The Evolution of Pharmacy: From Ancient Practices to Modern Science
Chapter 1
The Profession of Pharmacy
Learning Objectives
•
Describe the various cultural origins of
pharmacy and their impact on the profession
today.
•
Discuss the four stages of development of the
pharmacy profession in the twentieth century.
•
Differentiate the major roles and
responsibilities of the pharmacist and the
pharmacy technician.
Learning Objectives
•
Understand the educational and licensing
requirements for today’s pharmacist and
pharmacy technician.
•
Differentiate among various workplace
environments such as community and
institutional pharmacies.
In the beginning….
•
Pharmacy has undergone significant change.
•
Beginning as an ancient art combining
nature’s elements with spiritualism or magic.
•
Now a scientific pursuit.
•
Pharmacists
and
pharmacy technicians
educated and trained to ensure the well-being
of the patient population.
The Origins of Pharmacy Practice
•
How was sickness or disease thought to be in
early civilizations?
•
The use of drugs in healing is as old as civilization
itself.
•
Modern archaeologists have unearthed clay
tablets listing hundreds of medicinal
preparations.
•
Early inhabitants used the trial-and-error method
to compile lists of drugs,
pharmacopeias
, or
dispensatories.
•
Modern day
formularies
are based on these drug
lists.
Emergence of Traditional Eastern and
Western Medicine
•
Far East cultures relied mainly on the healing
properties of plants and herbs.
•
Traditional Eastern medicine
involves the use
of botanicals.
•
What herbal treatments from the Far East do
we still use in Western culture today?
Traditional Western Medicine
•
Hippocrates (ca. 460-370 BCE), famous Greek
physician, known as what?
•
Illness had a rational and physical explanation.
The four humors must be in correct balance to
maintain health. What are the four humors?
•
Pharmacy
comes from the ancient Greek word
pharmakon
, meaning “drug or remedy.”
Traditional Western Medicine
•
Dioscorides, Greek physician, is credited with
writing one of the world’s greatest
pharmaceutical texts:
De Materia Medica (On
Medical Matters)
.
•
What is included in this text?
•
De Materia Medica
has served as the standard
reference text for drugs and is considered the
forerunner of modern-day references such as the
United States Pharmacopeia (USP)
and
Physician’s
Desk Reference (PDR)
.
Traditional Western Medicine
•
Galen (129-216 CE), notable Greek physician.
•
Galen studied the effects of herbal medicine
on the human body, leading to the term
galenical pharmacy
, or the process of creating
extracts of active medicinals from plants.
•
Why is Galen is known as “The Father of
Pharmacy”?
Roots of the Pharmacy Profession
•
The Middle Ages, the profession of pharmacy was
evolving in Persian and European empires.
•
Arabic civilizations were some of the first cultures to
develop a list of drugs and dosage forms (pills, syrups,
extracts), and to identify the pharmacist as a qualified
healthcare professional.
•
Apothecary
(pharmacy) modeled after ancient Greek
and Arabic cultures.
•
Professional guilds led to the training of chemists and
pharmacists which led to the rise of formalized
universities and professional organizations.
Roots of the Pharmacy Profession
•
Questions arose during the Renaissance
(1350-1650 CE) in Europe of Greek, Roman,
and Arabic influences on the profession of
pharmacy.
•
Alchemy
combined elements of chemistry,
metallurgy, physics, and medicine with
astrology, mysticism, and spiritualism.
•
What did alchemy claim?
Roots of the Pharmacy Profession
•
During the Renaissance was the emergence of
hospitals and pharmacies run by religious orders.
•
These facilities served the larger communities by
providing free health care and medicines to the
poor.
•
17
th
century led to advances in pharmacy practice
with the publishing of scientific and medical
research.
•
Greek and Latin root words, prefixes, and suffixes
were used and are still used today in the scientific
naming of many medical terms.
Herbal Medicine and Apothecaries
•
The list of medicinal agents grew with the
arrival of exotic plants and spices.
•
Chemistry and
botany
was now a required
skill of pharmacists.
•
Many apothecary shops in the 1800’s were
still operated by physicians even though
pharmacists were being increasingly
recognized.
Herbal Medicine and Apothecaries
•
Herbal medicine
was common practice in the
early colonization of the United States.
•
What herbal medicines are still used today?
Roles of Early Pharmacy Practitioners
•
Pharmacists in the colonies were druggists,
doctors, merchants or storekeepers.
•
Until the 19
th
century physicians typically
owned the dispensary that distributed drugs
to patients.
•
Development of the United States formulary
known as the
United States Pharmacopeia
(USP)
.
•
What does the current
USP
provide?
Roles of Early Pharmacy Practitioners
•
1852, the American Pharmacist Association
(APhA) addressed
adulteration
of imported
drugs.
•
Late 1800’s community pharmacist
compounded many herbs and chemicals for
medicinal use.
•
1886, John Pemberton, began to sell a tonic
called Coca-Cola.
•
1893, Caleb Bradham, created Pepsi-Cola.
Roles of Early Pharmacy Practitioners
•
20
th
century pharmaceutical manufacturing
began to take hold.
•
The traditional compounding tasks (formulating
own liquids, powders and rolling their own pills)
became less common, pharmacy became more
scientific and technical.
•
American Society of Health-System Pharmacists
(ASHP) is credited with many innovations in
practice and training programs.
Modern-Day Pharmacy Practice
•
With the explosion of scientific research and
accessibility of information, the pharmacy
profession is able to keep pace with medical
advances.
•
Compounding has evolved from a trial-and-
error process to an exact science.
•
Pharmacists and technicians work together to
fill more than 4 billion prescriptions each year.
The Pharmacy Workplace of Today
•
Pharmacy technicians are employed in a
variety of pharmacy settings such as
community pharmacies (drugstores), hospital
pharmacies, home healthcare systems, and
long-term care facilities.
•
At any time, 24 hours a day, some of the
estimated 334,000 technicians in the United
States are at work in a pharmacy.
Community Pharmacies
•
Most pharmacists and technicians work in
community pharmacies,
retail pharmacies
.
•
The ratio of pharmacists to technicians is
dictated by the state board of pharmacy.
(There is no limiting ratio in Missouri)
•
Most community pharmacies are divided into
restricted prescription area and front-end
merchandise.
Independent Pharmacies
•
Independent pharmacy
– a community pharmacy
owned and usually operated by one pharmacist
or group of pharmacists.
•
The owner makes decisions regarding practice of
pharmacy, with more time and attention spent on
customer service.
•
Some independent pharmacies have developed
into
compounding pharmacies
– specializing in
the preparation of nonsterile (sometimes sterile)
preparations not commercially available.
Chain Pharmacies
•
Chain pharmacy
– national or regional, typical
corner drugstore (Wal-Mart, Target, Kroger,
Publix, Walgreens, CVS, Rite-Aid).
•
Chain pharmacies are typically located in
metropolitan areas with heavy use of technicians
and automation.
•
A chain pharmacy is owned by a corporation,
administrative decisions made at the corporate
level.
•
Some chains have established walk-in clinics.
Franchise Pharmacies
•
Franchise pharmacy
– combines characteristics of
an independent with a chain pharmacy.
•
Franchisors are granted exclusive use of company
name and rights to market and sell company
products.
•
Franchise pharmacies attempt to provide
personalized health care.
•
A franchise pharmacies typically has one
pharmacist (owner) and one technician.
Mail-Order Pharmacies
•
Mail-order pharmacies
– one of the fastest-
growing types of pharmacies.
•
A centralized operation using extensive
automation and technicians to dispense and
mail large volumes of prescriptions every day.
•
What advantages & disadvantages are there
to using mail-order pharmacies?
Institutional Pharmacies
•
Institutional pharmacy
– a pharmacy
associated with any organized healthcare
system.
•
Hospital pharmacy
is the most common
example of an institutional pharmacy.
•
Other examples include: long-term care
facilities, home healthcare systems, managed-
care organizations, and nuclear pharmacies.
Hospital Pharmacies
•
¼ of all pharmacists work in a hospital setting.
•
Hospital pharmacists and technicians prepare,
or supervise preparation of, unit-dose, IV, and
extensive floor stock medications.
•
Many technicians in the hospital work in a
“clean room” environment.
•
To work in a “clean room” requires education,
training, and certification.
Long-Term Care Facilities
•
Long-term care (LTC) facility
has different levels.
•
Extended-care facility (ECF) provides services to
older adults or disable residents who can no
longer provide activities of daily living (ADL).
•
Skilled-care facility (SCF) is limited to patients
requiring more round-the-clock care.
•
Facilities that treat patients with chronic or acute
psychiatric disorders or rehabilitation facilities are
additional examples of long-term care facilities.
Home Healthcare Systems
•
Home healthcare
– delivery of medical,
nursing, and pharmacy services to patients
who remain at home.
•
Home healthcare systems are expected to
grow as our population ages.
•
Home healthcare pharmacies
– provide IV
and oral medications and must often be
available 24/7.
•
Hospice care
– is a form of home healthcare.
Managed-Care Pharmacy Services
•
Managed-care
has grown dramatically.
•
Kaiser Permanente, was an early managed-care
or
health maintenance organization (HMO)
.
•
An HMO provides health insurance for medical
and pharmacy services using a managed-care
model.
•
The HMO philosophy is based on the idea that
keeping patients of all ages healthy, decreases
hospitalization and ER visits, lowering the costs to
the healthcare system.
Managed-Care Pharmacy Services
•
Most HMO’s are centralized primary-care clinics
serving adult, pediatric and OB/GYN patients.
•
Offering pharmacy, X-ray, and laboratory services
on-site.
•
HMO’s, like hospitals, have an approved
formulary (drug list).
•
HMO pharmacies and responsibilities of the
technician are similar to community pharmacies.
•
Effective use of technicians allows pharmacists to
provide more time counseling patients, resulting
in lower costs and fewer medication errors.
Nuclear Pharmacy
•
Nuclear pharmacy
– highly specialized
practice compounding and dispensing sterile
radioactive pharmaceuticals for diagnostic or
therapeutic uses.
•
Staffed by pharmacists and technicians with
advanced training and certification in
radiation safety.
•
Pharmacy personnel must
always
wear
badges that monitor radiation exposure.
The Pharmacist
•
The role of the pharmacist is to safeguard the
health of the public (patients).
•
Pharmacists today are highly trained and
educated to meet the demands of today’s
pharmacy.
•
Pharmacists must be vigilant in their
responsibilities: detecting an error; problematic
combination of drugs; dangerous use of a drug;
and interaction of medication with food, drink, or
environment.
Evolution of the Pharmacist’s Role
•
The role of the pharmacist, during the 20
th
century, has changed dramatically to keep
pace with medical and scientific advances.
•
There are four distinct eras:
–
The Traditional Era
–
The Scientific Era
–
The Clinical Era
–
The Pharmaceutical Care Era
Traditional Era
•
Beginning of the 20
th
century, pharmacists formulated
and compounded medications from natural sources.
•
Prescriptions were compounded by hand, using a
mortar and pestle, ingredients and dosages tailored to
individual patients.
•
Less than 1% of all prescriptions today are
compounded.
•
Pharmacists-in-training served as apprentices, learning
the trade in pharmacies rather than sitting in a
classroom.
•
Pharmacognosy
– the knowledge of the medicinal
functions of natural products from animal, plant, or
mineral origins was a piece of the limited education
pharmacist focused on at this time.
Scientific Era
•
Post WWII period, pharmaceutical manufacturers, like
Eli Lilly, Merck and Pfizer, developed and tested new
drugs and dosage forms.
•
Synthesized, developed and mass-produced theses
medications were more economical and better quality.
•
Educational institutions increased the emphasis on the
sciences and expanded the pharmacy curriculum.
•
Pharmacology
– the scientific study of drugs and their
mechanisms of action, was a required course of study.
•
1960, a five-year BS degree was required.
Clinical Era
•
Combining the traditional role of pharmacist with a
dispenser of drug information to the patient and physician.
•
Pharmaceutics
– the study of how drugs are introduced to
the body, was added to the pharmacy curriculum.
•
There was a feeling that training had shifted too far into the
sciences, away from the actual practice of pharmacy.
•
1973, the American Association of Colleges of Pharmacy
(AACP) reevaluated the mission of the pharmacy
profession.
•
Development of
clinical-
or
patient-oriented pharmacy
resulted in a change to the pharmacy curriculum and the
adoption of the PharmD degree program.
Clinical Era
•
New courses were also developed:
–
Pharmacokinetics
– individualizing doses of drugs
based on absorption, distribution, metabolism,
and excretion from the body.
–
Therapeutics
– the study of applying
pharmacology to the treatment of illness and
disease states
–
Pathophysiology
– the study of disease and
illnesses affecting the normal function of the
body.
Pharmaceutical Care Era
•
Pharmaceutical care
– expands the mission of
the pharmacy profession to include responsibility
for ensuring positive outcomes for drug therapy.
•
“Medication therapy management” (MTM) may
include recommending a less costly drug to a
physician, identifying a potential serious drug-
drug interaction, or counseling a patient.
•
MTM practices are being recognized by insurance
copies, providing reimbursement for pharmacist
interventions.
•
What role can a technician play in MTM’s?
Current Role and Responsibilities of a
Pharmacist
•
Pharmacists today dispense drugs for existing
disease but also create patient care initiatives
to prevent or identify future disease.
•
The tasks that the pharmacist takes on goes
well beyond what is mentioned above, see
pgs. 16-17.
•
How can technicians help a pharmacist with
their specific tasks in today’s pharmacies?
Additional Responsibilities
•
Based on the pharmacy setting pharmacists
may have specific responsibilities.
–
Community Pharmacies
: nonsterile and sterile
compounding; dispense and send medications in
special packaging; business person and
entrepreneur; hires and supervises employees
–
Institutional Pharmacies
: order entry; prepare
medications and IV’s; education; policy and
procedures; counseling patients
Educational Requirements of a
Pharmacist
•
Education of a pharmacist has transformed from an
apprenticeship to a full-time study of the sciences in an
academic setting.
•
Early 1800’s, the Philadelphia College of Pharmacy
became the first school to offer courses in
pharmaceutical sciences and grant pharmacy-specific
diplomas.
•
1868, the University of Michigan offered formal
education and degree programs in pharmacy.
•
Late 1800’s, the APhA encouraged state governments
to regulate the pharmacy profession, pass formal
certification examinations to obtain a licensure to
practice.
Educational Requirements of a
Pharmacist
•
Until 1920, formal education requirements were
not
required in order to take an exam to become
a pharmacist; applicants must have completed 3
or 4 year apprenticeship in a pharmacy.
•
Today, all colleges of pharmacy offer a PharmD
degree.
–
Pre-pharmacy course work
–
The Pharmacy College Admission Test (PCAT) > 80
–
GPA of 3.5 – 4.0
–
Challenging course work
Licensing Requirements of a
Pharmacist
•
Graduate from an accredited college of
pharmacy.
•
Pass a state board certification exam.
•
Serve an internship under a licensed pharmacist
either during and/or after formal schooling.
•
Specific continuing education requirements may
be required to renew licenses.
•
Licensing and professional oversight are carried
out by the state boards of pharmacy.
The Pharmacy Technician
•
The modern-day pharmacist would not be
possible without well-trained, educated, and
certified pharmacy technicians.
•
Pharmacy technicians allow the pharmacist to
spend more time doing other things, while
technicians assume routine functions/tasks.
•
Technicians assist with workload by entering
patient and prescription information into the
computer, prepare medication to be dispensed,
and provide customer service.
Evolution of the Pharmacy Technician’s
Role
•
Early 20
th
century, “pharmacy assistants” were
the predecessors of pharmacy technicians.
•
Training was received via seasoned pharmacy
professionals; early pharmacy technicians
were also trained as military medics.
•
Once a part-time floor stock and cashier, now
the pharmacy technician is an invaluable
assistant to the pharmacist in all pharmacy
settings.
Current Role and Responsibilities of a
Pharmacy Technician
•
A central piece to a technician’s job is accountability to
the pharmacist for the quality and accuracy of their
work.
•
The pharmacist takes final responsibility (and liability)
for the technician’s actions.
•
In a community setting technicians may:
–
Meet and great patients
–
Enter patient information
–
Assist the pharmacist
–
Operate cash register
–
Stock and inventory
–
Billing and resolving online insurance claims
Current Role and Responsibilities of a
Pharmacy Technician
•
Similar tasks to that of a community pharmacy
technician may be performed in a hospital
setting.
•
Long-term care setting responsibilities also mirror
those of the community and hospital pharmacy
technicians.
•
Technicians must possess certain personal
characteristics to successfully contribute to
patient care.
•
What are some of those personal characteristics?
Current Role and Responsibilities of a
Pharmacy Technician
•
Specific duties of a pharmacy technician will
vary depending on the pharmacy setting and
the needs of the workplace.
•
Technicians must act in accordance with state
and federal pharmacy laws, as well as
individual facilities policies and procedures.
•
There are some tasks that are solely the
responsibility of the pharmacist.
•
What are those tasks?
Educational Requirements of a
Pharmacy Technician
•
On the job training use to be sufficient but as the
role of the pharmacist has expanded so has the
role of the technician.
•
Formal training programs have been developed
to better train technicians to assist the
pharmacist.
•
The National Association of Boards of Pharmacy
(NABP) is working to develop standards with each
state in the educational curriculum of pharmacy
technicians.
Educational Requirements of a
Pharmacy Technician
•
Course work may include: introduction to
practice; medical terminology; pharmacology;
calculations; and some degree of experiential
training.
•
Programs are designed to better prepare the
student to pass a pharmacy technician
certification exam.
•
Certification is encouraged in some pharmacy
settings; required in order to work in a hospital.
State Board Requirements of a
Pharmacy Technician
•
State jurisdictions require licensure, registration,
or certification of pharmacy technicians.
•
http://www.pharmace.com/state-by-state-
requirements-to-become-a-pharmacy-
technician.html
•
Certification requires successful completion of a
standardized national pharmacy technician exam.
•
Certification is maintained by completing 20
continuing education credits biannually.
Healthcare Team
•
Health care is a collaborative effort between
physicians, nurse practitioners, dentists, vets,
nurses, and pharmacists.
•
Paraprofessionals like pharmacy technicians,
physician assistants, dental assistants, hygienists,
vet assistants, and licensed practical nurses assist
professionals in routine but necessary tasks.
•
Pharmacy technicians assist pharmacists allowing
pharmacists more time to meet the mission of
the profession: to ensure positive outcomes for
drug therapy in the patient population.
•
This workforce solution was funded by a grant awarded by
the U.S. Department of Labor’s Employment and Training
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does not necessarily reflect the official position of the U.S.
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implied, with respect to such information, including any
information on linked sites and including, but not limited to,
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Created by Jennifer Majeske, Mineral Area College
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Attribution 4.0 International License.
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•
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The profession of pharmacy has evolved significantly throughout history, from its origins in ancient civilizations to its current role as a scientific pursuit focused on patient well-being. This journey encompasses cultural origins, stages of development, major roles of pharmacists and pharmacy technicians, educational requirements, and different workplace environments. Explore the roots of pharmacy practice in early civilizations, the emergence of traditional Eastern and Western medicine, and the contributions of pioneers like Hippocrates and Dioscorides. Witness how pharmacy has transitioned from a mystical art to a vital healthcare profession.
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Presentation Transcript
Chapter 1 The Profession of Pharmacy
Learning Objectives Describe the various cultural origins of pharmacy and their impact on the profession today. Discuss the four stages of development of the pharmacy profession in the twentieth century. Differentiate the major roles and responsibilities of the pharmacist and the pharmacy technician.
Learning Objectives Understand the educational and licensing requirements for today s pharmacist and pharmacy technician. Differentiate among various workplace environments such as community and institutional pharmacies.
In the beginning. Pharmacy has undergone significant change. Beginning as an ancient art combining nature s elements with spiritualism or magic. Now a scientific pursuit. Pharmacists and pharmacy technicians educated and trained to ensure the well-being of the patient population.
The Origins of Pharmacy Practice How was sickness or disease thought to be in early civilizations? The use of drugs in healing is as old as civilization itself. Modern archaeologists have unearthed clay tablets listing hundreds of medicinal preparations. Early inhabitants used the trial-and-error method to compile lists of drugs, pharmacopeias, or dispensatories. Modern day formularies are based on these drug lists.
Emergence of Traditional Eastern and Western Medicine Far East cultures relied mainly on the healing properties of plants and herbs. Traditional Eastern medicine involves the use of botanicals. What herbal treatments from the Far East do we still use in Western culture today?
Traditional Western Medicine Hippocrates (ca. 460-370 BCE), famous Greek physician, known as what? Illness had a rational and physical explanation. The four humors must be in correct balance to maintain health. What are the four humors? Pharmacy comes from the ancient Greek word pharmakon, meaning drug or remedy.
Traditional Western Medicine Dioscorides, Greek physician, is credited with writing one of the world s greatest pharmaceutical texts: De Materia Medica (On Medical Matters). What is included in this text? De Materia Medica has served as the standard reference text for drugs and is considered the forerunner of modern-day references such as the United States Pharmacopeia (USP) and Physician s Desk Reference (PDR).
Traditional Western Medicine Galen (129-216 CE), notable Greek physician. Galen studied the effects of herbal medicine on the human body, leading to the term galenical pharmacy, or the process of creating extracts of active medicinals from plants. Why is Galen is known as The Father of Pharmacy ?
Roots of the Pharmacy Profession The Middle Ages, the profession of pharmacy was evolving in Persian and European empires. Arabic civilizations were some of the first cultures to develop a list of drugs and dosage forms (pills, syrups, extracts), and to identify the pharmacist as a qualified healthcare professional. Apothecary (pharmacy) modeled after ancient Greek and Arabic cultures. Professional guilds led to the training of chemists and pharmacists which led to the rise of formalized universities and professional organizations.
Roots of the Pharmacy Profession Questions arose during the Renaissance (1350-1650 CE) in Europe of Greek, Roman, and Arabic influences on the profession of pharmacy. Alchemy combined elements of chemistry, metallurgy, physics, and medicine with astrology, mysticism, and spiritualism. What did alchemy claim?
Roots of the Pharmacy Profession During the Renaissance was the emergence of hospitals and pharmacies run by religious orders. These facilities served the larger communities by providing free health care and medicines to the poor. 17thcentury led to advances in pharmacy practice with the publishing of scientific and medical research. Greek and Latin root words, prefixes, and suffixes were used and are still used today in the scientific naming of many medical terms.
Herbal Medicine and Apothecaries The list of medicinal agents grew with the arrival of exotic plants and spices. Chemistry and botany was now a required skill of pharmacists. Many apothecary shops in the 1800 s were still operated by physicians even though pharmacists were being increasingly recognized.
Herbal Medicine and Apothecaries Herbal medicine was common practice in the early colonization of the United States. What herbal medicines are still used today?
Roles of Early Pharmacy Practitioners Pharmacists in the colonies were druggists, doctors, merchants or storekeepers. Until the 19thcentury physicians typically owned the dispensary that distributed drugs to patients. Development of the United States formulary known as the United States Pharmacopeia (USP). What does the current USP provide?
Roles of Early Pharmacy Practitioners 1852, the American Pharmacist Association (APhA) addressed adulteration of imported drugs. Late 1800 s community pharmacist compounded many herbs and chemicals for medicinal use. 1886, John Pemberton, began to sell a tonic called Coca-Cola. 1893, Caleb Bradham, created Pepsi-Cola.
Roles of Early Pharmacy Practitioners 20thcentury pharmaceutical manufacturing began to take hold. The traditional compounding tasks (formulating own liquids, powders and rolling their own pills) became less common, pharmacy became more scientific and technical. American Society of Health-System Pharmacists (ASHP) is credited with many innovations in practice and training programs.
Modern-Day Pharmacy Practice With the explosion of scientific research and accessibility of information, the pharmacy profession is able to keep pace with medical advances. Compounding has evolved from a trial-and- error process to an exact science. Pharmacists and technicians work together to fill more than 4 billion prescriptions each year.
The Pharmacy Workplace of Today Pharmacy technicians are employed in a variety of pharmacy settings such as community pharmacies (drugstores), hospital pharmacies, home healthcare systems, and long-term care facilities. At any time, 24 hours a day, some of the estimated 334,000 technicians in the United States are at work in a pharmacy.
Community Pharmacies Most pharmacists and technicians work in community pharmacies, retail pharmacies. The ratio of pharmacists to technicians is dictated by the state board of pharmacy. (There is no limiting ratio in Missouri) Most community pharmacies are divided into restricted prescription area and front-end merchandise.
Independent Pharmacies Independent pharmacy a community pharmacy owned and usually operated by one pharmacist or group of pharmacists. The owner makes decisions regarding practice of pharmacy, with more time and attention spent on customer service. Some independent pharmacies have developed into compounding pharmacies specializing in the preparation of nonsterile (sometimes sterile) preparations not commercially available.
Chain Pharmacies Chain pharmacy national or regional, typical corner drugstore (Wal-Mart, Target, Kroger, Publix, Walgreens, CVS, Rite-Aid). Chain pharmacies are typically located in metropolitan areas with heavy use of technicians and automation. A chain pharmacy is owned by a corporation, administrative decisions made at the corporate level. Some chains have established walk-in clinics.
Franchise Pharmacies Franchise pharmacy combines characteristics of an independent with a chain pharmacy. Franchisors are granted exclusive use of company name and rights to market and sell company products. Franchise pharmacies attempt to provide personalized health care. A franchise pharmacies typically has one pharmacist (owner) and one technician.
Mail-Order Pharmacies Mail-order pharmacies one of the fastest- growing types of pharmacies. A centralized operation using extensive automation and technicians to dispense and mail large volumes of prescriptions every day. What advantages & disadvantages are there to using mail-order pharmacies?
Institutional Pharmacies Institutional pharmacy a pharmacy associated with any organized healthcare system. Hospital pharmacy is the most common example of an institutional pharmacy. Other examples include: long-term care facilities, home healthcare systems, managed- care organizations, and nuclear pharmacies.
Hospital Pharmacies of all pharmacists work in a hospital setting. Hospital pharmacists and technicians prepare, or supervise preparation of, unit-dose, IV, and extensive floor stock medications. Many technicians in the hospital work in a clean room environment. To work in a clean room requires education, training, and certification.
Long-Term Care Facilities Long-term care (LTC) facility has different levels. Extended-care facility (ECF) provides services to older adults or disable residents who can no longer provide activities of daily living (ADL). Skilled-care facility (SCF) is limited to patients requiring more round-the-clock care. Facilities that treat patients with chronic or acute psychiatric disorders or rehabilitation facilities are additional examples of long-term care facilities.
Home Healthcare Systems Home healthcare delivery of medical, nursing, and pharmacy services to patients who remain at home. Home healthcare systems are expected to grow as our population ages. Home healthcare pharmacies provide IV and oral medications and must often be available 24/7. Hospice care is a form of home healthcare.
Managed-Care Pharmacy Services Managed-care has grown dramatically. Kaiser Permanente, was an early managed-care or health maintenance organization (HMO). An HMO provides health insurance for medical and pharmacy services using a managed-care model. The HMO philosophy is based on the idea that keeping patients of all ages healthy, decreases hospitalization and ER visits, lowering the costs to the healthcare system.
Managed-Care Pharmacy Services Most HMO s are centralized primary-care clinics serving adult, pediatric and OB/GYN patients. Offering pharmacy, X-ray, and laboratory services on-site. HMO s, like hospitals, have an approved formulary (drug list). HMO pharmacies and responsibilities of the technician are similar to community pharmacies. Effective use of technicians allows pharmacists to provide more time counseling patients, resulting in lower costs and fewer medication errors.
Nuclear Pharmacy Nuclear pharmacy highly specialized practice compounding and dispensing sterile radioactive pharmaceuticals for diagnostic or therapeutic uses. Staffed by pharmacists and technicians with advanced training and certification in radiation safety. Pharmacy personnel must always wear badges that monitor radiation exposure.
The Pharmacist The role of the pharmacist is to safeguard the health of the public (patients). Pharmacists today are highly trained and educated to meet the demands of today s pharmacy. Pharmacists must be vigilant in their responsibilities: detecting an error; problematic combination of drugs; dangerous use of a drug; and interaction of medication with food, drink, or environment.
Evolution of the Pharmacists Role The role of the pharmacist, during the 20th century, has changed dramatically to keep pace with medical and scientific advances. There are four distinct eras: The Traditional Era The Scientific Era The Clinical Era The Pharmaceutical Care Era
Traditional Era Beginning of the 20thcentury, pharmacists formulated and compounded medications from natural sources. Prescriptions were compounded by hand, using a mortar and pestle, ingredients and dosages tailored to individual patients. Less than 1% of all prescriptions today are compounded. Pharmacists-in-training served as apprentices, learning the trade in pharmacies rather than sitting in a classroom. Pharmacognosy the knowledge of the medicinal functions of natural products from animal, plant, or mineral origins was a piece of the limited education pharmacist focused on at this time.
Scientific Era Post WWII period, pharmaceutical manufacturers, like Eli Lilly, Merck and Pfizer, developed and tested new drugs and dosage forms. Synthesized, developed and mass-produced theses medications were more economical and better quality. Educational institutions increased the emphasis on the sciences and expanded the pharmacy curriculum. Pharmacology the scientific study of drugs and their mechanisms of action, was a required course of study. 1960, a five-year BS degree was required.
Clinical Era Combining the traditional role of pharmacist with a dispenser of drug information to the patient and physician. Pharmaceutics the study of how drugs are introduced to the body, was added to the pharmacy curriculum. There was a feeling that training had shifted too far into the sciences, away from the actual practice of pharmacy. 1973, the American Association of Colleges of Pharmacy (AACP) reevaluated the mission of the pharmacy profession. Development of clinical- or patient-oriented pharmacy resulted in a change to the pharmacy curriculum and the adoption of the PharmD degree program.
Clinical Era New courses were also developed: Pharmacokinetics individualizing doses of drugs based on absorption, distribution, metabolism, and excretion from the body. Therapeutics the study of applying pharmacology to the treatment of illness and disease states Pathophysiology the study of disease and illnesses affecting the normal function of the body.
Pharmaceutical Care Era Pharmaceutical care expands the mission of the pharmacy profession to include responsibility for ensuring positive outcomes for drug therapy. Medication therapy management (MTM) may include recommending a less costly drug to a physician, identifying a potential serious drug- drug interaction, or counseling a patient. MTM practices are being recognized by insurance copies, providing reimbursement for pharmacist interventions. What role can a technician play in MTM s?
Current Role and Responsibilities of a Pharmacist Pharmacists today dispense drugs for existing disease but also create patient care initiatives to prevent or identify future disease. The tasks that the pharmacist takes on goes well beyond what is mentioned above, see pgs. 16-17. How can technicians help a pharmacist with their specific tasks in today s pharmacies?
Additional Responsibilities Based on the pharmacy setting pharmacists may have specific responsibilities. Community Pharmacies: nonsterile and sterile compounding; dispense and send medications in special packaging; business person and entrepreneur; hires and supervises employees Institutional Pharmacies: order entry; prepare medications and IV s; education; policy and procedures; counseling patients
Educational Requirements of a Pharmacist Education of a pharmacist has transformed from an apprenticeship to a full-time study of the sciences in an academic setting. Early 1800 s, the Philadelphia College of Pharmacy became the first school to offer courses in pharmaceutical sciences and grant pharmacy-specific diplomas. 1868, the University of Michigan offered formal education and degree programs in pharmacy. Late 1800 s, the APhA encouraged state governments to regulate the pharmacy profession, pass formal certification examinations to obtain a licensure to practice.
Educational Requirements of a Pharmacist Until 1920, formal education requirements were not required in order to take an exam to become a pharmacist; applicants must have completed 3 or 4 year apprenticeship in a pharmacy. Today, all colleges of pharmacy offer a PharmD degree. Pre-pharmacy course work The Pharmacy College Admission Test (PCAT) > 80 GPA of 3.5 4.0 Challenging course work
Licensing Requirements of a Pharmacist Graduate from an accredited college of pharmacy. Pass a state board certification exam. Serve an internship under a licensed pharmacist either during and/or after formal schooling. Specific continuing education requirements may be required to renew licenses. Licensing and professional oversight are carried out by the state boards of pharmacy.
The Pharmacy Technician The modern-day pharmacist would not be possible without well-trained, educated, and certified pharmacy technicians. Pharmacy technicians allow the pharmacist to spend more time doing other things, while technicians assume routine functions/tasks. Technicians assist with workload by entering patient and prescription information into the computer, prepare medication to be dispensed, and provide customer service.
Evolution of the Pharmacy Technicians Role Early 20thcentury, pharmacy assistants were the predecessors of pharmacy technicians. Training was received via seasoned pharmacy professionals; early pharmacy technicians were also trained as military medics. Once a part-time floor stock and cashier, now the pharmacy technician is an invaluable assistant to the pharmacist in all pharmacy settings.
Current Role and Responsibilities of a Pharmacy Technician A central piece to a technician s job is accountability to the pharmacist for the quality and accuracy of their work. The pharmacist takes final responsibility (and liability) for the technician s actions. In a community setting technicians may: Meet and great patients Enter patient information Assist the pharmacist Operate cash register Stock and inventory Billing and resolving online insurance claims
Current Role and Responsibilities of a Pharmacy Technician Similar tasks to that of a community pharmacy technician may be performed in a hospital setting. Long-term care setting responsibilities also mirror those of the community and hospital pharmacy technicians. Technicians must possess certain personal characteristics to successfully contribute to patient care. What are some of those personal characteristics?
Current Role and Responsibilities of a Pharmacy Technician Specific duties of a pharmacy technician will vary depending on the pharmacy setting and the needs of the workplace. Technicians must act in accordance with state and federal pharmacy laws, as well as individual facilities policies and procedures. There are some tasks that are solely the responsibility of the pharmacist. What are those tasks?
Educational Requirements of a Pharmacy Technician On the job training use to be sufficient but as the role of the pharmacist has expanded so has the role of the technician. Formal training programs have been developed to better train technicians to assist the pharmacist. The National Association of Boards of Pharmacy (NABP) is working to develop standards with each state in the educational curriculum of pharmacy technicians.
