Pharmacy - Cornerstone of Health Care!

Whatever disease, illness or condition you may come across (go ahead and think of at least 3), part or the entire treatment protocol will require medicines. And who says medicine says: PHARMACY!

Who's in charge and running (around in) the pharmacy? Pharmacists of course! With the help of their assistants. 

But that's overly simplified you might think. Medicines being sold in a pharmacy don't quite illustrate the entire health care scenery does it? So why is pharmacy cornerstone?

Well they give you the final products. The end valuable result of the complex pharmacy machine! That's not all! You see,  health care in essence is the organized provision of medical care to individuals or communities. As each component of care giving requires either consumables, medicines or tools; pharmacists are the only licensed, sworn in, and responsible authorities for safely providing these to everyone else.  

To provide quality health care, rigorous investigations must be done. Diseases, their cause and progression, their treatment or management etc is studied with the aim of curing or at least controlling the condition. Pharmacists do that. Any agent which causes a desired physiological response can be deemed a drug, how it works and should be administered to treat and cure diseases is the pharmacists' prerogative! If you're still not convinced,  consider the following concluding points.

5 ways pharmacists are the cornerstones of health care: 

○They manufacture ALL available drugs; no pharmacist, no medication. 

○They understand both sides of diseases: etiologies vs therapies; no pharmacist, no prescription, disease & drug gate keeping. 

○They have basic and advanced knowledge regarding Primary, Emergency and Secondary/ Tertiary health care; no pharmacists, no adequate intermediate resources connecting all treatment levels. 

○They ensure quality treatments from obtaining raw materials, to maintaining quality through storage, manufacturing, packaging, distribution, prescribed indications and patient use. No pharmacist, no quality treatment. 

○they are the ultimate health care multitaskers: making the actual medications, ordering and controlling supply, supervising staff, consulting & counselling patients, intervening in patient therapies, mediating between prescribers and insurance providers, referring or initiating care, teaching and educating communities, while running profitable businesses among many others! No pharmacist, no cross-disciplinary, functional health care system!

You just can't beat them.

Pharmacists remain the undefeated,  unprecedented but ultimately undermined,  health care professionals!

Love and respect your pharmacist. Be patient while your community pharmacist helps you. They are there to optimize your treatment (outcomes) and improve your quality of life but if you rush them and they make a mistake it could really harm you.




Brought to you by: www.pharmers.co.za

Pharmacy Blog 

Flu Virus - to vaccinate or not?

So you know by now every year when flu season is about to start,  (roughly a 13 weeks duration spanning from March to July) the influenza vaccine gets promoted through advertisement everywhere! So is this a sales gimmick or is there some real benefit to it?

Well it depends! Who's asking?

Young children (from 12months), pregnant mothers up to 2 weeks post partum, the elderly or the immuno-compromised ( esp HIV/TB), lung/chronic disease and co morbid patients, certainly will benefit from it. The advantage isn't as directly observable as one would think (not catching any virus/not getting sick for the entire season etc). It is more of a "lessening of risk" , or aversion of exacerbation from a viral infection, which is key! After vaccination, the special groups (those mentioned above) patient drastically reduces their risk of landing up in hospital due to severe infection and secondary complications (cardiovascular, pulmonary, etc). The burden of the influenza related hospitalizations depends on the transmission and virulence of the strain each year.

Let's mention the three strains which cause illness. Influenza A - most usual cause of epidemics or yearly outbreaks, Influenza B - less severe outbreaks and illness, mostly burdensome on children and the immuno-compromised individuals. Lastly, Influenza C - which caused minor respiratory illnesses.

However the influenza virus (including all infectious strains) is not the only flu-like virus in the air.
Rhinoviruses which cause the common cold are another huge culprit; the adenovirus, coronavirus and other viruses all thrive during the colder months as indoor ventilation decreases and human clusters (viral harbouring and sharing) increase. So you may still get a cold, or another viral infection or even allergies, which all involve sneezing, rhinorea and sinus congestion among others. NB: the flu has a sudden onset of symptoms, includes fever and body aches, git disturbances in children, sore throat, and running nose as differential.

The question remains, do you vaccinate or not?

Considering the above information. If you fall within this special group, the safe advise to receive is: vaccinate.

If you live or work (especially health care workers) with this special group including newborns/infants, avoid becoming a source of infection to them: vaccinate

If you fall outside of this group, are a healthy individual and have no additional risk: you can skip the vaccine

The trivalent vaccine (TIV) in itself is not a live attenuated strain (it contains three dead/inactivated strains of 2 different A strains & 1 B strain) , therefore the rumors of it causing the flu or other diseases are unfounded/unrelated. However, after vaccination, a mild localized irritation might occur which clears quickly.

Lastly, it is worth mentioning that since the flu vaccine is not long lasting (6 months longevity), it should be re-administered annually at the start of flu season (in SA it's March/April). This also means that if you've had the flu at the beginning of the season, you may still get it again towards the end even if you vaccinate.

Look at this table which shows reduction in severity of disease and morbidity in those who vaccinate vs not:

Heads up, Now you know.

ALWAYS ask your pharmacist for sound pharmacy related advise.

Happy flu aversion

Have pharmacists given up their power?

One of the biggest mistake people make is to give their power away by thinking they don't have any!

This couldn't be more true for most pharmacists it seems. As observed in the retail setting, patients increasingly tend to push their luck and demands towards pharmacists. While entitlement isn't right, times have changed and in this day and age, your professional identity has to marry your personal conviction of who you are in a way you may not have ever experienced before. You have to know who you are and what your strengths and weaknesses might mean to your workplace. Your authority, your jurisdiction, your territory can never be threatened. Don't allow it. On the flip side, you can't rely on your mere title or name tag to suffice in the respect department anymore that's for sure. Patients are notoriously earning their instant online degrees after a few google quick searches and are ready to challenge you - the professionally trained pharmacists with a plethora of misguided, misinformed and misleading statements, questions or comments amongst other atrocities.

The guts!

For such a climate, the winning pharmacists are those who not only know who they are and what their roles, duties, responsibilities and rights are, down to the T! But can equally voice them unafraid. Your pharmacy degrees are no longer enough! You need wit, confidence and a lot of assertiveness to add to the community pharmacy scene. Being nice was often a trait which meant bending rules, doing favours and being "understanding" for many dispensaries. To the point where often, this leniency happens at the expense of the pharmacy's rules, policies and even the law! 

Fast forward to today and community pharmacists are all paying for having given their power away and allowed their dispensaries to become fast-meds pubs on steroids. So what has being "overly nice" got to do with professional power? Everything! If you're familiar with the phrase "familiarity breeds contempt" then you know that when you repeatedly show soft kindness over any other traits such as sternness or even assertiveness, it often is mistaken for weakness...

What do opportunists do when they perceive weakness? Take advantage of course! 

*Wait an hour at the doctors, but if you spend more than 5 minutes at the pharmacy... someone has to apologize! 

*Ask how they know how to read a prescription but never understand nor value the scrutiny involved in cross checking each item for safety. 

*Worry about asking your doctor if you can switch to a generic, while you ignore the one who actually studied your medication's various formulations  kinetics and dynamics.

*The list is very long...

Patients keep asking the wrong questions while pharmacists keep giving their power away... 

Before they ask, tell them. Before they stray, restrain them. Before they run off to their prescriber, educate them. Unfortunately the damage is done and the only way to fix it now is to overcompensate.  Over explain. Have readily available guidelines policies or laws, provide overflowing therapy information, do superfluous continuous self study, and be astoundingly resourceful. You cannot be caught slipping, or not knowing.

In short, always add and verbalize value to your patients (and other health care professionals whom we haven't touched on in this particular blog) during usual services. They will start understanding and respecting your work better. 

Become aware of such gaps. Fill them.

Go the extra mile in your supervision and training. 

Be excellent.

Just a thought.

Fix your face!

We often discussed the issues surrounding pharmacy practice, but never in a progressive or helpful manner. It's easy to see what's wrong in a situation but we seldom find ways to improve issues or "fix our faces". A particular problem, and one that requires immediate attention is that of the public perception and resulting interaction with pharmacists. Now, many reasons exist for the cause and escalation of this problem but that's a discussion for a different day. 

For now let's look at some "common sense" tips pharmacists (and assistants) can implement to improve patient perception and value added/superior (retail) service:

Using the following scenario, notice the type of questioning and the rationale behind each. Much of the work pharmacists do is internal (screening, medication option selection, prescription reviews, dosage adjustments, comorbidities assessments, double checking etc) which can be mistaken for not doing anything at all so to make it more evident to patients, it needs to be voiced and brought to their attention in every way possible.

- don't let a session, no matter how quick, start and end without asking any questions. Questioning shows knowledge (which translates into more respect for the profession) and it opens doors for deeper interrogations on patient history which is required for optimal service and therapy initiation.

The mistake most dispensers make is that when patients request a product by name, they think the patient knows all about it. Sometimes this is true but often it's not. A friend, colleague or family member who isn't a health care professional might have recommended the product without putting much thought into it. It is our duty to check if it is warranted and safe for that particular person. 

When a patient isn't "engaged with" they assume they are automatically correct in their selection and the need or perception of requiring counselling is quenched. They might not realise that medicine is potentially dangerous. It always needs assessing, dosage monitoring and contraindication checks.  Always remind them that we are here to assist in medication selection amongst other things.  Even with repeat buyers (otc or chronic scripts), make sure to inquire about: who is it for? ( even when sent, the messenger's perception of that "pharmacist " will change)

What the need/problem is (establish it if new) and if there are any co-morbidities/ contraindications, allergies etc (dangerous factors to consider before initiating therapy). 

For repeat patients, inquire about the progress of therapy, is it helping, any side effects or noticeable changes etc?  

All these will let them know that you care, and are able & willing to assist further if need be. Boosting the "fix" to your face!

Scenario Example:  

Patient: good day

Medicine's Expert (ME): good day, how can I help you? 

Patient: I'd like some Mybulen please.

ME: sure, is it for you or someone else?

Patient: it's for my wife. She's in pain.

ME: where is the pain located and how sever is it sir? Does she have asthma, stomach ulcers or any kidney issues? Is she pregnant? 

Patient: hmm it's her neck, she slept wrong last night. No she doesn't have any of those things. But she has diabetes. The pain is average..

ME: alright, because she has diabetes, just be mindful that mybulen has antiinflammatories which further accelerate kidney damage in the long run. Therefore when possible opt for local pain relief such as Voltaren gel or transact patches which bypass systemic absorption and hence renal excretion.  

For now I can suggest you take a muscle relaxant combination like Uniflex if you really want tablets but rubbing it with an antiinflammatory gel should be sufficient. It relieves localized muscular pain, avoids codeine which can quickly become habit forming and provides a safer alternative. 

Patient: oh wow I didn't know that, thanks a lot. I'll take the uniflex and gel but also give me a mybulen just in case she shouts at me. 

ME: ok, just let her know that there are options next time she has pain. She should always inquire with the pharmacist for the best alternatives.

Patient: ok, you've been helpful. Bye now. 

Patient thoughts: 

*Wow they're really thorough!*

*they checked if the medication is safe for her!*

*they're really knowledgeable*

*maybe they can recommend something for my nom's illness* 

*I'll bring my script here next time*

Obviously this scenario is simplified and can escalate or be more complex but the idea is to always be inquisitive.  Fix your face, and we fix our profession. 

Hope this helps even one person and makes sense. What are your thoughts?

www.pharmers.co.za 

At home self testing HIV kits: progressive or destructive

There are always new items being sold in the pharmacy. Products and tools to improve health, and others that prevent illness. Lately, next to the common pregnancy tests are drug tests and even HIV test kits. They are also very affordable (not aimed at any specific class of people). Pharmacists need to be increasingly aware and sufficiently warned about products hitting their shelves. When I saw these for the first time, I immediate had mixed feelings and couldn't help but wonder: is this even legal? So many questions flooded my mind. What happened to the pre and post counselling? What do the positive test result patients do after? How do they cope? Who is accountable or responsible for allowing this? Where were pharmacists? 

Health care is such a basic primary necessity. It must be accessible and available to all but are we doing the public a disservice by exposing them to a potentially dangerous territory to which they are inexperienced? What are the pros and cons of having such test kit so readily available?

In the country with the  highest prevalence of HIV/ AIDS in the world (~19% of the general population) how do we approach the matter conscientiously? Is normalization the way to go? I don't have all the answers to these many questions but my unsettling intuition is alarming.

Yes, HIV is closer to a typical "chronic"  disease in its management today than it ever was but does that mean we lower our guard and efforts of detection and management? How about its prevention? Are we over it? 

Who is the kit targeted at? Conscious couples who want to engage in sexual practises and are being cautious? Or individuals who have been exposed/ at risk and now want to confirm infection? Let's be frank, those who buy them are not on the prevention side if things. In fact this tool might have a negative impact on the prevention spectrum. 

Isn't that what clinics were for? Free testing in the presence of a health care professional? What is the advantage of secrecy? Are people known to do the right/ healthy thing when no one is there to counsel them? I think not. Especially when a new younger generation of sexually active individuals have not been part of the intense campaigns that once were efficacious in preventing STIs and HIV

Nowadays youngsters are desensitized and the illness is de-stigmatized as perpetrated. Not that stigma is positive in itself, but in a context of at least deterring some, it was useful.

Can we leave the numerous already existing testing methods alone and focus on heightening prevention methods. Prevention has always been better than cure, especially when there still is no official cure. If we start preventing more than detecting, perhaps numbers van go down and new infections can cease. What happened to: no new HIV infections by 2020? Or was that not a thing?

Can we ask psychologists on how behavioural patterns are modified when susceptibility perceptions drop? When new infections or disease stigma disappear? But why don't we? Perhaps big pharma doesn't really care. This is just another money making tool.

The number of undiagnosed and untested individuals is high, but encouraging people to test in clinics is better than leaving them to depressive disorders or dangerous behaviors in the case of positive results. 

If anything is going to be sold in a pharmacy, pharmacists should at least stand up for patients who cant defend themselves and refuse such practises. It is dangerous, irresponsible and seldom beneficial.

Shocked,  saddened and confused.

Prescribers' scribble; Dispensers' struggle

Poor handwriting is a common cause of error in 100% of dispensaries across the world. In SA, most prescribers think that money is more important than lives, therefore they hurry on scribbling things away unbeknownst to the patients who often leave the practice confused and unsatisfied. 

Upon arrival to their favourite pharmacy, they hand the mystical paper to the custodians who's bravery is understated👩‍🔬. They consult among each other, sometimes review history, or have to call the prescriber for clarification. 

This waste of time, and energy is distasteful,  disrespectful and border line unprofessional.  As part of the health care team, their role is to diagnose and prescribe in a manner that simplifies therapy initiation. They believe,  however that the art of pharmacy rhymes with wizardry.  

Technology luckily has come at a time where those who cant spell or those who've forgotten how to shape their letters can now type their script and print it. This old age (mystery-filled) (mal)practice, once considered honourable and prestigious must die a prompt and permanent death.

For a prescription to be valid, it must first be legible. How do we enforce clear or printed script from here on? Policies must change and we pharmacists need to be at the forefront. ✊

www.pharmer.co.za

BPharm + Post grad? But still stuck in your career?

I often ponder and reflect on my profession.  The choices I've made and those that have been made for me. Did I freely become what I am or was I coerced into it by default?

The south African pharmaceutical industry is great but it has its structural and recruitment challenges. when it comes to entry level posts, there exists a gap between industry needs and academic skills acquired. 

 Why are there virtually no junior posts that newly qualified pharmacists can apply and get into without much fuss? I'm speaking of sub sectors. Esp when it comes to regulatory; it seems many struggle to get a fair chance let alone apply for entry level posts.

 Why are posts not calibrated in a stepwise manner? Does the grading system even work? And if it does is it being used correctly?
 In industry, 90% of vacancies seek 5+years experience and are managerial positions.  So how does one get experience? 

There also seem to be a grey area when it comes to pre-qualifications. As many candidates without the five years requirement get posts by what seems like sheer luck or connections. 

Are post graduate course ever really necessary? Many have felt like it is a waste of resources as the courses are not reflected in the positions advertised nor are they remunerated consequently. 

How does one climb the ladder from junior to senior pharmacist, and when are specific courses required and not just advantageous? It's almost as if companies dictate and set the tone and standards for their personal requirements; and appoint whomever they want in any post without much explanation nor post grad qualification correlation. 

Should legislation jump in to save the echelons?! Who can change or implement new policies concerning such problems? 

Are pharmacists fast asleep and obliviously to challenges within their own profession? Where are they and why haven't they said anything about any of this? 

Have post grad qualifications become irrelevance to most employers?  How do we begin to fix this lack of uniformity in (growth) structures and start promoting specialties (oncology, etc) and academic skills more equitably with the assurance of matched  positions and remuneration?

Moving from one sub sector in to another is also very tricky. Has the BPharm degree become inadequate and lacking specialty training? Should it be scraped off and perhaps upgraded to a more complete and respectable PharmD?! 

I'm here, thinking out loud and would love your opinions on the matter! Thanks for commenting! 

#pharmers