Pharmacy profession is vital for smooth running of any country’s healthcare system-Latif Sheikh

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World Pharmacists Day meeting at AKUH

Pharmacy profession is vital for smooth running
of any country’s healthcare system-Latif Sheikh

Innovations & technological advancements require
enhancement of Pharmacist’s knowledge

Pharmacists urged to enhance their clinical skills to earn
respect and recognition for this discipline and profession

KARACHI: In a rare occasion, Hospital pharmacists, pharmacists working in the pharmaceutical trade and industry, Pharmacists in Academia and Drug Regulatory authority, hospital administration and eminent members of the medical profession got together under one roof to celebrate the World Pharmacists Day organized for the first time by Aga Khan University Department of Pharmacy on September 27th 2014. The meeting organized by Department of Pharmacy Services at AKUH in collaboration with Society of Hospital Pharmacists of Pakistan and Hospital Pharmacy Section of FIP- International Pharmaceutical Federation was very well attended and it discussed the opportunities and challenges faced by the pharmacists besides discussing as to why they have so far failed to get proper recognition for the discipline of pharmacy and respect for the profession of pharmacists which it deserves. Access of Pharmacists is Access to Health was the theme for this year’s World Pharmacists Day.

In his Key note address Mr. A. Latif Sheikh Director Pharmacy Services at AKUH, who is also President of Society of Hospital Pharmacists of Pakistan and Vice President EMRO Region Hospital Pharmacy Section of FIP, pointed out that pharmacy profession was vital for the smooth running of any country’s healthcare system and well being of its population. The practice of medicine and pharmacy has transformed from experimentation to evidence generation. The innovations that come with technological advancements require adaptations of health system which require enhancement in pharmacist’s knowledge base. This poses challenge to pharmacists at community level, primary care level and hospital based tertiary care level thus leading to multidisciplinary approaches to medications use at all levels of healthcare delivery. Advancement in technology, scientific breakthroughs and developments in medical field has contributed significantly to patient care. Drug developments in the scientific field have now moved from innovative chemistry to molecular drug designs. More recently the focus has been on predictive models, personalized medicine with genetics taking the center stage, he remarked.

Continuing Mr.Latif Sheikh said that the above challenges require many countries to critically assess the size, skills and competencies of the health work force like pharmacists and other professionals. Complexity of medication therapy has increased for hospitalized patients the importance of skilled, knowledgeable and experienced hospital pharmacists and advanced pharmacy services in all healthcare environments have become critical and vital. Safe medication management in these settings is a complex task with errors occurring due to variety of factors including but not limited to absence of trained, qualified and experienced pharmacist, scarcity of training facilities for pharmacy graduates, lack of trained trainers, lack of patient knowledge regarding their medications, the involvement of the lack there off of multiple care providers including specialists including use of multiple sources of medication for the same patient. Continued occurrence of unfortunate mediation related incidents which are highlighted by the media relates to unsafe medication usage in our society. This component of our healthcare system, Mr. Latif Sheikh opined, requires urgent attention and an oversight of the qualified, trained, competent pharmacists for the medication management system. Development of new drugs, emergence of new resistant microbes and changes in healthcare delivery systems has enhanced the role of pharmacists in the healthcare environment. With increasing healthcare costs, enhanced emphasis on patient safety, pharmacist’s role has become much more important in providing cost effective and safe medication.

Pharmacists expertise Mr. Latif Sheikh further stated lies in how medications should be used, how to maximize benefits and minimize adverse effects of drug therapy. Drugs are these days the most commonly used interventions to improve health and pharmacists alone have the extensive knowledge to detect how prescriptions drugs interact with other medications. They have to ensure that patient’s medications are most effective and are used in the safest and most appropriate manner. Numerous studies have demonstrated cost reduction with pharmaceutical care is provided. It has showed decrease in adverse drug events thus resulting in cost saving. Clinical pharmacists help in reducing cost of treatment and shortened hospital stay. We at AKU have documented, established and published that pharmacist’s involvement in multidisciplinary rounds in ICU results in substantial savings in antibiotics usage. There is a need for health sector reforms to meet the challenge of aging populations and disease profiles, changing pharmaceutical landscape. Pharmacy has now moved from historical orientation of product-focused service to patient-centered approaches and now on to multidisciplinary approaches. As such pharmacists have to develop enhanced inter professional relationships with other healthcare providers.

Speaking about the Society of Hospital Pharmacists of Pakistan, he said, it was established to cater to the challenges mentioned above and to plan promote and help introduce international hospital pharmacy practices and indigenized pharmaceutical care concept in the country. It is affiliated with FIP the global federation of national associations of pharmacists and pharmaceutical scientists. It has 122 member organizations and over four thousand individual members.

Prof. Zafar Nazir Medical Director and Associate Dean Clinical Affairs at AKUH said that due to patient safety concerns pharmacists now join the ward rounds in AKUH. They are part of antibiotic steward program and infection control. We have now also formed a group for DVT and Pulmonary embolism to reduce complications, morbidity and mortality. Medical care is now becoming complex and specialized, he added.

Prof. Mohammad Khurshid said unfortunately in pharmacy we do not have many good role models. He urged the pharmacists to take up the challenge and upgrade this profession. Prof. Wasim Jafari said increase in life span has resulted in increase in chronic diseases. We see complex medications, devices and more emphasis on primary and preventive care. Pharmacists are supposed to improve patient care. Now there is lot of avenues for pharmacists. Pharmaceutical care has been established which aims at reduction in symptoms and prevention of diseases.

Mr. Shaukat Ali Jawaid Chief Editor Pulse International said pharmacists are important members of the healthcare team but unfortunately in Pakistan neither the discipline of pharmacy nor the profession of pharmacists have achieved the recognition and respect which they deserve. At present most of the pharmacists, he opined, suffer from inferiority complex while interacting with the medical profession. To find an answer as to why they have failed so far, they need to do some soul searching. He further stated that it is always only a few peple who bring changes. He advised the pharmacists to be honest and sincere to their profession, become keen learners, do not go for short cut, recognize the importance of continuing medical education and go for continuous professional development. Have unity among their ranks, elect or select leadership which is intelligent, competent, has a vision and is dedicated to promote the discipline of pharmacy and profession of pharmacists rather than promoting themselves. They need to enhance their skills, improve communication skills which will earn them respect and recognition. While making decisions healthcare professionals, he stated, must keep in mind the local socio economic conditions. Medical economics play an important role and it is no use writing a prescription which a patient cannot afford and then they go to quacks, he remarked.

Dr. Nadeedm Ahmad Chief Operating Officer of AKUH said at present 35% of pharmacists join Pharma industry, 15% join sales and marketing, another 15% join private sector and hardly any one goes to hospital pharmacy which is an important field. A brief video on evolution of pharmacy was also shown to the participants which laid emphasis on the importance of preventing diseases before birth through Gene therapy.

In the second session Dr. Sheikh A. Khaliq Rehan from Faculty of Pharmacy Hamdard University talked about evolution of profession of pharmacy and pharmaceutical care. He discussed managing pharmacy practice, managing medication use system, different roles played by pharmacists, lack of training programmes besides lack of collaboration between academia. Now different careers are open to pharmacists. He also emphasized the importance of increased interaction between students, teachers and other professionals in team work. We need to develop career center, training programmes, organize workshops and enhance professionalism, use new innovative teaching methodology and improve communication between students and faculty, he added.

Dr. Shaukat Khalid from Baqai University, Dr. Rahila from Karachi University, Dr. Sumbul Shamim from DUHS and Dr. Ali Akbar Sial Dean Faculty of Pharmacy Ziauddin University participated in the panel discussion. It was emphasized that previously the training programme was deficient in clinical pharmacy and with increase in duration of course experienced teachers have become available. Dr.Sial said that the three years and four years course was also comprehensive but at that time role of pharmacists was limited. They were going to marketing and industry but now five years programme has more emphasis on clinical pharmacy.Dr. Shaukat also referred to lack of therapeutics in the earlier training progammes wherein hospital side and clinical side was lacking though on the job training is very important. Dr.Rahila opined that pharmacists should learn practical knowledge in hospitals if they wish to join the academia. Institutions were also asked to go for visiting faculty to strengthen their teaching and training programmes. One of the participants also referred to the overloaded curriculum and meager remuneration which the pharmacists get after they qualify, hence they leave the country.

The next session was devoted to hospital pharmacy. Dr. Tahir Aziz Mughal from Shaukat Khanum Memorial Cancer Hospital Lahore talked about patient safety, quality of life and medicines. Speaking about the core competencies of pharmacists he mentioned supply of medicine, accessibility of services, healthcare quality, knowledge of service provider, automation in pharmacy, computerized physician order entry which has now increased to 89% in their hospital. He also referred to unit dose packing system, automated dispensing cabinets, pharmacy waste management. Competency, he said is the key and hospital administration looks towards pharmacy to reduce re-admission and reduce treatment cost in view of the resources constraints. In the presence of pharmacists, medical errors are reduced, percentage of wrong prescribing also reduces because of automation. In future we will have bar coded medications, e mediation for stroke.

Mr. Izhar Hussain from IBA said that hospital errors are the third leading cause of death in United States and what will be the situation in Pakistan can be very well imagined. He urged the physicians, nurses, pharmacists to take up the challenge and prepare guideline to promote rational use of drugs. We need local trials to find out for how long the triple therapy with antibiotics should be continued for eradication of H Pylori. There is lot of difference in price of branded and generic branded drugs; hence pharmacists have a role to play to come up with evidence based criteria for their use thus promoting rational prescribing.

Dr. Jibran Bin Yousuf form AKUH said government interest and consumer, patients interest is important for standardized pharmacy practices. He laid emphasis on safe use of drugs, patient satisfaction in ambulatory care. We at AKUH, he said, deal with over three thousand patients and dispense seven thousand drugs daily. We must ensure right drug for right patient, in right dose, right route and at right time to ensure rational use of drugs. He also talked about the role of community pharmacists. We at AKU have started pharmacists supervised immunization services, anti coagulation clinic, solid organ transplant, education of patients for hypertension and diabetes and all this has reduced patients waiting time and achieved 86.9% patient satisfaction. Dr. Salwa Ahsan from AKU spoke about complex drug regimens, vulnerable patients and hazardous procedures, supply of life saving drugs. There is lot of integration and interdependence and we must ensure minimum standards and help make best use of mediations. Talking about hospital pharmacy he referred to hospital formulary, optimizing medication therapy, packaging, labeling of indications, medication dispensing and delivery. Errors in mediation prescription account for 56%, administration 34% and transportation for 6%. Dr. Shaukat Sahad highlighted the skills needed to be a clinical pharmacist. He was of the view that we need to differentiate between important and urgent things. Credentials and competency standards for pharmacists were also highlighted. He also talked as to how to develop guidelines, hospital pharmacy drugs guidelines, Reaccreditation of pharmacists, review of curriculum and changing role of teaching pharmacists were also discussed. He suggested making a task force for development of pharmacy in Pakistan. Dr. Yasir Ali Hashmi spoke about Health Care Supply Chain Management an emerging field for pharmacists.

Last session was devoted to role of pharmacists in regulatory authority and Pharma industry.Dr. Obaidullah Deputy Director General in Drug Regulatory Authority of Pakistan (DRAP) talked about safety, efficacy and quality, need for regulation. Pharmacists, he said, can also observe quality of drugs but we need a proper system for this. He referred to the Thalidomide tragedy which gave birth to drug regulatory mechanism. DRAP Act 2012 now will also cover biologicals, Health and OTC products; hence there will be lot of opening for pharmacists. At present DRAP, he said has one hundred pharmacists and fifty two new posts have been advertised. There are six hundred drug manufacturers, sixty pharmacy education institutions. However, Pakistan has zero marketing of drugs in regulated markets. Clinical trials, pharmacovigilance, bioequivalence are the new fields. But we need to change our behaviour, discuss the issues and thus influence the system, look back but move forward, he remarked.

Dr. Saifur Rehman Khattak Director CDL urged the healthcare professionals to share ADRs with them. We need to change our attitudes, follow the guidelines and implement them, he stated. Syed Faisal Jilani from Hilton Pharma said, pharmacists know best about drug interaction, we can advise physicians on off label use of drugs which needs to be checked, we can help physicians in drug dosing schedule and we can make best product presentation.

Participating in the panel discussion which followed Mr. Jamshed Ahmad from PharmEvo said that mergers and acquisitions in the Pharma industry on one hand has created monopoly but it also shows that there are no new research molecules in the pipeline. By 2030 it is expected that 30-40% of drugs will be biologicals and branded generics are moving fast in Pakistan. National pharmaceutical industry was producing quality drugs and branded generics were cost effective and also affordable. It was also suggested that for orphan drugs and cold chain products we need some changes in regulations.

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