The Pharmacist Roles

and Settings
LECTURE 2

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Learning Outcomes
The pharmacist
The pharmacist roles
The position of pharmacy within the health care services
Describe a variety of pharmacy practice settings (fields)
Recent developments in the services being provided by pharmacists

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Pharmacists
Pharmacists are experts on the actions and uses of drugs, including their chemistry, their
formulation into medicines and the ways in which they are used to manage diseases.
The principal aim of the pharmacist is to use this expertise to improve patient care.
Pharmacists are in close contact with patients and so have an important role both in assisting
patients to make the best use of their prescribed medicines and in advising patients on the
appropriate self-management of self-limiting and minor conditions. Increasingly this latter
aspect includes OTC prescribing of effective and potent treatments.
Pharmacists are also in close working relationships with other members of the healthcare
team – doctors, nurses, dentists and others – where they are able to give advice on a wide range
of issues surrounding the use of medicines.

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The role & The changing role of pharmacy
Historically, pharmacists and general practitioners have a common ancestry as apothecaries.
Apothecaries both dispensed medicines prescribed by physicians and recommended medicines
for those members of the public unable to afford physicians' fees.
As the two professions of pharmacy and general practice emerged this remit split so that
pharmacists became primarily responsible for the technical, dispensing aspects of this role.

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The role & The changing role of
pharmacy
 With the philosophy of free medical care at the point of delivery, the advisory
function of the pharmacist further decreased.
 As a result, pharmacists spent more of their time in the dispensing of medicines – and derived
an increased proportion of their income from it.
 At the same time, radical changes in the nature of dispensing itself occurred;
 In the early years, many prescriptions were for extemporaneously prepared medicines, either
following standard ‘recipes’ from formularies such as the British Pharmacopoeia (BP) or United
State Pharmacopoeia or following individual recipes written by the prescriber.
The situation was similar in hospital pharmacy, where most prescriptions were prepared on an
individual basis.

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The role & The changing role of
pharmacy
 In both situations, pharmacists required manipulative and time-consuming skills to produce the
medicines. Thus a wide range of preparations was made, including liquids for internal and
external use, ointments, creams, eye drops and ointments, injections and solid dosage forms
such as pills, capsules and moulded tablets .

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 The role & The changing role of
pharmacy
 Scientific advances have greatly increased the effectiveness of drugs but have also rendered
them more complex, potentially more toxic and requiring more sophisticated use than their
predecessors.
 The pharmaceutical industry developed in tandem with these drug developments, contributing
to further scientific advances and producing manufactured medical products.
This had a number of advantages.
I. An increased reliability in the product, which could be subjected to suitable quality
assessment and assurance.
II. This led to improved formulations, modifications to drug availability and increased use of
tablets which have a greater convenience for the patient.

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The role & The changing role of
pharmacy
 Some doctors did not agree with the loss of flexibility in prescribing which resulted from having
to use predetermined doses and combinations of materials.
From the pharmacist’s point of view there was a reduction in the time spent in the routine
extemporaneous production of medicines, which many saw as an advantage.
 Others saw it as a reduction in the professional role of the pharmacist. There was also an
erosion of the technical skill base of the pharmacist.

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The role & The changing role of
pharmacy
 The changing patterns of work of the pharmacist, in community pharmacy in particular, led to
an uncertainty about the future role of the pharmacist and a general consensus that
pharmacists were no longer being utilized to their full potential.
 IF the pharmacist was not required to compound medicines or to give general advice on
diseases, what was the pharmacist to do?

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 The profession
Four main areas in which pharmacy should make a major contribution to health outcomes were
identified:
 Management of prescribed medicines. This covers;
I. drug development
II. provision of medicines
III. information and support
IV. ensuring patient needs are met safely, efficiently and conveniently so that they can get
maximum benefit from their medicines.

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 The profession
 Management of chronic conditions. Here the need is
I. To improve the quality of life and outcomes of treatment for the patient.
II. Pharmacists may help by supplying medicines and advice
III. Ensuring that patients are taking or using their medicines properly and working as part of
the healthcare team.

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The profession
Management of common ailments.
- Patients require reassurance and advice, with or without the use of non-prescription medicines
and referral to other professionals if necessary.

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 The profession
Promotion and support of healthy lifestyles.
Pharmacists can help people protect their own health through
I. health screening
II. giving advice on healthy living
III. providing educational materials

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 The profession
• During the consultation process, pharmacists expressed their views on the way the profession
should change.
I. The strengths of pharmacy.
II. Demonstrating the value of pharmacy.
III. Changes in practice.

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 The strengths of pharmacy
I. The knowledge base of pharmacy was very important. This is based on both the study of and
experience with medicines and also in managing medicines and handling relevant
information.
II. Pharmacists’ availability and accessibility in a wide range of different locations in the heart
of the community, such as health centers, hospitals and in people’s homes. This accessibility
is strengthened by easy communication with both patients and other professionals.

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 Demonstrating the value of pharmacy
Pharmacy must claim its rights as a profession and accept the responsibilities which come with
this.
I. Thus, high standards must be set and achieved.
II. Evidence must be produced which demonstrates clearly the value of pharmacy in health
care. This development will come from increased continuing education .

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 Changes in practice
Three main areas where there could be an increase in services were identified. These are:
I. The enhancement of services to patients (advice, counselling, health promotion and non-
prescription medicine sales);
II. improved relationships with other healthcare professionals (closer support for prescribers,
medicine management, liaison between hospital and community pharmacy and different
community pharmacists, training for other professionals and careers); and
III. practice research and audit, continuing education and better use of information technology
(all required to support the other developments).

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Pharmacists in Jordan
There are currently around 22 000 Jordanian member pharmacists registered with the
Jordanian Pharmaceutical Association (JPA), including those who are working in different sectors
of the profession.
Work in community pharmacy, in hospital Pharmacy, drug store and in the pharmaceutical
industry.

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 The Registration and Licensure in Jordan

 The Registration in JPA

I. Bachelor degree in pharmacy certification from accredited pharmacy college/University
II. Training requirements for pharmacy student s 1440 training hours in community pharmacy,
in hospital Pharmacy or in the pharmaceutical industry ONLY.
III. Pass the Training Exam held by JPA.
 The Licensure from the Ministry of Health

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Pharmaceutical sciences
The pharmaceutical sciences are a group of interdisciplinary areas of study concerned with the
design, action, delivery, and disposition of drugs.
They apply knowledge from
 Chemistry (inorganic, physical, biochemical and analytical)
 Biology (anatomy, physiology, biochemistry, microbiology, cell biology, and molecular biology),
 epidemiology, statistics, mathematics.

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 The pharmaceutical sciences
 The pharmaceutical sciences are further subdivided into several specific specialties, with four
main branches:
1. Pharmacology: the study of the biochemical and physiological effects of drugs on human
beings.
I. Pharmacodynamics: the study of the cellular and molecular interactions of drugs with their
receptors. Simply "What the drug does to the body“
II. Pharmacokinetics: the study of the factors that control the concentration of drug at various
sites in the body. Simply "What the body does to the drug"
III. Pharmaceutical toxicology: the study of the harmful or toxic effects of drugs
IV. Pharmacogenomics: the study of the inheritance of characteristic patterns of interaction
between drugs and organisms.

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The pharmaceutical sciences
2. Pharmaceutical chemistry: the study of drug design to optimize pharmacokinetics and
pharmacodynamics, and synthesis of new drug molecules (Medicinal Chemistry).
3. Pharmaceutics: the study and design of drug formulation for optimum delivery, stability,
pharmacokinetics, and patient acceptance.
4. Pharmacognosy: the study of medicines derived from natural sources.

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The fields of pharmaceutical work
Areas of Practice
• Community pharmacy
• Hospital pharmacy
• Pharmaceutical industry / Regulatory Affairs
• Academia

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Community pharmacy

• The community pharmacist is one of the main providers of medicines and medicines advice in
primary care.
•This sector has the largest proportion of registered pharmacists working within it.
•The business may be anything from an independently run single pharmacy, small chains of
pharmacies, or a large multiple chain of pharmacies.
The community pharmacy is a privately run business which is contracted to deliver health
services including the dispensing of prescriptions and the sale of over the counter medicines .

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Activities of community pharmacists (WHO)
1. Processing of prescriptions
2. Care of patients or clinical pharmacy
3. Monitoring of drug utilization
4. Extemporaneous preparation and small-scale manufacture of medicines
5. Health promotion

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Activities of community pharmacists (WHO)
The main activities of community pharmacists are described below.
Processing of prescriptions
The pharmacist verifies the legality, safety and appropriateness of the prescription order, checks
the patient medication record before dispensing the prescription (when such records are kept in
the pharmacy), ensures that the quantities of medication are dispensed accurately, and decides
whether the medication should be handed to the patient, with appropriate counselling, by a
pharmacist.

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Activities of community pharmacists (WHO)
Care of patients or clinical pharmacy
The pharmacist seeks to collect and integrate information about the patient’s drug history,
clarify the patient’s understanding of the intended dosage regimen and method of
administration, and advises the patient of drug-related precautions.
Monitoring of drug utilization
The pharmacist can participate in arrangements for monitoring the utilization of drugs, such as
practice research projects, and schemes to analyze prescriptions for the monitoring of adverse
drug reactions.

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Activities of community pharmacists (WHO)
Extemporaneous preparation and small-scale manufacture of medicines
Pharmacists everywhere continue to prepare medicines in the pharmacy. This enables them to
adapt the formulation of a medicine to the needs of an individual patient.
New developments in drugs and delivery systems may well extend the need for individually
adapted medicines and thus increase the pharmacist’s need to continue with pharmacy
formulation.
In some countries, developed and developing, pharmacists engage in the small-scale
manufacture of medicines, which must accord with good manufacturing and distribution
practice guidelines.

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Activities of community pharmacists (WHO)
Health promotion
The pharmacist can take part in health promotion campaigns, locally and nationally, on a wide
range of health-related topics, and particularly on drug-related topics (e.g., rational use of drugs,
alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent
abuse, poison prevention) or topics concerned with other health problems (diarrheal diseases,
tuberculosis, leprosy, HIV-infection/AIDS) and family planning.
They may also take part in the education of local community groups in health promotion, and in
campaigns on disease prevention, such as the Expanded Programme on Immunization

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Hospital pharmacy
•The pharmacist’s role within the hospital is more specialized than that of the community
pharmacist and, usually, there is more than one pharmacist working in the same hospital.
•They work closely with other healthcare professionals in the hospital to ensure the safe use and
delivery of medicines to the patient regardless of the type of hospital.
•Hospital pharmacists are responsible for the purchase, manufacture, dispensing and supply of all
the medicines used in the hospital.
•One of their main roles is to advise other staff on the most safe and effective use of medicines
for individual patients including the selection of the drug, dose, formulation, administration and
monitoring of that drug.
•During ward rounds hospital pharmacists will speak to patients to improve patient
understanding and concordance with their medicines during their stay and before they leave the
hospital and some pharmacists will develop specific clinical specialisms to support this work.

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Activities of Hospital pharmacists (WHO)
has more opportunity to interact closely with the prescriber and, therefore, to promote the rational
prescribing and use of drugs;
• in larger hospital pharmacies, is usually one of several pharmacists, and thus has a greater
opportunity to interact with others, to specialize and to gain greater expertise;
• having access to medical records, is in a position to influence the selection of drugs and dosage
regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and
report adverse drug reactions;
• can more easily than the community pharmacist assess and monitor patterns of drug usage and
thus recommend changes where necessary;
• serves as a member of policy-making committees, including those concerned with drug selection,
the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and thereby
influences the preparation and composition of an essential-drug list or formulary;
• is in a better position to educate other health professionals about the rational use of drugs;

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Pharmacy industry
(The pharmaceutical industry)
• Privately run industrial companies are the main source of research and development for
medicines worldwide.
• The pharmaceutical industry is largely responsible for the identification and development of
new medicines and ensuring the safety of the medicine.
•Pharmacists have a number of roles within industry including identifying a compound which
could become a medicine, testing its safety, formulating it into a usable medicine and marketing
the final product for sale and distribution.

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 Activities of industrial pharmacists
(WHO)
The main activities of industrial pharmacists are :
I. Research and development (RND)
II. Manufacture and quality assurance
III. Drug information(‫)اﻟﻣﻌﻠوﻣﺎت اﻟدواﺋﯾﺔ‬
IV. Pharmacovigilance (‫)اﻟﯾﻘظﺔ اﻟدواﺋﯾﺔ‬
V. Patent applications and drug registration(‫)طﻠﺑﺎت ﺑراءات اﻻﺧﺗراع وﺗﺳﺟﯾل اﻷدوﯾﺔ‬
VI. Clinical trials and post-marketing surveillance(‫)اﻟﺗﺟﺎرب اﻟﺳرﯾرﯾﺔ وﻣراﻗﺑﺔ ﻣﺎ ﺑﻌد اﻟﺗﺳوﯾﻖ‬
VII. Sales and marketing
VIII. Management
IX. Regulatory affairs

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Activities of industrial pharmacists
Research and development
Pharmacists contribute to research, and their expertise in formulation development is of
particular relevance to the biological availability of active ingredients.
Manufacture and quality assurance
The pharmacist’s broad knowledge of the pharmaceutical sciences ensures an integrated
approach to quality assurance (including good manufacturing practice) through the validation of
the various stages of production and the testing of products before release.
Drug information
The pharmacist has the knowledge and expertise to provide detailed information on medicines
to members of the health professions and the public. Also, pharmacists provide an information
service within the company.

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Activities of industrial pharmacists
Pharmacovigilance
A career in pharmacovigilance provides good prospects with generation of new drugs every day.
Pharmacovigilance is the process of collecting, researching, monitoring, evaluating and assessing
information derived directly or indirectly from patients to identify adverse effects of marketed
medications and ensure drug safety. The aim of pharmacovigilance is to identify new hazards
associated with medications and provide effectively safer medicines to the public.

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Activities of industrial pharmacists
Patent applications and drug registration
The pharmacist is ideally qualified to understand and collate the diverse information required for patent and
authorization submissions.
Clinical trials and post-marketing surveillance
The pharmacist has the knowledge of drugs and health care provision required to facilitate collaboration between
companies, health professionals and governments in relation to clinical trials and surveillance.
Sales and marketing
The pharmacist, whose professional ethics demand a concern for the interest of patients, can make a contribution
to proper marketing practices related to health care and to the provision of appropriate information to health
professionals and the public.
Management
The inclusion of pharmacists in all levels of management promotes an ethical approach within management
policies.

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Activities of industrial pharmacists
Regulatory affairs
The role of the regulatory affairs department
The regulatory affairs (RA) department of a pharmaceutical company is responsible for obtaining
approval for new pharmaceutical products and ensuring that approval is maintained for as long
as the company wants to keep the product on the market.

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