A pharmacy (also called drugstore in American English or community pharmacy or chemist in Commonwealth English) is a premises which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.
Most drugs are commercially made at factories and dispensed by pharmacies. Drugs that are not commercially made must be compounded from other ingredients. In 1930, 75% of medications were compounded, but by 1970 only 1% were compounded. [1]
In most countries, a premises for prescription drugs is subject to legislation; with requirements for storage conditions, staff qualifications, equipment, record keeping (especially of controlled drugs) and other matters, all specified in legislation. It was once the case that pharmacists stayed within the premises compounding/dispensing medications, but there has been an increasing trend towards the use of trained pharmacy technicians,[ citation needed ] with the pharmacist spending more time communicating with patients. Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients' prescriptions and patient safety issues.
Pharmacies are typically required to have a qualified pharmacist on-duty at all times when they are open. It is also often a requirement for the owner of a pharmacy to be a registered pharmacist, but that is not the case in all jurisdictions: where permitted, many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.
Community pharmacies offer a unique added value by building direct relationships with their customers. They are able to provide more personalized, dedicated care to local members of their community and even offer enhanced services such as Medication Therapy Management (MTM), Medication Synchronization, and compounding. With the aid of pharmacy management systems and different integrated technologies, these smaller pharmacies are able to keep up with their large-scale competition.
Community pharmacists’ understanding of ethics, confidentiality, patient autonomy, trustworthiness and reliability are essential in community practice and must influence their decision making should an ethical dilemma arise.[ citation needed ] In some countries, community pharmacists may be asked to compromise on their values and ethical issues may arise not only because of patient's or physician's request but may also because of their employers' intrusion.[ citation needed ] Individual factors such as age, gender, work experience, and educational level and organizational factors such as the number of pharmacists in a pharmacy and location of pharmacy may affect the ethical perspectives of community pharmacists.[ citation needed ]
The American Association of Colleges of Pharmacy recommends that consumers choose a pharmacy at which they can have a consulting relationship with the pharmacist. [2] Anyone using drugs benefits when they have easier access to a pharmacist. Being timely includes both processing the request quickly and having drug stock available to fill the prescription. [2] Some consumers need drugs delivered to their home, perhaps by mail, and may select a pharmacy that offers that service. [2] Different pharmacies may charge different prices for the same drugs, so shopping for lower prices may identify a pharmacy offering better value. [2] In addition to fulfilling prescriptions, a pharmacy might offer preventive healthcare services like vaccinations. [2] Up-to-date technology at a pharmacy can assist a patient with prescription reminders and alerts about potential negative drug interactions, thereby reducing medical errors. [2]
The International Pharmaceutical Federation has declared their vision of a community-based pharmacist: [3]
Community-based pharmacists' responsibilities include: checking and dispensing of prescription drugs, providing advice on drug selection and usage to doctors and other health professionals and counseling patients in health promotion, disease prevention and the proper use of medicines. [4]
In most countries regulations govern how dispensaries may operate, with specific requirements for storage conditions, equipment and record keeping.
It is becoming more common for pharmacists to take on extended roles that provide more clinical care directly to patients as part of a primary care team. There are around 11,400 community pharmacies in England. Many are open for extended hours in the evenings and weekends and they are accessible without appointment. [5] [6]
In the English NHS there were 438 million visits nationally to community pharmacies for health related reasons in 2015. [7] More than 1.1 billion prescription items were dispensed in 2022. More than £10 billion is spent on prescribed drugs annually. [8] Under the 2005 NHS Community Pharmacy contract all community pharmacists in England and Wales provide: [9]
Widely available Advanced Services:
Enhanced Services which are not available unless locally commissioned:
The introduction of the digital hospital-to-pharmacy referral service, which was to launch in July 2020, as part of the new community pharmacy contract, was postponed to 15 February 2021 because of the COVID-19 pandemic in England. It will enable hospitals to digitally notify community pharmacies when patients are discharged and may need advice on taking new medicines, and about changes to their prescriptions. [10]
In 2022 the average pharmacy carried out around 19 consultations per day, averaging 5.6 minutes each - about 65 million consultations across 10,800 pharmacies in the year. [11]
To help pharmacists be able to take on extended roles, it is common for them to work as part of a team that can include pharmacy technicians, dispensing assistants and counter assistants. [12]
In parts of mainland Europe, the pharmacist is required to own the pharmacy of which she or he is the licensee. Under this arrangement, a pharmacist can be the operator of only a single outlet. [13] In the UK, 60% of all community pharmacies are owned by companies that own multiple pharmacies. [14]
In the United States, more than 25% of independent owners have ownership in two or more pharmacies. [15]
Most of Australia's and New Zealand's community pharmacies are owner-operated. [16] [17] In Australia, pharmacists recognise the need to integrate professional pharmacy services into the health system to meet the changing health care needs of the population. [18]
A survey conducted by PrescribeWellness found that almost half of Americans older than 40 years-old value pharmacies that offer preventative care services, and would be willing to transfer their prescriptions to pharmacies that offer those services. [19] Patients also value pharmacies where they can receive medical advice concerning their prescription medications, how those medications may interact with each other, and receive over-the-counter drug recommendations for the management of common ailments. [19] In a survey of over 1,000 U.S. adults older than 40 years-old conducted by Propeller Insights, 67% of patients responded that they would prefer that their pharmacist discuss new prescriptions with them, rather than their physician, because they viewed their pharmacist as "better at explaining side effects and has more time to spend with them." [19]
Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as online pharmacies) are also recommended to some patients by their physicians if they are home-bound.
While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription.[ citation needed ] Some customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor, or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of medication. There also have been reports of such pharmacies dispensing substandard products. [20]
Of particular concern with Internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the Internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship.[ citation needed ] There are instances where a practitioner issues a prescription, brokered by an Internet server, for a controlled substance to a "patient" s/he has never met.[ citation needed ] In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship. The Food and Drug Administration (FDA) is also heavily involved in monitoring internet pharmacies and has issued warnings against several companies who have violated the U.S. Federal Food, Drug, and Cosmetic Act that protects individuals against rogue online pharmacies.
Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers (who must otherwise pay one of the world's highest drug prices). [21] In recent years, many consumers in the US (and in other countries with high drug costs), have turned to licensed Internet pharmacies in India, Israel, and the UK, which often have even lower prices than in Canada.
In the United States, there has been a push to legalize the importation of medications from Canada and other countries,[ citation needed ] in order to reduce consumer costs. While in most cases importation of prescription medications violates FDA regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.
According to IQVIA, Vietnam had 55,300 drugstores in 2016, of which 185 belonged to modern drugstore chains. [22] [23] In 2021, the total number of drugstores decreased to 44,600, but the number of drugstores in modern chains increased to 1,600. [24] [25] According to a report by VNDIRECT Securities Company, Vietnam had about 70,000 drugstores in 2022, including 59,000 traditional retail drugstores (accounting for 84%) and 11,000 chain drugstores (accounting for 16%). The revenue of Vietnam's pharmaceutical retail market reached about 80,000 billion VND. According to a report by MBS Securities Company in 2023, the size of Vietnam's pharmaceutical market is about 6-7 billion USD, [26] [27] with more than 3,000 modern chain drugstores. [28] [29]
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) and strengths of final products.
A pharmacist, also known as a chemist in Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in order to dispense them safely to the public and to provide consultancy services. A pharmacist also often serves as a primary care provider in the community and offers services, such as health screenings and immunizations.
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.
A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin recipe, that gave the list of the materials to be compounded.
A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.
The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.
A pharmacy technician performs pharmacy-related functions including but not limited to filling out prescription medications. Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in some countries regionally as well as by employer.
An independent pharmacy is a retail pharmacy that is not directly affiliated with any chain of pharmacies and is not owned by a publicly traded company. Independent pharmacies are pharmacist-owned, privately held businesses in varying practice settings. They include single-store operations, pharmacist-owned multiple store locations, franchise, compounding, long-term care (LTC), specialty, and supermarket pharmacy operation. Independent pharmacy owners generally have more flexibility to build personalized customer relationships and they strive to differentiate their services from big-chain corporations.
An online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal.
In the field of pharmacy, compounding is preparation of custom medications to fit unique needs of patients that cannot be met with mass-produced products. This may be done, for example, to provide medication in a form easier for a given patient to ingest, or to avoid a non-active ingredient a patient is allergic to, or to provide an exact dose that isn't otherwise available. This kind of patient-specific compounding, according to a prescriber's specifications, is referred to as "traditional" compounding. The nature of patient need for such customization can range from absolute necessity to individual optimality to even preference.
A veterinary pharmacist is a specially trained pharmacist who dispenses veterinary drugs and supplies or products and advice to owners of companion animals and livestock. In addition, they advise the regulatory bodies and are involved in the formulation of veterinary drugs. Veterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals.
Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.
Pharmacy in China involves the activities engaged in the preparation, standardization and dispensing of drugs, and its scope includes the cultivation of plants that are used as drugs, the synthesis of chemical compounds of medicinal value, and the analysis of medicinal agents. Pharmacists in China are responsible for the preparation of the dosage forms of drugs, such as tablets, capsules, and sterile solutions for injection. They compound physicians', dentists', and veterinarians' prescriptions for drugs. Pharmacological activities are also closely related to pharmacy in China.
Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.
Remote dispensing is used in health care environments to describe the use of automated systems to dispense prescription medications without an on-site pharmacist. This practice is most common in long-term care facilities and correctional institutions that do not find it practical to operate a full-service in-house pharmacy.
Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.
Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS, pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.
Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.
Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment. Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover drugs after treating patients and discarding of expired drugs. Failure to properly dispose of drugs creates opportunities for others to take them inappropriately. Inappropriate disposal of drugs can also cause drug pollution.
The pharmacy management system, also known as the pharmacy information system, is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.
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