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THE PRIMARY ROLES OF COMMUNITY PHARMACISTS IN THE UNITED STATES AND IN PHILIPPINES - NICOLE ANNE M. APA
Pharmacists are specialists in the science and clinical use of medications. As health care providers, “they serve important roles for helping assure that the use of medicines results in the highest likelihood of achieving desired health and economic outcomes” (Pharmacist Contributions to the U.S. Health Care System, 2010, p.1). Their roles vary in different areas of practice in different parts of the world. Nevertheless, they share one common mission. According to the International Pharmaceutical Federation, “the mission of all pharmacists is to help people and the society make the best use of their medicines” (“ASHP guidelines: Minimum Standards for Pharmacies in Hospitals”, 2013). They are not only responsible for the provision of medicines and other healthcare products but the results of their services as well. Pharmacists practice in wide variety of setting, though, community pharmacists are arguably the most accessible health care providers to the public. Community pharmacists are health care professionals who serve an integral role as part of a patient’s health care team by providing services such as the coordination of medications, disease prevention and management and patient education. In an annual survey conducted by Gallup, an American research-based, global-performance-management consulting company, pharmacists were ranked second as one of the most trusted professionals in United States in terms of honesty and ethical standards in year 2012 (Oldfield, 2012). In other developing countries, such as Philippines, where there is inefficient health care system and less access to health care and the public perception of community pharmacists is very weak. They are merely viewed as drug sellers. Although, pharmacists in the United States and in Philippines both perform similar roles in the practice of community pharmacy, they differ in the complexity and efficacy of their services in the areas of medication management and reconciliation, preventive care services and patient education.
Mosby’s Medical Dictionary (2009) defines medication management as “the facilitation of safe and effective use of prescription and over-the-counter drugs”. In addition, medication reconciliation is “the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency and route of administration by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider”(2009).
It is the primary responsibility of community pharmacists both in the United States and in the Philippines to control, dispense and distribute medicines according to legal and ethical guidelines. They verify the authenticity, safety and accuracy of prescription orders and ensure that quantity of medication dispensed is accurate. In United States, pharmacists collect patient-specific information, such as demographics and patient-reported information such as medical history, previous adverse drug reactions, allergies, complaints and even third party information for billing purposes. They also create a list of all medications that the patient is taking based on prescription orders dispensed and obtained from a patient, hospital or other health care providers. In dispensing, pharmacists provide medication labels that indicate the prescriber’s instruction on how the medication should be taken, the frequency, the quantity dispensed, the remaining fills, the intended effects, the side effects and what the medication is for. It is a common practice among community pharmacists in the United States to communicate and clarify with prescribers that dosages are correct and verify that new treatments are compatible with other medications the patient may be taking. With the help of developed computer systems in U.S., community pharmacists are able to detect adverse drug reactions and inform patients of the dates their prescriptions are due to fill. It is one of their duties to bill the patient’s medications through his insurance and communicate with the third party whenever problems in billing arise. The billing, filling, verifying and dispensing of medications by the pharmacists are mostly processed through computers with customized system developed by pharmacy companies. Meanwhile, community pharmacists in Philippines are not obligated to collect or maintain patient records. Most pharmacies return written prescriptions to patients once the order is dispensed. As a result, pharmacists cannot keep track of all the medications currently in use by a patient nor the remaining fills needed for each medication. In most cases, pharmacists do not bill medications through insurance, mostly because, in developing and transitional economies such as Philippines, 50-90% of medicines are paid out-of-pocket (Wiedenmayer et al., 2006). Although it is mandatory by law that prescription drugs shall be dispensed only upon presentation of prescription, it is unfortunate that most pharmacies in this country dispense them without prescriptions. In a national convention hosted by the Philippine Pharmacists Association last April 2012, Leonila Ocampo RPh. MS, former president of the association, reported that in the Philippines, there is a poor implementation of “no prescription, no dispensing” policy and that in most non-traditional drug stores, the sale of medicines are unsupervised by registered pharmacists. In addition, community pharmacists in this country dispense medications without medication labels. Hence, in terms of how and when the medication should be taken, patients mostly rely on memory based on what they remember during their counsel with a prescriber or pharmacist. Regardless of the significant difference between the standard of practice of community pharmacy in these two countries, the goal of medication management and reconciliation is to optimize drug therapy and improve therapeutic outcomes.
Another significant role played by community pharmacists in the United States and in Philippines is the provider of preventive care services. They provide individualized health promotion and disease prevention, including administration of immunization where there is legally and organizationally authorized. They perform screening tests for blood pressure or cholesterol. With a rapid growth of global population, there is also an increase in the usage of multiple medicines for chronic conditions (Chen, 2014). While chronic conditions are very common and expensive, many are preventable. In United States, forty-nine (49) states have adopted laws and regulations that authorize pharmacists to administer vaccines. More than 40,000 American pharmacists received training and recognition as providers of various immunization services (Manolakis & Skelton, 2010). “A number of preventive services currently rated “A” or “B” are frequently administered by pharmacists in U.S., including blood pressure, cholesterol screening, tobacco cessation and obesity-related counselling intervention and routine immunization” (Coster, 2010, p.2). In Philippines, administration of immunization was not authorized until September 2014 when the Food and Drug Administration collaborated with the Philippines Pharmacists Association to train and authorize FDA-licensed community pharmacists in drug stores to administer adult vaccines and other immuno-products (Uy, 2014). Community pharmacists help prevent progression and further disability of patients through providing preventive care services. These services help in the early detection and treatment of disease that may also help identify potential risks for early diagnosis and treatment.
One of the most professional roles of community pharmacists is patient education. It is their responsibility to incorporate appropriate patient counselling in their practice. Community pharmacists in United States and Philippines provide information, education, counselling to patients about medication-related needs. They counsel patients on their proper use of medicines and they ensure that the public is aware of the potential side effects of the medications they are taking. Besides providing information, they also help treat minor ailments. However, first, they determine whether an over-the- counter drug treatment is suitable and in what circumstances need referral to a physician. They use an evidence-based approach, relying on the information provided by a patient to address problems and make recommendations for optimization of therapy. If necessary, they provide special instructions and precautions such in the event of a missed dose. In United States, majority of pharmacies has consultation areas. Nineteen (19) states require pharmacists to provide oral counselling in certain situations such as when a patient is about to take a new prescription. In twenty-nine (29) states, pharmacists are only required to counsel or offer to counsel. In twenty-eight (28) states, pharmacists are obliged to counsel on the efficacy of a drug and price difference before a generic medication is substituted for a brand name drug (Spector & Youdelman, 2010). In the Philippines, although there are regulations that encourage pharmacists to perform patient counsel, it is not mandatory. As one can ordinarily observe, patient counsel is a practice often not rendered by community pharmacists because of several factors that may include the lack of initiative of pharmacists or the lack of awareness of the importance of a pharmacist from a patient or a mere customer of healthcare products or services. It has been estimated that over all adherence to medications is only around 50% (Blenkinsopp et al, 2000). Through patient counselling, medication errors are reduced and a patient’s understanding and management of his medications are increased.
In United States, where there is a strong presence of health care services, adequate access to health care and effective implementation of pharmacy law, community pharmacists are able to play more complex and varied roles in the health care system and provide a wide range of health care service to patients. In addition, the pharmacy profession in this country dedicates itself to a philosophy of practice that clearly identifies patients as the primary beneficiaries. In Philippines, where there is inadequate access to health care and poor reinforcement of pharmacy laws, the practice of community pharmacy is considered as a mere transactional process with minimal patient medication counselling and limited healthcare services. Community pharmacists in this country act more as dispensers of drugs and are less viewed as providers of pharmaceutical service. Therefore, the service and treatment provided to a patient by a community pharmacist can vary significantly depending on several factors and this includes the standards of practice of community pharmacy set in a country.
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