Pharmacy (from the Greek φάρμακον = drug) is a chemical science and profession charged with ensuring the safe use of medication. Traditionally, pharmacists have compounded and dispensed medications on the orders of physicians. More recently, pharmacy has come to include other services related to patient care including clinical practice, medication review, and drug information. Some of these new pharmaceutical roles are now mandated by law in various legislatures. Pharmacists, therefore, are drug therapy experts, and the primary health professionals who optimise medication management to produce positive health-outcomes.
The symbols most commonly associated with pharmacy are the mortar and pestle and the ℞ (recipere) character. Pharmacy organisations often employ other elements, such as the Bowl of Hygieia, conical measures, and caduceuses in their logos. Other symbols are common in different countries such as the green Greek cross in France and Great Britain, the increasingly-rare Gaper in The Netherlands, and a red stylised letter A in Germany.
Disciplines
The field of Pharmacy can generally be divided into three main disciplines:
The boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut; and often, collaborative teams from various disciplines research together.
Pharmacology is sometimes considered a fourth discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Therefore it is usually considered to be a field of the broader sciences.
There are various specialties of pharmacy practice. Some specialisation is based on the place of practice including: community, hospital, consultant, locum, drug information, regulatory affairs, industry, and academia. Other specialisations are based on clinical roles including: nuclear, oncology, cardiovascular, infectious disease, diabetes, nutrition, geriatric, and psychiatric pharmacy.
Pharmacists
-
Pharmacists are highly-trained and skilled healthcare professionals who perform various roles to ensure optimal health outcomes for their patients. Many pharmacists are also small-business owners, owning the pharmacy in which they practice. This unique dichotomy is often the subject of debate within the profession—in part due to the perception of pharmacists as "common shopkeepers" by many in the community.
Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society of Great Britain (RPSGB), the Pharmaceutical Society of Australia (PSA), the American Pharmacists Association (APhA), and the American Society of Health-System Pharmacists (ASHP). See also: List of pharmacy associations.
In some cases, the representative body is also the registering body, which is responsible for the ethics of the profession. Since the Shipman Inquiry, there has been a move in the UK to separate the two roles.
Separation of prescribing from dispensing
In most jurisdictions (such as the United States), pharmacists are regulated separately from physicians. Specifically, the legislation stipulates that the practice of prescribing must be separate from the practice of dispensing. These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public, and that pharmacists cannot form business partnerships with physicians or give them "kickback" payments.
In the minority of jurisdictions (particularly in Asian countries such as China, Hong Kong, Malaysia, and Singapore), doctors are allowed to dispense drugs themselves and the practice of pharmacy is integrated with that of the physician.
In Canada it is common for a medical clinic and a pharmacy to attached and for the ownership in both enterprises to be common, but licensed separately.
The reason for the majority rule is the high risk of a conflict of interest. Otherwise, the physician has a financial self-interest in "diagnosing" as many conditions as possible, and in exaggerating their seriousness, because he or she can then sell more medications to the patient. Such self-interest directly conflicts with the patient's interest in obtaining cost-effective medication and avoiding the unnecessary use of medication that may have side-effects.
A campaign for separation has begun in many countries and has already been successful (like in Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g. in Malaysia).
Community pharmacy
A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; 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 grocery stores and mass merchandisers) now include a pharmacy as a department of their store.
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 the medication use system, 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.
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. Some hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding.
Consultant pharmacy
-
Consultant pharmacy practice focuses more on medication regimen review 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. 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 Health Care, and PharMerica). This trend is beginning to reverse 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. Many community pharmacies employ consultant pharmacists and/or provide consulting services.
Internet pharmacy
Recently, a number of pharmacies have begun operating over the Internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient (and private) than traveling to a community drugstore. Internet pharmacies are also recommended to some patients by their physicians if they are homebound.
Some Internet pharmacies sell prescription drugs without requiring a prescription. Some 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 have also been reports of such pharmacies dispensing substandard products.
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. Although importation of prescription medication currently violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers.
The future of pharmacy
In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists expect to be paid for their cognitive skills.
This paradigm shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In Great Britain, pharmacists (and nurses) who undertake additional training are obtaining prescribing rights. In the United States, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy."
Many universities are altering their programs to increase emphasis in fields such as pharmacotherapeutics, clinical pharmacy, nuclear pharmacy, disease state management, etc.
See also
External links
Regulatory
History and traditions
Other