Pharmacy Practice Fields

Fields of Pharmacy Practice:

 Pharmacists practice in a variety of areas including retail, hospitals, nursing homes, drug industry, and regulatory agencies. Later, clinical pharmacy, social and administrative pharmacy, and pharmaceutical care are introduced which are relatively new to pharmacy practice. Pharmacists can specialize in various areas of practice including but not limited to: hematology/oncology, infectious diseases, ambulatory care, nutrition support, drug information, critical care, pediatrics, etc.

Community pharmacy

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 This latter requirement has been revoked in many jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.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.

Hospital pharmacy

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, potentially dangerous drugs that require close monitoring are dosed and managed by clinical pharmacists.

Compounding pharmacy

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
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.

Internet pharmacy

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, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.

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. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

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 is one of the major fields for pharmacists. Here pharmacists work in the production, Q.C. & Q.A. department., Product development and other departments.

 Pharmacists in the pharmaceutical industry work with other disciplines in producing medicines of the highest quality and safety. A pharmaceutical qualification is an excellent basis for achieving posts of responsibility up to the most senior level.

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:

 Independent ownership means the pharmacy practice where the pharmacist is self employed.

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. for over 200 years. Today, more than 60.000 independent pharmacists dispense 42 percent of the nation’s retail prescription medicines.

“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.”