Pharmacy
Pharmacy (from the
Greek φάρμακον = drug) is a chemical science and
profession charged with ensuring the safe use of
medication. Traditionally, pharmacists have compounded and dispensed medications on the orders of physicians. More recently, pharmacy has come to include other services related to
patient care including clinical practice, medication review, and drug information. Some of these new pharmaceutical roles are now mandated by law in various
legislatures.
Pharmacists, therefore, are drug therapy experts, and the primary health professionals who optimise medication management to produce positive health-outcomes.
The
symbols most commonly associated with pharmacy are the
mortar and pestle and the (
) character. Pharmacy organisations often employ other elements, such as the
Bowl of Hygieia,
conical measures, and
caduceuses in their
logos. Other symbols are common in different countries such as the green
Greek cross in
France and
Great Britain, the increasingly-rare
Gaper in
The Netherlands, and a red stylised letter A in
Germany.
The field of Pharmacy can generally be divided into three main disciplines:
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Pharmaceutics*
Pharmaceutical chemistry (often
Medicinal chemistry)
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Pharmacy practiceThe boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut; and often, collaborative teams from various disciplines research together.
Pharmacology is sometimes considered a fourth discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Therefore it is usually considered to be a field of the broader
sciences.
There are various specialties of pharmacy practice. Some specialisation is based on the place of practice including: community, hospital,
consultant,
locum, drug information, regulatory affairs, industry, and academia. Other specialisations are based on clinical roles including: nuclear, oncology, cardiovascular, infectious disease, diabetes, nutrition, geriatric, and psychiatric pharmacy.
Pharmacists are highly-trained and skilled healthcare professionals who perform various roles to ensure optimal health outcomes for their patients. Many pharmacists are also
small-business owners, owning the pharmacy in which they practice. This unique
dichotomy is often the subject of debate within the profession"in part due to the perception of pharmacists as "common shopkeepers" by many in the community.
Pharmacists are represented internationally by the
International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the
Royal Pharmaceutical Society of Great Britain (RPSGB), the
Pharmaceutical Society of Australia (PSA), the
American Pharmacists Association (APhA), and the
American Society of Health-System Pharmacists (ASHP).
See also: List of pharmacy associations.In some cases, the representative body is also the registering body, which is responsible for the
ethics of the profession. Since the
Shipman Inquiry, there has been a move in the
UK to separate the two roles.
In most jurisdictions (such as the
United States),
pharmacists are regulated separately from
physicians. Specifically, the legislation stipulates that the practice of prescribing must be separate from the practice of dispensing. These jurisdictions also usually specify that
only pharmacists may supply scheduled
pharmaceuticals to the public, and that pharmacists cannot form business
partnerships with physicians or give them "kickback" payments.
In the minority of
jurisdictions (particularly in
Asian countries such as
China,
Hong Kong,
Malaysia, and
Singapore),
doctors are allowed to dispense
drugs themselves and the
practice of pharmacy is integrated with that of the
physician.
In Canada it is common for a medical clinic and a pharmacy to attached and for the ownership in both enterprises to be common, but licensed separately.
The reason for the majority rule is the high risk of a conflict of interest. Otherwise, the physician has a financial self-interest in "diagnosing" as many conditions as possible, and in exaggerating their seriousness, because he or she can then sell more medications to the patient. Such self-interest directly conflicts with the patient's interest in obtaining cost-effective medication and avoiding the unnecessary use of medication that may have
side-effects.
A campaign for separation has begun in many countries and has already been successful (like in
Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g. in
Malaysia).
|
19th century Italian pharmacy |
A
pharmacy (commonly the
chemist in
Australia,
New Zealand and the
UK; or
drugstore in
North America; or
Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers.
Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment,
etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications; there has been an increasing trend towards the use of trained
pharmacy technicians while the pharmacist spends more time communicating with patients.
All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that many
retailers (including
grocery stores and
mass merchandisers) now include a pharmacy as a department of their store.
Pharmacies within
hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues. Because of the complexity of the medication use system, many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area.
Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including
total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Some hospital pharmacies have decided to
outsource high risk preparations and some other compounding functions to companies who specialize in compounding.
Recently, a number of pharmacies have begun operating over the
Internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient (and private) than traveling to a community drugstore. Internet pharmacies are also recommended to some patients by their physicians if they are homebound.
Some Internet pharmacies sell prescription drugs without requiring a prescription. Some customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There have also been reports of such pharmacies dispensing substandard products.
In the
United States, there has been a push to legalize importation of medications from
Canada and other countries, in order to reduce consumer costs. Although importation of prescription medication currently violates
Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers.
In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists expect to be paid for their cognitive skills.
This paradigm shift has already commenced in some countries; for instance, pharmacists in
Australia receive remuneration from the
Australian Government for conducting comprehensive Home Medicines Reviews. In Great Britain, pharmacists (and nurses) who undertake additional training are obtaining prescribing rights. In the United States,
consultant pharmacists, who traditionally operated primarily in
nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy."
Many universities are altering their programs to increase emphasis in fields such as pharmacotherapeutics, clinical pharmacy, nuclear pharmacy, disease state management, etc.
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List of pharmacies*
List of pharmacy associations*
Clinical pharmacy*
Hospital pharmacyRegulatory
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National Association of Boards of Pharmacy*
Pharmacy Board of New South Wales*
Pharmacy Board of Victoria (Australia)*
Pharmacy Council of New ZealandHistory and traditions
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Navigator History of Pharmacy Collection of internet resources related to the history of pharmacy.
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RPSGB Museum Information Sheets Illustrated information sheets on objects in the history of pharmacy.
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History of Pharmacy Web Pages Perbo´s History of Pharmacy Web Pages.
Other
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The Virtual Library of Pharmacy - Extensive index of pharmacy-related resources, including information on careers in pharmacy, pharmacy schools, pharmaceuticaul companies, associations and conferences.
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Virtual Library of Biochemistry and Cell Biology - Resource devoted to drug discovery and chemical and pharmacological approaches to biology, biomedicine and biotechnology.
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The British Library, Pharmacy Industry section*
EgyPharmaZone - Largest Egyptian Pharmaceutical Portal.
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Pharmweb.Net - Portal site for pharmacists and healthcare professionals.
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Pharmacist.com - Portal site for pharmacists and pharmacy students.
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Museu da Farmácia - Pharmacy Museum in
Lisbon*
auspharm.net.au - Portal for pharmacists practising in Australia, providing useful links, a discussion list, and feature articles
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Pakistan Pharmacists Society - National association of pharmacists to promote and expand their role in public health and patient care in Pakistan
