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Pharmacists

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Pharmacists

For the precursor profession, see Apothecary.


Pharmacists, also known as druggists in North American English and chemists in Commonwealth English, are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of the pharmacist has shifted from the classical "lick, stick, and pour" dispensary role (that is, "lick & stick the labels, count the pills & pour liquids"), to being an integrated member of the health care team directly involved in patient care.[1][2] Pharmacists undergo university-level education to understand biochemical mechanisms of action of drugs, drug uses, and therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialized knowledge to patients, physicians, and other health care providers.

Among other licensing requirements, different countries require pharmacists to hold either a Bachelor of Pharmacy or Doctor of Pharmacy degree.

The most common pharmacist positions are that of a community pharmacist (also referred to as a retail pharmacist, first-line pharmacist or dispensing chemist), or a hospital pharmacist, where they instruct and counsel on the proper use and adverse effects of medically prescribed drugs and medicines.[3][4][5] In most countries, the profession is subject to professional regulation. Depending on the legal scope of practice, pharmacists may contribute to prescribing (also referred to as "pharmacist prescriber") and administering certain medications (e.g., immunizations) in some jurisdictions. Pharmacists may also practice in a variety of other settings, including industry, wholesaling, research, academia, military, and government.

Nature of the work

Historically, the fundamental role of pharmacists as a healthcare practitioner was to check and distribute drugs to doctors for medication that had been prescribed to patients. In more modern times, pharmacists advise patients and health care providers on the selection, dosages, interactions, and side effects of medications, and act as a learned intermediary between a prescriber and a patient. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Pharmacists may practice compounding; however, many medicines are now produced by pharmaceutical companies in a standard dosage and drug delivery form. In some jurisdictions, pharmacists have prescriptive authority to either independently prescribe under their own authority or in collaboration with a primary care physician through an agreed upon protocol.[6]

Increased numbers of drug therapies, ageing but more knowledgeable and demanding populations, and deficiencies in other areas of the health care system seem to be driving increased demand for the clinical counselling skills of the pharmacist.[1] One of the most important roles that pharmacists are currently taking on is one of pharmaceutical care.[7] Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and management of each to improve outcomes. Pharmaceutical care has many benefits that may include but are not limited to: decreased medication errors; increased patient compliance in medication regimen; better chronic disease state management; strong pharmacist–patient relationship; and decreased long-term costs of medical care.

Pharmacists are often the first point-of-contact for patients with health inquiries. Thus pharmacists have a significant role in assessing medication management in patients, and in referring patients to physicians. These roles may include, but are not limited to:

  • clinical medication management, including reviewing and monitoring of medication regimens
  • assessment of patients with undiagnosed or diagnosed conditions, and ascertaining clinical medication management needs
  • specialized monitoring of disease states, such as dosing drugs in renal and hepatic failure
  • compounding medicines
  • providing pharmaceutical information
  • providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states
  • supervising pharmacy technicians and other staff
  • oversight of dispensing medicines on prescription
  • provision of non-prescription or over-the-counter drugs
  • education and counseling for patients and other health care providers on optimal use of medicines (e.g., proper use, avoidance of overmedication)
  • referrals to other health professionals if necessary
  • pharmacokinetic evaluation
  • promoting public health by administering immunizations

Education and credentialing

The role of pharmacy education, pharmacist licensing, and continuing education vary from country to country and between regions/localities within countries. In most countries, pharmacists must obtain a university degree at a pharmacy school or related institution, and/or satisfy other national/local credentialing requirements. In many contexts, students must first complete pre-professional (undergraduate) coursework, followed by about four years of professional academic studies to obtain a degree in pharmacy (e.g., PharmD- Doctorate of Pharmacy). Pharmacists are educated in pharmacology, pharmacognosy, chemistry, organic chemistry, biochemistry, pharmaceutical chemistry, microbiology, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, physiology, anatomy, pharmacokinetics, pharmacodynamics, drug delivery, pharmaceutical care, nephrology, hepatology, and compounding of medications. Additional curriculum may cover diagnosis with emphasis on laboratory tests, disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).

On graduation, pharmacists are licensed, either nationally or regionally, to dispense medication of various types in the areas they have trained for. Some may undergo further specialized training, such as in cardiology or oncology.

Practice specialization

Specialties include:

Training and practice by country

Australia

The Australian Pharmacy Council is the independent accreditation agency for Australian pharmacists.[8] It conducts examinations on behalf of the Pharmacy Board of Australia towards eligibility for registration. The Australian College of Pharmacy provides continuing education programs for pharmacists.

Wages for pharmacists in Australia appear to have stagnated. The award wages for a pharmacist is $812 a week.[9] Pharmacist graduates are the lowest paid university graduates most years. Most pharmacists do earn above the award wage; the average male pharmacist earns $65,000, a female pharmacist averages $56,500. Over recent years, wages have stagnated, and even gone backwards. There are more graduates expected in the next few years making it even harder to get a job. Job security and increase in wages with regards to CPI could be unlikely. This is due to the large numbers of pharmacy graduates in recent years, and government desire to lower PBS costs. Contract and casual work is becoming more common. A contract pharmacist is self-employed and often called a locum; these pharmacists may be hired for one shift or for a longer period of time. There are accounts of underemployment and unemployment emerging recently.

Canada

The Canadian Pharmacists Association (CPhA) is the national professional organization for pharmacists in Canada.[5] Specific requirements for practice vary across provinces, but generally include a Bachelor's of Science in Pharmacy from a recognized university, successful completion of a national board examination through the Pharmacy Examining Board of Canada, and practical experience through an apprenticeship/internship program.

The vast majority (80%) of Canada’s licensed pharmacists work in community pharmacies, another 15 percent in hospital or institutional pharmacies, and the remainder work in situations that may not legally require licensed pharmacists such as associations, pharmaceutical companies, and consulting firms.[1] The wages for pharmacists, at about CAD $95,000, have been said to be slightly better than Australia but not as good as in the USA. This likely depends on what parts of Canada and or the USA are compared. Wages being significantly higher in Canada than the prospect for most developing countries, recruitment of pharmacists from South Africa and other countries with acute health workforce shortages to work in private franchise chains is subject to controversy.[10]

British Columbia

A Pharmacist must be registered with the University of British Columbia is the only institution in the province that trains pharmacists.

BC Professional association/college
  • College of Pharmacists of British Columbia
  • British Columbia Pharmacy Association

Germany

In Germany, the education and training is divided into three sections, each ending with a state examination:

  • University: Basic studies (four semesters)
  • University: Main studies (four semesters)
  • Community Pharmacy / Hospital Pharmacy / Industry: Practical training (12 months; 6 months in a Community Pharmacy).

Today, many pharmacists work as employees in public pharmacies. They will be paid according to the labour agreement of Adexa and employer associations.

Japan

History

In ancient Japan, the men who fulfilled roles similar to pharmacists were respected. The place of pharmacists in society was settled in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists — and even pharmacist assistants — were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.[11]

Contemporary

As of 1997, 46 universities of pharmacy in Japan graduated about 8000 students annually.[12] Contemporary practice of clinical pharmacists in Japan (as evaluated in September 2000) focuses on dispensing of drugs, consultation with patients, supplying drug information, advising on prescription changes and amending prescriptions. These practices have been linked to decreases in the average number of drugs in prescriptions, drug costs and incidence of adverse drug events.[13]

Sweden

In Sweden, the national board of health and welfare regulates the practice of all legislated health care professionals, and also is responsible for registration of pharmacists in the country. The education to become a licensed pharmacist is regulated by the European Union, and states that minimum educational requirements are five years of university studies in a pharmacy program, of which six months must be a pharmacy internship. To be admitted to pharmacy studies, students must complete a gymnasium (school for 15–18-year-olds) program in natural sciences after elementary school (6–15-year-olds). In Sweden, pharmacists are called Apotekare. At pharmacies pharmacists work together with another class of legislated health care professionals called receptarier, who have completed studies equal to a bachelor of science in pharmacy, i.e., three years of university. These latter also have dispensing rights >

Pakistan

In Pakistan, the Pharm.D. (Doctor of Pharmacy) degree is a graduate-level professional doctorate degree. Twenty-one universities are registered with the Pharmacy Council of Pakistan for imparting Pharmacy courses. In 2004 the Higher Education Commission of Pakistan and the Pharmacy Council of Pakistan revised the syllabus and changed the 4-year B.Pharmacy (Bachelor of Pharmacy) Program to a 5-year Pharm.D. (Doctor of Pharmacy) program. All 21 universities have started the 5-year Pharm.D Program. In 2011 the Pharmacy Council of Pakistan approved the awarding of a Doctor of Pharmacy degree, a five-year programme at the Department of Pharmacy, University of Peshawar. A Pharmacist holding a Doctor of Pharmacy (Pharm.D) qualification can use the prefix Dr. before their name.

Tanzania

In Tanzania, pharmacy practice is regulated by the national Pharmacy Board, which is also responsible for registration of pharmacists in the country. By international standards, the density of pharmacists is very low, with a mean of 0.18 per 10,000 population. The majority of pharmacists are found in urban areas, with some underserved regions having only 2 pharmacists per region. According to 2007–2009 data, the largest group of pharmacists was employed in the public sector (44%). Those working in private retail pharmacies were 23%, and the rest were mostly working for private wholesalers, pharmaceutical manufacturers, in academia/teaching, or with faith-based or non-governmental facilities. The salaries of pharmacists varied significantly depending on the place of work. Those who worked in the academia were the highest paid followed by those who worked in the multilateral non-governmental organizations. The public sector including public retail pharmacies and faith based organizations paid much less. The Ministry of Health salary scale for medical doctors was considerably higher than that of pharmacists despite having a difference of only one year of training.[14]

United Kingdom

In the United Kingdom, most pharmacists working in the National Health Service practice in hospital pharmacy, community pharmacy or in primary care trusts. Pharmacists can undertake additional training to allow them to prescribe medicines for specific conditions.[15]

In British English (and to some extent Australian English), the professional title known as "pharmacist" is also known as "dispensing chemist". A dispensing chemist usually operates from a pharmacy or chemist's shop (also called a "drug store" elsewhere), and is allowed to fulfil medical prescriptions and sell over-the-counter drugs and other health-related goods.

The new professional role for pharmacist as prescriber has been recognized in the UK since May 2006, called the "Pharmacist Independent Prescriber". Once qualified, a pharmacist independent prescriber can prescribe any licensed medicine for any medical condition within their competence. This includes controlled drugs except schedule 1 and prescribing for the treatment of addiction.[16]

Education and registration

Pharmacists, pharmacy technicians and pharmacy premises in Great Britain are regulated by the General Pharmaceutical Council (GPhC). The role of regulatory and professional body was previously carried out by the Royal Pharmaceutical Society of Great Britain, which remained as a professional body after handing over the regulatory role to the GPhC in 2010.[17]

The following criteria must be met for qualification as a pharmacist in Great Britain:

  • Successful completion of a 4-year Master of Pharmacy degree at a GPhC accredited university. Pharmacists holding degrees in Pharmacy from overseas institutions are able to fulfill this stage by undertaking the Overseas Pharmacist Assessment Programme (OSPAP), which is a one-year postgraduate diploma. On completion of the OSPAP, the candidate would proceed with the other stages of the registration process in the same manner as a UK student.
  • Completion of a 52-week preregistration training period. This is a period of paid employment in an approved hospital or community pharmacy under the supervision of a pharmacist tutor. During this time the student must collect evidence of having met certain competency standards set by the GPhC.
  • A pass mark in the GPhC registration exam. This includes a closed-book paper and an open book/mental calculations paper (using the British National Formulary and the GPhC's "Standards of Conduct, Ethics and Performance" document as reference sources). The student must achieve an overall mark of 70%, which must include at least 70% in the calculations section of the open book paper.
  • Satisfactorily meeting the GPhC's Fitness to Practice Standards.[18]

Pharmacists in Northern Ireland are regulated by the Pharmaceutical Society of Northern Ireland. They operate separate but broadly similar registration requirements to the GPhC.[19]

There are currently too many Pharmacists graduating in the UK, making it very difficult for newly graduated Pharmacists to secure employment. One of the reasons for this is the fact that many new Schools of Pharmacy have opened in the past decade. In a survey conducted by the British Pharmaceutical Students' Association (BPSA) it was found that 92% of registered Pharmacists thought that there were too many Pharmacists in the UK.

Vietnam

School students must take a national exam to enter a university of pharmacy or the pharmacy department of a university of pharmaco-medicine. About 5- 7% of students pass the exam. There are 3 aspects to the exam. These are on math, chemistry, and physics. After being trained in the university students receive a 5 - year bachelor’s degree in pharmacy (universitary pharmacist to discriminate between college pharmacist or vocational pharmacist). An alternative method of obtaining a Bachelor's degree is as follows. School pupils study in a college of pharmacy or a vocational school of pharmacy. After attending the school or college they go to work. And with two years of practice they could take an exam to enter university of pharmacy or the pharmacy department of a university of pharmaco-medicine. This exam is easier than the national one. Passing the exam they continue studying to gain 3 - year bachelor’s degrees or 4 - year bachelor’s degrees. This degree is considered equivalent to a 5 - year bachelor’s degree.

United States

In the United States, the majority (65%) of pharmacists work in retail settings, mostly as salaried employees but some as self-employed owners. About 22% work in hospitals, and the rest mainly in mail-order or Internet pharmacies, pharmaceutical wholesalers, practises of physicians, and the Federal Government.[4]

All graduating pharmacists must now obtain the Doctor of Pharmacy (Pharm.D.) degree before they are eligible to sit for the North American Pharmacist Licensure Examination (NAPLEX) to enter into pharmacy practice.[20]

Pharmacy School Accreditation

The Accreditation Council for Pharmacy Education (ACPE) was founded in 1932 as the accrediting body for schools of pharmacy in the United States.[21] The mission of ACPE is “To assure and advance excellence in education for the profession of pharmacy.”[22] ACPE is recognized for the accreditation of professional degree programs by the United States Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA).[23] Since 1975, ACPE has also been the accrediting body for continuing pharmacy education. The ACPE board of directors are appointed by the American Association of Colleges of Pharmacy (AACP), the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP) (three appointments each), and the American Council on Education (one appointment). To obtain licensure in the United States, applicants for the North American Pharmacist Licensure Examination (NAPLEX) must graduate from an ACPE accredited school of pharmacy. ACPE publishes standards that schools of pharmacy must comply with to gain accreditation.[24] There are currently 30 standards organized within six major categories of 1) mission, planning, and evaluation, 2) organization and administration, 3) curriculum, 4) students, 5) faculty and staff, 6) facilities and resources. A Pharmacy school pursuing accreditation must first apply and be granted Pre-candidate status.[25] These schools have met all the requirements for accreditation, but have not yet enrolled any students. This status indicates that the school of pharmacy has developed its program in accordance with the ACPE standards and guidelines. Once a school has enrolled students, but has not yet had a graduating class, they may be granted Candidate status. The expectations of a Candidate program are that they continue to mature in accordance with stated plans. The graduates of a Candidate program are the same as those of fully accredited programs. Full accreditation is granted to a program once they have demonstrated they comply with the standards set forth by ACPE. The customary review cycle for established accredited programs is six years, whereas for programs achieving their initial accreditation this cycle is two years. These are comprehensive on-site evaluations of the programs. Additional evaluations may be conducted at the discretion of ACPE in the interim between comprehensive evaluations.

Education

A Pharmacy student must complete eight years of professional level training at a pharmacy school, or 4 years after receiving a bachelors degree. A bachelors degree is not required as some pharmacy schools only require two years of undergraduate education and the completion of a list of prerequisites. Competition to obtain entry into pharmacy school, however, limits the number of students admitted without a bachelors degree. Before schools went to the all PharmD programs students could do 5 years of professional undergraduate level training and receive a BScPharm with the option of continuing for one more year for the PharmD. There are currently 116 accredited pharmacy schools in the United States (late 2009), and 6 of these schools offer "accelerated" 3-year PharmD programs by attending school almost year round – with fewer breaks for summer and holidays. There also is one fully accredited "distance/online" 4-year PharmD program offered by Creighton University. Pharmacists receive a PharmD (Doctor of Pharmacy) upon graduation, and licensure after passing the NAPLEX and MPJE. Both the PharmD and the BScPharm take the same licensure exams.

Mandatory courses may include:

Besides taking classes, additional requirements before graduating may include, for instance, a certain number of hours for community service, e.g., working in hospitals, clinics, and retail.

Specialization and credentialing

American pharmacists can become certified in recognized specialty practice areas by passing an examination administered by one of several credentialing boards.

Earnings and wages

According to the 2010 "Pharmacy Compensation Survey":[28]

  • Directors of Pharmacy $125,200
  • Retail Staff Pharmacists $113,600
  • Hospital Staff Pharmacists $111,700
  • Mail Order Staff Pharmacists $109,300
  • Clinical Pharmacists $113,400

According to the US Bureau of Labor Statistics – Occupational Outlook Handbook, 2010–11 Edition:[4]

  • Median annual wages of wage and salary pharmacists in May 2008 were $106,410. The middle 50 percent earned between $92,670 and $121,310 a year. The lowest 10 percent earned less than $77,390, and the highest 10 percent earned more than $131,440 a year.

Noted people who were pharmacists

See also

References

Further reading

  • (Japanese) Asai,T. (1985). Nyokan Tūkai. Tokyo: Kōdan-Sha.
  • (French) ...Click link for digitized, full-text copy of this book (in French)

External links

  • Association of Community Pharmacists of India (ACPI)
  • Pharmacy Council of India (PCI)
  • DMOZ
  • Nepal Pharmacy council (NPC)
  • International Pharmaceutical Federation (FIP)
  • RPSGB Veterinary Pharmacist Education Programme (VPEP)
  • International Pharmaceutical Students Federation (IPSF)
  • Royal Pharmaceutical Society of Great Britain
  • Canadian pharmacy technicians (rxpt.ca)
  • [1]
  • Pakistan Pharmacists Association (PPA)
  • Canadian Pharmacist Journal
  • United Kingdom Clinical Pharmacy Association (UKCPA)


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