Welcome to Rx Generics
Pharmacy (from the Greek φάρμακον = drug) is the health
profession that links the health sciences with the chemical sciences, and it is
charged with ensuring the safe use of medication. The scope of pharmacy practice
includes more traditional roles such as compounding and dispensing medications
on the orders of physicians, and it also includes more modern services related
to patient care, including clinical services, reviewing medications for safety
and efficacy, and providing drug information. Pharmacists, therefore, are
experts on drug therapy and are the primary health professionals who optimize
medication use to provide patients with positive health outcomes.
Disciplines
Pharmacy,
tacuinum sanitatis casanatensis (XIV century)
The field of Pharmacy can
generally be divided into three main disciplines:
- Pharmaceutics
- Medicinal chemistry and Pharmacognosy
- Pharmacy practice
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
-
Main article: Pharmacist
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.
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 Pharmacy Guild of Australia (PGA), and the American
Pharmacists Association (APhA). 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.
Types of
pharmacy practice settings
Community
pharmacy
19th
century Italian pharmacy Modern pharmacy in Norway
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
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 shampoo, bandages, office supplies, candy,
and snack foods.
Hospital
pharmacy
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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. Some hospital
pharmacies have decided to outsource high risk preparations and some other
compounding functions to companies who specialize in compounding.
Nuclear
pharmacy
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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.
Compounding
pharmacy
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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.
Compounding pharmacies specialize in compounding, although many also dispense
the same non-compounded drugs that patients can obtain from community
pharmacies.
Consultant
pharmacy
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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. 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.
Internet
pharmacy
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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 course as history has shown,
substandard products can be dispensed by both Internet and Community pharmacies,
so it is best that the buyer beware.
Canada is home to dozens of licensed Internet pharmacies, many which sell
their lower-cost prescription drugs to U.S. consumers, who pay the world's
highest drug prices. However, there are Internet pharmacies in many other
countries including Israel, Fiji and the UK that serve customers worldwide.
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.
Issues in
pharmacy
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.[citation
needed] 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. However, the American Medical Association (AMA) Code of
Ethics provides that physicians may dispense drugs within their office practices
as long as there is no patient exploitation and patients have the right to a
written prescription that can be filled elsewhere. 7 to 10 percent of American
physician practices reportedly dispense drugs on their own.[1]
In other 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 sometimes integrated with that of the physician,
particularly in traditional Chinese medicine.
In Canada it is common for a medical clinic and a pharmacy to be located
together 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).
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.[2]
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 the United Kingdom,
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."[3]
