Public health is the science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research on disease and prevention.
Public health is the science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research on disease and prevention. Public health helps improve the health and well-being of people in local communities and around the globe. Public health to prevent health problems before they occur.
Pharmacists and the health care system:
In Greek and Roman mythology, Hygicia (the source of the word “hygiene”) was the daughter of the father of medicine. She was the goddess of health, cleanliness, sanitation, and social welfare and was associated with the prevention of sickness and the continuation of good health.
In today’s world, we would say she was a public health specialist, contrary to her father, Asclepius, who directly dealt with healing. Her ordinary presentation is with a serpent, which she is feeding from a large bowl. The bowl is universally recognised as the symbol of the pharmacy profession. Therefore, symbolically, public health and pharmacy seem to have been linked since the ancient world.
When public health was at its infancy stage, when it was confined to sanitation and good housing with special attention on the use of dean water, there was little for pharmacists to get involved in. However, with the changing scope of public health to include addressing current challenges and the provision of quality services, pharmacists should seize the opportunity and take their place at the table.
The onus is on them to demonstrate to professional peers and policymakers that their special skills in medicine management are unique attributes of the profession that make them an integral part of the healthcare system. The 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—someone who is equal in excellence to a five-star hotel yet accessible to everyone, from the richest to the poor. The future 7-star pharmacist will have seven principal roles to play:
–Care giver;
— Decision-maker
–Communicator;
–Leader;
–Manager;
–Lifelong learner
7-star pharmacist:
In 1997, the World Health Organisation introduced the “seven-star pharmacist” concept, covering the different roles each pharmacist must perform: carer, decision-maker, communicator, manager, lifelong learner, teacher, and leader. And the first star refers to the pharmacist’s role in public health.
Health care system:
Pharmacists play a vital role in the 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.
Pharmacists 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 who are ultimately concerned about their patients’ health and wellness. The World Health Organisation (WHO) report on “The Role of the Pharmacist in the Health Care System”, states that the competence of the pharmacist is already proven and controlled.
-In health promotion and social responsibilities;
-In the direction and administration 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 distribution;
-In drug procurement agencies and in national and institutional formularies and 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 disease chains. Discussed below in
Sexually Transmitted Diseases: AIDS:
HIV drugs are expensive and beyond the reach of the common man. A huge resource of community pharmacists can educate people on the prevention and information of HIV/AIDS.
The National AIDS Programme’s latest figures show that over 4,000 HIV cases have so far been reported since 1986, but UN and government estimates put the number of HIV/AIDS cases around 97,000, ranging from the lowest estimate of 46,000 to the highest estimate of 210,000.
More realistic estimates that are based on actual surveillance figures, however, suggest that this number may be closer to 40,000–45,000. The overall prevalence of HIV infection in adults aged 15 to 49 is 0.1%. (0.05% if one accepts the lower estimates).
Officials say that the majority of cases go unreported due to social taboos about sex and victims’ fears of discrimination. On the other hand, more detailed and recent data suggest that this may be an overestimate.
Pneumococcal disease and influenza
The role of a pharmacist in immunising adults against pneumococcal disease and influenza is very important. Pneumococcal disease and influenza each cause up to 40,000 deaths annually in the United States. Influenza vaccine, or the ‘flu shot, is a vaccine against influenza that is given every year around October, before the influenza season, to protect against this disease.
Influenza is a viral infection that causes significant respiratory illness in people of all ages. The vaccine is made against the strains of influenza that are likely to be circulating in the coming season. 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 immunisations against pneumococcal disease and influenza.
Chronic disease management:
A pharmacist’s role in the control of chronic disease can range from the support of proven community programmes such as screening and disease management clinics for diabetes, etc.
Nutrition Counselling:
A community pharmacist can play a significant role in ensuring adequate nutrition by advising his patients about basic food needs, keeping track of improper food habits in children, advising on special requirements, suggesting special diet instructions for diabetic patients and people with food allergies, and participating in school lunch programmes and schemes like mid-day meals, etc., in rural areas.
There are certain facts, such as that women who often eat fish or omega-3 fatty acids are less likely to suffer stroke, symptoms of hypervitaminosis result in an irregular menstrual cycle, and excessive intake during pregnancy may cause birth defects.
Oral health:
A report by the surgeon Generas (May 2000) and the Healthy People 2010 focus area on oral health. The call to action seems to expand on these efforts by enlisting the expertise of individuals, health researchers, 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 of caries, OTC and prescription dental drugs, and how these two professions can collaborate.
Environmental health:-
Pharmacists should adapt his methods of health education. A pharmacist’s role in environmental health is related primarily to being alert to the conditions prevailing in the community and working with others to adequately control any of the attendant hazards. All elements of the natural environment can be altered, sometimes with harmful results.
Air, food, water, and the earth can all become sources of illness in the home, public, or work environments. Food remains a significant vehicle for disease organisms. Through pasteurisation, milk has been eliminated 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 behaviour to these facilities may be lifesaving. Especially in those who demonstrate suicidal tendencies.
Epidemiology:
Epidemiology is the study of the distribution and determination of health-related events in a specific population and the application of this field to the control of these events.
Epidemiology 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 principles of epidemiology in their community will become a significant member of the health team.
Health measurement:
A pharmacist is a health professional in most frequent contact with the general public, and this function as a community health educator makes the pharmacist’s role unique. By staying abreast of local health statistics, pharmacists can function as a valuable resource for researchers conducting epidemiological studies in the community.
Health education:
The objective of health education is to provide the individualized information necessary for patients to modify their behaviour 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 through the use of pamphlets and 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.
Alcohol, drug abuse, and smoking cessation
The diseases of alcoholism and drug abuse also come under the care of the community pharmacist. The pharmacist has a key role in helping individuals who become dependent on alcohol.
Drug abuse is similar to alcoholism but different because it has gained more acceptance among young people. Annual mortality from tobacco use exceeds that from all other causes combined. Smoking is the single greatest preventable cause of morbidity and mortality in India.
It is the responsibility of a community pharmacist to take an active role in helping smokers stop smoking. Following a number of smoking policies throughout the pharmacy, through written information and posters, can do this. The pharmacist can advise on the products available to assist the patient in giving up smoking. Counselling sessions can be made by the community pharmacist to help people 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 thousands of people 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 family planning. Many patients 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 the available methods, and refer patients to physicians in case of problems. The pharmacists should cooperate with physicians and other health professionals to provide family planning services and should participate in the elaboration of laws regulating the manufacture, storage, prices, and distribution of contraceptives.
The price 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 subsidised by some donor organisation.
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, a 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 the performance of a fasting cholesterol panel by the physician or the addition or increase in dose of cholesterol-lowering medication. As a result, the external monitoring committee recommended early study termination due to benefits. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians.
Women’s Welfare: Pregnancy and Infant Care:
Women’s health care is the first priority in India. Women are the cornerstone of effective public health, and investing in women translates into investing in family, community, and the nation.
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 breast feeding and play a major role by guiding the mother for the protection of the child by following a proper immunization schedule. Efforts are definitely underway in this area.
Individualization of Drug Therapy:
Today, the latest concept in medicine is the individualization of drug therapy. Where judicious patient care is needed, individualization of drug therapy becomes a necessity, 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 counselling regarding pharmacoeconomics, drug information, alternative therapy, moral support, etc.
A pharmacist can set up a separate consultation room and provide counselling 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 can be implemented.
Radio pharmacy:
This is a specialised area of pharmacy where radioactive materials are produced as drugs for the diagnosis of certain diseases, like thyroid problems, using lodine isotopes. Here, a pharmacist has a significant role to play.
Consultancy service:-
It’s another area in which a pharmacist can play a direct role in public health. Independent careers and business consulting in the pharmacy profession are challenging and demanding and have a good scope for successful career building.
Disease prevention: –
Three levels of prevention exist. Here, pharmacists play a great role in education.
1) Primary:
Primary prevention is helping people maintain their health or improve the quality of their lives through a healthy lifestyle. An example of primary prevention is the control of infection through immunisation.
2) Secondary:-
Secondary prevention is the early diagnosis and treatment of an already existing disease. The use of penicillin in the treatment of a streptococcal infection prevents the onset of rheumatic fever. Thus, a pharmacist can perform a vital service by advising patients who present with a febrile illness characterised by a sore throat to see a physician.
3) Tertiary prevention:
Tertiary prevention largely consists of rehabilitation. Most chromic diseases cannot be cured, but their progress can be retarded with maximum benefit to the patient. Much can be done, for instance, with rheumatoid arthritis to make patients more comfortable and productive in their daily lives.
Rational Use of Drugs
A community pharmacist can also discuss the administration of the medication, provide information on the storage of the medication, and, wherever necessary, counsel the patient. A drug information system should be set up, and access to the adverse drug reaction ‘system should be made available.
A community pharmacist should do therapeutic drug monitoring, and he should have a sound knowledge of genotype reporting, i.e., predictive pharmacology. How many among the common people know that drugs such as Action 500 and Coldarin can increase blood pressure in patients with hypertension?
Even pain shows a difference between men and women. Where women respond better to opiods such as morphine, pentazocine, and pethidine, men respond better to the non-steroidal anti-inflammatory drug ibuprofen.
In a nut shell there should be rational use of drug i.e., right drug in right patient in right dose at right time A community pharmacist is one of the inevitable members of the health care team who can help to achieve goal of rational use of drugs.
In hospital management:
A pharmacist has a great role to play in hospital administration. In most hospitals, the governing body has total accountability within the organization’s structure. This board commonly hires a CEO to lead the organisation and make recommendations to the board.
This person is commonly referred to as the CEO, president, or superintendent. In the case of federal hospitals, there is usually a federal structure through which local hospitals are organised and report. State, county, and city hospitals often have a governing board appointed by the designated political officer.
In a nonprofit, nongovernmental hospital, there is usually a governing board, board of trustees, board of governors, or other titled group that assumes overall responsibility for the proper operation of the hospital so that adequate service can be rendered to the sick and injured at as low a cost as is compatible with efficiency.
All these posts are restricted to physicians and pharmacists. The responsibilities of a hospital pharmacist are to develop a high-quality comprehensive pharmaceutical service, properly coordinate and meet the needs of the numerous diagnostic and therapeutic departments, the nursing service, the medical staff, the medical equipment of the hospital, and the hospital as a whole in the interest of improving patient care in the formulation and quality control of pharmaceutical products. The formulation of any medication is only dependent on the pharmacist.
It is one of the important roles of a pharmacist. The physical, chemical, and biological quality of a pharmaceutical product intended for administration to patients at home must be of the highest quality attainable.
This quality must be built into the product at each step of the aseptic compounding process, that is, in the starting components, the design and operation of the compounding facilities, the control of the environment, and the qualifications of operators, which contribute to the final quality of the product, either in a positive or negative manner.
Therefore, the control of quality is a continuous process throughout the compounding of the product. Testing of the finished product can only confirm the quality built into the product during its preparation. Here, only a pharmacist can play his role.
In the inspection and assessment of drug manufacturing facilities:
Another important duty of a pharmacist (by joining the government testing laboratory and medicine regulatory service) is to inspect the pharmaceutical industries, their environment, quality of medications, facilities, and assess the medications.
In the assurance of product quality through the distribution chain:
The distribution of medication is of two types:
1. From industry to market
2. from the hospital to the patient (through a prescription)
From industry to market:
After being produced, before sending them to the market, ensuring the quality of pharmaceutical products is a must because it is directly related to life. Here, only a pharmacist plays a significant role.
From the hospital to the patient (through prescription):
The medication distribution system in hospitals is very complex and involves several health care professionals. The usual flow is that the physician prescribes, the pharmacist dispenses, and nurses administer medication. Here, the pharmacist, who dispenses, has the right to change the medicine that is prescribed by the physician to ensure the quality of that medicine.
In drug procurement:
The work of drug procurement agencies is to supply the medication and find out the possible customers at home and abroad. Here, a pharmacist plays a great role.
Conclusion:
Pharmacy is a dynamic profession. However, in developing countries, the profession has remained stagnant in a quagmire of past glory, risking the very essence of its existence. To arrest the waning image of the profession in developing countries, particularly in Africa, there is a need to identify service opportunities that would perpetuate the continued relevance of the profession to health systems and communities.
Even though new opportunities in the areas of public health, pharmaceutical supply chain management, pharmacovigilance, regulation, management, rational drug use, and others are emerging in different forms and designs, pharmacists appear slow to seize these opportunities and espouse them as their bread and butter.
Changes in mind sets, perceptions, curricula, and teaching methodologies are some of the ammunition required to catalyse the process of modernising the profession of pharmacy in developing countries.
More importantly, the onus is on the profession to carve its own tunnel to professional progression or to swaddle itself in the dispensing comfort of yesteryear while others dig its grave. From the above consideration, it is clear that 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 patients within and outside the hospital. The provision of public health pharmacy services is commonplace today.
Any person can enter a community pharmacy to seek drug information and obtain assistance in selecting nonprescription medicines to care for common ailments. Any institutional health care worker can request a pharmacist’s consultation for therapeutic drug monitoring or drug information.
Few health care professionals routinely offer free services to the public, as do pharmacists. Pharmacists have been providing public health services for decades, and with greater frequency at present during the pharmaceutical era paradigm.
It is a matter of regret that the government of our country is making very little effort to employ highly skilled pharmacy personnel in different sectors of the health services. But in developed countries, pharmacists are in a unique position in this regard. So, the governmental health policy should be modified by incorporating pharmacists in different sectors to improve and ensure the health service for the wellbeing of the people of our country.