LECTURE 2: HISTORY AND

DEVELOPMENT OF SOCIAL
PHARMACY

Development of the
profession
 Introduction

• In this topic we attempt to trace the

development of social pharmacy
• Leading to the convergence of the
pharmacist’s role in providing advice to
physicians and pharmaceutical care
• In many countries social pharmacy
developed from the processes of
preparation and dispensing of medicinal
products as well as patient counselling
 Social importance of Drugs

• The profession of pharmacy has existed in

human societies for centuries
• However its social significance remained
unrecognized until the 19th century

• Preparing medicines is a matter of general

importance, because public health is
involved- (Thorbecke, Dutch statesman
1865)
 Drugs in society
• Furthermore it was not until 1960s that the
providers of medicines recognised their
impact on society
• Prior to the end of 19th century the
pharmacist’s role was largely perceived as
medical although they also had social
roles encompassing
 Drugs in society
• Preparing and dispensing remedies
• Patient care
• Diagnosing
• Simply put there was no institutional
separation of medical and pharmaceutical
roles in the West until the 19th century
 Industrial production of drugs

• Industrial production of drugs began in

Western countries at the end of 19th
century

• It also marked the beginning of the shift in

the pharmacist’s professional role

• Control of drugs and their distribution

became the central focus
 Commercialisation of Pharmacy

• Led to a decline in patient care

• Decline in the level of social and ethical

standards in pharmacy practice

• Gradual reduction of the role of the

pharmacist in the preparation of medicines
 Patient-focused Approach

• The 1980s and 1990s however witnessed

another shift in focus of the pharmacy
profession to a more patient-focused
approach

• Internationally the profession began to

embrace pharmaceutical care
 Patient-focused Approach

• This involved paying more attention to

• Pharmacists’ activities
• Their patient advisory role
• Clinical pharmacy movement
• Advancement of the field of social
pharmacy
 A New Approach

• This approach in addition involved

• Providing information
• Recognising the role of the patient in
health care
• Increased awareness of the needs and
expectations of clients (service recipients)
• Re-professionalisation of pharmacists
 Drug Advertising

• When the pharmaceutical industry started

to advertise their drugs to prescribers,
• Physicians and pharmacists increasingly
started to question the ethical aspects of
these advertisements
• The role of the pharmacist in advising
physicians became increasingly
recognised
 Health education

• The pharmacists role in offering health

education to the public also became
increasingly important beginning in the
1960s (e.g., drug information support)

• This period coincided with the

establishment of community health centres
in many countries in Africa, Asia and
Europe
 Role of the Patient

• Societal factors that drove the patient

advisory role of the pharmacist after the
1940s (post-second World War) were;
• Growing commercial influence of television
advertising on drug consumption from the
1960s
• Growing recognition that the provision of
drugs should ultimately serve the interest
of the patient
 Role of the Patient

• Emergence of social pharmacy in early

1960s coincided with the realization
among professional pharmacists of;

• Duty to provide optimal pharmaceutical

care to the individual and community

• Professional responsibility with regard to

the clients
 Role of the Patient

• There was also acceptance among the

pharmacy professionals that the patient
had a right to drug information

• This realisation coincided with the ‘Paris

Revolution’ (1968) that triggered demands
of greater rights for the individual
 Role of the Patient

• Political and human rights movements

spreading from Paris (1968) challenged
long held arguments among medical
professionals that physicians had the right
to decide what information was given to
the patient
 Concerns

• According to the Dutch society for

advancement of pharmacy (KNMP) the
potential areas of concern with regard to
patient rights were

• Privacy of patients
• Education level and attitude of the co-
workers in the pharmacy (i.e. securing
their commitment to pharmaceutical care)
 Concerns

• Consequently there were moves from the

1970s in Europe to modify the information
leaflets/package inserts for patient
information

• Originally the inserts were developed by

the manufacturers and were written in
scientific language to serve as information
source for physicians
 Concerns

• From the 1970s onwards informational

leaflets were developed on groups of
drugs and they were patient-oriented
instead of physician oriented
• Thus there has been greater professional
and political focus on satisfying patients’
demands for more information on the
drugs they are taking in the last two-three
decades
 Medication surveillance
• Clinical pharmacy movement started first
in the USA in the late 1960s and in Europe
in the early 1970s

• These movements stimulated the

introduction of social pharmacy into the
pharmacy curriculum in schools of
pharmacy
 Surveillance
• Patients previously viewed as passive
objects/recipients of drugs,

• Period witnessed increased recognition of

need to focus on care or the social life of
the patient

• Patients became active participants in

use/consumption of drugs and services
 Surveillance
• Instruments for medication-evaluation
initially came into use in 1970s,
• Cards and later computers containing
prescription information were thus
introduced in the pharmacy
• These became critical instruments in
medication surveillance and in extending
the role of the pharmacist
 Surveillance
• From 1980s pharmacists began in a
limited way to communicate directly with
patients and not through physicians like
before.
• Alongside surveillance the profession
embraced counselling as an integral part
of pharmaceutical care
• In the last two decades i.e. from roughly
1990s computer systems have become
critical in maintaining patient medication
data and in medication analysis
 Surveillance
• Medication surveillance and information
sharing is have increasingly focusing on
• Interactions
• Contraindications
• Compliance
• Dosing
 Surveillance
• Based on the above information
pharmacies are able to;
• Establish quality control mechanisms
• Develop routines for to handle information
generated by their surveillance systems
• Complement the information available to
physicians on patients’ medication that
tends to range from 50-75%
 Patient centred approach
• Became necessary from 1980s onwards
• Pharmacists realised that their role went
beyond being drug specialists and
protecting the public from drug misuse
• Patient-centred care developed alongside
the concept of comprehensive care
(holistic care)
 Higher responsibility
• Patient-centred care required a re-
definition of the role of pharmacist (from
1990s)
• Grew from recognition of the need for
continuing education for communities on
use of medications and patient care