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Opinions of Sunday, 24 September 2017

Columnist: Harry Amoaning Okyere

World Pharmacist Day! A time to step out of the woods?

World Pharmacist day is here again, and according the International Pharmaceutical Federation (FIP), the theme for this year’s celebration is chosen to highlight the numerous contributions the Pharmacy profession makes to health.

In contemporary healthcare, it is practically impossible to obtain medical intervention that doesn’t involve the use of medicines. Medicines use, however, is not without risk. For this reason, coupled with the increasingly complex and demanding task of drug selection and prescribing, the World Health Organization advocates for a multi-disciplinary approach to healthcare, which should inexorably involve Pharmacists. Pharmacists are custodians of medicines and a useful repository of medicines information. For the purpose of this piece of article, I want to focus more on Pharmacists’ direct contribution to healthcare and attempt to shed light on why many people do not appreciate what Pharmacists do in our part of the world.

Despite their immense potential and actual contribution to healthcare in our country, Pharmacists in Ghana are faced with an unfortunate, enormous lack of recognition and appreciation for their roles within the healthcare system. In fact, empirical and scientific evidence exist to suggest that Pharmacists are the most underutilized and under-recognized health professionals in our sub region. Sadly, the role of Pharmacists in healthcare is not deemed to be very important by the community and even by some healthcare professionals.

The reason for this execrable development is multi-faceted; there are too many barriers to the provision of good quality pharmaceutical care, driven by weak regulatory structures, and a fairly relaxed pharmaceutical society and a business oriented pharmacy practice.

In the hospital setting, the responsibility of many Pharmacists are obscured within a dispensary where the patient may not even have a glance at the Pharmacist. Due to time constraints, a large patient per Pharmacist ratio and a lack of legally and professionally binding standard practice guidelines, the science of dispensing is often not as pronounced and elaborate as it ought to be.

This has created a predominant belief among many people that pharmacists’ most important contribution to healthcare is medication distribution. Another reason is that Pharmacists are largely marginalized in the clinical drug selection process itself; a sharp contrast to the situation in developed countries. In many developed countries, a paradigm shift in Pharmacy practice encourages pharmacists and support staff to shift their focus from a solely product-oriented role towards more direct engagement with patients and the problems they encounter with medicines. Ghana is yet to fully embrace this shift. Critics of the profession may readily cite capacity deficiency as the ostensible reason for this marginalization. However, the real reason is the lack of revised definition of roles for all healthcare professions on the healthcare team to meet demands of changing times. There is an apparent unhealthy struggle for various professions to protect their ‘practice territory’. This undoubtedly threatens the call for a multidisciplinary approach to healthcare and the ultimate outcome is that patients are denied the best healthcare they deserve. What is needed is a regulation that will give impetus to far greater involvement of pharmacists in patient care and management.

At minimum, the most obvious responsibility of the Pharmacist is the art of dispensing. The Pharmacist clarifies the patients understanding of the intended dosage regimen and method of administration and advises the patient of drug related precautions. What patients need to understand, however, is that many behind-the-scene activities go on before drugs are dispensed or supplied. Pharmacist and the support staff review prescriptions to make sure the prescriber’s recommendation is appropriate and safe for the patient. Those with the right to prescribe know far less about drug therapies than Pharmacists, and patients need to make full use of that knowledge.

In a favorable setting where a multidisciplinary approach to healthcare is practiced, Pharmacists advise the team on the selection, dosage, interactions, and side effects of medications. It is also worth noting that Pharmacists are involved in administrative roles that procure quality and affordable medicines. Elsewhere, data from medicines use reviews and evaluations make it easier to quantify the interventions that Pharmacists make. In Ghana, due to poor record keeping, it is difficult to actually measure the contribution of Pharmacists to the healthcare team. In hindsight, it has become increasingly imperative and long overdue for Pharmacists to record all clinical interventions in the hospitals and devise some check tools for evaluating the work they do in the hospitals.

In the community setting where Pharmacists are more visible, the image of the profession is often soiled by a number of factors. Chiefly, in a genuine quest to ensure widespread accessibility of Pharmaceutical care, the regulatory authorities have allowed the proliferation of Private owned retail and wholesale Pharmacies as well as over-the-counter medicine sellers. Many of these Pharmacies cannot afford the services of Pharmacists, and many of the over-the counter medicine sellers end up stocking and supplying all classes of restricted medicines. For example, findings from a survey conducted in a rural region of Ghana revealed that drug retailers in five pharmacy outlets were found to have little or no training in pharmacy; the population bought drugs without prescriptions; the staff of these shops contributed to drug misuse by providing misinformation about drugs and selling drugs according to popular demand.

Yet, to many people, anyone working within those facilities may be called a Pharmacist. Even in situations where facilities are manned by qualified personnel, pressure from Pharmacy owners and the desire to make huge sales can sometimes negatively influence rational drug selection and use. Irrational use of medicine and weak regulatory enforcement of drug sales are very serious Public health issues that need to be addressed as a matter of urgency. Pharmacist must clearly identify themselves within the community and work with utmost professionalism if they wish to win over the heart of the public over their roles in the community.

Pharmacists in retail pharmacies counsel patients and answer questions about prescription drugs, including questions regarding possible side effects or interactions amongst various drugs. They also counsel patients on what constitutes a healthy diets, the benefits of physical exercise, tips for stress management, and appropriate use of durable medical equipment. Pharmacists also help patients monitor their blood sugar, blood pressure, their body weight and their blood hemoglobin levels.

Efforts to use community Pharmacies as Reproductive health centers is also being aggressively pursued and piloted in some facilities. Within the limits of state laws on healthcare provision, Pharmacist often diagnose and treat disease of common occurrence. In a country where the time and monetary cost of hospital visit is skyrocketing, many people use community Pharmacist as their first point of call for many ailments. They are optimally positioned within the community, are accessible and do not charge for consultation.

The Pharmacist is both partly a cause and fully a victim of this development and they have a huge role to play to stay visible and relevant in our healthcare system. Many people assume that anyone using a white coat within the hospital is a medical doctor. Pharmacists must therefore rebrand and distinguish themselves in the hospitals. They must use some form of identification that clearly identifies them and their profession. Pharmacists must also push to be more proactive and engage a lot with patients. Pharmacists should develop a trusting relationship with their patients.

Staying up-to-date in the pharmacy profession is non-negotiable for every practitioner if their impact is to be seen in the society. There should be an unflinching efforts to be an actively engaged pharmacist, who is abreast with the most current trends in their various practice. To wit, Pharmacists should not only focus on optimizing drug use in the individual, the profession as a body must begin to be actively involved in Public Health and Social interventions in the country. Programmes to promote, among many others, Adolescent Reproductive health, Environmental Sanitation, health screening, disease prevention and health promotion, reduce maternal and perinatal morbidity and mortality, Malaria and HIV related mortality, are some of the interventions where Pharmacists can be very useful considering the expansive and intensive nature of their training.

Essentially, Pharmacists are the backbone of health in many settings. However, until they step out of the woods into the plain, or even unto the hills, nothing will change and Pharmacists will be continued to be seen as those annoying guys that do nothing but count pills and take huge, undeserving amount of money.