Perspectives on Global Health from Pharmacists Around the World, Part 3

As healthcare continues to morph and adapt based on the requirements of kind, compassionate, evidence-based care, pharmacists are playing a vital role in ensuring patient’s needs are met in countless regions across the earth. In this four-part IH Blog series, the pharmacy role accompanied by profession-related challenges and pharmacist-led global health initiatives will be explored within a profession that is often underappreciated. The following perspectives, shared by practicing pharmacy professionals from the United Arab Emirates (UAE), India, Cambodia, and the United States of America (USA) aim at highlighting various aspects of healthcare that should be properly addressed by governmental bodies, NGOs, and all stakeholders by both sustainable political will and empowering solutions. 

This third segment focuses on local and global pharmacist roles in each of these areas and the thoughts that pharmacists from these respective nation states have been willing to share with IH Connect.

Healthcare systems across the globe are unceasingly identifying novel approaches for health professionals to fulfill. The traditional roles that physicians, nurses, and other allied health workers performed in the past have metamorphosed as patient-care management is altered to effectively accompany patients. A few illustrations include: one of the most prominent international non-governmental organizations (INGO), Partners In Health, has a nurse – Sheila Davis – as it’s CEO contrasting a physician fulfilling this position; physician assistants and nurse practitioners being heavily utilized as primary care providers; and the introduction of community health outreach specialists as vital patient resources. The vocation of a pharmacist, in particular, has been altered significantly depending on the area of the world one inhabits. The majority of humanity believe that pharmacists are those who solely dispense medications, but several regions on the earth have realized the benefit of incorporating pharmacists in direct patient management, treatment guideline development, and even directors of ministries of health. Regardless of the development of pharmacy in a country, this healthcare profession is a key to kind, compassionate patient-centered care. The following commentaries from the United States of America, India, United Arab Emirates, and Cambodia explore the profession of pharmacy both locally and internationally while exposing initiatives to improve global health through pharmacists.  

 Dr. Moeung Sotheara, Ph.D. 

Clinical Research Assistant & Part Time Lecturer – University of Health Sciences

Phnom Penh, Cambodia 

In Cambodia, a large proportion of pharmacists work in community pharmacy, pharmaceutical enterprises and hospital pharmacy. However, there is still an insufficient presence of pharmacists in each area. In community pharmacy in particular, the inadequate presence of pharmacists is due to the current system of “name renting”, a legacy of post-war public health policy in response to the shortage of healthcare professionals. In such a system, any person having minimum knowledge in medicine dispensing and having been trained by the Ministry of Health for a specific period of time can “rent” a pharmacist’s name to apply for a pharmacy permit. Nevertheless, despite the growing number of pharmacists owning a pharmacy in recent years, the pharmacists’ role remains the traditional product-oriented functions of dispensing and distributing medicines and health supplies. In other words, pharmacists are still viewed as “simple medicine sellers” by the public. As the country develops and medicine consumption has increased, the pharmacist’s services in community as well as in hospital pharmacy must shift from medication dispensing to a focus on safe and effective medication use to achieve optimal patient outcomes. Pharmacists must assert themselves as medication experts and play a more active role in patient counseling and promoting the rational use of medicine. In addition, pharmacists must also be actively involved in public health. The functions of public health that can benefit from pharmacists’ expertise may include disaster preparedness, immunizations, preventive health measures and educating other healthcare providers about various techniques of prescribing medications and issues related to the drug use process.

Transitioning the discussion to global health, pharmacists have unique skill sets and assets that put them in a prime position to collaborate with members of the health care team to address global health issues and challenges. However, there is limited information on the role of the pharmacist in this field. There are 3 areas pharmacists can play in global health in the future: global health practice and program delivery, global health research, and global health policy. In the area of global health practice and program delivery, pharmacists can serve an important role on the health care team in under-served countries by helping address barriers to the delivery of care due to their knowledge of drug products, storage requirements, dispensing requirements, and logistics of pharmacy operations. They can improve clinical outcomes through patient-centered services such as glucose monitoring and blood pressure management, and also potentially work with local and national health organizations to help develop global health programs based on successful interventions made locally in the community. In the area of global health research, pharmacists who are affiliated with a university that has a focus on this area can assess global health projects and research initiatives to determine if opportunities exist for pharmacy to get involved and to add new dimensions to existing global health research. Finally, the outcomes of global health research often stimulate the need for proposing and evaluating global health policy at both the governmental and national level at which pharmacists can lend their expertise. As medication experts, pharmacists routinely exercise their knowledge of the rational use of medications, their cost-effectiveness, and the safety and efficacy of therapeutic regimens. These concepts can be applied domestically toward the development of policies that have global implications.

Nazgul Bashir, B. Pharm

Registered Pharmacist – Super Care Pharmacy

Dubai, United Arab Emirates

The role of the pharmacist varies from region to region and differs in several aspects. While there are areas of this world in which Pharmacists have vital roles in health sectors, there are other parts where pharmacists are given underutilized roles. Pharmacists are scattered throughout the community allowing them to be the most approachable healthcare professional – needing no appointment, no time restrictions and often being available 24 hours. Due to their aforementioned accessibility, their roles should be thoroughly revised, and the public should be made more adequately aware of their significance in communities.

Regarding the regional role of pharmacists in the United Arab Emirates, there was little utilization of pharmacists 10 to 20 years ago. Even now, some locations lack proper utilization due to their role being more product-based selling and dispensing any medication prescribed by the physicians. This occurs even though pharmacists in UAE are available in hospitals, health clinics, community and in retail stores allowing them significant access to patients.

To elaborate on the under-utilization of pharmacists, the current healthcare system typically does not promote pharmacist’s interventions in patient-management. This could include managing the dose of a hypertension agent, discussing change of therapy to more efficiently achieve patient outcomes, and a larger role in discharges from hospitals where pharmacists can provide counseling and follow-up.

Immunization is another role of pharmacists which could make a huge impact. Currently, most of the immunizations in this region are taking place in hospitals and health centers which are handled by nurses and physicians. However, this role can be handed to pharmacists in the community who can bring awareness to communities so that people won’t miss their vaccinations . In particular, many people are not even aware about the importance of flu shots. Pharmacists should be given an equal responsibility in bringing the awareness in a community and assisting people to receive their shots on time and prevent ailments. Counseling on family planning, use of contraception, palliative care, prevention of disease, identifying high-risk patients for diabetes and cardiovascular diseases are services not offered in pharmacies. Over-the-counter advice and educating patients on dietary supplements are often performed, but pharmacists are still underutilized overall.

However, the future of pharmacists in UAE look promising as several chain pharmacies make new exceptions in implementing more significant roles for their pharmacists. For example, physicians are advised to use the generic name so that pharmacists can choose to dispense the trade name.Additionally, pharmacists are being advised to minimize the use of antibiotics by making them strictly prescription based thus avoiding unnecessary use of them. Many barriers for increased pharmacist services need to be overcome: lack of time to offer services, shortage of pharmacists, lack of patient demand and low patient acceptance, lack of knowledge and skills, and underestimation of enhanced pharmacy services by physicians. With these barriers in mind, government and health authorities are planning their best and making promising change to bring the best of the pharmacy divisions.

Dr. Bryce Adams, Pharm D., RPh.

Oncology Medical Science Liaison

Washington D.C., United States of America 

Before delving into the role of the pharmacist in the United States, I would like to highlight the Oath of a Pharmacist as this serves as the model of how a pharmacist should view their role:

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:

  • I will consider the welfare of humanity and relief of suffering my primary concerns.
  • I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
  • I will respect and protect all personal and health information entrusted to me.
  • I will accept the lifelong obligation to improve my professional knowledge and competence.
  • I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
  • I will embrace and advocate changes that improve patient care.
  • I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”

Currently, the USA is in the midst of a great shift in the pharmacist profession. According to 2017 statistics, 60% of pharmacists in the United States were practicing in retail pharmacies – this includes drug, merchandise, and grocery stores. However, these roles are expected to decrease over the coming years. There are several contributing factors for this decrease – one being a decrease in the price margins per prescription. As pharmacies make less money for each prescription that is filled, businesses have to fill more prescriptions with less staff. This can cause a host of issues, such as having less time to counsel patients, more reliance on technology to catch errors, an increase in likelihood for medication errors, and a more difficult time fulfilling the oath of a pharmacist. Ultimately, this leads to under-utilization of the pharmacist profession by placing less of a value on their role of positively impacting patient care.

Fortunately, pharmacists have been realizing this shift and have been proactive in adapting. They have achieved this by advocating for additional venues to provide value, such as being able to bill for medication therapy management services and administering vaccines. These services are extremely beneficial for patients and also increase revenue for the businesses. While roles in the retail setting are expected to decrease, roles in the hospital and ambulatory care settings are expected to increase. Currently, 30% of pharmacists are in these settings. With an increasingly elderly population, these roles are becoming even more important.

These aforementioned pharmacist provided-services typically utilize this profession in a more productive way by rounding with physicians and helping to inform clinical decisions for specific patients. The rest of pharmacists are scattered across a variety of specialties. Two of these specialties are academia and the pharmaceutical industry. Both of these have more of a global health impact, as academia is training the next wave of professionals who will have an international presence and will impact care while the pharmaceutical industry is developing the next wave of transformative medications that will improve patient care on a global level.

Before I finish, I want to revisit the oath of a pharmacist. As the United States healthcare system is being scrutinized due to the cost, as technology is becoming more utilized, and processes are becoming more automated, pharmacists will need to “embrace and advocate changes that improve patient care.” Pharmacists are in a unique position as the medication experts to greatly impact patient care, and it’s up to this profession to ensure that the right patient gets the right drug at the right dose via the right route at the right time.

Dr. Maneesha Erraboina, PharmD.

International Business Manager – Helics Group Scientific Networks 

Hyderabad, India 

In theory, the role of Indian pharmacists is to dispense medications by adjusting the dose for patients based on their health condition, and they play a major role in the rational use of drugs especially antibiotics. However, in India, it is very difficult to find a pharmacist in clinical hospital settings and none of the medical organizations have pharmacist professionals in the healthcare team. 

According to mainstream Indian psychology, most of the population only accepts medications from physicians rather than another profession, like pharmacists. This is an ongoing trait of Indian citizens that has existed for several years with very few signs of significant change in the future. 

In my own personal experience, I had an opportunity to attend an interview for a pharmacy position; however, the role was not directly related to dispensing medications. Due to the disconnect between the doctorate level education and the available job opportunities, I ended up in another profession within the health arena that wasn’t directly related to my education. Although I feel all PharmD. graduates are in a very good position today, they may need to explore unique opportunities as the profession catches up with the education level. 

In the future, I feel pharmacists could play an active role in the healthcare system as they are meant for patient care. I believe this feeds into having a primary role in clinical hospital settings. In addition, Pharm.D graduates will have other opportunities in clinical and medical research, pharmacovigilance, teaching, and scientific journal publishing companies in India.

In India pharmacists are underutilized in professional pharmacy roles such as a clinical pharmacist. However, in exploring other areas of the health field, Indian pharmacy graduates have taken advantage of their education to influence the global health society. As a personal example, my current role as an international business manager allows me to organize health conferences around the world to advance healthcare. As the pharmacy profession continues to grow and adapt across the globe, I believe one role for pharmacists will be ubiquitous: avoiding the irrational use of drugs to protect patients and improve health outcomes.

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