Community pharmacy practice-A few thoughts

pharmaceticalI have no doubt at all in my mind that Community Pharmacy should be a strong face of pharmacy practice in the country.

The way society views pharmacy practice is to large extent shaped at the community level. It is on this basis that no effort should be spared in continuously building capacities and competencies at the community level within pharmacy practice.

A good community pharmacist will know when to intervene and when to roll over a client to the next level of care within the health care delivery system.

He or she will also forge relationships with health care providers within the community and beyond to facilitate seamless care for clients.

Therefore as a community pharmacist you will be the first to see the client and even again after the client is referred (by you) to see another health care provider because it will be necessary to do medication reconciliation and counselling when the client returns to the community. It is not gain-saying that a good community level pharmacy practice will only inure to the benefit of health care delivery in the country.

This is another reason why I would advocate for every family in the country to have a family pharmacist. It is important to stress that one can only attain this through continuous training and with a mindset of a life-long learning all in the interest of enhanced client care.

It was against this backdrop that I readily accepted the invitation to do a presentation on Counselling skills to Community Pharmacists in the Greater Accra region recently.

Somehow the campaign on the Disposal of Unused/Unwanted Medicines Programme (DUMP) is being noticed in unexpected quarters within the country.

The presence of unused/unwanted medicines at homes to a large extent underlies the importance of patient counselling and the need to improve communication skills.

The organizers, Novartis, had rightly deduced that effective communication was critical in ensuring adherence to medication. It is an area we intend to explore thoroughly in the ensuing year in line with our Disposal of Unused/Unwanted Medicines Program (DUMP).

How do you ensure medication adherence in a client (diabetic/hypertensive/high cholesterol) who fills his prescription at your community pharmacy for example for Tab. Glibenclamide 5mg twice daily, Tab. Metformin 500mg twice daily, Tab. Pioglitazone 15mg daily, Tab. Lisinopril 10mg daily, Tab. Amlodipine 10mg daily, Tab. Atorvastatin 20mg daily, Tab. Aspirin (Soluble) 75mg daily?

What role is each medication playing in the management of the disease condition? When should the medication be taken? What are the required precautions? What are the expected untoward effects? What should the client do in the face of untoward effects? What should the client do if a dose of a medication is missed?

What simple aids can one provide at the community pharmacy level to monitor blood sugar, cholesterol, blood pressure and even weight of the client? What can you do at the community pharmacy level to promote health literacy and improve the client’s understanding of the various disease conditions?

The United States Pharmacopoeia (USP) has guidelines for medication counselling divided into four different stages (l-IV). Stage l is the Medication information transfer, during which there is a monologue by the pharmacist providing basic, brief information about the safe and proper use of medicine.

Then comes Stage II referred to as Medication information exchange, during which the pharmacist answers questions and provides detailed information adapted to the patients’ situation. Stage III is Medication education, during which the pharmacist provides comprehensive information regarding the proper use of medicines in a collaborative, interactive learning experience. T

hen comes Stage IV described as Medication counseling, during which the pharmacist and patient have a detailed discussion intending to give the patient guidance that enhances problem-solving skills and assists with proper management of medical conditions and effective use of medication.

I am sure many readers will be the first to point out that many practitioners hardly go beyond Stage l if one looks at the steps as outlined by the USP. I am sure we could find various reasons ranging from constraints of time, high number of clients, limited number of practitioners, challenges with regard to the design of areas of practice.

Let us a look at another scenario at the Community pharmacy: An elderly diabetic hypertensive with osteoarthritis patient walked to your pharmacy with a pile of medications from home. The patient is 71yrs.

He is on Tabs. Amlodipine 10mg daily, Atenolol 50mg daily, Bend-rofluazide 5mg daily, Glibenclamide 5mg 2x daily, Metformin 500mg 2x daily, Paracetamol 500mg prn, Diclofenac Retard 100mg prn, Cap. Tramadol 50mg prn. The medicines he brought along in a big bag were : Atenolol 50mg (205tabs), Amlodipine 10mg (125tabs), Bendrofluazide 5mg (165tabs), Glibenclamide 5mg (160tabs), Metformin 500mg (190tabs), Tab. Paracetamol 500mg (120tabs), Diclofenac Retard 100mg (110tabs), Tramadol 50mg (210 caps).

The Community pharmacist checks on the client showed the ensuing: Wt 83kg, Ht 1.65m, B.P. 150/100, P 110, RBS 13mmol/l.

The client needed advice on the continuing use of the medications which he had kept for several months at home.

I am sure readers would be wondering how the client ended up with a ‘mini pharmacy’ at home. Well the client has children spread out between the four different countries abroad and each sends down ‘something’ for Daddy.

It was a very interesting exercise during the session with the Community pharmacists because it had appeared the story was familiar.

With the fore-going there can be no doubt at all about the need for a vibrant and responsive Community Pharmacy Practice in the country. What is required is continuous upgrading of capacities and developing competencies to cope with the dynamics of the health delivery system.

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