Pharmacists in SA are doing more for their patients than ever before, and pharmacy services have expanded significantly over the last decade. However, if pharmacists are medication experts and community pharmacy is the model for delivering medications and services to optimise their use, further change in the way the current model operates is required, writes Jackie Maimin, CEO of The Independent Community Pharmacy Association (ICPA).
The role of the pharmacist is no longer limited to a dispensing function but rather to provide pharmaceutical care.
Pharmaceutical care is defined as a patient-centred, outcomes-oriented pharmacy practice that requires the pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. The goal of Pharmaceutical Care is to optimise the patient's health-related quality of life, and achieve positive clinical outcomes, within realistic economic expenditures1.
The South African Pharmacy Council (SAPC) supports the shift from dispensing to providing comprehensive pharmaceutical care and annually publishes a list of services and related fees a pharmacist may charge2.
Within the current scope of practice, a pharmacist can provide a comprehensive set of professional services including Pharmacist Initiated Therapy (PIT) and under certain circumstances can prescribe medicines above schedule 2 – examples are colchicine for acute gout and doxycycline for malaria prophylaxis. Pharmacists can also screen for disease and monitor therapeutic outcomes.
Task shifting at the primary level allows for an expanded scope of practice and a pharmacist who has successfully undertaken an approved supplementary training course can apply for a permit as an authorised prescriber. Currently there are three courses approved by SAPC:
- Family planning,
- Primary care drug therapy (PCDT), and
- Immunisation and injection technique.
On completion, the pharmacist registers the training with SAPC and then applies to the DG: Health for a section 22A(15) permit. This permit gives the pharmacist access to an approved list of medicines which they may prescribe for a set of defined conditions.
A fourth supplementary training course was approved by SAPC together with the competency standards and a scope of practice. This course is Pharmacist Initiated Management of Antiretroviral Therapy (PIMART), but implementation is on hold as it has been legally challenged by some doctors. We await the outcome of the case.
The future of pharmacy is in services and retailers who are focused on product and mark-up need to rethink their business models.
REFERENCES:
- https://www.pharmacist.com/principles-practice-pharmaceutical-care
- Rules relating to the services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees BN 539 of 2023 - https://www.sapc.za.org/Media/Default/Board%20Notices/BN539%20Rules%20relating%20to%20services%20for%20which%20a%20pharmacist%20may%20levy%20a%20fee_2024.pdf
