Vol 16 - Nov 2010
huture P IPSF Education Supplement
: e r tu u f e h on t i s o s t e f n i o r p ok ’’ e s o h l d t r s A a w o re i t e h ing W v ’’ o m
International Pharmaceutical Students’ Federation
Message From IPSF
Dear IPSFers,
Contact us: www.ipsf.org IPSF Secretariat PO Box 84200, 2508 AE Den Haag, The Netherlands
It is my pleasure to present to you Phuture 2010 with the theme “A look into the Future - Where is the profession moving towards?’’. Through Phuture we are trying to fulfill the IPSF objective: ‘’To encourage full dissemination of scientific and professional knowledge.’’ This year we focus on the direction our profession is heading and what it holds for various areas of pharmacy. We focus on the areas of Hospital Pharmacy, Pharmaceutical Sciences, Community Pharmacy and Pharmacy Education. Through this we hope to give you a glimpse of the future. I would like to thank the authors for their invaluable contributions, Pharmacy Education Sub Committee, Shirley Yeung, Lena Kojukarov and Bastien Venot for their contributions.
Viva la pharmacie, Satyanarayana Murthy Chittoory IPSF Chairperson of Pharmacy Education 2009 - 10
Table of Contents A look into the Future - What is the Future In Pharmaceutical Sciences? Dr. Tathagata Dutta 4 A look into the Future – Where is Hospital Pharmacy heading? Lea Knez 8 A look into the Future – Where is Community Pharmacy moving? What should we do? Raj Vidya 10 A look into the Future - Where is Pharmacy Education heading globally? Andreia Bruno 13
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A look into the Future: What is the Future in Pharmaceutical Sciences? Dr. Tathagata Dutta, Aizant Drug Research Solutions Pvt. Ltd., Dr. Tathagata Dutta graduated with a PhD in Pharmaceutical Sciences from Dr. Hari Singh Gour University, Sagar and Postdoctoral studies from School of Pharmacy, University of Queensland, Brisbane, Australia. Currently, he is the Deputy Director- Formulation Development and Research of Aizant Drug Research Solutions Pvt. Ltd., a premier drug discovery and formulation research organization. He is an expert in Nanotechnology and Dendrimer based drug and gene delivery. He has published more than 33 international papers in reputed journals, authored several book chapters and serves on the editorial board member of several international journals on drug delivery research.
ting crowded with more and more companies each day and the number of molecules getting off patent decreasing, generic companies are focusing more on biosimilar/follow on biologics formulation development. Development of novel drug delivery system (NDDS) and nanotechnology based formulations is also gaining tremendous importance.
Biosimilar or Follow on Biologics Formulations:
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iosimilars, or follow-on biologics, are new versions of existing ooking back into the past century, it is biopharmaceuticals whose paclear that medical science has made tents have expired1-3. They are ground-breaking advances and pharmaceutical produced using the same core genetic companies have made tremendous progress in material and are approved on the basis that they treatment of many illnesses like cancer and are equal to the reference product in terms of AIDS. This is shown, for instance, by the fact that both safety and efficacy. Biosimilars are large, life expectancy has risen to about eighty years, complex molecules produced by living orgacompared fifty-five years in early twentieth cen- nisms, which are sensitive to manufacturing tury. However, remaining at the cutting edge of changes; generics are small molecules, produtechnology in the face of such rapid advance- ced by chemical synthesis, which are usually ment is becoming increasingly expensive. Des- very stable. Biosimilars is the official term used pite the enormous progress that has been made, by the European medical authorities; the US terdeveloping a new drug is still a bit like looking for minology is follow-on protein products (FOPPs). a needle in a haystack, only one in 10,000 subsBiosimilars are formulations of highly unstances screened eventually becomes a fully fled- table proteins produced in living organisms often ged product that can be used to treat patients. provided with an application device, therapeutics And as I have said, it takes ten to fifteen years to equivalence with the innovator product establiachieve that. That costs an average of about one shed by extensive clinical studies. Biopharmabillion USD for each drug brought onto the mar- ceutical drugs have outperformed the ket, including opportunity costs and the cost of pharmaceutical market as a whole largely due to failures. Over the past twenty years, the cost of two factors: they address areas of clinical need developing new drugs has increased by a factor that are unmanageable with conventional theraof eight. Therefore, pharmaceutical companies peutics, including many cancers and genetic diare focusing less on discovering new chemical seases, and they are able to command a entities and more on newer technologies to make premium price. Usually, the imminent expiry of a novel formulations of existing drugs for better sa- drug’s patent leads to companies developing fety and efficacy. With the generics market get- cheaper, bioequivalent versions of the original
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brand, generics, followed by intense price competition. This approach to the biopharmaceuticals market can yield significant reward: according to Frost & Sullivan, the biosimilars markets in Europe and the USA has the potential to generate sales of $16.4 billion by 2011 at an average annual growth rate of 69.8%. However, the commercial and scientific hurdles facing biopharmaceuticals hinder the entry of generic biopharmaceuticals, so called biosimilars and, less accurately, biogenerics, and mean that companies that want to develop biosimilars will need to rethink some fundamental assumptions about the generics market and work according to new business models. Companies that are likely to succeed in the biosimilar market need to have an appropriate marketing structure as well as the financial resources to develop the products and to accept higher upfront risks in development, commercialisation and capital investment, a major shirt in skills for most generic players. This skills shift means that biosimilars players will need to evaluate their strategic options and to adopt different business models and skill sets to conventional generics companies. This is new territory for most generic players and the likely commercial rewards of entering most biosimilars markets, in the short-term at least will probably be small.
duced side effects. In addition, intravenously injected nanovehicles travel along the bloodstream without blocking vessels. Floating nanoparticles are accumulated at the inflamed site having leaky blood vessels by the enhanced permeability and retention (EPR) effect. The presence of targeting molecules at the surface of nanocarriers increases the targeting ability, resulting in higher accumulation at the target site. Predicting the future of nanotechnology in drug delivery systems is not simple because the technology is moving forward fast and dynamically changing, and we are in the middle of such changes. One could, however, find possible clues from the efforts to overcome the problems facing the research community today. One of the first things that can be predicted is the minimalistic design of drug delivery systems. Multifunctional drug delivery systems have been reported, but only few of them were used successfully in small animal models. The future of nanotechnology in drug delivery is very bright, as combined efforts of scientists in different disciplines are bound to make nanotechnology practical.
Liposomes
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iposomes are spherical vesicles that are prepared using one or more amNanotechnology in Drug Delivery and Novel Drug Delivery Formula- phiphilic phospholipids (such as phosphatidylcholine) and cholesterol that self-associate into tions bilayers that have aqueous interior. Liposomes may be formulated into anotechnology deals with the design, small structures (80–100 nm) that production, characterization and apencapsulate either hydrophilic plication of sub-micron-sized particles. The popudrug in the aqueous interior or lilarity and effectiveness of small-sized particles pophilic within the lipid bilayers. can be extended to broad areas in pharmaceutiDrug release, in vivo stability and cal, medical, chemical and engineering applicabiodistribution are determined by tions mainly due to their unique properties. The main goal of developing a nanotechnology based the size, surface charge, surface hydrophobicity NDDS formulation of a drug is either to alter is and membrane fluidity. Some of the highly successful commerpharmacokinetics, or to reduce its toxicity by targeting to specific cellular targets thereby impro- cially available liposomal formulations are AmBioving its safety and efficacy. Nanocarriers can someŽ (Gilead sciences/ Fujisawa Healthcare), carry poorly soluble, unstable, or systemically containing membrane-intercalated amphotericin toxic drugs with extended blood half-lives and re- B; DaunoXomeŽ (Gilead Sciences), containing
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encapsulated daunorubicin; Myocet® (Elan), containing encapsulated doxorubicin; and Doxil® (J&J Alza), containing doxorubicin encapsulated in PEGylated liposomes. A critical evaluation of pharmacokinetic parameters of Myocet® and Doxil® clearly shows that PEGylation of liposomes has increased the area under the curve (AUC) of doxorubicin by 100 folds while decreasing its clearance by 80 folds4-6.
Dendrimers
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endrimers have generated a great deal of interest as controlled and targeted drug/gene delivery systems due to their exceptional structural properties such as monodispersity (≈1.0), high density of peripheral functional group, and well-defined globular shape and multivalency. Dendrimers are globular, nano scaled macromolecules with a particular architecNanoparticles ture constituted of three distinct domains: (i) a central core that is either a single atom or a group anoparticles made of biocompatible having at least two identical chemical functionaand biodegradable polymers are gai- lities; (ii) branches emanating from the core, comning importance, especially in pharmaceutical posed of repeat units having at least one junction areas, and have proved to be good candidates of branching, whose repetition is organized in a as novel drug delivery devices. Nanoparticles are geometric progression that results in a series of solid colloidal particles, ranging in size from 1 to radially concentric layers called generations (G); 1000 nm, consisting of various macromolecules, and (iii) many identical terminal functional groups, in which the therapeutic drugs can be adsorbed, generally located in the exterior of the macromoentrapped or covalently attached. Solid nanopar- lecule, which play a key role in their gene-comticles offer distinct advantages in drug develop- plexing or drug-entrapping ability. Because of ment, which can be ascribed to their physical their molecular architecture, dendrimers show stability and the possibility of modifying the for- some unique physical and chemical properties, mulating materials in order to achieve controlled which make them particularly interesting for drug release characteristics. The ability to formulate and gene delivery applications. Dendrimers are nanoparticles to achieve sustained release offers widely explored in the field of controlled and taran opportunity for product life cycle management geted drug delivery, gene delivery and genetic by developing formulations with decreased do- immunization, transdermal and topical drug delising frequency for drugs that are going off patent. very, peptide and vaccine delivery, and delivery There has been a variety of materials used to en- of diagnostic agents. Starpharma’s lead product gineer solid nanoparticles both with and without VivaGel®, is a dendrimer based vaginal microbisurface functionality. Perhaps the most widely cide gel, which is effective in preventing sexually used are the aliphatic polyesters such as transmitted disease including HIV is currently unpoly(lactic acid) (PLA), the more hydrophilic dergoing clinical trials13-15. poly(glycolic acid) (PGA), and their copolymers poly(lactide-coglycolide) (PLGA). The degrada- Conclusion tion rate of these polymers and often the corresponding drug release rate can vary from days, for Nanopharmaceuticals are PGA, to months, for PLA. The effectiveness of emerging complex drug nanoparticles in drug delivery can be attributed delivery systems that are to many factors, such as physical and biological being shown to be benestability, good tolerability of the components, sim- ficial for therapeutic use plicity of the manufacturing process, possibility of with their targetability and facile scale-up of the manufacturing process, improved bioavailability. However, they might preamenability to freeze drying and sterilization7-12. sent new and unusual risks, and there is very little information from sponsors about how the risks
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can be identified, assessed, and controlled. Safe nanopharmaceuticals will not become a reality unless proper risk management and mitigation tools are utilized.
References 1. EMEA guideline on similar biological medicinal products 2. EMEA guideline on similar biological medicinal products containing biotechnology-derived proteins as active substance: quality issues 3. EMEA guideline on similar biological medicinal products containing biotechnology-derived proteins as active substance: non-clinical and clinical issues. 4. Weissig, V., Boddapati, V.S., Cheng, M.S., D’Souza, G.M.G. (2006) Liposome and liposome like vesicles for drug and DNA delivery to mitochondria. J. Liposome Res.16, 249-264. 5. Nagayasu, A., Uchiyama, K., Kiwada, H. (1999)The size of liposomes: a factor which affects their targeting efficiency to tumors and therapeutic activity of liposomal antitumor drugs. Adv. Drug Del. Rev. 40, 75-87. 6. Zuidam, N.J., Lee, S.S.L., Crommelin, D.J.A. (1992) Sterilization of liposomes by heat treatment. Pharm. Res. 10, 1591–1596. 7. Kayser, O., Lemke, A., Hernandez-Trejo, N. (2005) The impact of nanobiotechnology on the development of new drug delivery systems. Curr. Pharm. Biotech. 6, 3–5 8. Jung, T., Kamm, W., Bretenbach, A., Kaiserling, E., Xiao, J.X., Kissel, T. (2000) Biodegradable nanoparticles for oral delivery of peptides: is there a role for polymers to affect mucosal uptake? Eur. J. Pharma. Biopharm. 50, 147–160 9. Hu, J., Johnston, K.P., Williams, R.O. (2004) Nanoparticle engineering process for enhancing the dissolution rates of poorly water soluble drugs. Drug Dev Ind. Pharm. 30, 233–245 10. Alle`nmann, E.,Gurny,R.,Doelker, E. (1993) Drug-loaded nanoparticles-preparation methods and drug targeting issues. Eur. J. Biopharm. 39, 173–191. 11. Kipp, J.E. (2004) The role of solid nanoparticle technology in the parenteral delivery of poorly water-soluble drugs. Int. J. Pharm. 284, 109–122. 12. Lockman, P.R., Mumper, R.J., Khan, M.A., Allen, D.D. (2002) Nanoparticle technology for drug delivery across the blood-brain barrier. Drug Dev. Ind. Pharm. 28-32. 13. Dutta, T and Jain, N.K. (2007) Targeting potential and anti HIV activity of mannosylated fifth generation poly(propyleneimine) dendrimers. Biochim. Biophys. Acta. 1770, 681-686. 14. Dutta, T., Garg, M., and Jain, N.K. (2008) Targeting of efavirenz loaded tuftsin conjugated poly(propyleneimine) dendrimers to HIV infected macrophages in vitro. Eur. J. Pharm. Sci. 34 (2-3), 181-189. 15. Dutta, T., Garg, M., and Jain, N.K. (2008) Poly(propyleneimine) dendrimer and dendrosome based genetic immunization against Hepatitis B. Vaccine. 26 (27-28), 3389-3394.
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A look into the Future – Where is Hospital Pharmacy heading? Lea Knez, University Clinic Golnik, Slovenia
Lea Knez is a young pharmacist embracing the path of clinical pharmacy in Slovenia. She graduated in 2006 from the Faculty of Pharmacy, University of Ljubljana. Lea continued practicing in the field of clinical pharmacy at the same institution and started her PhD at the Faculty of Medicine, University of Ljubljana and is studying the impact of pharmacogenomics of multidrug resistance on chemotherapy outcomes. Lea tries to implement the principles of evidence-based practice, contributing evidence also through her own research which was presented in the form of papers and presentations on national and international conferences as ESOP and FIP congress.
vices provided by hospital pharmacists, the diversity in the availability of human and other resources, and the level of recognition of the role of hospital pharmacists; all contribute to the heterogeneity in the level of practice of hospital pharmacy among and within different countries. And as each of us is struggling to improve patient care in our own hospital setting, can we be sure that we are taking the profession to the next level? To do so, each small step needs to be streamlined toward a common goal to achieve global impact.
The need for a consensus on future directions for hospital pharmacy practice was recognised and served as a drive for the organisation of hrough the undergraduate pharmacy the Global Conference on the Future of Hospital curriculum, the first idea of hospital Pharmacy. The conference was organised by FIP pharmacy is created, an idea that is later eluci- Hospital Pharmacy Section just preceding the dated and refined through clinical practice and, 68th FIP congress in Basel, Switzerland in Aufinally, coloured when experiences are shared gust 2008. The conference produced a shared viand mixed with pharmacy colleagues worldwide. sion among hospital pharmacy leaders around The final picture is indeed very bright and colour- the world about the preferred future on hospital ful; and this is the image I have of hospital phar- pharmacy practice. The Basel Statements offer macy at the very time of writing. Although it is guidance on the cornerstone elements in hospital hard to imagine a common future for such diver- pharmacy and further evaluates in detail six tosity and describing this in 1000 words seems pics: medicine procurement, prescribing, prepanearly impossible, I am convinced that the idea ration and distribution, administration and on where hospital pharmacy is heading was monitoring, and human resources and training in never as clear as it is today. Why? Keep rea- hospital pharmacy. Since the Basel Statements ding... are freely available on FIP website and the proceedings of the conference were published as a supplement in the March 1, 2009, issue of the American Journal of Health-System Pharmacy, only few overarching statements of strong consensus, as selected by the editors of the abovementioned conference proceedings, are highlighted herein.
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The overreaching goal of hospital pharmacists is to optimise patient outcomes through the judicious, safe, efficacious, appropriate, and costeffective use of medicines. All prescriptions should be reviewed, interpreted, he ultimate goal of hospital pharmacy and validated by hospital pharmacist before meis unequivocally clear: to provide the dicine is dispensed and administered. best patient care in a hospital setting. However, The “five right� (right patient, right medicine, right unequivocal is also the diversity found in the ser- dose, right route, right time) should be fulfilled in
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all medicine-related activities in the hospital. Thus, the Basel Statements definitely answer the question posed in the title: where is hospital pharmacy heading. The primary message of the Global Conference on the Future of Hospital Pharmacy is for hospital pharmacists to orientate their efforts towards an improvement in patient care, minimising the risks associated with medicines use in hospitals and accepting the responsibilities for all medicines, everywhere in the hospitals, and at all times. Moreover, the Basel Statements do not only provide guidance on what shall we aim to, but in doing so, it is not restricting its applicability due to the different levels of practices by defining the way of how to do it. And, as the Basel Statements indicates the way forward, hospital pharmacists from all over the world have to take leadership in improving hospital pharmacy practice in their country. They need to transform the vision into clinical services to improve the health of patient treated with medicines. In these initiatives, while evaluating current practices and implementing new services, research should be integrated at all times to provide evidence on the need and importance of hospital pharmacy contribution to patient care.
genetics of enzymes involved in drug metabolism, and the choice between different treatment modalities will be based on the presence of different molecular biomarkers. These principles are already being implemented in the treatment with specific medicines in the field of oncology. As these ideas are finding their way into clinical practice, all healthcare professionals are required to acquire extensive knowledge and understanding of pharmacogenetics. In a hospital setting, pharmacists have the best position to assist the translation of new discoveries from laboratory benches to patients’ bedside with the appropriate clinical interpretation as no other healthcare professional has a more comprehensive understanding of both, basic research and its clinical applicability. Personalised medicine is, indeed, an area of new challenges for hospital pharmacists.
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verwhelmed by the hectic rhythm of everyday practice, research is often neglected as being something “on top” of other activities, while it should be recognised as an essential tool for convincing hospital boards and healthcare policymakers about the need for changes and bringing these changes to life. Thus, well-designed and well-conducted research of clinical practice that focuses on important clinical outcomes, ultimately, quality of life and survival, is of outmost importance. Moreover, while advocating for hospital pharmacy, the gained evidence should be reported and published in order to reach a broad pharmacy audience, other healthcare professionals, healthcare policymakers and the general public.
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hus, where is hospital pharmacy heading? Towards the realisation of the Basel Statements and beyond. For sure, the future of hospital pharmacy was never before so focused and goal oriented as it is today, and hospital pharmacists were never so passionate and motivated to improve their profession as they are today. And while constant improvement is imperative in providing best patient care, hospital pharmacists are fulfilling their role as they could never have before.
Being more futuristic in looking at what awaits the profession, new challenges for hospital pharmacists will emerge as patient-centred care is entering the era of personalised medicines, where the “one fits all” principle will be substituted by an individual approach. For example, dose selection will not be based solely on patient’s health condition but will consider also the
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A look into the Future - Where is Community Pharmacy moving? What should we do? Raj Vidya, Indian Pharmaceutical Association
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ther health care professionals, doctors and nurses, have well accepted the roles of pharmacists, as equal partners in decision making for patient care, with the onus of making choices for medicines and medicine management slowly shifting towards the pharmacists. That the pharmacists have attained knowledgeable and professional levels are grounded in the practice oriented curriculum and thorough training and exposure to practice oriented learning, compulsory internships in practice settings, and the need to pass a pre-registration exam. In short, one needs to be thorough, well ommunity pharmacy is making giant versed and knowledgeable with pharmacy pracstrides in the developed countries of tice before being allowed a license to practice! the world. It is moving from strength to strength The developing and the underdeveloped and pharmacists have professionalized and are countries unfortunately remain far behind in all also innovating towards improving their services these areas. Unfortunately, most people see towards patient benefit. Pharmacy is seen as a pharmacy as a business with no need of profesprofession with a business outcome. Community sionalism! In many of these countries, there are pharmacists are one of the highest paid pharma- severe shortages of healthcare manpower, and cists in these countries. It is a rewarding as well that includes pharmacists also. Large number of as a professionally satisfying career. Majority of pharmacies can function without a pharmacist pharmacists in these countries go into community most of the times. Even if a pharmacist is prepharmacy, followed by hospital pharmacy, but sent, the professional backing and touch is often very small percentage of pharmacists go into in- missing. Access to health care and essential medicines also remains a problem. In many of these dustry, research, academics, etc. The professional practice has been countries, there is no pre-registration exam, and backed by the small beginning in the late 1960’s, thus not much can be judged of the quality of where the focus first slowly but steadily started pharmacists being churned out. shifting from product to patient. Today, the prooday, in most places in India, and so duct aspects are being looked into more by the also in large areas of south –east asia, trained technicians, whilst the pharmacists look more into the patient aspects. Providing informa- community pharmacies largely operate as trade tion about their medicines through verbal and – merely doing buying and selling. Most prescripwritten instructions, and backed by patient coun- tion medicines are available without a prescription. The regulatory authorities have failed selling. miserably in implementing the important provisions, presence of a pharmacist in the pharmacy, and sale of prescription medicines only against an authorized doctor’s prescription. The main crux of the issue lies in these two very important aspects. The third issue is of trained pharmacists executing a professional task in the pharmacy. Other problems are include, too many pharmacy licenses concentrated in some areas too close to one another, cut throat competition with large discounts, expiry problems, pharmacies reluctant to Mr. Raj Vaidya is a Master of Pharmacy. As a community pharmacist he has been actively involved in the activities of IPA at the state and national level for a decade and a half. He is the team leader and active resource person of GPP Project of IPA and has been the major contributor in framing the GPP guidelines. He is also part of the FIP GPP working group. He is also the Vice Predident of IPA and Chair of the Community Pharmacy Division of IPA. Mr. Vaidya is Co-ordinator of Peripheral Adverse Drug Reporting Centre, Goa.
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hire or pay pharmacists well, etc. Public are not much aware of the role of the pharmacist, they are unidentifiable, nor do pharmacists have confidence in discussing medicines management eye to eye with doctors. Another vital ingredient in this unprofessional cocktail is the ignorance of the authorities and politburo who have even made strong recommendations that a pharmacist is not necessary to run pharmacies! And the icing on the cake has been the pharmacists’ lack of awareness of their true potential in community pharmacy and a strong resistance to change!
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he scenario is of course changing and optimists feel that they can see a shimmer of light at the end of the long winding tunnel we have to traverse. The consistent work done by professional pharmacy associations, educational institutions, pharmacy stalwarts and professionals across the world in the past fifteen to twenty years has slowly generated the importance of community pharmacy and slowly awakened the pharmacists in community that they need to do something. The FIP with its international presence and its various Forums in the six regions of the world have been able to go strong on policies and document the role of the pharmacist, education material for pharmacists, need for inter-professional interaction and working together, and promoting good pharmacy practice (GPP) across continents. Experiments of Accreditation of pharmacies in Uruguay and Thailand have certainly helped to lay down the platform for further spread of this concept, and improve community pharmacy practice.
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n India, the Indian Pharmaceutical Association (IPA) and the All India Organization of Chemists & Druggists (AIOCD ) are involved in training of pharmacists, promoting GPP. Pharmacists are trained through patient counselling courses (PCC), opening their inner windows, which explores their own potential for professionalism, playing a crucial role in society and ultimately professional satisfaction. Currently, the PCCs are conducted in Maharashtra, for “owner-pharmacists”, and very shortly, pharmacists in other parts of the country will come under the training radar. The challenge for countries like India is huge considering it has more than half a million pharmacies
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ome steps which need to be taken in underdeveloped and developing countries to gear up community pharmacy in their countries are: 1. Sensitization and awareness of authorities and politburo about the role of the pharmacist and importance of professionalizing pharmacies across the country. 2. Proper implementation of drug laws uniformly across the country. 3. Upgrading the curriculum and making it more practice oriented along with better exposure at undergraduate level. 4. Orientation & training of pharmacy teachers towards practice, and introducing the concept of teacher practitioners. 5. Continuous training of pharmacists in the country, helping them to professionalize 6. Sensitization of pharmacy owners (especially non-pharmacists) to professionalize their pharmacies, importance of pharmacist, and need to implement GPP in their pharmacy. Students role: Community pharmacy is in the need of heroes. In the public eye, the credentials and professionalism of a pharmacist are reflected from the community pharmacies. If pharmacists are not present in them, or if they are present but not noticeable, if they do not function other than plain ‘selling’ of drugs, it in no way will convey what role of pharmacist in health care can be!
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ho are the pharmacists in the pharmacies? They are non-other than ‘students’ of Pharmacy Colleges once upon a time. Had they been well captured, and well trained, and well oriented towards community pharmacy and the concepts of ‘taking the health of the public’ in their hands, we could have had better pharmacist interfacing with the public. The seeds of professionalism have to be planted in the phar-
macy colleges!” The ‘Good Pharmacy Students’ of today will be ‘Good Pharmacist’ of tomorrow.
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he future of pharmacy thus lies in the HANDS of our pharmacy students. It is the student who can make or break the profession of pharmacy. It is time now to take the tremendous task of development of the true pharmacy profession, into your hands! The time to act as now, for tomorrow will always be too late! The pharmacy profession cannot grow and gain recognition unless we, pharmacists, give back something. The profession will benefit the most when we, the pharmacists, venture out into the community pharmacies and enlightened the patient – pharmacy interface. Only when more and more interested, dedicated and knowledgeable pharmacists venture into this field of pharmacy, will the possibility arise of influencing and impressing the community... To gain something we have to sacrifice a lot! Do we have young pharmacist willing to do that? It’s time to inspect, and...
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...act!
A look into the Future - Where is Pharmacy Education heading globally? Andreia Bruno, FIP Collaborating Centre | School of Pharmacy, University of London Andreia Bruno graduated from the Instituto Superior de Ciencias de Saude Egas Moniz in Portugal. At this time she is doing her PhD in the FIP Collaborative Centre | School of Pharmacy, University of London in the Competency domain of the Pharmacy Education Taskforce, developing a Global Competency Framework for pharmacy workforce. She was involved in IPSF for three years, 2003 to 2006, as a Contact Person and part of the Public Health Sub-committee while a student; and now she is still involved as a coordinator in the Moving On II project. She has attended many international events and congresses (FIP Congresses, ISPW, and several IPSF congresses).
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harmacy education relates to what is mentioned above, but confusion is often present when we try to think globally. One can argue that there is a need to have pharmacists that are competent and fit-for-purpose when leaving universities, but how do we assess it? What is the appropriate path to follow in education? Is there only one path? This article will try to provide a global perspective on what is in practice nowadays and also to extrapolate what will happen in the future.
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he challenges facing the profession relate to the shortage of qualified pharmacists to provide pharmaceutical care and patient-focused practice to meet the demands of ccording to Wikipedia (a tool use by our society. Unfortunately, this happens not only many as an online encyclopaedia), in low human development countries, such as the pharmacy profession links the health Malawi, as possibly expected, but also in the mesciences with the chemical sciences and is char- dium human development ones, such as ged with ensuring the safe and effective use of China1,2. New opportunities within the profesmedicines. It further explains that the scope of sion have shaped our professionals to become pharmacy practice focus has shifted from a tra- more involved with patients; this is a tendency ditional role (compounding and dispensing medi- that we can observe worldwide. As technology cation) to a more modern role which includes and medicines become more complex pharmaclinical services, reviewing medication for safety cists need to keep up-to-date with the latest and efficacy and providing medicines information. trends and arm themselves with new and/or imIt also states that pharmacists, therefore, are the proved skills to face new challenges - here is experts in medicines therapy and are the primary where education can step in. This is valid for both health professionals who optimise medications undergraduate education and continuing profesuse to provide patients with positive health out- sional development as education underpins our comes. pursuit of continually expanding our knowledge and professional performance.
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s humans we are a complex species and do not always share the same opinion when it comes to education. In different countries, different pharmacy programmes are taught with the same common goal ‘producing quality pharmacists’, and even within one country different degrees are awarded2,3. This makes it difficult to unify a profession that at the starting point is already divided, but not all is lost and I do believe that we will reach a consensus in the future.
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espite many differences, Europe developed the Bologna Process, with the purpose of creating the European Higher Education Area (EHEA). EHEA makes academic degree standards and quality assurance standards more comparable and compatible throughout Europe. In a press release from the European Commission, the students also had a voice in what is happening at the moment: “A new Europe-wide survey among students shows that they want wider access to higher education and that universities should open up cooperation with the world of work and to lifelong learning. A large majority agree that it is important for higher education institutions to foster innovation and an entrepreneurial mindset among students and staff, and that there should be the possibility to undertake work placements in private enterprises as part of a study programme. More students want to study abroad and a majority want more information about the quality of higher education institutions in order to inform their study choices.” 4
tors6, who have a method to ensure uniformity of competency-based skills. Why not develop an agreement on the core competencies and behaviours for the pharmacy profession in a global sense that would be adapted according to the specificities of the country?
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n emergent role for pharmacists that we are currently witnessing in the United Kingdom8 is the introduction of supplementary and independent prescribing. Such new roles have to be supported by appropriate training and continuing professional development.
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o think about the future of pharmacy education, one has to think about the future of the profession as these cannot be dissociated one from the other. To support a unified pharmacy profession worldwide focused on the interests of patients and their health outcomes, I foresee developments in education that will expand among other things the use of problem based learning, objective structured clinical examination and competency-based outcomes. I also foresee strengthened mobility of students, researchers, staff and pharmacists that will enable a shared vision of the pharmacy profession. References
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t is a growing trend for students and practitioners to seek other countries different from their own to pursue further studies, expand their knowledge and skills, and bring what they have learned back home.
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harmacists wish to reinforce their role as medicines experts and education programmes need to ensure that they are competent to undertake these new responsibilities. Competency-based programmes are already being used in some countries such as Australia 5, and are possibly the future for pharmacy education. The term ‘competency’ is a challenging one, since there is no universally accepted competency framework or performance standard at the point of graduation or post-registration for pharmacists in the same way there is for doc14
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1. Wuliji T. 2009 FIP Global Pharmacy workforce report. 2009 2. Ryan M, Shao H, Yang L, Nic XY, Zhai SD, Shi LW, Lubawy W. Clinical Pharmacy Education in China. American Journal of Pharmaceutical Education. 2008; 72(6): 129. 3. Kheir N, Zaidan M, Younes H, Hajj M, Wilbour K, Jewesson P. Pharmacy Education and Practice in 13 Middle Eastern Countries. American Journal of Pharmaceutical Education. 2008; 72(6): 133. 4. Last assess 13th of July 2010 - http://europa.eu/rapid/pressReleasesAction.do?reference=IP/09/618&format=HTML&aged=0&la nguage=EN&guiLanguage=fr 5. Marriott J, Nation R, Roller L, Costelloe M, Galbraith K, Stewart P, Charman W. Pharmacy Education in the Content of Australian Practice. American Journal of Pharmaceutical Education. 2008; 72(6): 131. 6. World Federation of Medical Education. WFME Global Standards for Quality Improvement in Medical Education: 2003. 7. Sosabowski M, Gard P. Pharmacy Education in the United Kingdom. American Journal of Pharmaceutical Education. 2008; 72(6): 130.