04 Organization of pharmaceutical care conception of responsible selftreatment. Organization of non- prescription drugs sales
In the last quarter century, pharmacy has expanded its role within the health are delivery system from a profession focusing on preparation and dispensing of nedications to patients to one in which pharmacists provide a range of patient-fiented services to maximize the medicine’s effectiveness.
Is this the right medicine, doc?” In 1948, patients asked their pharmacists that uestion every day, and physicians didn’t seem to mind at all. Fifty years later, atients don’t refer to their pharmacists as “doc,” but they still ask the same question. Jow, however, physicians seem concerned about pharmacists intruding on their turf s providers of medical care and advice.
The worry comes as pharmacists seek an increased role in providing ounseling and clinical services to patients as well as greater payment for their ervices. Pharmacists see themselves as health care professionals licensed to apply ieir special knowledge, and they’re telling health care systems, patients and insurers Ш they are an integral part of the managed care solution or pharmaceutical care. Statement On Pharmaceutical Care
Pharmaceutical care is the responsible provision of drug therapy for the “rpose of achieving definite outcomes that improve a patient’s quality of life. These ‘comes are: cure of a disease, elimination or reduction of a patient’s
omatology, arresting or slowing of a disease process, or preventing a disease or ymptotnatology.
Pharmaceutical care involves the process through which a pharmacist, і cooperation with a patient and other health professionals, designs, implements, monitors a pharmaceutical care plan that will produce specific therapeutic outconv for the patient. This in turn involves three major functions performed by 4 pharmacist: identifying potential and actual drag-related problems, ‘resolving actui drug-related problems, and preventing potential drug-related problems.
Pharmaceutical care is a necessary element of health care that should integrated with other elements. Pharmaceutical care is, however, provided for tl direct benefit of the patient, and the pharmacist is responsible directly to the patie for the quality of that care. The fundamental relationship in pharmaceutical care і mutually beneficial exchange in which the patient grants authority to the provider am the provider gives competence and commitment (accepts responsibility) to th< patient.
The fundamental goals, processes, and relationships of pharmaceutical care exi regardless of practice settings.
• The basis of pharmaceutical care is responsibility and accountability to patiem for the outcome of their drug therapy.
« The overall goal of pharmaceutical care is to maintain patients at the highes possible level of functional and psychosocial well-being through optimal management of drug therapy. ,–….: .
• Pharmaceutical care requires continuity of care/between different practice
settings. ,. ..’•; ,. ,. •• .: v .•;;.• .„.
Drug-Related Problems
Pharmaceutical care involves the pharmacist in three major functions on behalf of thi patient: identifying potential and actual drug-related problems, resolving actual drug related problems, and preventing potential drug-related problems. A drug-relatd problem is an event or situation involving drug therapy that actually or potential^ interferes with an optimum outcome for a specific patient. Drug-related problems include: .,1
Untreated indications. The patient has a medical problem that requires drag
therapy but is not receiving a drag for that indication.
Improper drag selection. The patient has a drug indication but is taking the
wrong drag, or is taking a drag that is not the most appropriate for the special
needs of the patient. . Subtherapeutic dosage. The patient has a medical problem that is being treated
with too little of the correct medication. . Failure to receive medication. The patient has a medical problem that is the
result of not receiving a medication due to economic, psychological,
sociological, or pharmaceutical reasons. . Overdosage. The patient has a medical problem that is being treated with too
much of the correct medication. . Adverse drug reactions. The patient has a medical problem that is the result of
an adverse drug reaction or adverse effect.
• Drug interactions. The patient has a medical problem that is the result of a drug-drug, drug-food, or drug-laboratory test interaction.
• Drag use without indication. The patient is taking a medication for no medically valid indication.
• Treatment failures. The patient has a medical problem that is being treated with
a medication that is generally considered appropriate for the indication, but the
desired therapeutic outcome is not achieved.
Its main aim is to work in partnership both with other healthcare professionals “id with patients, to ensure they make the best and safest use of medicines.
Pharmaceutical care reflects a systematic approach that makes sure that the •atient gets the right medicines, in the right dose, at the right time and for the right easons. it is about a patient-centred partnership approach with the team accepting cSPonsibility for ensuring that the patient’s medicines are as effective as possible and
e as possible. This is done by identifying, resolving and preventing medicine-a ed problems so the patient understands and gets the desired therapeutic goal for !ach medical condition being treated.
Pharmacists can and do make a unique contribution to improving patient < Medicines are the most common of all the steps taken by clinicians to help patients. And of all the healthcare professions, pharmacists have the wid knowledge in the science and use of medicines. Whether in the community, in hospitals or specialist units, pharmacy focuses on empowering and protectin patients. Pharmacists have a key role to play in ensuring health gain whereve medicines are used.
Pharmacists provide care not just to patients but to the wider general publiej The ‘pharmaceutical health’ of the nation depends on good access to medicine^ advice and to tailoring therapy to the needs of individuals. : * к Principles of Practice for Pharmaceutical Care
Pharmaceutical Care is a patient-centered, outcomes oriented pharmacj practice that requires the pharmacist to work in concert with the patient and th patient’s other healthcare providers to promote health, to prevent disease, and assess, monitor, initiate, and modify medication use to assure that drug therap)! regimens are safe and effective. The goal of Pharmaceutical Care is to optimize thq patient’s health-related quality of life, and achieve positive clinical outcomes, within realistic economic expenditures. To achieve this goal, the following must accomplished:
A. A professional relationship must be established and maintained.
Interaction between the pharmacist and the patient must occur to assure that.’
relationship based upon caring, trust, open communication, cooperation, and mutual
decision making is established and maintained. In this relationship, the pharmacil
holds the patient’s welfare paramount, maintains an appropriate attitude of caring fijj the patient’s welfare, and uses all his/her professional knowledge and skills on patient’s behalf. In exchange, the patient agrees to supply personal information preferences, and participate in the therapeutic plan. The pharmacist develop mechanisms to assure the patient has access to pharmaceutical care at all times.
В Patient-specific medical information must be collected, organized, recorded, and maintained.
Pharmacists must collect and/or generate subjective and objective information aarding the patient’s general health and activity status, past medical history, medication history, social history, diet and exercise history, history of present illness, and economic situation (financial and insured status). Sources of information may include, but are not limited to, the patient, medical charts and reports, pharmacist-conducted health/physical assessment, the patient’s family or caregiver, insurer, and other healthcare providers including physicians, nurses, mid-level practitioners and other pharmacists. Since this information will form the basis for decisions regarding the development and subsequent modification of the drug therapy plan, it must be timely, accurate, and complete, and it must be organized and recorded to assure that it is readily retrievable and updated as necessary and appropriate. Patient information must be maintained in a confidential manner.
C. Patient-specific medical information must be evaluated and a drug therapy plan developed mutually with the patient.
Based upon a thorough understanding of the patient and his/her condition or
disease and its treatment, the pharmacist must, with the patient and with the patient’s other healthcare providers as necessary, develop an outcomes-oriented drug therapy plan. The plan may have various components which address each of the patient’s diseases or conditions. In designing the plan, the pharmacist must carefully consider the psycho-social aspects of the disease as well as the potential relationship between the cost and/or complexity of therapy and patient adherence. As one of the patient’s advocates, the pharmacist assures the coordination of drug therapy with the patient’s other healthcare providers and the patient. In addition, the patient must be apprised of U) various pros and cons (i.e., cost, side effects, different monitoring aspects, etc.) of e options relative to drug therapy and (2) instances where one option may be more neticial based on the pharmacist’s professional judgment. The essential elements of e Plan, including the patient’s responsibilities, must be carefully and completely P amed to the patient. Information should be provided to the patient at a level the patient will understand. The drug therapy plan must be documented in the patient!
I pharmacy record and communicated to the patient’s other healthcare providers 3
necessary. D. The pharmacist assures that the patient has all supplies, informatioi and knowledge necessary to carry out the drug therapy plan.
The pharmacist providing Pharmaceutical Care must assume ultimat responsibility for assuring that his/her patient has been able to obtain, and і appropriately using, any drugs and related products or equipment called for in th drug therapy plan. The pharmacist must also assure that the patient has a thorougl understanding of the disease and the therapy/medications prescribed in the plan. ,
E. The pharmacist reviews, monitors, and modifies the therapeutic plan aj necessary and appropriate, in concert with the patient and healthcare team.
The pharmacist is responsible for monitoring the patient’s progress in achievin; the specific outcomes according to strategy developed in the drug therapy plan. Th< pharmacist coordinates changes in the plan with the patient and the patient’s othe healthcare providers as necessary and appropriate in order to maintain or enhance thi safety and/or effectiveness of drug therapy and to help minimize overall healthcan costs. Patient progress is accurately documented in the pharmacy record an< communicated to the patient and to the patient’s other healthcare providers a appropriate. The pharmacist shares information with other healthcare providers as th< setting for care changes thus helping assure continuity of care as the patient move between the community setting, the institutional setting, and the long-term can
setting.
••: . -•…••• -.-• vi<; Practice Principles 1
1. Data Collection
1.1 The pharmacist conducts an initial interview with the patient for th< purposes of establishing a professional working relationship and initiating th’ patient’s pharmacy record. In some situations (e.g. pediatrics, geriatrics, critical care language barriers) the opportunity to develop a professional relationship with an’
information directly from the patient may not exist. Under these • mstances, the pharmacist should work directly with the patient’s parent, guardian, and/or principal caregiver.
1.2 The interview is organized, professional, and meets the patient’s need for onfidentiality and privacy. Adequate time is devoted to assure that questions and answers can be fully developed without either party feeling uncomfortable or hurried. The interview is used to systematically collect patient-specific subjective information and to initiate a pharmacy record which includes information and data regarding the patient’s general health and activity status, past medical history, medication history, social history (including economic situation), family history, and history of present illness. The record should also include information regarding the patient’s thoughts or feelings and perceptions of his/her condition or disease.
1.3 The pharmacist uses health/physical assessment techniques (blood-pressure monitoring, etc.) appropriately and as necessary to acquire necessary patient-specific objective information.
1.4 The pharmacist uses appropriate secondary sources to supplement the information obtained through the initial patient interview and health/physical assessment. Sources may include, but are not limited to, the patient’s medical record or medical reports, the patient’s family, and the patient’s other healthcare providers.
1.5 The pharmacist creates a pharmacy record for the patient and accurately records the information collected. The pharmacist assures that the patient’s record is appropriately organized, kept current, and accurately reflects all pharmacist-patient encounters. The confidentiality of the information in the record is carefully guarded and appropriate systems are in place to assure security. Patient-identifiable ‘”formation contained in the record is provided to others only upon the authorization of the patient or as required by law.
2- Information Evaluation
2-1 The pharmacist evaluates the subjective and objective information collected m the patient and other sources then forms conclusions regarding: (1)
opportunities to improve and/or assure the safety, effectiveness, and/or economy of current or planned drug therapy; (2) opportunities to minimize current or potential future drug or health-related problems; and (3) the timing of any necessary future pharmacist consultation.
2.2 The pharmacist records the conclusions of the evaluation in the medical and/or pharmacy record.
2.3 The pharmacist discusses the conclusions with the patient, as necessary апШ appropriate, and assures an appropriate understanding of the nature of the condition] or illness and what might be expected with respect to its management.
3. Formulating a Plan
3.1 Tie pharmacist, in concert with other healthcare providers, identifies evaluates and then chooses the most appropriate action(s) to: (1) improve and/o assure the safety, effectiveness, and/or cost-effectiveness of current or planned dru; therapy; and/or, (2) minimize current or potential future health-related problems.
3.2 Thi pharmacist formulates plans to effect the desired outcome. The plan may include, but are not limited to, work with the patient as well as with other healtl providers to develop a patient-specific drug therapy protocol or to modify prescribe* drug therapy, develop and/or implement drug therapy monitoring mechanisms recommend rutritional or dietary modifications, add non-prescription medications о non-drug treatments, refer the patient to an appropriate source of care, or institute ai existing drug therapy protocol.
3.3 For each problem identified, the pharmacist actively considers the patient’; needs and cetermines the desirable and mutually agreed upon outcome and incorporates these into the plan. The plan may include specific disease state and drug therapy endpcints and monitoring endpoints.
3.4 The pharmacist reviews the plan and desirable outcomes with the patient and with the f atient’s other healthcare provider(s) as appropriate.
3.5 The pharmacist documents the plan and desirable outcomes in the patient’ medical and/er pharmacy record.
4. Implementing the Plan
4 1 The pharmacist and the patient take the steps necessary to implement the
These steps may include, but are not limited to, contacting other health
oviders to clarify or modify prescriptions, initiating drug therapy, educating the
atient and/or caregiver(s), coordinating the acquisition of medications and/or related
applies, which might include helping the patient overcome financial barriers or
festyle barriers that might otherwise interfere with the therapy plan, or coordinating
ppointments with other healthcare providers to whom the patient is being referred.
4.2 The pharmacist works with the patient to maximize patient understanding nd involvement in the therapy plan, assures that arrangements for drug therapy ionitoring (e.g. laboratory evaluation, blood pressure monitoring, home blood lucose testing, etc.) are made and understood by the patient, and that the patient ;ceives and knows how to properly use all necessary medications and related quipment. Explanations are tailored to the patient’s level of comprehension and ;aching and adherence aids are employed as indicated.
4.3 The pharmacist assures that appropriate mechanisms are in place to ensure lat the proper medications, equipment, and supplies are received by the patient in a raely fashion.
4.4 The pharmacist documents in the medical and/or pharmacy record the steps Жеп to implement the plan including the appropriate baseline monitoring arameters, and any barriers which will need to be overcome.
4.5 The pharmacist communicates the elements of the plan to the patient and/or
‘is patient’s other healthcare provider(s). The pharmacist shares information with
er healthcare providers as the setting for care changes, in order to help maintain
°ntinuity of care as the patient moves between the ambulatory, inpatient or long-
Sfm care environment.
5- Monitoring and Modifying the Plan/Assuring Positive Outcomes
5.1 The pharmacist regularly reviews subjective and objective monitoring parameters in order to determine if satisfactory progress is being made towar<j achieving desired outcomes as outlined in the drug therapy plan.
5.2 The pharmacist and patient determine if the original plan should continul to be followed or if modifications are needed. If changes are necessary, th<j pharmacist works with the patient/caregiver and his/her other Healthcare providers ц modify and implement the revised plan as described in “Formulating the Plan” anf “Implementing the Plans” above.
5.3 The pharmacist reviews ongoing progress in achieving desired outcomes with the patient and provides a report to the patient’s other healthcare providers as appropriate. As progress towards outcomes is achieved, the pharmacist should provide positive reinforcement.
5.4 A mechanism is established for follow-up with patients. The pharmacis uses appropriate professional judgement in determining the need to notify the’ patient’s other healthcare providers of the patient’s level of adherence with the plan.
5.5 The pharmacist updates the patient’s medical and/or pharmacy record with information concerning patient progress, noting the subjective and objective information which has been considered, his/her assessment of the patient’s current progress, the patient’s assessment of his/her current progress, and any modifications that are being made to the plan. Communications with other healthcare providers should also be noted.
Pharmaceutical care is a process of drug therapy management that requires a change in the orientation of traditional professional attitudes and re-engineering oC the traditional pharmacy environment. Certain elements of structure must be in place to provide quality pharmaceutical care. Some of these elements are: (1) knowledge* skill, and function of personnel, (2) systems for data collection, documentation, and transfer of information, (3) efficient work flow processes, (4) references, resources) and equipment, (5) communication skills, and (6) commitment to quality improvement and assessment procedures.
Knowledge, skill, and function of personnel
The implementation of pharmaceutical care is supported by knowledge and k’lls in the area of patient assessment, clinical information, communication, adult teaching and learning principles and psychosocial aspects of care. To use these skills, responsibilities must be reassessed, and assigned to appropriate personnel, including pharmacists, technicians, automation, and technology. A mechanism of certifying and credentialling will support the implementation of pharmaceutical care.
Systems for dala collection and documentation i( ‘ • ‘•”•-••’•’
The implementation of pharmaceutical care is supported by data collection and documentation systems that accommodate patient care communications (e.g. patient sontact notes, medical/medication history), interprofessional communications (e.g. jhysician communication, pharmacist to pharmacist communication), quality assurance (e.g. patient outcomes assessment, patient care protocols), and research ;e.g. data for pharmacoepidemiology, etc.). Documentation systems are vital for reimbursement considerations.
Efficient work flow processes
The implementation of pharmaceutical care is supported by incorporating patient care into the activities of the pharmacist and other personnel.
References, resources, and equipment
The implementation of pharmaceutical care is supported by tools which lacilitate patient care, including equipment to assess medication therapy adherence and effectiveness, clinical resource materials, and patient education materials. Tools таУ include computer software support, drug utilization evaluation (DUE) programs, disease management protocols, etc.
Communication Skills . • .,..,, ne implementation of pharmaceutical care is supported by patient-centered
wncation. Within this communication, the patient plays a key role in the VeraH management of the therapy plan.
Quality Assessment/Improvement Programs , ‘ The implementation and practice of pharmaceutical care is supported and improved by measuring, assessing, and improving pharmaceutical care activities utilizing the conceptual framework of continuous quality improvement.
This document will not cover each and every situation; that was not the intent
•j of the Advisory Committee. This is a dynamic document and is intended to be revised
as the profession adapts to its new role. It is hoped that pharmacists will use these
principles, adapting them to their own situation and environments, to establish and
implement pharmaceutical care. і
(l)Although “drug therapy” typically refers to intended, beneficial effects of
pharmacologic drugs, in this document, “drug therapy” refers to the intended^
і beneficial use of drugs – whether diagnostic or therapeutic – and thus include^
diagnostic radiopharmaceuticals, X-ray contrast media, etc. in addition to pharmacologic drugs. Similarly, “drug therapy plan” includes the outcomes oriented plan for diagnostic drag use in addition to pharmacologic drug use. ,
1. Criteria for categories of dispensing of medicines
Medications are divided into two categories:
• prescription drugs
• medicines, dispensing without a prescription
Prescription medications can be divided into separate groups according to the following classification:
medicines for dispensing by single or reusable recipes
medicines, dispensing with the special recipes
Medicines are released by one-time or reusable recipes:
if they can cause direct or indirect threat to the health of the consume, even when properly applied, but without medical supervision
if they are used by many consumers incorrectly, which could be direct or indirect threat to the health of the consumer
if they contain substances, actions and side effects of which require further study
If the drug is intended for parenteral poreparat appointment
Medications, which released by special recipe account the following factors:
the medicinal product is attributed to narcotic or psychotropic in accordance with the laws
the incorrect application of medicinal may cause a significant risk (of abuse, addiction, or use of medication for illegal purposes)
the medicinal product contains a substance which because of the novelty or pharmacological properties can be attributed to this group
the medicinal product contains substances of the list 1 and 2 of Table IV ( Decision of CMU #770)
Medicines prescription and have a limited range of application, consider the following factors:
the medicinal product in connection with its pharmacological properties or novelty or in the interests of health of the population intended for use only in hospital
medicinal product used for the treatment of diseases, diagnosis of which can be installed in a hospital or institutions that have the necessary diagnostic equipment
the medicinal product is intended for outpatient treatment, but its application can lead to serious side effects, resulting in the need that prescription was issued for specialists and treatment was carried out under medical supervision.
Medicines products are dispensed without prescription if they do not apply to prescription. They contain small quantities of narcotic drugs or psychotropic substances and precursors included in the respective tables of Resolutions # 770 and will not be extracted from the medicines easily accessible way in quantities that will abuse them.
The list of drugs approved for use in Ukraine, dispensing without a prescription from pharmacies, chemist’s kiosks and chemist’s items described in order MH of Ukraine № 897.
2. Causes of the concept of self-treatment.
Issue by drugs without a prescription is an integral part of retail pharmacies. In Ukraine, as well as around the world, experiencing growth in sales of OTC medicines, which has a number of reasons, including:
Improve access to medicines
Increase awareness of population
Increasing responsibility for their health and the health of family members
Attempts to healthy lifestyle.
Over the counter drug – OTC-drug forms an important part of the pharmacy. This activity becomes even more pharmacies in connection with a significant focus of public policy in health on improving responsibility of the citizens for their health, which provides independent selection of drugs. It is necessary to know that such processes take place in most developed countries.
OTC sales of medicines to the population is closely related to the self treatment, in which understanding disease prevention, treatment of not very difficult deseases, or lesions with drug dispensing without prescription.
OTC drugs are often used to treat: headaches, high temperature, coughing, colds, stomach disorders, heart attacks, skin disease.
Self-treatment – the use of a consumer of medicinal preparations, which are in open sale for preventive of disorders with health and treatment of symptoms, which are recognized by consumers himself. In practice self treatment also includes a treatment of family members and friends, especially when it comes to children. In 1994 the European association of manufacturers of OTC drugs introduced the term “responsible self-treatment”.
Self-care understands those cases where is necessary to help on health by those or other drugs in the period of exacerbation of chronic disease and give first aid before the arrival of doctor.
Self-profilaxys of disease helps to take measures by population to reduce the risk of disease.
Information on box of OTC – drugs.
Safe effective use of OTC medicinal preparations is possible only if patients receive a clear and available information about these medicines. Consumers should clearly know in which cases of the illness it may be treated without doctor.
Instruction must contain in the form available to the consumer with the exhaustive list of information about medicinal drugs.
1.Information for identification of medicinal product:
Name of medicinal product and its International title (or name of the active complex);
complete qualitative and quantitative characterization of active complex;
medicinal form and its composition, doses (one for each medicinal form);
Pharmacotherapeutic group or character of pharmacologic actions in the term, which is clear for patient;
address of the manufacturer’s and its name;
2. Pharmacotherapeutical information about the properties of the drug:
indications;
contraindications;
•measure barrier in the application;
interaction with other medicinal means;
interaction with food, alcohol;
any special warning.
All these data should:
Draw attention to the distinctiveness of certain categories of consumers (children, pragnent, women who are breastfeeding, older age, drivers of vehicles);
Reminded of the possible effects on speed of reactions in operation of vehicles or other engines of potential dangerous.
3. Information on how to use medicinal preparations should include:
Information about the dosage, method and path of input, frequency of reception with appointment, if necessary, time of day when the medicines should be taken;
Duration of treatment course when it should be limited;
Actions in case of overdose.
4. Information about the term of use:
Warning not to take medication after a specified period;
Appointment for any special storage conditions.
Let say that even in the provision of full information about drugs with instructions no warranty that the patients understood the text. Professional understanding of the text intended for patients with certain medical or pharmaceutical training.
Several patients adversely affect your option to explore in detail instructions from a medical application. All these reasons in case of growing popularity among the population concept self-treatment determine the necessity of vocational training of pharmacists as a strategic choice of experts from the use of OTC drugs. Separate category of patients need an increased attention, because of the risk of side effect it may be much higher than in other patients.
The original medicinal product – a product which is exclusive property of the company that develop it – Brand.
Generic drug (generic drug) the term of patent protection on the actions of the active substance is ended.
Pharmaceutical care – is a complex problem of interaction of pharmacist and patient during the total period of medicinal therapy. Pharmaceutical care understands the responsibility of pharmacist to the patient fop effectiveness and result of treatment.
To provide the pharmaceutical care to leave OTC drugs in pharmacy pharmacist must:
1. Correctly estimate the problem of patients:
Obtain information that allows you to properly estimate the specific health problem with patients (when there are problems, symptoms, or taken other drugs).
Decide whether the symptoms associated with serious health disorders
2. Ensure patient OTC medicines
Pharmacist must maximize their professional knowledge and professional experience in case of choose of OTC medicines means (effectiveness, safety, quality and economic feasibility).
In case of leaving OTC products provide patients with information about effect of the drug, method of use, duration of treatment, the possible actions of side effect.
3. To ensure patients follow-up:
Pharmacists have to estimate effectiveness of the drug by patients
Pharmacists have to recommend to the patients to consult with a doctor if symptoms do not disappear after a certain period
In accordance with the recommendations of GPP for each symptom that can be treated independently exists independently developed algorithm, which should be known to the pharmacist:
1. Set for the treatment of which symptom medicinal drug is supposed.
2. Explain on the basis of survey of patients, or is this a symptom of disease that requires an intervention of the doctor.
3. Identify pharmacological group of drugs to treat this symptom.
4. Choose among a group of medicinal preparations optimal preparation for this patient.
5. Provide the patient with adequate information about the selected drug.
After choosing OTC products Pharmaceutical care includes the following recommendations for patients and consultations:
1. Choice of optimal form of the drug and ways of input
2. Rules on the use of various medicinal forms
3. Features of individual doses
4. Features of the interaction with other medicinal drug
5. Features of the interaction of drugs with food, alcohol and cigarettes
6. Time, which is optimum for the reception of the medicinal product
7. Possible undesirable effects on the functions of human organs and systems
8. Specific storage conditions of drugs
To implement the above algorithm of realization of pharmaceutical care pharmacist should be able to:
Initiate a dialog with patients to obtain data about disease
Ask Key questions for elucidation of the patients
Recognize specific symptoms of desease
For a short time (3.4 asking questions) take a decision about the possibility of self-treatment
Convince the patient about the need to treat a limited term and doctor consultations if the treatment is not effective
Persuade the patient to visit the doctor in the case of “threatening” symptoms
Provide confidentiality of details of the status of the patients condition
Know well OTC-drugs
Know the chemical, pharmaceutical and pharmacological properties of OTC drugs
Provide unbiased information about medicines and send it in available for patients form
Help patients to provide responsible self-treatment
Today is an important place take such factors as the willingness of patients to doctor recommendations, prepossession of patient before treatment. This new phenomenon was named complience.
In prepossession of patients can affect:
Age, education level
Frequency of dosing
Number of doses on days
Medicinal form
Time needed for results of treatment
Limitations at taking of drug
Side effects of treatment
Completeness and Availability of information on drug
Price of drug and cost of the course treatment
Number of simultaneously used drugs
Any drug is potentially dangerous and can be prescribed to the patient in extremis.
Thalidomide, a tranquilizer weak, cause severe birth defects in 10 thousand babies. In West Germany without a prescription.
There are 220 medicinal substances that have adverse effects included in the drug. Diane-35.
In the U.S. medicines are sold in specialty stores by persons who do not have pharmaceutical education. Doctors themselves have to offer big profits for producers, realizing their products.
Medicine and Pharmacy ceased to be primitive and become increasingly industrial nature and become commercial.
4. Organization of OTC Department
Independent department of OTC organized in pharmacies of 1 group. In other pharmacies it is usually together with the department of prepared medicinal forms.
In the workplace of OTC department an important place is for registration information for visitors.
5.Organization of work of retail trade network
Retail trade pharmacy network is organized for approaching medicinal assistance to the population. It includes pharmacy points of 1category, 2 category, pharmacy kiosks. “A typical rules about pharmacy kiosks ” approved by order of the Ministry of Health 49 in 1993. In accordance with this rules pharmacy points of 1 category are organized by self-supporting pharmacies in hospitals. In cities where hospitals located in distance more than 0.5 km from the nearest self-supporting pharmacy, in other locations its are organized in case of absence of pharmacies according to Decision of CM 447 1997. The minimum area must be not less than 18m sq.m.. Premises for pharmaceutical points of 1 category are provided by hospitals and equipment – by pharmacy. Pharmaceutical points of 1 category must have:
– Equipment and furniture: Pinwheel, refrigerator, safe for poisons, cabinets, table for receiving of prescriptions and leaving of drugs.
– Unit and devices – scales, engineering, distiller, water bath.
Production facilities, utensils – funnels, flasks, beaker, mortars and etc.
Economic facilities – rubber mat, scissors etc.
In cities pharmacy points of 1 category leave ready means on prescription – with the exception of narcotic drugs, psychotropic, and without prescription, realizes sanitary items, hygiene, care, takes recipes from people for the manufacture of drugs in pharmacy and leave them after making .
Pharmacy points of 1 category make medicines by prescription, control their quality and leave it for patients in other towns, villages. Pharmacy points of 1 category is headed by chief. He is assigned by a chief of pharmacy.
Pharmaceutical point of 2category is organized at health posts. They provide population with prescription medicinal means (except narcotics) and non-prescription drugs, medicinal herbs, dressing materials, care objects.
From the chemist’s point of 2 category can be leaved drugs which is prescribed by midwife of health posts and doctors for free or in preferential terms. According to the Law #360 free recipes at the end of the month is donated to the pharmacy to take payment from hospitals.
Equipment of pharmaceutical points of 2 category includes table for leaving of drugs, turntables for finished drugs, safe for toxic medicines. Realization of pharmaceutical products is performed by specialists with nursing education
Pharmaceutical kiosk organize its work in accordance with the “typical rules of the pharmacy kiosk” (49 order). The area must be at least 18 square meters. Pharmacy kiosks realize to people ready medicinal means which are allowed to OTC leaving, care items,other goods. Pharmacy kiosks are located in crowd places – stations, post offices.
The contents of the normative acts that regulate the presence of medicinal resources in pharmacy network.
According to order of MOH of Ukraine 233 1997 “On approving the list of medicines means that are registered in Ukraine” approved:
1.list of medicinal preparations that are allowed for use in Ukraine, which are leaved with prescription from pharmacy and pharmacy points. This list includes 1735 drugs -1997 – domestic and foreign production. Information about medicinal products include:
trade name
internationally generic name
medicinal form with appointment of number of doses in the package
2.List of medicinal preparations that are allowed for use in Ukraine, which are leaved without prescription from pharmacy points and kiosks. This list includes near 670 medicinal preparations.
2. Organization of the Department of finished medicinal preparations.Equipment. Rights and duties of department employees. Department of finished medicinal means is organized to leave to the population ready means of industrial production and medicines, which are made in pharmacy.
Independent department finished medicinal preparations is presented in pharmacies of 1 group. In more pharmacies of lower groups they are leaved from recipe-production department
Department of finished medicinal means includes material room of finished medicinal forms and workstations of pharmacist which is posted in reception hall of visitors for taking of receipts and leaving of drugs according to the receipts. In pharmacy of 1 group should be 2 material rooms of finished medicinal forms. Material rooms in accordance with the requirements of the order 44 are equipped with shelves and cabinets, premises for the storage of narcotic medicinal means – safes, security and fire facilities, refrigerators, purge ventilation. Material rooms are equipped with hygrometrs and thermometers to monitor the maintenance of necessary temperature and moisture.
Workstations of pharmacist, who is busy in taking of receipts and leaving drugs, is equipped with a desk, counter and cabinets for medicinal means.
Workstations of pharmacist of department of finished medicinal means is equipped with:
list of surnames of doctors, phone numbers
stamps – not a full-prescription, drugs released
calculator
reference literature
orders
accounting documentation
Every day at the end of the day (changes) pharmacist fill into the appropriate gaps of the “Journal of the recipes” the number and sum (price) of finished medicinal means which are leaved to the population. As recipes for free and preferential medicinesa remain in pharmacy so number of drugs and amount (price) which are leaved according to this recipts is calculated by this receipts and included into the Journal of compounding-form AP -7.
In the staff of department of finished medicinal means are all individuals with higher pharmaceutical education: the head of department, deputy head of the department and pharmacists.
Head of the department must:
organize the work of department, provide sale of medicines to population
control the presence of the necessary range of medicines at the department department and follow the rules of trade
provide the storage of medicines in accordance with their properties
maintain accounting inventory of material values, introduce into the practice modern methods of organization of medicines to the population
organize work to improve the skills of workers of the department
inform the head of pharmacy managers and medicinal-preventive institutions of all cases of violations of the writing retseptiof receipts
– Deputy head of department in absence of the head of department take all duties of head of the department.
The department released:
Medicines that are allowed to leave without prescription
Medicinal thermometers, one-time syringes and syringes of multiple applications, different kit and others.
-items of personal hygiene – tooth powder, toothpaste, toilet soap, beauty creams and others.
Dezinfectants which are allowed for sales to population – lizol, monohloramin, karbozol and others.
Department of OTC leave as i finished likasrkyh means department, consisting of department i kladovyh workstations pharmacist, rozpolozhenoho in the hall oobsluhovuvannya vidviduvachiv.V shtati department is the head of department-provizor or pharmacist, deputy head of department, pharmacists from secondary education, molodshi pharmacists (position zamischayetsya person zi secondary education, or one person in order perdbachynymy rules for admission to the pharmaceutical activities)
Junior pharmacist conducts leaving of drugs according to the specific allocation of duties, approved by order of pharmacy.
Pharmacist of Department of finished medicinal means must:
receive recipes, control right of their writing and clearance. All cases of violation of writing of recipes immediately bring to a known direct head.
follow the rules of storage of medicines in the material room
conduct the leaving of drugs in accordance with the requirements of orders of MOH of Ukraine
lead registration of absent and denied to the population drugs
participate in composing of planning applications for medicines
monitor compliance with the sanitary regime in the premises of the department
LIST
Of drugs (psychotropic) drugs that contain a small quantity of narcotic drugs or psychotropic substances and precursors, dispensing without prescription.
(Order of the Ministry of Health of Ukraine
14.05.2003 N 210)
|
Trading of name |
Preparations |
composition of active ingredients |
|
Aktifed Ekspektorant |
Solution for peroral application for 100 ml in the small bottles N 1 |
5 ml contains: Triprolidin – 1.25 mg of pseudoephedrine – 30.0 mg huayfenezyn – 100.0 mg |
|
Aktifed |
Solution for peroral application for 100 ml in the small bottles N 1 |
5 ml contains: Triprolidina – 1.25 mg of pseudoephedrine – 30.0 mg |
|
Barboval |
Solution for 25 ml in small bottles-droppers |
100 ml contain: ethyl ether acid alpha-bromizovalerianic -1.8 g, Validolum – 8.01 g, phenobarbital – 1.7 g |
|
Bronkhobryu |
Syrup is for 125 ml in small bottles |
1 ml of syrup contains:
sodium dyterbutylii –
naftalindysulfonatis-1.0 mg, ephedrine hydrochloride – 1.0 mg sodium kamfosulfonatis-1, 0mh |
|
Bronkholitin |
Syrup for 125 ml in the small bottles of N 1 |
125 ml syrup contains:
glaucini hidrobromidi – 0.125 g
ephedrine hydrochloride – 0.1 g
basil oil – 0.125 g |
|
Bronkhosept |
Syrup for 125 ml in the small bottles of N 1 |
125 ml syrup contains:
glaucini hidrobromidi – 0.125 g
ephedrine hydrochloride – 0.1,
basil oil- 0.125 g |
|
Bronkhocin |
Syrup for 125 ml in the small bottles of N 1 |
125 ml syrup contains:
glaucini hidrobromidi – 0.125 g
ephedrine hydrochloride – 0.1 g
basil oil – 0.125 g |
|
Valokordin |
Drops for 20 ml in the small bottles-droppers N 1 |
100 ml contain:
phenobarbital – 2.0 g, ethyl ester of alpha-bromizovalerianic acid – 2.0 g, oil mint – 0.14 g hop oil – 0.02 g |
|
Valokordin |
Drops for peroral application for 25 ml in small bottles |
100 ml contains: alpha-ethyl ether bromizovalerianic acid – 2.0 g, phenobarbital – 2.0 g |
|
Kaffetin |
Pills of N 10 |
1 tablet contains: propifenazoni – 210.0 mg, paracetamoli – 250.0 mg, coffeini – 50.0 mg, codeine, 10, 0mg |
|
Korvaldin |
Solution is for 25 ml in small bottles-droppers |
100 ml contain: alpha-ethyl ether bromizovalerianic acid – 2.0 g, phenobarbitali – 1.8 g
mint oil – 0.14 g
hop oil – 0.02 g |
|
Korvalol |
Solution is for 25 ml in small bottles-droppers |
100 ml contain: alpha-ethyl ether of bromizovalerianic acid – 2.0 g, phenobarbitali – 1.826 g, oil mint – 0.142 g |
|
Kofeks |
Syrup for 60 ml in the small bottles of N 1 |
5 ml syrup contains: hlorfeniramini maleatis-4, 0 mg, codeini phosphatis – 10.0 mg |
|
New figure drop Dr. Theiss |
Solution for internal application for 50 ml in small bottles |
100 ml containing homoeopathic Divorced: brown algae D1 – 6 ml, gold metal D8 – 6 ml, phosphoric acid D3 – 6 ml, lilies D2 – 6 ml, pankreatyni D8 – 6 ml, trees Gvozdikova D6 – 6 ml, ephedrini D2 – 20 ml, rhamni D2 – 2 ml, birch D1 – 2 ml, onion sea D4 – 2 ml, Lycopodii clavati D 4 – 2ml kendyri hemp D4 -2 ml , celandine D2 – 2 ml, Hawthorn D1 – 2 ml tsymitsyfuhy D2 – 2 ml, sulfur D6 – 2 ml, milkweed D4 – 2ml |
|
Nomigren |
Pills, obducted,N10 |
1 tablet contains: propifenazoni – 200.0 mg, coffeini – 80.0 mg, kamilofini hydrochloridi – 25.0 mg, mekloksamini citratis – 20.0 mg, erhotamini tartratis – 0.75 mg |
|
Penalgin-icn |
Pills of N 12 |
1 tablet contains: Metamizoli Sodii – 300.0 mg, paracetamoli – 300.0 mg, coffeini – 50.0 mg and codeini phosphatis – 8.0 mg, phenobarbitali – 10.0 mg |
|
Pentalgin-Á |
Pills of N 10 |
1 tablet contains: Metamizoli Sodii – 0.3 g, paracetamoli-0.3 g, codeini – 0.01 grams, coffeini-sodii benzoatis – 0.05 g phenobarbitali – 0.01 g |
|
Piralgin |
Pills of N 10 |
1 tablet contains: Metamizoli Sodii – 0.3 g, 0.1 g of naproxeni, coffeine – 0.05 g, phenobarbitali – 0.01 g, codeini – 0.008 g |
|
Sedalgin-neo (R) |
Pills of N 10 |
1 tablet contains: paracetamoli – 300.0 mg, sodii Metamizoli – 150.0 mg, coffeini – 50.0 mg, phenobarbitali – 15.0 mg and codeini phosphatis – 10.0 mg |
|
Solpadein |
Pills of N 6, N 12 |
1 tablet contains: paracetamoli – 500.0 mg, coffeini – 30.0 mg, codeini – 8.0 mg |
|
Solpadein |
Capsules of N 2, N 12 |
1 tablet contains: paracetamoli – 500.0 mg, caffeine – 30.0 mg,codeine – 8.0 mg |
|
Solpadein |
Pills soluble N 2, N 12 |
1 tablet contains: paracetamoli – 500.0 mg, coffeini – 30.0 mg, codeine – 8.0 mg |
|
Spazmoleks |
Pills N 4 |
1 tablet contains: paracetamoli – 500.0 mg, ditsiklomini hydrochloridi, 10.0 mg, dekstropropoksyfeni hydrochloridi – 50.0 mg |
|
Traifed (R) |
Syrup for 100 ml in the small bottles N 1 |
10 ml syrup contains: tryptolidyni Hydrochloridi – 2.5 mg, pseudoephedrini hydrochloridi – 60.0 mg |
|
Traifed (R) – expectorant |
Syrup for 100 ml in the small bottles N 1 |
10 ml syrup contains: tryptolidyni Hydrochloridi – 2.5 mg, pseudoephedrini hydrochloridi – 60.0 mg, hvayfenezyni – 200.0 mg |
2. Medicines that are allowed to release without medical prescription, dispensing with the pharmaceutical institutions of all forms of property not more than 2 packages
Compulsory minimum range of drugs
For pharmacy
Order of MOH of Ukraine 25.11.2004 N 569
|
1. Adenozintriforic acid |
55. Metronidazolum |
|
2. Allocholum * |
56. Tincture of hawthorn * |
|
3. Althaea * |
57. Tincture of nettle doggy * |
|
4. Combination of aluminium and magnesium * |
58. Solution Natrii chloridi isotonicum *
|
|
5. Ambroksol |
59. Nafazolin |
|
6. To the ammonia solution * |
60. Nicotine acid |
|
7. Amiodaron |
61. Nistatin |
|
8. Ampicillin |
62. Nitroglycerine * |
|
9. Ascorbic acid |
63. Nitroxolinum |
|
10. Asparkam * |
64. Nitrofural |
|
11. Atenolol |
65. Nifedipin |
|
12. An acetophene and its combination |
66. Omeprazol |
|
13. Bellasthesinum * |
67. Papaverin and its combination |
|
14. Bendazolum |
68. Paracetamolum |
|
15. Benzilbenzoat |
69. Perekis hydrogen * |
|
16. Valeriana and its combination is with the lily of the valley, deadly, Mentholum * |
70. Pertussinum * |
|
17. Validol * |
71. Pyracetamum |
|
18. Verapamilum |
72. Pyridoxin |
|
19. Vicairum * |
73. Platyphyllinum |
|
20. Vicalinum * |
74. Polivitamini * |
|
21. Water is for injections |
75. Prednizolon |
|
22. Coal is activated * |
76. Prokain |
|
23. Heparinum |
77. Propranolol |
|
24. Hydrochlorthiazidum |
78. Antihaemorrhoidal candles * |
|
25. Glibenclamidum |
79. Raunatin * |
|
26. Glyukoza * |
80. Regidron * |
|
27. Hormonal contraceptive * |
81. Solution of iodine * |
|
28. Dekametoksin |
82. Salbutamolum |
|
29. Digoksin |
83. Sena * |
|
30. Diklofenak |
84. Silibininum |
|
31. Diamond green |
85. Solizim |
|
32. Doksiciklin |
86. Sulfanilamidum |
|
33. Drotaverinum |
87. Thiaminum |
|
34. Eleuterokok * |
88. Tocopherolum * |
|
35. Enalapril or his combination |
89. Famotidin |
|
36. Iron combination * |
90. Folieva acid |
|
37. Inozin |
91. Ftalilsul’fatiazol |
|
38. Inhalyptum * |
92. Furazolidonum |
|
39. To the calcium chloride |
93. Furosemidum |
|
40. Kaptopril |
94. Cefazolin |
|
41. Clotrimazolum |
95. Cinnarizinum |
|
42. Combination with ethyl ether alpha-bromizovalerianic acids * |
96. Cianokobalamin |
|
43. Caffeine-benzoate of sodium |
97. Cotton wool or wares is from cotton wool |
|
44. Levamisole |
98. Girchichniki |
|
45. Lidocainum |
99. Hot-water bottles |
|
46. Liniment is balsam after Vishnevskim * |
100. Sparadrap
|
|
47. Loperamid |
101. A sparadrap is bactericidal |
|
48. To magnesium sulfate |
102. Bandaging material |
|
49. Ointment is sulphuric simple * |
103. Pipette |
|
50. Mebgidrolin |
104. Contraceptives |
|
51. Menovasinum * |
105. Devices/systems are for ³íôóç³é |
|
52. Metamizolum is sodium |
106. Sprincivki |
|
53. Metoclopramidum |
107. Thermometers |
|
54. Metoprolol |
108. Syringes |
References:
1. Materials lectures .
2. MoH Ukraine of 31.10.2011 № 723 “On approval of the licensing conditions of the business of drug manufacturing , wholesale and retail sale of medicines .”
3. MOH of Ukraine of 11.07.2012 , № 515 “On Amendments to license conditions for the business of drug manufacturing , wholesale , retail, pharmaceuticals ‘
4. MOH of Ukraine of 28.10.02 , № 385 “On approval of list of health ” I health , medical , provizorskyh positions and positions for junior specialists in pharmaceutical education in health care . “
5. MOH of Ukraine of March 16, 1993 № 44 “On the organization of storage in pharmacies different groups of medicines and products of medical purpose “
6. MOH of Ukraine of 30.10.2001 № 436 ” Instruction on the procedure for quality control of medicines during the wholesale and retail sale .”
7. MOH of Ukraine of 21.01.2010 № 11 On approval of the narcotic drugs, psychotropic substances and precursors in healthcare Ukraine
8. Ministry of Health of 18.11.2010 , № 1006 ” On approval of the register of wholesale prices of medicines and the procedure for its amendment and declaration form changes the wholesale price of a drug “
