Topic:

Public Health and role of Pharmacist in Public Health

Presented to:
Mam Qurat-Ul-Ain
Presented by:
Aaqib Aqeel
&
Abdullah Malik

What is Public Health
all about?
What is Public Health?


The activities that ensure conditions in
which people can be healthy. These
activities include community wide efforts
to identify, prevent, and combat threats to
the health of the public.

- Institute of Medicine Definition of Public Health




Public Health: Past, Present and
Future
Achievements of the 20
th
century:
Vaccinations
Improved sanitation
Fewer deaths from disease and stroke
Healthier mothers and babies
Reduction in tobacco use






Emerging threats of the 21
st
century:
Chronic diseases
H1N1
New and re-emerging infectious diseases
Natural disasters



The 10 Essential Public Health
Services
1. Monitor the health status of the community.
2. Investigate and diagnose health problems and hazards.
3. Inform and educate people regarding health issues.
4. Mobilize partnerships to solve community problems.
5. Support policies and plans to achieve health goals.
6. Enforce laws and regulations to protect health and safety.
7. Link people to needed personal health services.
8. Ensure a skilled, competent public health workforce.
9. Evaluate effectiveness, accessibility and quality of health services.
10. Research and apply innovative solutions.


What does Public Health do?
Provide disease
control and prevention
Assure air and
water quality
Promote healthy
lifestyles
Public Health is a wise
investment


It helps people:
Save money
Enjoy good health
Live longer
People are living longer
Drugs and medical care
+5 years
Public Health impact
+25 years
Increased Years of Life
40
45
50
55
60
65
70
75
80
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
. *
Public Health
Is Your
Health Too!
Public Health
Achievements
in the 20th Century
Public Health achievements in the 20th century
Immunizations
have virtually eliminated:
Smallpox
Diphtheria
Pertussis
Tetanus
Polio
Measles
Rubella
Public Health achievements in the 20th century
Infectious disease control

Public Health achievements in the 20th century
Safe and healthier foods
are now commonplace because of:
Hand washing
Sanitation
Refrigeration
Pasteurization
Pest control
Healthier animal care, feeding,
and processing
Improved food supply safety
Public Health achievements in the 20th century
Fluoridation

Primary factor in the
decline of tooth decay
Benefits all, regardless of
age, education, or income
Public Health achievements in the 20th century
Coronary heart
disease
and stroke
The leading cause
of death in the U.S.
despite a 60%
decrease in death rates
since 1950.
Public Health achievements in the 20th century
Recognition of tobacco
as a health hazard
Smoking, once socially
acceptable, is on the
decline among U.S. adults.

% of population who smoke
196542.4%
199724.7%
VMT: vehicle miles traveled
Public Health achievements in the 20th century
Motor vehicle
safety

192518 deaths
per million VMT
19971.7 deaths
per million VMT
Public Health achievements in the 20th century
Motor vehicle safety
Public Health efforts
have influenced:
Increased seat belt use
Vehicle safety improvements
Traffic safety regulation
and enforcement
Improved streets and highways
Public Health achievements in the 20th century
Mother and
infant
mortality rates

Maternal mortality
rates down 99%
Infant mortality
rates down 90%
Public Health achievements in the 20th century
Mother and
infant
mortality rates

Improved standards
of living
Technological advances in
medicine
Greater access to maternal
and
well-baby care
Public Health achievements in the 20th century
Family planning

Desired birth spacing
and family size
Public Health achievements in the 20th century
Safer, healthier
workplaces

Mining safety
Industrial safety
Indoor air quality
Ergonomics
Core functions of
Public Health
Core functions of
Public Health
Assessment
Core functions of
Public Health
Assessment
Policy Development
Core functions of
Public Health
Assessment
Policy Development
Assurance

A. Assessment
1. Assess community health needs
2. Investigate health hazards and effects
3. Analyze health factors

B. Policy Development
4. Advocate for community needs and
issues
5. Prioritize health needs
6. Plan and develop policies

C. Assurance
7. Manage resources
8. Implement programs
9. Evaluate programs
10. Inform the public
Some top priority health
issues:
Obesity
Cardiovascular
disease
Diabetes
Poor nutrition
Lack of exercise
Tobacco use
Other communicable
diseases
Access to dental
care
Environmental
health

What we are doing
Education is key
to prevention
Lifestyle changes
can reduce diabetes
development by
4060%

What we are doing
Promoting importance
of balanced diets
What we are doing
Educating youth and adults
about the value of physical
activity
Creating environments and
policies that are supportive
of physical activity
What we are doing
Tobacco-Free: program
including
tobacco cessation.
Grants to local communities
Youth empowerment activities
17 October 2014
40

Community
pharmacist is the
professional who
would be in direct
access to the public
and whose duties
are widely sought
after by the public
and patients.
A community pharmacist
works according to legal
and ethical guidelines to
ensure the correct and safe
supply of medical
products to the general
public

As we are the person
who will be in direct
contact with the public
we have to play an
important role in
decreasing the
mortality and
morbidity in the
public.

17 October 2014
44
A community pharmacist is the health
professional who focuses on the
patients drug therapy.
While a physician prescribes drugs
and a nurse administers them, the
pharmacist is the drug expert.
Pharmacists expertise lies in
How medications should be used?
How to maximize benefits and
minimize adverse effects of drug
therapy?
How prescription drugs interact with
other medications.
The pharmacists primary role is
To ensure that the medications used
by a patient are the most effective and
are used in the most appropriate
manner
In general:
They can recommend an over-the-counter (OTC) product for a cold,
Demonstrate the proper use of an asthma inhaler, and
Help patients manage their diabetes.
Clients can also talk to their pharmacist about
How to store and take medication?
What foods or activities to avoid, and
what to do if a dose is missed.
Working with patients, physicians and other health care providers to help
patients achieve their health goals by improving the quality of their drug
therapy
Ensuring safe, secure and effective distribution of medications
Taking medication histories and maintaining patient drug profiles
Monitoring adverse drug reactions and patients adherence with their drug
treatment

17 October 2014
45
Assessing patients drug therapy for possible
interactions with current medications and health
conditions
Making recommendations to prescribers and other
health care professionals for adjustments to patients
drug regimens to enhance the quality of care
Providing education to patients and caregivers on
proper use of medications and medical devices
Managing minor illnesses by providing information
to patients on self-care and nonprescription
medications
Providing referrals and advice on health promotion
and wellness
17 October 2014
46
In their current role,
pharmacists
contribute to the
health care system
world wide by:








17 October 2014
47
There is need to educate and advice the consumers on proper and
safe use of medicines, because
There is growing OTC segments of products
Self medication
Drug abuse
Mixing of OTC medicines with prescription medicines
Changing life style and food habits
Prevalence of diseases like asthma, tuberculosis, diabetes etc.,
Hence it requires regular refresher courses to prepare the
community pharmacists in patient care and counseling.
With the advent of IT, a wealth of information is available through
web sites and Drug Information Centers which can be used by the
community pharmacists
17 October 2014
48
It is in the interest of pharmacists
that they buy the medicines from
authorized sources with proper
purchase records.
Maintain sales memos with patients
name and address, batch number of
the medicines sold, as a legal
requirement and to safeguard
themselves in the event of any drug
found substandard or unsafe
requiring recall etc.

17 October 2014
49
Statute : An established law or rule, as
of a corporation
Pharmaceutical associations, manufacturers can
provide brochures to be distributed to patients at the
counters on disease like asthma, diabetes,
hypertension, epilepsy even common cold and cough,
with Dos and Don'ts etc,.
17 October 2014
50
For Immunization and
If space permits, vaccination programs can be
organized with the help of manufacturers in the
pharmacies.
17 October 2014
51
Elderly patients tend to get confused or forget to take
medicines properly.
Complementary packs for keeping each medication
separately with dosage marked will help them to take
medicines as prescribed.
17 October 2014
52
In the counseling area pharmacists can
Provide BP apparatus,
Devices that are available to test blood sugar etc
17 October 2014
53
All medicines are temperature sensitive and to retain
their potency and efficacy proper storage is essential,
protected from sunlight and heat.
While it is recommended that all Community
Pharmacies are air conditioned.
17 October 2014
54
To
Drug Information centres
reference books
web-sites on drug information
This is possible by providing Computers and Inter-net
connectivity.
17 October 2014
55
As pharmacists, to understand customer needs, it is necessary to
develop
listening skills,
Questioning skills.
To develop a positive mind set for ethical pharmacy practices,
evolving all professional, legal and moral obligations to the society.
These should be basic parameters on which we must introduce a
practical approach to Community pharmacy environment.
As a supplementary activity, a Journal dedicated to Community
Pharmacy is necessary to constantly update their knowledge on
new molecules, and this should reach all leading pharmacies in
Pakistan.
Such professional Journals can be sponsored by manufacturers.
17 October 2014
56
57
Communicator
Decision Maker
Manager Care Provider
Leader
17 October 2014 58
The practice of pharmacy is continuing to
undergo a paradigm shift from a dispensing-
focused to a patient-care-focused profession.
Pharmacists have more time to provide
clinical services
Pharmacists have the opportunity to become
involved in patient care is disease
management
17 October 2014 59
Aspects of case and outcomes management, but
the approach focuses on specic diseases,
looking at what creates the costs, what
treatment plan works, educating patients and
providers, and coordinating care at all levels:
hospital, pharmacy, physician, etc.
DM has also been dened as a systematic
management tool applied to specic diseases
with an emphasis on prevention and best
practices to provide high quality care at a
reasonable cost with an ongoing process of
monitoring and continuous improvement.

17 October 2014 60
Device and laboratory companies,
Medical product wholesalers and distributors,
Physician groups, and
Community pharmacies

There are now companies that specialize in
selling DM services to health care providers
who choose not to develop programs with
their own staff.
17 October 2014 61
The origin of pharmacists involvement in DM
can be traced back to the hospital
environment.
In the late 1960s and early 1970s, clinical
pharmacy practice began to discuss
direct patient contact
clinical involvement of the pharmacist.
17 October 2014 62
Hence the concept of pharmaceutical care was started.
Pharmaceutical care means the responsible provision of drug
therapy for the purpose of achieving definite therapeutic
outcomes that improve a patients quality of life.
Pharmaceutical care targets those with risk factors for drug-
related problems, a history of non-adherence, and frequent
changes in medication regimens.
In practicing pharmaceutical care, a pharmacist is expected to
assume greater responsibility for patients medication-related
outcomes.
For example,
pharmacists have taken on roles to help assess patients
therapeutic needs,
prevent adverse drug reactions,
individualize drug therapy, manage chronic disease, and
monitor follow-up care.
17 October 2014 63
Research suggests that the potential impact
of a pharmacists intervention in patient care
is significant.
In a follow-up project, it is estimated that
pharmacist intervention and pharmaceutical
care could reduce the annual expense of
drug-related problems by $45.6 billion
making a great difference.

17 October 2014 64
Patient access:
Consistency between sites:
Organization and structure of pharmacies (e.g.,
chain drug stores), which allow the administration
of a program through pharmacists practicing at
different locations.
Expanding the role of pharmacy technicians:
Greater use of technicians might allow pharmacists
to devote more time to patient care.
It is expected that advanced training of technicians
will reduce the amount of time that pharmacists
typically devote to medication dispensing and allow
more time for pharmacists to provide pharmaceutical
care.

17 October 2014 65
Governmental efforts:
Under this legislation, pharmacists
with appropriate training can be
reimbursed for providing cognitive
services for patients with
diabetes,
asthma,
lipid disorders, and
anticoagulation under patient-
specific treatment protocols
approved by a physician

66
Targets specific patient populations suffering from a
disease.
Integrates health care services directed toward the chosen
disease by various components of the health care system,
providing a seamless system of prevention and care.
Support health care services on consistent application of:
the best scientific information available on treatment and
evaluation of care,
constant updating and improvement through use of quality
improvement techniques.
Links care to the outcomes of interest to consumers of
health care,
This takes into account
clinical,
economic, and
humanistic outcomes.
17 October 2014 67
Most DM efforts have focused on chronic
conditions that are common or have high
associated treatment costs, or both.
Some specific disease states for which the
impact of the pharmacists has been
demonstrated are
asthma,
cardiovascular conditions (hypertension,
hyperlipidemia, and anticoagulation),and
diabetes.
17 October 2014 68
Educate patients about the role of each medication.
Instruct patients about the proper techniques for
inhaling medications.
Monitor medication use and refill intervals to help
identify patients with poorly controlled asthma.
Encourage patients purchasing nonprescription
asthma inhalers or tablets to seek medical care.
Help patients use peak-flow meters appropriately.
Help patients discharged from the hospital after an
asthma exacerbation to understand their asthma
management plan.
17 October 2014 69
Pharmacist can provide:
Diabetes education,
medication counseling, and
evaluation and adjustment of the medication
regimen in noninsulin-dependent diabetes mellitus
(NIDDM) patients
This has significance in:
lowering average weekly blood glucose levels,
a decreased incidence of hyperglycemic events, and
significant increase in their understanding of diabetes
medications as well as a positive difference in their
perception and attitude toward communication with
the pharmacist.
17 October 2014 70
COMMUNITY PHARMACY
Learning Objectives:
Community Pharmacy
Type of pharmacy
Nature of business
Roles of community pharmacist



Community Pharmacy
Most pharmacies have experienced
support staff who work under the
personal supervision of the
pharmacist.
Therefore, community pharmacists,
by far the largest segment of the
profession, require scientific,
administrative, supervisory,
counselling and pharmaceutical skills
of a very high standard.
Salaries for community pharmacists
are generally quite attractive.


TYPE OF PHARMACY
Chain-
e.g GUARDIAN,
WATSON

Independent-
e.g Anis Pharmacy,
Rimadex Pharmacy
etc


NATURE OF BUSINESS

Retail
sell direct to user/customer
Type A license from Ministry Of
Health

Wholesale
supply to other
retailers, General Practitioners
(Clinics), Hospitals etc
Type A license from Ministry
Of Health
Wholesale license from NPCB


How the Community Pharmacy
Operate?
Organization of The Community
Pharmacy
Prescription Counter & Consulting Area
Front Area e.g OTC Area
Controlled Substances
Store
Refrigeration
Computer systems Point-Of-Sale, Inventory,
Accounting etc
Purchasing & Inventory Control
Prescription Counter & Consulting
Area
Consultation area
Strictly for the
pharmacists use



The prescription processing area
Pharmacist use to
prepare prescriptions
Front Area






Cosmetics, toiletries, rehabilitation
products & other merchandises
Vitamins and supplements
OTC drugs
Controlled Substances
Kept in a locked storage cabinet
Under supervision of pharmacist
Psychotropic Drugs :
require prescriptions and must record
Repeated checking of the products, labeling,
packaging
Cough Mixture
Contain Dextromethorphan


Store/Storage
To keep the excess stocks
General store or Drug store (must lock)
Dry, cool place
Refrigeration

A refrigerator to store drugs
Required to be kept at temp between 2 & 8
o
C
Exclusively for medications
No food or beverages
Computer systems

Familiar with computer hardware & software
Hardware
Monitor, CPU, keyboard, mouse, scanner, modem, printer
Software
Point of Sales, Accounting, Inventory eg: UBS








Most chain pharmacies are linked together
Facilitate the sharing of information between pharmacies

Purchasing & Inventory Control
Must complete a purchase order (PO)
Product name
Amount & price
Order transmitted directly to the manufacturer
During receiving carefully check the product
against the PO
Damaged products must be reported without
delay & returned to the manufacturers
Must check all products for expiration dates
Community Pharmacist
MUST SHOW:
good communication skills -
be able to listen carefully
to what patients say
be able to explain
complex and sometimes
sensitive information to the
general public & other
healthcare professionals;
concern for the welfare of
the general public;


an understanding of business principles;
a professional and confident manner;
the ability to inspire the trust of others;
a willingness to take on a high level of
responsibility.
Community Pharmacist
MUST SHOW:
dispensing
prescription
medicines to the
public check
dosage,ensure
the medicine are
correct and safe
and label it

liaising with
doctors about
prescriptions;

supervising the
preparation of any
medicines (not all are
supplied ready made-
up by the
manufacturer);
Roles of Community
Pharmacist:
keeping a register of controlled drugs for
legal and stock control purposes;
e.g. Prescription Book, Poison Book,
Psychotropic Book, Cough Preparation
Book etc.


Example:
Drugs Example: Type of book
Antihypertensive,
anticholesterol
Prescription Book
Sleeping pills,
antidepressant



Psychotropic
Books
Cough and cold Poison Book
Cough syrup
containing
Dextromethorphan
Dextromethorphan
Book
selling over-the-counter medicines;

Roles of Community Pharmacist:
counseling and
advising the public on
the treatment of minor
ailments and any
adverse side-effects of
medicines or potential
interactions with other
medicines/treatments;




providing specialist
health check
services, such as
monitoring blood
pressure and
cholesterol levels,
diabetes screening
and pregnancy
testing.
preparing dosette and cassette boxes, usually for
the elderly but also for those with memory/learning
difficulties, where tablets are placed in
compartments for specified days of the week

overseeing the ordering and safe storage of
medical products and, in some cases, arranging
the delivery of prescription medicines to
patients;

keeping up-to-date with current pharmacy
practice, new drugs and their uses.
maintaining computerized records;

managing,
supervising and
training pharmacy
support staff;
budgeting and
financial
management;
promoting sales and
developing the
business.

selling healthcare and other products, such as
toiletries, cosmetics and rehabilitations product
e.g wheel chair

For Every Disease, Levels and Modes
of Intervention are:
Levels of Prevention Modes of Intervention
1. Primary prevention


2. Secondary prevention


3. Tertiary prevention
1. Health promotion
2. Specific protection

3. Early diagnosis and
prompt treatment

4. Disability limitation
5. Rehabilitation


101
Level of Prevention
102
C. Secondary prevention A. Primordial Prevention
B. Primary prevention D. Tertiary prevention
103
Mode of Interventions
A. Health Promotion





B. Specific protection
It involves:
1. Health Education
2. Environmental Modification
3. Nutritional Intervention
4. Periodic medical examination
5. Sex education & marriage counseling
6. Genetic counseling
7. Healthy life style
It is done by:
1. Immunization
2. Use of specific nutrition (before the
occurrence of disease)
3. Protection against occupational hazards
4. Avoiding carcinogens (cancer prevention)
5. Chemoprophylaxis
a. Health Protection b. Chemo prophylaxis

Provision of conditions for normal mental and physical functioning
of the human being individual and in the group
Promotion of health
Prevention of sickness
Curative and restorative medication in all aspects

Administration of chemicals to a person also includes the
administration of antibiotics to prevent the development of
infection or progression of infection to active manifest disease.
1. Causal Prophylaxis (complete prevention by the early
elimination of invading causal agent)
2. Clinical prophylaxis (prevention of clinical symptoms)
104
Mode of Interventions
C. Early diagnosis and Prompt treatment





D. Disability Limitation





E. Rehabilitation

It objectives are:
1. Prevention and spread of communicable
diseases to other
2. Prevention of complication is ensured
3. Disease gets arrested and disability is
limited
Concept of disability:
Disease Impairment Disability
Handicap
1. Impairment: It is defined as any loss or
abnormality of psychological, physiological or
anatomical structures
2. Handicap: disadvantage for a given individual
from an impairment or a disability that limit the
normal life style
Aims:
1-vocational guidance
2-psychotherapy
3-speech therapy
4-physiotherapy e.g
exercise in polio
105
106