale drug
firms.
Independent
ownership:
Only
independent pharmacy ownership offers the ultimate freedom one needs to control
his own destiny. Independent pharmacies have been at the center of
pharmaceutical care in the U.S.
“Pharmacists
should move from behind the counter and start serving the public by providing
care
instead of pills only. There is no future in the mere act of dispensing. That
activity can
and
will be taken over by the internet, machines, and/or hardly trained
technicians. The fact
that
pharmacists have an academic training and act as health care professionals puts
a
burden
upon them to better serve the community than they currently do.”
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