Can you envision what pharmacy practice will be like in the next 10 to 20 years? I imagine a world where medication orders are filled by robots, medication drops done to patient homes by drones, Telemedicine is a normal thing and actually going to hospital or pharmacy for a routine check or minor ailment is not common anymore. Hey a girl can dream! As we mark this years World Pharmacist Day with FIP (Fédération Internationale Pharmaceutique) lets take a look back and then map our way into the future.
History of Pharmacy
The word “pharmacy” was coined from the Greek word “pharmakon” meaning “medicine” or “drug“. Therefore, a pharmacist is a “medicine or drug man“. Early studies show that man used clay, mud, leaves and supernatural means for alleviating symptoms of various diseases. Women were reported to be earliest gatherers of medicinal plants but the practice was taken up by men in the society. A lot of history in pharmacy dates back to Sumerian times where there is evidence of cuneiform tablets recording prescriptions. In Asia records date back to 1st century AD, where materia medica was compiled during the Han dynasty. So how did pharmacy transition from herbalist roles to what it is today? Between the 5th and 15th Centuries alot of knowledge was lost as the fall of the roman empire ensued. In 1240 emperor Fredrich II issued a decree by which the physician’s and the apothecary’s professions were separated. This spurred the opening of pharmacy like shops. The oldest pharmacy is claimed to be set up in 1221 in the Church of Santa Maria Novella in Florence, Italy. Industrialization in the 1800s brought about increased technical sophistication, things like purification of organic compounds was now possible as was organic synthesis. Pharmacy profession experienced a vast growth in Europe especially with the evolution of new study areas like biochemistry, microbiology, and biology. The 19th century welcomed the discovery of important alkaloids such as morphine, quinine, and emetine. The trend of pharmacy practice shows that the practice is becoming more patient-oriented and no longer product-based. The role of the pharmacist has shifted from the classical “lick, stick and pour” dispensary role to being an integrated member of the health care team directly involved in patient care.
The role of the pharmacist has evolved and continued to evolve. We are moving from dispenser centered roles to patient centered roles. Also looking at the patient in a holistic manner. Further, the technology in healthcare has advanced beyond any means comprehensible just a few centuries ago. Pharmacists have therefore been promoted to advance themselves to new fields. These days patients consult Google before and after hospital visits and at times determine their own path. Is this risky? Yes but that is the reality of the times. About 80% of pharmacists are practicing the hospital and community pharmacies and with the advent of health technology, this role is threatened.
We first ventured into clinical pharmacy (an area that was highly contested before it was finally accepted), then to pharmacovigilance, telepharmacy among many others. In America and Europe most of these specializations have existed for several decades.
In the Kenyan scenario we are now catching up with more and more clinical pharmacists, pharmacovigilance experts, oncology pharmacists, medication therapy management pharmacist being released into the market annually. More than this though we still have huge room for growth. Telepharmacy was introduced in the US in 2001 and its only now that some brands in Kenya are opting to go for this route. Ironically, it was started as a way to serve rural Americans in North Dakota and in Kenya it mainly focuses on the urban areas mainly due to stability of internet as well as access to android devices.
With the onset of pandemics and reduced need for travel (working from home, schooling from home, grocery home delivery) this maybe a venture that needs to be considered more seriously in the years to come. Acceptability will increase among Kenyans as well. A lot of pharmacists will tell you that they think telepharmacy is a job killer but it is actually quite the opposite. It allows for value based care and allows for increase in scope of the pharmacist practice, offer more comprehensive patient care, and overall improve patient satisfaction rates. Additionally, traceability is much improved as all of the records are online, if a batch needs to be recalled you can trace exactly when and where a patient received their medicines. Profitability for a pharmacy and technician team usually stands at approximately 75-100 scripts per day. If you are considering setting up this type of venture ensure you do a comprehensive market research and a solid business plan (am available for consults!!)
To quote Heraclitus, a Greek philosopher, “Change is the only constant in life”. As such we as pharmacists must evolve, adapt and grow otherwise we will wind up extinct.
In the recent past, automated dispensing cabinets (ADCs) come into existence. These allow medications to be stored and dispensed near the point of care while controlling and tracking drug distribution. This allows for a reduction in human error, increase in fill time, and allows staff to focus on patient contact rather than filling the prescription.
Medication reminder devices, these offer smart medicine delivery systems that can lock once a dose is given or have alarms or flashing lights when its time for a dose. This is especially helpful for patients who are elderly and may not have a full time care giver. These devices can be of great help to patients who may have a hearing or sight impairment.
Medication management platforms, work to promote adherence among patients. This is especially so for patients who are just starting a new regime (Patient just started on a diabetic therapy) or having a complicated regimen (oncology treatment plans). These platforms are available to give the patient text, audio or video instructions on how to use their medication, when and where to take them and what to expect.
Artificial Intelligence, AI as its more commonly called, allows for huge data sets to be collected and medical professionals or even insurance companies can flag patients for non-adherence or non-compliance with specific regimens. For example, if a patient misses picking up their regular prescription for several months, they can be flagged as non-adherent patient. In the Africa setting this can be very helpful for patients on DOT (directly observed therapy) therapies, like those on TB medication, HIV medications etc. AI also allows for machine learning and can be used to establish personalized patient regimes. It can also be used to identify over prescribers or potential opioid abusers.
Consider the possible impact on lifestyle diseases, more and more we are able to trace shopper patterns on groceries and matching this with their prescriptions. An app can send an alert to let say a cholesterol patient who is purchasing red meat, and inform the individual about red meat’s fat and calorie content and could make recommendations about the appropriate use of that food, even including healthy recipes.
Linked systems, these offer the ability for various devices used in hospitals and outpatient centers to be interconnected with electronic medical records. This allows for real time patient data that can advice doctors, pharmacists and other medical professionals. Imagine if we had an interlinked system in Kenya so that patients do not have to lug their patient files and histories to every second consult or new facility they go to. Doctors would be able to view full histories in a few minutes and pharmacies can easily pick up the prescription trail.
Am I ready to be a new age Pharmacist?
As a new age pharmacist, there are lots of opportunities for growth. You just need an open mind and be a perpetual learner. You have gotten the root of your work now its about building yourself growing that tree. Keep yourself updates constantly, join a mentorship circle for pharmacists in the role you intend to pursue, Network, hone your soft skills, look for relevant courses online to pursue, never give up!
All your doing now is getting ready for the new you that is coming soon or is about to emerge. You never know how what you learn today will impact you tomorrow. Most importantly, though plan out your career. Have a map for the points you want to hit to get you to your summit.
Physical aspects of pharmacy are changing with the entry of robotics. We are headed towards the more intellectual aspects of pharmacy rather than the every day mechanics of pharmacy. Build upon your knowledge of drugs and communication skills.
In the future, dispensing medication may not be a significant component of on-site pharmacy services. We will be focused more on clinical outcomes and personalized care. Increased involvement of pharmacists could result in lower cost of care to patients and their loved ones.
Pharmacists, particularly those who work in the community, are well positioned to support better integration of patient care across the health care system. Support structures and systems will have to change to enable pharmacists access to lab and other diagnostic test results. We should be able to triage and refer patients accordingly to primary health care centers or referral centers.
Pharmacists are an under-utilized resource in health care and we see opportunities for pharmacists to really become a patient’s partner in preventing and managing illness, improving transitions between different levels of care, as well as their medication use.
As always stay safe, stay healthy, stay focused.
By Dr Judith Getugi
Head of Operations SysPharma
LinkedIN @Judith Getugi-Kerini
24th September 2020.