Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel

Eyal Schwartzberg,Sivan Avron,Joseph P Nathan,Eli Marom

doi:10.1186/s13584-018-0251-y

Abstract

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients’ health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients’ and the healthcare system’s needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist’s scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.

Highlights

Non-traditional/clinical services offered by pharmacists in the community – The international experience the conventional definition of a pharmacist is likely to be similar around the world, professional requirements and the pharmacist’s practice skills diverge widely across countries [12]
In another study [19] conducted at an independent community pharmacy in the Midwest United States (US), patients whose proportion of days covered (PDC; a measure of the percent of time that patients have their medication on hand, available for use) for their oral anti-diabetic medications was less than 80% were counseled by phone by a pharmacist
The authors recommend targeting other high-risk populations that may benefit from singular or periodical pharmaceutical intervention. These include patients released from hospitals to the community, since they are often in need of a medication reconciliation service, patients moving between different healthcare systems (e.g., Israel Defense Forces (IDF), different health maintenance organizations (HMOs)), and other special situations when a need is identified and patients are referred by the physician for clinical pharmaceutical consultation services. It appears that community pharmacy services in Israel have made great strides over the years

Summary

Background

The Israeli Pharmacist Ordinance [1] defines the term “pharmacist” and states that no person should be designated as a pharmacist unless properly licensed according to the directive of the Israeli Ministry of Health (MOH). In Israel, a person can become a pharmacist by earning a Bachelor in Pharmacy degree from 1 of the 2 Israeli schools of pharmacy (Ben Gurion University of the Negev [2] and The Hebrew University of Jerusalem [3]) and In both schools of pharmacy in Israel, within the undergraduate Bachelor’s program, students are educated/trained on consultation services, minor ailment management, and compounding activities. Pharmacies rely on a team of pharmacists and pharmacy staff members (unlicensed personnel) who have no formal pharmacy education but assist in the logistical aspects of the pharmacy and not with medication dispensing It is well recognized within Israel [6,7,8], as well as worldwide [9,10,11], that the aforementioned description of a pharmacist does not adequately capture the healthcare service that he or she provides and that the pharmacist is an integral member of the healthcare team. We will analyze the evidence supporting such services as well as weaknesses that exist within community pharmacy, and we will conclude with recommendations for the future of community pharmacy practice in Israel

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