Role of a Pharmacist in Health Care SystemThe foremost parts of this issue are—

1. Pharmacist2. Position of a Pharmacist3. Health care system

Pharmacist: A Pharmacist in one who is well-informed & certified to prepare & dispensing drugs & to afford drug & associated information to the community.

There has never been a better time to consider a rewarding career in pharmacy. The demand for trained pharmacy professionals has dramatically increased in recent years due the rapid growth of the health care and pharmaceutical industries, especially for the growing elderly population. The number of Pharmacists in health care services also is escalating as Pharmacists become more actively involved in drug therapy decision-making for patients of all ages.Role of a Pharmacist: Role of a Pharmacist means, in which fields a Pharmacist can perform.

The ideal frontline Pharmacist of the future has been described as a seven star Pharmacist-some one who is equal in excellence to a five star hotel yet accessible to everyone from the richest to the poor. The future 7 star Pharmacists will have seven principal roles to play:

--Care giver; -- Decision-maker;-- Communicator; -- Leader; -- Manager; -- Life long learner and -- Role model.

A Pharmacist with the above skills and attitudes should make himself an indispensable partner in health care system of a nation.Health care system: Pharmacists play a vital role in health care system through the medicine and information they provide.

While responsibilities vary among the different areas of pharmacy practice, the bottom line is that Pharmacists help patients get well. Pharmacist responsibilities include a range of care for patients, from dispensing medications to monitoring patient health and progress to maximize their response to the medication. Pharmacists educate consumers and patients on the use of prescriptions and over-the-counter medications, and advise physicians, nurses, and other health professionals on drug selection and utility. Pharmacists also provide expertise about the composition of drugs, including their chemical, biological, and physical properties and their manufacture and use. They ensure drug purity and strength and make sure that drugs do not interact in a harmful way. Pharmacists are drug experts ultimately concerned about their patients’ health and wellness.

The World health organization (WHO) report on “The role of the Pharmacist in the health care system” states that the competence of the Pharmacist is already proven and control.

- In health promotion and social responsibilities;- In the direction and administrative of pharmaceutical services;- In drug regulation and control;

- In the formulation and quality control of pharmaceutical products;- In the inspection and assessment of drug manufacturing facilities;- In the assurance of product quality through the distribution chain;- In drug procurement agencies and- In National and institutional formulary & therapeutics committees.

In health promotion and social responsibilities: - A Pharmacist has an important role to play in health promotion and primary, secondary and tertiary prevention, especially in relation to the management of chronic diseases. Discussed below in details-----

Sexually Transmitted Diseases-AIDS: - India has 3.5 million HIV positive cases, which is about 10% of the global HIV cases and barely second to South Africa. HIV drugs are expensive and beyond the reach of common man. Huge resource of community Pharmacist can educate people in the prevention and information of HIV/AIDS. For this, Federation of Indian Pharmacists project in India on involvement of Pharmacist in fight against AIDS is very relevant.

Another sensitive issue is the increasing number of women patients suffering from AIDS. The number rose from 7% in 1985 to 18% in 1995. Although many classes of antiretroviral are available like protease inhibitors, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors, patients need close monitoring and strict dietary regimen. Explaining to what HIV is, its transmission, risk reduction, patient counseling are the components of the counseling that a community Pharmacist can provide.

Pneumococcal disease and influenza: - The role of a Pharmacist in immunizing adults against pneumococcal disease and influenza is discussed. Pneumococcal disease and influenza each cause up to 40,000 deaths annually in the United States. Vaccination against these diseases is encouraged for all people 65 years of age or older and for those with certain chronic diseases or immunosuppressant. Influenza virus vaccine should also be given to residents of long-term-care facilities, many pregnant women, and health care workers. Pneumococcal vaccine is usually given once in a lifetime; influenza virus vaccine is given annually in the fall. Advocacy of immunization is consistent with the precepts of pharmaceutical care, and Pharmacists can promote immunization by assuming the roles of educator, facilitator, and immunizer. Despite lack of specific mention of it in accreditation standards, health-system personnel have a duty to vaccinate adults, just as they do pediatric patients. Pharmacists should review immunization records with patients periodically and at the time of immunization. As with other drug products, formulary decisions and the distribution, storage, and handling of vaccines are important Pharmacist responsibilities. Pharmacoeconomic studies have demonstrated the value of pneumococcal and influenza virus vaccines. Medicare covers these vaccines under Part B. Pharmacists have an important role to play in promoting adult immunizations against pneumococcal disease and influenza.

Chronic disease management: - A Pharmacist’s role in the control of the chronic disease can range from the support of proven community programs such as screening and disease management clinics for diabetes etc.

Nutrition Counseling: - Community Pharmacist can make, significant contributions in assuring adequate nutrition by advising his patients about basic food needs, keeping to correct improper food habits in children, advising on special requirements, suggesting special diet instructions for diabetic patients and people

with food allergy and participating in school lunch programs and schemes like mid-day meals etc. in rural areas.

There are certain facts such as women who often eat fish or omega-3-fatty acids are less likely to suffer stroke, symptoms of hyper vitaminosis result in irregular menstrual cycle and excessive intake during pregnancy may cause birth defects. The Pharmacist can tell these facts to people to ensure better health. Now a days designer foods i.e. nutraceuticals/ dietary supplements have not only gained considerable acceptance but also have newfound use and applications. They are considered to provide medical or health benefits. The community Pharmacist could explain these new innovative products and their standardization.

Oral health: - A report of the surgeon Generas (May 2000) and the healthy people 2010 focus area on oral health. The call to action seems expand on these efforts by enlisting the expertise of individuals, health researchers and cure providers communities and policymakers at all levels of society. A Pharmacist has numerous opportunities on a daily basis to positively affect his trend.

The American dental association has published pamphlets for dentists and Pharmacists that cover oral structures and diseases prevention to caries, OTC and prescription dental drugs and how these two professions can collaborate

Environmental health: - About this a Pharmacists should adapt his methods of health educations.

A Pharmacist role in environmental health is related primarily to being alert to the conditions prevailing in the community and of working with others to adequately control any of the attendant hazards

All elements of the natural environment can be altered, some time with harmful results. Air, food, water and the earth can all become sources of illness in the home, public or work environments. Such as Food remains a significant vehicle of disease organisms. Al through pasteurization has eliminated milk as a medium for disease distribution.

Mental health: - A Pharmacist should be aware of their local community mental health services, especially those catering to ambulatory patients. The timely referral of patients exhibiting unusual behavior to these facilities may be life saving, especially in those persons who demonstrate suicidal tendencies.

Epidemilogy: - Epidemilogy is the study of the distribution and determination of health related events in specific population and the application of this field in the control of these events. Epidemilogy relates to the interaction of hosts and their environment with attention to those particular agents in the environment that are causal factors of disease. The alert Pharmacist who can apply the basic principal of Epidemiology in their community will become a significant member of the health team.

Health measurement: - A Pharmacist in the health professional in the most frequent contact with the general public and this function as a community health education makes the Pharmacist role unique. By staying abreast of local health statistics Pharmacist can function as a valuable resource person to researchers conduction epidemiological studies in the community.

Health education: - The objective of health education is to provide the individualized information necessary for patients to modify their behavior, all in an effort to live a healthier life. Pharmacists actively promote good health practices through their own personal example and by reaching out to provide professional information to the public. Many Pharmacists participate in patient health education

through the use of pamphlets & bulletins that cover every medical subject imaginable. Participation of a Pharmacist in community health education programs must be recommended but it is in the every person to person contact that the Pharmacist serves most effectively.

Alcohols, Drug Abuse and Smoking Cessation : - The diseases of alcoholism and drug abuse also come under the preview of the community Pharmacist. The Pharmacist has a key role to help individuals who become dependent upon alcohol. Drug abuse is similar to alcoholism yet different because it has been gaining more acceptances among young people. Annual mortality from tobacco use exceeds that from all other causes combined. Smoking is the greatest single preventable cause of morbidity and mortality in India. It is the responsibility of a community Pharmacist to take an active role in helping the smokers to stop smoking. Following a number of smoking policies through out the pharmacy, by written information and posters, can do this. The Pharmacist can advise on the products available to assist the patient in giving up smoking. Counseling sessions can be made by the community Pharmacist to stop smoking.

Vaccinations: - Administering vaccines to patients and health care workers is enabling some health-system Pharmacists to assume a prominent role in public health. Pharmacists have noticed that immunization needs were not being met and, through their advocacy, increased the numbers of patients and employees of health systems who have been vaccinated.

Family planning: - Although pharmacies now dispense primarily modern products originating in large multinational corporations, the community Pharmacist has not been replaced by any ultramodern technological advance. Many thousand persons acquire family planning products in pharmacies. The Pharmacist works many hours a day, is always available, and provides free advice to his clients. Pharmacists are consulted daily on numerous topics, especially on family planning. Many parsons in rural areas are without the services of a physician and rely on Pharmacists all the more. Pharmacists could orient the public on family planning in general, help in choosing the most appropriate of available methods, and refer patients to physicians in case of problems. Participants at the recent International Conference on the Role of Retail Pharmacists in Family Planning, held in Alexandria, Egypt, concluded that Pharmacists should cooperate with physicians and other health professionals to provide family planning services and should participate in elaboration of laws regulating the manufacture, storage, prices, and distribution of contraceptives. The prices of contraceptive supplies to the consumer could be reduced if taxes and import duties were removed, if supplies were produced locally, or if supplies were subsidized by some donor organization.

Cholesterol Risk Management:- A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to Pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point

was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication.

As a result the external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs, 31% in usual care.

Finally, A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community Pharmacists working in collaboration with patients and physicians.

Women Welfare-Pregnancy and Infant Care : - A famous Sanskrit Shloka from Manusmriti scriptures goes as “Yatra Nariyastu Poojayanta, Ramante Tatra Deva” which means, “where women are worshipped Gods preside there”.Women are the corner stone for effective public health and investing in women translate into investing in family, community and the Nation. Against the backdrop of a hectic and demanding schedule, women’s health receives the least priority when it should be the first. A woman goes through different stages throughout her life, each of which has specific need and the presence of a counselor is needed in each one of them. The Pharmacist who understands the normal course of pregnancy and infancy is at a distinct advantage as he or she can guide the mother in simple matters of hygiene and management. The community Pharmacist can encourage breastfeeding and can play a major role by guiding the mother for the protection of the child by following proper immunization schedule. Efforts are definitely underway in this area.

Individualization of Drug Therapy : - Today the latest concept in medicine is towards individualization of drug therapy. Where judicious patient care is needed individualization of drug therapy becomes a need, and a Pharmacist can play a vital role in this. A physician who is preoccupied with patient diagnosis and treatment may not spare time for patient counseling regarding pharmaco-economics, drug information, alternative therapy, moral supporting etc. A Pharmacist can set up a separate consultation room and provide counseling to the patient. He can store the details of patient history, allergies and other details necessary for therapy so that the concept of individualization of drug therapy could be implemented.

Radio pharmacy: - This is a specialized area of pharmacy, where radio active materials are produced as drugs for the diagnostics of certain diseases like Thyroid problem by Iodine isotope. Here a Pharmacist has a significant role to play.

Consultancy service: - It’s another area in where a Pharmacist can play a role directly in public health.

For independent career & business consultancy in pharmacy profession is challenging & demanding & has got a good scope of successful career build up.

Disease prevention: - Three levels of prevention exist. Here pharmacists play a great role.

1) Primary: - Primary prevention is helping people maintain their health or improve the quality of their lives through a health lifestyle. An example of primary prevention is the control of infection through immunization. 2) Secondary: - Secondary prevention in the early diagnosis and treatment of an already existing disease the use of penicillin in the treatment of a streptococcal infection prevent the onset of rheumatic fever. Thus a pharmacist can perform a vital service by advising patients, who present a febrile illness characterized by a sore throat to see a physician. 3) Tertiary prevention: - Tertiary prevention largely consists of rehabilitation. Most chromic disease can not be cured but their progress can be re-tarded with maximum benefit to the patient. Much can be done for instance with rheumatoid arthritis to make patients more comfortable and more productive in their daily lives.

In the direction & administrative of pharmaceutical services: - In this branch there are opportunities to a Pharmacist of all education levels. The largest numbers of Pharmacists are involved in marketing & administration. There marketing people (Pharmacists) educate physicians & community Pharmacists, hospital Pharmacists etc. about manufactures product. This can be a rewarding career for a Pharmacist with right personality & motivation. Pharmacist with master degree in business or additional LLB degree find opportunities in the marketing sales & regulatory affairs departments. Production & quality control supervisory positions are held by Pharmacists with bachelor or master degree. Pharmacist with higher like pharm D or PhD degree serve the industry as top post executive or research scientist.

In Hospital management: - A Pharmacist has a great role to play in hospital administration. The governing body has total accountability within the organization’s structure in most hospitals. This board commonly hires a CEO to lead the organization & make recommendations to the board. This offer is commonly referred to as the CEO, president or superintendent. In the case of the federal hospitals, there is usually a federal structure through which local hospitals are organized & report. State, county & city hospitals often have a governing board appointed by the designated political officer. In the nonprofit, nongovernmental hospital, there is usually a governing board, board of trustees, board of governors or other titled group that assumes over all responsibility for the proper operation of the hospital so that adequate service can be rendered to the sick & injured at as low a cost as is compatible with efficiency. All this posts are restricted for only physicians & Pharmacists.

The responsibilities of a hospital Pharmacist is to develop a high quality comprehensive pharmaceutical service, properly coordinate & meet the needs of the numerous diagnostic & therapeutic departments, the nursing service, the medical staff, medical equipments of hospital & the hospital as a whole in the interest of community improving patient care.

In health maintenance organizations: - In health maintenance organizations (HMO) is a public or private organization that provides & manages comprehensive health services to individuals enrolled win the HMO of the health plan. Here a Pharmacist can play a role in the administration of this kind of organization or give direction.

In drug regulation & control: A Pharmacist in government drug regulatory affair department plays his role by regulating the quality of medications, price of the medications, applying the ethics & law about medications & industries.In the formulation & quality control of pharmaceutical products: The formulation of any medication is only depended on Pharmacist. It is one of the important roles of a Pharmacist.

The physical, chemical & biological quality of a pharmaceutical product intended for administration to patients in the home must be of the highest quality attainable. This quality must be built in to the product in each step of the aseptic compounding process, that is, in the starting components, the design & operation of the compounding facilities, the control of the environment & the qualifications of operators all contribute to the final quality of the product, either in a positive or negative manner. Therefore, the control of quality is a continuous process through out the compounding of the product. Testing of the finished product can only confirm the quality built in to the product during its preparation. Here only a Pharmacist can play his role. In the inspection & assessment of drug manufacturing facilities: The another important duty of a Pharmacist (by joining the government testing laboratory & medicine regulatory service) is inspect the pharmaceutical industries, their environment, quality of medications, facilities & assesses the medications. In the assurance of product quality through the distribution chain: Distribution of medication is two types—

1. From industry to market2. From hospital to the patient (through prescription)From industry to market: - After produced, before sending to the market

ensuring the quality of pharmaceutical products is must, because it is directly related with life. Here only a Pharmacist plays a significant role.

From hospital to the patient (through prescription): - The medication distribution system in hospitals is very complex & involves in several health care professionals. The usual flow is physician prescribes, Pharmacist dispenses & nurses administer medication. Here the Pharmacist who dispenses, has the right to change the medicine which is prescribed by the physician to ensure the quality of that medicine.In drug procurement agencies: The work of drug procurement agencies is to supply the medication & find out the possible customer in home & abroad. Here a Pharmacist plays a great role.In national & intuitional formulary & therapeutics committees: During recent years, with the development of the clinical pharmacy movement, a number of clinical Pharmacists on the staff of some departments have developed expertise in specific therapeutic specially areas. Therefore, it was a logical development under the pharmacy & therapeutics committee.

The formulary system has attempted to outline the scientific data on a medication, including its toxicities, untoward side effects, safety profile & beneficial effects- has been a controversial method of appraising medication therapy. All these are provided by a formulary committee of a nation & this formulary committee is constructed by the Pharmacists.

Except these a Pharmacist has important role to play as an Academic Pharmacist, Chain Drug Store Pharmacist, Compounding Pharmacist, Critical Care Pharmacist, Drug Information Specialist, Grocery Chain Pharmacist, Home Care Pharmacist, Hospice Pharmacist, Hospital Staff Pharmacist, Infectious Disease

Pharmacist, Long-Term Care Pharmacist, Managed Care Pharmacist, Military Pharmacist, Nuclear Pharmacist, Oncology Pharmacist, Operating Room Pharmacist, Pediatric Pharmacist, Pharmacist in Non-traditional Settings, Pharmacy Benefits Manager, Poison Control Pharmacist, Primary Care Pharmacist, Psychiatric Pharmacist, Veterinary Pharmacist.

Conclusion: From the above consideration, it is clear that the Pharmacists have definite beneficial roles regarding health matters. A Pharmacist is the legally qualified and professionally competent person to handle drugs and allied supplies required for the patients within and outside the hospital. It is a matter of regret that the government of our country is taking very little effort to employ highly skilled pharmacy personnel in different sectors of the health services. But in the developed countries, Pharmacists are in unique position in this regard. So, the governmental health policy should be modified by incorporation Pharmacist in different sectors to improve and ensure the health service for the well being of people of our country.

[References: -1. Remington (The science and practice of Pharmacy)

21st edition2. Article: Pharmacists' Involvement with Vaccinations Leads to Preventive Health Care Role

BY: Krysten. A. ModrzejewskiAmerican society of health – System Pharmacists.

3. Article: Smoking Cessation Guidelines for Health Professionals - A guide to effective smoking cessation interventions for the health care system

By: MARTIN RAW, PhD Freelance Consultant; Honorary Senior Lecturer in Public Health

King's College School of Medicine and Dentistry, University of London, London, UK4. Article: A Randomized Trial of the Effect of Community Pharmacist Intervention on Cholesterol Risk Management The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)

By: Ross T. Tsuyuki, BSc(Pharm),PharmD,MSc; Jeffrey A. Johnson, BSP,PhD; 5. Article: Health-system pharmacists' role in immunizing adults against pneumococcal disease and influenza

By: JD Grabenstein and J BonassoAmerican Journal of Health-System Pharmacy, Vol 56, Issue suppl_2, S3-S22

6. Article: The pharmacist should play an active role in family planningNCBI, a service of the National Library of Medicine and the National Intuition of

Health 7. Article: Role of community pharmacist in ensuring better healthcare

By: Harish Dureja and Deepak KaushikLecturers at Department of Pharmaceutical SciencesM. D. University, Rohtak (Haryana)

8. Article: New role for pharmacists

By: Jessica Whiteside University of Toronto

9. Article: Role of the pharmacist in healthcare systemBy: S S BhiseThe author is principal, Government College of Pharmacy, Osmanpura,

Aurangabad10. Article: Community pharmacy in Australia

NCBI, a service of the National Library of Medicine and the National Intuition of Health11. Article: SIUE school of Pharmacy

Board of Trustees, Souther Illinols University12. http://www.pubmed.gov13. http://www.pubmed.gov