The evolution of pharmacy practice

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Chapter 2 The evolution of pharmacy practice

INTRODUCTION

The practice of pharmacy in Australia has changed over recent years from a traditional focus on the product to a greater emphasis on the patient and the provision of pharmaceutical care. The International Pharmaceutical Federation (also known by the French term Federation Internationale Pharmaceutique, hence being abbreviated as FIP) has defined pharmaceutical care as ‘…the responsible provision of pharmacotherapy for the purpose of achieving definite outcomes to improve or maintain a patient’s quality of life…’.[1]

The World Health Organization (WHO) has also recognised the pharmacist’s role in the provision of pharmaceutical care services in their handbook Developing pharmacy practice[2]

The following Key Statement for the Profession of Pharmacy in Australia has been developed by the Pharmaceutical Society of Australia:

General characteristics required of pharmacists were also identified by the WHO through the concept of the ‘seven-star pharmacist’, and involve the roles of caregiver, decision-maker, communicator, manager, life-long learner, teacher and leader.[4]

This chapter will focus on the evolution of the pharmacy profession in Australia and the development of regulatory controls applicable to pharmacy practice.

DEVELOPMENT OF THE STRUCTURE OF THE PROFESSION

The establishment of pharmacy practice in Australia followed the English tradition applicable at the time of the First Fleet. Pharmacists had no recognised role or status and had to compete with medical practitioners, grocers and retailers.[5]

Australia’s first ‘pharmacist’, John Tawell, arrived in 1815 as a convict and opened his business in 1820, a combination of grocery and dispensary. A specially convened medical board certified him fit to ‘compound and dispense’ medicines.[5]

The practice of pharmacy in the colonies was casual and no qualifications were necessary and activities were not regulated.[5]

Tawell returned to England in 1840 and he was later hanged for poisoning his mistress with a mixture of prussic acid and stout.[6]

The first major legislative controls regulating pharmacy practice were introduced in the latter part of the 19th century. Prior to federation under the Australian Constitution in 1901 most of the six colonies had a licensing system for selling poisons. In order to ensure that the public would be protected from untrained quacks, groups of chemists and druggists got together to establish colonially organised Pharmaceutical Societies.[7] Each new society was modelled on the Pharmaceutical Society of Great Britain (now the Royal Pharmaceutical Society of Great Britain), and these colonial societies were a powerful influence and exerted a significant force on the development of Australian pharmacy. The societies developed the first written standards in education, qualifications and ethics. They assumed a responsibility to maintain the first schools of pharmacy in Australia.

The societies influenced the development of pharmacy legislation in each colony or state. Pharmacy Acts provided some restrictions regarding titles and right to practise as a chemist. However, the enforcement of the legislation was vested in pharmacy boards following a separation of roles.[7, 8]

The separation of roles was a departure from British precedent, where the society had the authority to maintain the register, conduct examinations, and discipline pharmacists. The creation of separate bodies, distinct from professional organisations, was intended to keep the boards independent of the organisations and to clearly establish that boards existed for the public good. On the other hand, the society acted on behalf of the profession. Ultimately, this approach was to be followed by all jurisdictions except for Western Australia, which followed the British model in the society having a combined role of being the professional association and the registering authority. Table 2.1 provides a summary of the dates involved in the foundation of the societies and the promulgation of the first legislation.[7]

Today, state and territory legislation provides for the regulation of the profession throughout Australia by pharmacy registering authorities that are statutory bodies acting as authorities for the protection of the public. The pharmacy registering authorities are also responsible for the registration of pharmacists in the various jurisdictions.

The three main pharmacy professional organisations in Australia — namely the Pharmaceutical Society of Australia (PSA), the Pharmacy Guild of Australia (PGA) and the Society of Hospital Pharmacists of Australia (SHPA) — assume a significant role in developing pharmacy practice. The PSA and the SHPA are national professional organisations in Australia with a primary focus on the development of practice standards. The PGA is an employers’ organisation registered under the Federal Workforce Relations Act 1996 (Cth) with a membership drawn from owners of community pharmacies throughout Australia.

Therefore, except for Western Australia, there is a separation of roles between the registering authorities, acting in the interests of the public, and the professional organisations, acting in the interests of its members. The Australian pharmacy registering authorities are entrusted with the regulation of the profession of pharmacy including the registration and discipline of registered pharmacists with the aim of protecting the public. In contrast, the professional organisations, although having a public interest aspect to their function as demonstrated in their development of standards, guidelines and codes of practice, exist primarily to represent the interests of pharmacists.

The first Australian Pharmaceutical Formulary Handbook was published in 1902 with a range of formulae for non-official formulations.[9] Other pharmacopoeias (Greek pharmakon, a drug and poieo, I make) still being referred to in drugs and poisons legislation include the British Pharmacopoeia (BP), the British Pharmaceutical Codex (BPC) and the Extra Pharmacopoeia (Martindale).

Pharmaceutical Defence Limited (PDL) was formed following a court case against a chemist, Francis Gough, who was sued for damages by a farmer, William Hilton, following an alleged poisoning in 1911. The farmer won the case and Gough had to pay damages. Chemists recognised their vulnerability and were alarmed as they realised that any alleged dispensing error, real or not, whether originating with the prescriber or the dispenser, could lead to a chemist being sued.[10] PDL was hence set up to allow chemists to take out insurance against such happening.

NATIONAL MEDICINES POLICY FRAMEWORK

The changes in pharmacy practice in Australia have taken place against a background of government initiatives and developments in the pharmaceutical policy framework.

A major review of medication usage and waste by the federal government Department of Health and Ageing in the 1990s led to the launch of Australia’s National Medicines Policy (NMP) in 2000. The overall aim of this policy is to meet medication and related service needs through achieving both optimal health outcomes and economic objectives.[11] The policy is based on four objectives, namely:

QUM is defined as the judicious, appropriate, safe and effective use of medicines, with the term ‘medicine’ encompassing prescription and non-prescription medicines, including complementary health care products.

The Australian Pharmaceutical Advisory Council (APAC) was created in 1991 as a consultative forum to advise the government on a wide range of pharmaceutical policy issues. APAC includes representatives of peak health professions (pharmacy, medicine and nursing), the pharmaceutical industry (including over-the-counter and complementary medicines), consumer organisations, the media, indigenous peoples as well as government members, all with an interest in implementing the NMP. The council identifies and considers issues and needs in health care with particular reference to pharmaceuticals. The Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee is a multi-disciplinary committee that is specifically responsible for reviewing and overseeing QUM implementation in Australia.

Following a formal review of the operational arrangements of APAC and PHARM in 2008, a need was identified to introduce new arrangements to support the implementation of the NMP. At the time of writing it has been recommended that APAC and PHARM be replaced with a National Medicines Policy Executive, a National Medicines Policy Committee and an annual National Medicines Policy Partnerships Forum.

Australia’s National Strategy for QUM was released in 2002 to complement the NMP, and specifically details the range of partnerships and activities to improve QUM.[12] The strategy lists the key partners in achieving QUM, which include prescribers and providers of medicines. In fulfilling both these roles, pharmacists are crucial to the achievement of QUM. The strategy places a specific obligation on pharmacists, as health practitioners and educators, to:

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