Traditional Pharmacy Research Articles

Evaluation of a Pharmacist-Led Remote Warfarin Management Model Using a Smartphone Application (Yixing) in Improving Patients' Knowledge and Outcomes of Anticoagulation Therapy.

Background: The management of warfarin-treated patients has been recognized as a challenge due to narrow therapeutic range and food and drug interactions in warfarin therapy. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy. Methods: Eligible patients who had received warfarin therapy after mechanical heart valve replacement were enrolled. The intervention group was offered a pharmacist-led remote warfarin management model using the app named Yixing. Yixing incorporates functions including automatic daily reminder, personal health record, educational program, and online counseling. The control group received traditional pharmacy services without Yixing. Co-primary outcomes were patients’ awareness score of warfarin therapy obtained from questionnaire, the medication adherence measured by the percentage of the correct-warfarin-taken days in the monitored period, the fraction of time in therapeutic range (FTTR), and the incidence of anticoagulation-related complications. The needed information of the patients was acquired via electronic medical records from the hospital, Yixing system and telephone follow-up when necessary. Results: 64 and 66 patients were initially in the intervention and control groups respectively. After propensity score matching, 50 patients were assigned in each group. The intervention group had a median age of 51.0 years, in which 27 (54%) were male. The control group had a median age of 50.5 years, in which 28 (56%) were male. Patient awareness score in the intervention group was 8.00 (2.00), which was higher than that in the control group, with score at 6.50 (2.50) (p = 0.001). No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p = 0.520). The median (interquartile range) value of FTTR was 80.3% (21.9%) and 72.1% (17.7%) in the intervention and control groups respectively (p = 0.033), and no significant differences in the incidence of anticoagulation-related complications were observed (p = 0.514). Conclusion: The pharmacist-led remote warfarin management model using Yixing improves patients’ awareness of warfarin therapy and increases FTTR, but may not have significant improvements on medication adherence and safety.

Bridging the Gap: Community Pharmacists’ Burgeoning Role as Point-Of-Care Providers During the COVID-19 Pandemic Through the Integration of Emerging Technologies

Community pharmacies are an under-utilized setting for the provision of primary and preventative care measures, especially the provision of clinical dietary care. The SARS-CoV-2 pandemic presented a unique opportunity to study pharmacist-based nutritional counseling in the absence of ready access to primary nutritional care. In the present interventional pilot study, we analyzed the efficacy of a Clinical Decision Support System (CDSS) for community pharmacy integration on patient weight management, monitoring, and goal setting over a 4-week period. 57 Greek adult patients (16 males and 41 females) of a community pharmacy in the greater Athens area were enrolled in the intervention and subsequently assigned a hypo- or iso-caloric diet according to baseline anthropometric measurements, total daily energy expenditure, medical history, and drug treatment status as assessed by the CDSS. At the end of the intervention period participant weight (kg) and corresponding Body Mass Index (BMI) (kg/ m2) calculations were recorded to gauge sample diet and CDSS recommendation efficacy. Among patients who remained diet compliant to study completion, body weight and BMI were significantly decreased in the hypo-caloric diet group compared to baseline (n=13) (mean difference = -2.685 kg, p = 0.004; mean difference = -1.112 kg/m2, p = 0.004, respectively). No significant change in body weight nor BMI from baseline of isocaloric diet compliant patients was registered (n=9) (p=0.273; p=0.320, respectively), succeeding in the purported goal of weight maintenance. This study provides preliminary evidence for the efficacy of a CDSS in assisting pharmacists with nutritional assessment, screening, and sample diet counselling concordant with patient dietary and weight-loss requirements. This trial also builds on emerging research into the broadening purview of traditional pharmacy services in primary care settings.

A Comparison Study on Traditional Mixtures of Herbal Teas Used in Eastern Mediterranean Area.

Multipurpose herbal teas with numerous ingredients, in which flowers are the main component, are common in the traditional medicine and pharmacy of Greece and the Eastern Mediterranean countries. In this study, we combine ethnobotany and ethnopharmacology field work techniques and botany and pharmacognosy laboratory methods for the study of traditional herbal mixtures with flowers, we identify their botanical ingredients and record the local medicinal uses of these mixtures, in Greece, Lebanon, Syria, Iran and Turkey. These, and their industrial versions, are analyzed, using morphological and multivariate analysis techniques in order to determine marker species, relevant patterns of combination and local styles. The medicinal properties attributed to the different flowers are discussed in relation with their role in the mixtures. These blends are consumed for their relaxing, digestive, and anti-infective properties. These mixtures are not consumed as a treatment when one is sick but rather to avoid getting sick, as a preventive measure. The formulations can reach forty ingredients (sarantha in Greek, arbain in Arabic language of Palestine), usually entire or coarsely chopped in the more traditional formulations, leading to extreme variability of individual doses. We ask what biological signification this randomness can have. To give an answer requires new and more comprehensive pharmacological approaches. The flowers of Rosaceae, Asteraceae, Lamiaceae, Malvaceae and Fabaceae species characterize these mixtures in which other materials (roots, leaves, and fruits) and other species are present as well. Flowers of some species, particularly of Fabaceae, are exclusively used in mixtures, and their use in monospecific herbal teas is not yet recorded. We draw attention on the urgent need in exhaustively recording in Greece and the Near East, the formulation and use of traditional herbal mixtures and their numerous local variants. To consider these mixtures and the contribution of flowers (most mixtures receive the general name of tea of flowers) merits further extensive study.

Application Value of Standardize Path Management in Traditional Chinese Medicine Pharmacy Management

Application Value of Standardize Path Management in Traditional Chinese Medicine Pharmacy Management

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions

ObjectivesThis study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care. MethodsIn this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee. ResultsThe frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services. ConclusionVirtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.

A Systematic Review of the Effect of Telepharmacy Services in the Community Pharmacy Setting on Care Quality and Patient Safety.

While community pharmacy-based telepharmacy services can expand medication access for underserved communities, the safety and quality of these services is uncertain. A systematic review was conducted in August 2020 exploring the effect of community pharmacy-based telepharmacy services on patient safety and care quality. Database searches identified 866 studies, of which six met the inclusion and the risk of bias measurement criteria. Medication dispensing errors, adherence, and patient satisfaction were the most frequently evaluated outcomes. Literature suggests no overall difference in medication safety and adherence, conflicting evidence on patient satisfaction, and insufficient evidence on inappropriate medication use in community pharmacy-based telepharmacies compared with traditional pharmacies. Due to the potential for high risk of bias, no definitive conclusions could be made about telepharmacy outcomes. Research with stronger study designs and more rigorous evaluation methodologies is needed to create conclusive evidence on the effectiveness of community pharmacy-based telepharmacy services.

Development Strategy of Integrative Pharmacy

Integrative pharmacy is proposed owing to the increasingly profound understanding in complex diseases. It involves new drug research and development, innovation of traditional Chinese medicine, clinical practice of drugs, construction of the pharmacy discipline, cultivation of pharmaceutical professionals, and many other fields. To promote the practice of integrative pharmacy in China, this study clarifies the concept and connotation of integrative pharmacy and proposes future development strategies for integrative pharmacy. The research methods we used in this study includes literature research, academic exchange, and expert consultation. To integrate modern and traditional pharmacy, we suggest that clinical practice guidelines for integrative medication should be established and improved, innovative research of traditional Chinese medicine based on integrative thinking should be encouraged, and clinical application of Chinese and western medicine should be integrated and standardized. To promote the new drug research and development based on integrative pharmacy, the design idea of integrative drugs should be innovated, a drug evaluation system that adapts to integrative pharmacy should be developed,and a new drug development system should be established for integrative drugs. To promote the clinical application of integrative pharmacy, patient-centered clinical medication guidance should be further improved, individualized treatment should be encouraged, the clinical practice content of integrative pharmacy should be enriched, and the rational application of integrative drugs should be emphasized. To promote the construction of the integrative pharmacy discipline, the theoretical and practice curricula for undergraduate education should be enriched based on integrative pharmacy, and educational training and professional collaboration should be strengthened. Integrative pharmacy develops based on the theories and practices of modern pharmacy and integrates the theories and practices of all related disciplines of pharmacy. It is a new pharmacy theory and practice system that can promote human health and improve the existing medical system in China.

Telepharmacy and medication adherence in urban areas

BackgroundTelepharmacies, which dispense medications on-site under the supervision of an off-site pharmacist using telecommunication technologies, have been proposed as a means to ameliorate the impact of pharmacy closures and improve access to medications. ObjectivesTo examine whether adherence varies among individuals filling prescription medications through a telepharmacy versus a traditional pharmacy in an urban neighborhood. MethodsWe conducted a retrospective cohort study using dispensing records of a traditional pharmacy and a telepharmacy, located in the same low-income Chicago neighborhood, from January 2016 to December 2018. We focused on individuals using statins (n = 1044), angiotensin-converting enzyme inhibitors (ACEs)/angiotensin II receptor blockers (ARBs) (n = 1003), or noninsulin diabetes medications (NIDMs) (n = 692). We defined adherence as a proportion of days covered greater than 80% over 12-months. We examined the association between telepharmacy use and medication adherence using logistic regressions adjusted for demographics (age and sex) and index prescription characteristics (method of payment, e-prescription, 90-day supply). ResultsTelepharmacy users were less adherent to statins (37.6% vs. 54.3%, adjusted odds ratio 0.54 [95% CI 0.38–0.76], P < 0.01) and ACEs/ARBs (41.4% vs, 56.5%, 0.61 [0.44–0.84], P < 0.01) than users of the traditional pharmacy. However, adherence to NIDMs was similar among users of the tele- and traditional pharmacies (65.5% vs. 60.1%, 1.47 [0.92–2.35], P = 0.11). Our findings were similar when we conducted a series of sensitivity analyses, including restricting our cohorts to those who only used their index pharmacy and analyzing cohorts of new rather than continuing users of these medications. ConclusionIn this analysis, medication adherence was lower among users of telepharmacy than users of a traditional pharmacy in some but not all drug classes examined. Further research is needed to identify whether other interventions to improve adherence, such as longer hours of operation, at-home delivery, or 90-day supply, may be coupled with telepharmacies to increase their use in urban areas.

Telepharmacy and Quality of Medication Use in Rural Areas, 2013-2019.

IntroductionPharmacy closures in rural areas is an increasingly common problem. Closures disrupt medication access and decrease adherence to prescription medications. Telepharmacy is a potential solution to this problem; however, research on the relationship between telepharmacy and the quality of medication use is scarce. Our study sought to address this gap by comparing the quality of telepharmacies serving rural areas and traditional pharmacies that support them.MethodsWe obtained dispensing data for the first 18 months of operation from 3 telepharmacies and 3 traditional pharmacies located in the upper Midwest. We evaluated adherence for noninsulin diabetes medications, renin-angiotensin system antagonists, and statins, as well as inappropriate use of high-risk medications in older adults and statin use in persons with diabetes. All metrics were calculated using Medicare Part D specifications. We estimated the differences between telepharmacies serving rural areas and traditional pharmacies using generalized linear regression. We adjusted our models for potential sociodemographic and clinical confounders.ResultsA total of 2,832 patients contributed 4,402 observations to the quality measures. After covariate adjustment, we observed no significant differences between telepharmacies and traditional pharmacies for noninsulin diabetes medications, renin-angiotensin system antagonists, statins, and high-risk medications. However, statin use in persons with diabetes was higher in telepharmacies than traditional pharmacies.ConclusionWe found that the quality of medication use at telepharmacies that serve rural areas was no worse than at traditional pharmacies. For communities considering the adoption of telepharmacy, results indicate that telepharmacies provide a suitable solution for expanding medication access and that using telepharmacy would not negatively affect the quality of medication use.

Comparison of Discounted and Undiscounted Cash Prices for Cardiovascular Medications by Type of US Community Pharmacy.

Cash prices for prescription drugs vary among community pharmacies in the USA. GoodRx is a discount platform that provides coupons for use in community pharmacies without a membership requirement. Analytical pharmacy is a new type of pharmacy that tests drugs before dispensing to verify medication quality. To compare undiscounted and GoodRx-discounted cash prices for common cardiovascular (CV) drugs by pharmacy type. A cross-sectional study. GoodRx-discounted and GoodRx-undiscounted cash price data; analytical pharmacy cash price data (all data collected in July 2020). GoodRx cash price data for 30 units of 41 generic and 16 brand-name common cardiovascular medications at mass merchandiser, regional supermarket, two national chains, and analytical pharmacy (only one of its kind in the USA). The average (SD) undiscounted generic CV medication cash price was $42.41 (44.1). The average GoodRx-discounted generic CV medication cash prices were $11.01 (8.6), $9.88 (6.7), $17.85 (10.5), and $21.73 (14.1) in mass merchandiser, supermarket, and two national chain pharmacies, respectively. The average generic CV medication cash price was $20.84 (25.7) at the analytical pharmacy. The average (SD) undiscounted brand-name CV medication cash price was $368.33 (127.00). The average GoodRx-discounted brand-name CV medication cash prices were $269.16 (118.1), $258.84 (108.6), $270.28 (118.4), and $274.60 (122.50) for mass merchandiser, supermarket, and two national chain pharmacies, respectively. The average (SD) brand-name CV medication cash price was $365.12 (116.20) at the analytical pharmacy. GoodRx-discounted cash prices of generic CV medications were significantly lower than undiscounted cash prices at supermarket, massmerchandiser, and national chain pharmacies. Analytical pharmacy cash prices too were significantly lower than traditional pharmacy undiscounted cash prices. GoodRx-discounted prices for brand-name CV medications did not differ significantly from undiscounted cash prices and between pharmacy types.

Developing Physical Assessment Skills in Pharmacy Students through Participation in a Creative Movement Workshop: An Interdisciplinary Study between Pharmacy and Dance

The role a pharmacist plays in the care of patients is continually changing and expanding. Most recently, there is movement towards including pharmacists in the physical assessment of patients. We developed a creative movement workshop with the purpose of increasing students’ levels of comfort with touch, ability to interpret non-verbal mannerisms, to increase empathy for the patient, and to increase student comfort in conducting physical exams. In this interventional study, surveys were administered to third year pharmacy students, before and after the creative movement workshop, in order to assess participant’s change in level of comfort with a variety of behaviors needed to conduct effective physical assessment. The two hour workshop involved: partner stretching, mirroring, and creative spatial exploration between bodies. The 11-item survey evaluated students’ perceptions on touch, nonverbal communication, and sharing personal space. Our results showed that the level of comfort improved for the ability to give touch (p = 0.001), the ability to receive touch (p = 0.002), and the ability to share personal space (p = 0.001). Participants commented that the workshop increased their understanding of how important confidence is when performing physical assessment and reported an increased appreciation for how much non-verbal mannerisms can communicate to another. This study explores how an interdisciplinary workshop between pharmacy and dance has the potential to increase student effectiveness as future healthcare professionals, by targeting skills not often focused on within traditional pharmacy curriculums, including: sharing personal space, displaying empathy, and providing a comforting and confident touch.

Pilot Study of Pharmacists' Attitudes towards and Expectations for Remuneration of Valueadded Pharmacy Services (VAPS) in Bulgaria.

Value-added pharmacy services (VAPS) are additional services to the traditional pharmacy activities, which do not in-clude dispensing of medicinal products and professional consultation. These services have cost reduction effect on the healthcare system and add value to the work of the pharmacist as a healthcare professional. To assess the pharmacists' attitudes and expectations towards the remuneration of value-added pharmacy services (VAPS) in Bulgaria. A cross-sectional study including pharmacists working in community pharmacies was carried out between August 2018 and October 2018. A web-based 15-item questionnaire was developed. The questionnaire was distributed to all members of the Bulgarian Pharmaceutical Union (n=5165). Two hundred thirty-three questionnaires were filled in and returned (response rate of 4.5%). Data were processed by SPSS v. 24.0. Over 51% of the community pharmacies in Bulgaria offer VAPS, mainly measuring blood pressure (67.4%) and blood glucose (12.9%). Over two-thirds of the pharmacists considered charging a remuneration fee for blood pressure measurement irrelevant. About 30.5% of those who held the opposite opinion proposed that the fee charged should not be higher than EUR 2.56. Over 44% of the re-spondents proposed that the fee for blood glucose measurement should not be higher than the same amount. Most pharmacists (98.3%) supported the idea of charging a remuneration fee for injections and influenza vaccination in a pharmacy. The study shows that pharmacists in Bulgaria are ready to offer VAPS, but additional remuneration for the services should be provided.

Pharmacy education and practice in Syria: Past, present, and future

AbstractSyria, a country with a strong rooted pharmacy history is still following a traditional pharmacy curriculum in its public and private institutions. The rising number of pharmacy graduates is putting pressure on an already weakened pharmacy job market with the majority of graduates still pursuing careers in retail pharmacy. This report sheds light on the development of pharmacy education and practice in this country. It provides a review of the curriculum content, the level of experiential training, and the current available practice venues. Existing graduate diploma available in public universities can be restructured to provide a Pharm D program. Existing residencies need to be revisited to include more clinical competencies that cover different pharmacy specialties. Pharmacists need to prove they are competent for the local authorities and other health care professionals to recognize the need for their clinical services and create new career venues and role recognitions. A clear legal framework to redefine the role of pharmacists as health care providers and their scope of practice need to be advocated by pharmacists associations and adopted by the Syrian authorities.

The current condition of traditional medicine in the United Republic of Tanzania and coping strategies on China-Tanzania traditional Chinese medicine cooperation

This paper summarizes and analyzes the current conditions of Tanzania traditional medicine practitioners, organization structure, herbal medicine resources, and the exported pharmaceutic products and related companies. The result shows that Tanzania government gradually pays the attention to the development of its own traditional medicine industry. Due to the current TCM cooperation dilemma with Tanzania, coping strategies should be adopted to provide certain references for the next stage of China-Tanzania TCM cooperation, such as adjusting the professional fields of dispatched experts, adjusting cooperative fields, including the export and investigation of TCM companies to Tanzania. Key words: The United Republic of Tanzania; Medicine, traditional; Status analysis; International cooperation; Traditional Chinese medicine and pharmacy; Coping strategy

Behind closed doors: What happens when pharmacies close?

Behind closed doors: What happens when pharmacies close?

Competency-based education in pharmacy: A review of its development, applications, and challenges.

There has been a resurgence of interest in the application of competency-based education (CBE) in health care professionals' education in recent years, including the pharmacy profession. This model strives to prepare a competent pharmacy workforce to help meet societal needs for effective, safe, and economical health care services. The aim of this narrative review is to provide an overview of the applications of CBE in the education and training of pharmacists, the process for constructing a competency-based pharmacy curriculum, and the potential advantages and challenges associated with its implementation. A comprehensive literature review was conducted via PubMed and Scopus databases using a variety of keywords related to the topic (from 1975 to 2019). Other electronic resources (Google Scholar and the Education Resources Information Center) were searched to identify educational outcomes of pharmacy programmes emphasizing competency development and competency frameworks/standards for the pharmacy profession that were published up to 2019. CBE has been increasingly adopted in pharmacy education, mainly in developed countries. A number of competency frameworks have been advanced to support the design of CBE curricula, accreditation standards of pharmacy programmes, and professional pharmacy registration/licensure. Several examples of the application of competency-based pharmacy education (CBPE) were identified at undergraduate, postgraduate, and professional development levels. Transforming a traditional pharmacy programme into CBPE offers several potential benefits but can also be associated with significant challenges. Successful implementation of CBPE programmes requires strong and supportive institutional leadership; proper curricular design, implementation, and management; and focus on faculty training and development. The adoption of CBPE can enhance the ability of pharmacy education to meet the rapidly evolving societal health care needs. This model has been applied in developed countries at different levels throughout the pharmacist's learning continuum. It has also been investigated in some developing regions.

Analysis of omeprazole and esomeprazole obtained from traditional pharmacies and unlicensed internet websites using Raman spectroscopy, 1H-NMR and chemometric analysis

The relevant therapeutic outcomes obtained with the use of proton pump inhibitors for the treatment of gastric conditions have an important reflection on the prescribing habits of clinicians of primary and secondary care organizations. With the attempt to reduce their financial impact on the health systems, generic medications, obtained both from tradition distribution chain and from parallel import, have represented the main type of proton pump inhibitors used in clinics recently. The effect of parallel import and the use of the internet as an international distribution network significantly facilitates the entry of falsified medicines in the official channels of distribution. Since the interchangeability of different omeprazole preparations has been previously questioned, in this study we used Raman and 1H-NMR to characterise different omeprazole and esomeprazole formulations produced by different manufacturers and obtained from both traditional pharmacies and from unlicensed internet market in order to establish if any differences could be found to substantiate any different clinical performances. A chemometric study of Raman spectra allowed partial separation indicating that there are not sufficient chemical differences for PCA groups to be established using this analytical approach and for these specific medications. On the contrary, NMR investigations allowed the identification of impurities in internet samples, not detected by the Raman analyses, making this technique a valid candidate analytical tool to adopt for the investigation of falsified medicines.

1303. Impact of Pharmacy Type on HIV Viral Suppression at a University-Based HIV Clinic in the Midwest

BackgroundPeople with HIV (PWH) utilize various pharmacy types beyond the traditional local pharmacy including mail order and specialty pharmacies. Some pharmacies often provide additional adherence services such as refill reminders, expedited delivery, and adherence packaging. Limited data are available describing the relationship between pharmacy type and HIV viral suppression (VS). We evaluated the impact of pharmacy type on VS.MethodsWe conducted a single-center, retrospective cohort study of PWH (≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2018, and December 31, 2018, with at least 1 HIV RNA reading during the study period. We collected sociodemographic information, ART regimen, adherence (PDC—percentage of days covered), and clinical characteristics. Patients were stratified by pharmacy type: local (traditional pharmacy without adherence services), local specialty (traditional pharmacy with adherence services and same-day, couriered delivery), and mail order (mail order pharmacy with or without adherence services). Pearson Chi-squared tests and binary logistic regression were used to examine the effect of pharmacy type on VS (HIV viral load ≤50 copies/mL).ResultsA total of 1014 patients met study criteria; 164 (16%) utilized a local, 720 (71%) local specialty, and 130 (13%) mail order. VS rates were similar between pharmacy types: local (91%), semi-specialty local (88%), and mail order (96%). After adjusting for sociodemographic characteristics, ART regimen, ART adherence and other clinical characteristics, there was no association between pharmacy type and VS when comparing local and mail to local specialty pharmacy types (local—aOR: 0.98, 95% CI, 0.46–2.12; mail—aOR: 1.65, 95% CI, 0.46–6.0). Factors found to be negatively associated with VS were single marital status (aOR: 0.49; 95% CI, 0.24–0.95), current or historical opportunistic infection (aOR: 0.51; 95% CI, 0.26–0.99), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI, 0.16–0.98).ConclusionDespite additional services offered by some pharmacies, no differences were observed in HIV VS between pharmacy types.Disclosures All authors: No reported disclosures.

Iran

Persian Medicine that is practiced as a traditional system of medicine in Iran and neighboring countries nowadays is one of the oldest traditional systems of medicine dating back to at least 7000 years ago. History of medicine in Iran can be divided into three periods: pre-Islamic (early), medieval (Islamic), and modern period. In the books of Avesta (6th century BC), three kinds of medicine were described: medicine through the knife (surgery), through the plants (herbal medicine), and through the divine words (cure by prayers). Another remarkable point from the pre-Islamic era is successful establishment of the Academy of Gondishapur (3rd century AD), which is believed to be the first teaching hospital in which medical students were trained under the supervision of physicians. Persian medicine flourished during Islamic era, in particular 9th to 13th century AD which is called as Islamic Golden age. Renowned physicians such as Rhazes, Haly Abbas, Avicenna and Jorjani(Sorsanus) belong to this era. Some of their contributions in medicine including the texts of Razi’s (The Continent) and Avicenna’s (The Canon) were the core of western medicine for several centuries. In the Persian medicine, physiological functions of the human body are considered to be based on seven factors. These are as follows: Elements, Temperament, Humors, Organs, Spirits, Forces and Functions. Since 2006, the Persian Medicine Schools have been established in Iran. Specialized education at the PhD level has been defined for two fields of Traditional medicine and Traditional pharmacy in Iran. At present there are 8 schools of Persian medicine and 17 departments of traditional medicine all around the country.

Evaluation of the current status of the value-added pharmacy services and pharmacists’ attitude in Bulgaria

Value-added pharmacy services (VAPS) are additional services to the traditional pharmacy activities, which do not include dispensing of medicinal products and professional consultation. Over 51% of the community pharmacies in Bulgaria offer VAPS but mainly measuring of blood pressure (67.4%) and blood glucose (12.9%). About 60% of community pharmacists in the country are willing to perform other VAPS. About 70% of them believe that patients would rate VAPS as useful. Younger pharmacists with professional experience less than 5 years (90.9%) tend to believe that VAPS would be positively rated by their patients. The study shows that VAPS different from consultation and dispensing of medicinal products have a potential for development in the community pharmacies in Bulgaria.