Access to high-quality health services is vital for the delivery of a nation’s positive health outcomes. For ex- ample, the reduction of morbidity associated with long- term conditions requires access to pharmacy teams who can provide medicines and services, to ensure their responsible use. Ensuring the availability of an appropri- ately skilled pharmacy workforce within services and facilities with effective distribution across a nation is an important approach for improving equitable access. Each country and territory in this report started from a differ- ent baseline in terms of the number of pharmacists. The impact of changes in the density of the pharmacy work- force (whether this is an increase or decrease) on health outcomes is difficult to judge. Additionally, changing epidemiology and disease burden at a country level as well as population increases need to be considered and an assessment made as to whether the development of pharmacy human resources has adapted and made an impact over time.
Sixty-nine papers were identified for inclusion (48 peer reviewed and 21 non-peer-reviewed). Evaluation of evidence revealed the global pharmacy workforce to be composed of increasing numbers of females who were working fewer hours; this decreased their overall full-time equivalent contribution to the workforce, compared to male pharmacists. Distribution of pharmacists was uneven with respect to location (urban/rural, less-developed/more-developed countries) and work sector (private/public). Graduates showed a preference for completing pre-registration training near where they studied as an undergraduate; this was of considerable importance to rural areas. Increases in the number of pharmacy student enrolments and pharmacy schools occurred alongside an expansion in the number and roles of pharmacy technicians. Increased international awareness and support existed for the certification, registration and regulation of pharmacy technicians and accreditation of training courses. The most common factors adding to the demand for pharmacists were increased feminization, clinical governance measures, complexity of medication therapy and increased prescriptions.
Globally, people are living longer with multiple co- morbidities and are requiring increased access and use of medicines. Pharmacists are a key component of the healthcare workforce, and in many countries, pharma- cists are the most accessible healthcare profession. Phar- macists play an important role in the delivery of healthcare services since they are involved in community and hospital environments, as well as academia, re- search, and regulation. However, pharmacist workforce shortages have been reported in all sectors . Alongside the increased demand for the global healthcare work- force, the pharmacy profession itself is undergoing dy- namic change with more of a focus on patient-centred care, clinical decision-making on medicine use, and in- terprofessional collaboration. Whilst pharmacists are trusted and accessible healthcare professionals, it is im- portant to monitor how the pharmacy workforce is changing. These changes will affect the planning of the delivery of healthcare services. There is an imperative to understand the current trends in the global pharmacy workforce and the implications of these trends on the future supply of pharmacists. Only then can it be de- cided how and what measures are required in order to balance the demand versus supply of pharmacists to help improve the global healthcare workforce.
Brazil has also acknowledged the importance of hospital pharmacists with laws stating they must be present in all hospitals [13, 32]. In addition, the Mini- mum Standards for Hospital Pharmacy and Health- care Services recommend at least one pharmacist for every 50 hospital beds for basic dispensing services . Despite these recommendations and growing evi- dence that hospital pharmacy services improve pa- tients’ clinical outcomes [15, 16], low compliance with these legal requirements and standards have been ob- served . Brazil currently has a higher density of pharmacists (9.1 per 10,000 population) than the glo- bal average (6 per 10,000 population) with growing capacity over the past years [4, 18]. Additionally, ex- pressive gains were obtained concerning pharmaceut- ical care [19–21]. However, to the best of our knowledge, current studies have not evaluated the distribution of the hospital pharmacy workforce in Brazil [4, 18]. This study aimed to describe the phar- macy workforce distribution in hospital settings in Brazil.
Nitaqat, a program of the Saudi Ministry of Labor aiming at the increase of employment of Saudi citizens, might provide a partial solution to the problem of exces- sive employment of expatriates. However, establishments with less than 10 employees are exempt from this pro- gram, and essentially all community pharmacies—col- lectively the largest employers of pharmacists—are included in the category of small establishments . Moreover, Saudization has to be applied to the pharmacy sector with extreme caution, as underscored by recent closures of reportedly 200 000 businesses as a result of imposing quotas for Saudi employees . Arguably, the recurrence of this phenomenon in case of pharmacies would have disastrous consequences for the residents in Saudi Arabia. Thus, exceptional care must be exercised in Saudization of the pharmacy workforce.
7 Although data is available from multiple sources, the United States has no current and comprehensive effort with regards to pharmacy workforce planning. The last formal assessment was performed by the DHHS in 2008 and while providing useful information, its projections have now shown to be outdated, and no updates are known. In 2010, the American Pharmacists Association (APhA) and ASHP released a joint discussion paper examining the expansion of pharmacy education. 19 Among their key recommendations was the need for a stakeholders‟ conference on workforce planning, and the establishment of an on-going assessment of workforce needs and response to said needs. 19 However, follow-up action to this recommendation remains to be seen. The de-facto approach by the profession thus far has been a reliance on the free market to self-determine pharmacist supply and demand.
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The finding that more than a third of the licensed pharmacists in 2016 are undergoing National Youth Service Corps (NYSC) suggests that a significant propor- tion of the active workforce are new entrants. NYSC is a one-year mandatory service for recent graduates and involves working in government institutions with mini- mum pay . The finding corroborates existing report that show that recent graduates account for a large number of new recruits in public sector health facilities in Nigeria . Effective utilisation of pharmacists under the NYSC scheme in underserved regions of the country may be short term strategies that can improve the avail- ability of pharmacists in these areas. The Australian rural pharmacy workforce programme is a notable example of an initiative aimed at recruiting, retaining and retraining the pharmacy workforce and involve strategies such as provision of undergraduate and post- graduate scholarships, emergency locum scheme, rural intern training and incentive allowance as well as rural pharmacy maintenance allowances for pharmacist in underserved areas .
The interviews identified amongst participants a lack of understanding of the scope and function of the PDC operation at the early implementation stages. Participants believed the PDC would supply most if not all items, but as sites went live participants found that this was not the case and some items required to be sourced from elsewhere, for example compliance aids. Participants also believed that the PDC would be reactive to emergency orders but reported instances of ‘out of stock’ items at the PDC creating the need to spend time calling other dispensaries to locate medicines or, on occasions, to ‘borrow’ the medicine from community pharmacy. This coupled with the major technological malfunctions in the robotic conveyor system in the first few months of the project put significant pressure on the reliability of the PDC supply chain, with consequent varied site responses to minimise any impact of lack of delivery of medicines for their patients. The resolution of the PDC technology issues and the move from local to more standardised approaches to responding to supply issues was a major focus in the first 12 months of going live. Additionally at this time delineation of different teams became an important issue as staff moved from old to new teams with new relationships and dependencies needing to be established and embedded, challenged further by the pressure of technology malfunctions and the introduction of the MMyM rollout. Participants expressed that this stage of the redesign was a particularly difficult and stressful experience:
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The high pharmacist to population ratio is indicative of poor workforce planning and a general lack of regula- tion to the pharmacy education sector. It may also be in- dicative of a potential oversupply of pharmacists. The experience of other countries shows that this may enhance the risk of unemployment among pharmacy graduates or it may force pharmacists’ income down . However, unemployment among pharmacy gradu- ates is not the case in Lebanon since only a minute proportion of pharmacists (0.6%) report unemployment. This could be explained by the following: 1—the distribution of pharmacists across various sectors of employment with a good proportion working in the pharmaceutical sector, 2—the large number of commu- nity pharmacies in Lebanon (one pharmacist per phar- macy), or 3—the proportion of pharmacists who may be keeping their registration active and indicating employ- ment to benefit from the retirement benefits of the OPL. While unemployment does not surface as an issue, reduced income and profit margin certainly do [13–15]. Future studies are recommended to validate the explana- tions offered above and better guide policymaking con- cerning pharmacy workforce planning.
The lack of trained pharmacy staff at the health center service delivery level to manage medicines and supply chain has become a critical bottleneck in national efforts to improve access to medicines and primary health-care service delivery. The demand for pharmaceutical ser- vices, particularly with the advent of the HIV/AIDS epi- demic, has increased markedly and points to the need for a comprehensive and sustainable scale up of the pharmaceutical workforce in low-income countries like Malawi. This project seeks to evaluate the causal effect of a potentially efficient, community-level intervention in which pharmaceutical services at lower-level health facilities are delegated to lower-level cadre pharmacy worker. We theorize that addressing this human re- sources constraint will improve medicines management, logistics information flow, and supply chain function at the health facility level, leading to improved medicines availability at public health facilities, access to essential medicines in the community and health outcomes. Al- though similar programs are already being implemented in Namibia, South Africa, and Tanzania, associated costs and impact on medicines availability at public health fa- cilities have not been reported. Moreover, the impact of supply chain enhancements on health outcomes has also not been rigorously evaluated.
the higher education model developed in Cuba, accord- ing to which a professional profile is combined with an extensive basic training. This equips students to solve many of the common problems encountered in pro- fessional practice. The educational process consists of three approaches: instruction in knowledge and skills, value based education, and development of abilities. The desired outcomes are the unity between instruc- tion and education, and the connection between theory and practice. Unlike the previous curriculum (Program A (1976-1985), Program B (1986–1989), Program C (1990–2000), the Program C1 strengthen pharmacy training in skills and knowledge and orient it toward clinical practice. This curriculum promotes the devel- opment of analytical thinking, problem-solving abilities, and a commitment to lifelong learning. Communication skills, professional ethics, social responsibility, profes- sional citizenship are also included in the curriculum. It also ensures knowledge of the chemical, biological, social, and clinical sciences that underlie pharmacy and an understanding of the relevance of that knowledge to patient care. Moreover, it provides the skills to apply this knowledge to specific patient care circumstances. Tradi- tional basic science courses and social and administra- tive science courses are also integrated into the program to facilitate learning. 6
In Northern Cyprus, a CPP course was established at the Near East University Hospital (NEUH) during the 2015– 2016 academic year. NEUH is a tertiary university hos- pital that provides acute, intermediate, rehabilitation and outpatient health services. It is one of the largest health- care centers in Northern Cyprus with 500 beds. It is also one of the leading medical facilities affiliated with the Near East University. Clinical pharmacy services were first established in the respiratory disease unit. Later, the services were extended to other clinics in cardiology, in- ternal medicine, gynecology, geriatrics and infectious diseases. Pharmaceutical care services are provided to patients from all these clinics by the Clinical Pharmacy and Drug Information Center of the Hospital. Preceptors received training in mentoring internship students, assessing clinical competencies and applying active teaching skills. Preceptors were also required to deliver advanced ward-based pharmaceutical care services. They were required to document the outcomes over a period of 60 days before they started training 5th-year graduate students to ensure that their pharmaceutical care competencies were developed and up-to-date (Fig. 1).
A better understanding of the vaccination market is needed to attract more consumers. It is important to examine the attributes of persons currently using the channel to tailor programs and marketing that will continue to attract consumers. What segments are being serviced in the new channel? Does gender, health status, previous immunization history, attitudes, health beliefs, etc. influence the use of a retail pharmacy for seasonal influenza immunization? Attitude can have an enormous impact on the decision of a patient to seek immunization from their pharmacist. Factors influencing a patient’s attitude include trust, access, cost, and convenience. There have only been a few published studies (Grabenstein, 2001; Blake, 2003; Grabenstein, 2002 on this subject and all are over seven years old, and since that time there has been broader acceptance of pharmacists as immunizers.
Third, Health and Drug Policy, Patient Safety: a lack of these types of subjects was shown in the developing countries group, wherein 38% and 31% of the schools tested did not offer courses in Health and Drug Policy and Patient Safety, respectively. A detailed representa- tion of this disparity is shown in Table 3 and Chart 1. Further results deal with the obligatory or elective char- acter of courses. Differences were shown both region- ally and regarding individual subjects. In Europe and developing countries 83% of all courses related to Social Pharmacy were shown to be obligatory, while in the North American schools tested the rate was 96% of these subjects being required. A significant number (more then 30%) of some elective courses were not offered at all in the North American group. These sub- jects include, in European schools Industrial Pharmacy (50% not offered), Pharmaceutical management (36%) and Psychology (33%), and at institutions in developing countries Pharmacoepidemiology (42% not offered), Psychology (42%) and Pharmacoeconomics (33%). The open question part of questionnaire enabled the respondents to submit information about the other featured in the curricula of most schools of pharmacy,
Health systems are frequently resource constrained, so streamlining and dividing responsibilities during the medica- tion reconciliation process is necessary for sustainment of practices. In many health care settings, pharmacy teams con- sisting of pharmacists, pharmacy technicians, pharmacy resi- dents, interns (eg, pharmacy students), and clerks may be tasked with the medication reconciliation process. Previous research has shown that pharmacy technicians and pharmacy students have been successfully involved with medication reconciliation activities. Champion et al 31 conducted a review of 32 studies to examine how pharmacy students and techni- cians have been utilized in medication reconciliation processes in an effort to evaluate expanded roles for pharmacy students and technicians. The authors reported that pharmacy students and technicians with proper training were able to obtain med- ication histories, identify discrepancies, and take appropriate action to correct these discrepancies. Cost savings to health systems were also reported in select studies when pharmacy technicians or students replaced pharmacists or nurses during part of the medication reconciliation process. 31 In another
curriculum content has been noted for the institutions offering Clinical Pharmacy, with differing modules on disease management and pharmacotherapy. Ultimately, students would join internship programs in hospitals and communities (lasting for either a pre-defined number of hours or up to a whole semester), where pharmacy interns are exposed to the actual hospital systems and to the interaction with working pharmacists and clinical pharmacists. The practicing hospital and clinical phar- macists are then tasked to evaluate these students. Regarding curriculum, several hospitals or institutions are already practicing the fundamentals of clinical phar- macy such as patient education or counselling, medi- cation order review prior to dispensing and providing the proof of drug information to other healthcare professionals. The American College of Clinical Pharmacy (ACCP) has developed set standards of practice for clinical pharmacists as a reference in designing and assessing clinical pharmacy education and training programs. These standards address the clinical phar- macist’s involvement in collaborative, team-based practice and privileging; professional development and maintenance of competence; professionalism and ethics; research and scholarship and other professional responsibilities. 5
These realizations led our team of Kenyan and North American pharmacists to propose that a new cadre of pharmacist in LMICs that can more effectively respond to both the clinical needs and medication supply needs of LMIC populations, could ultimately improve patient outcomes. Despite the availability of clinical pharmacy providers in high-income countries, this is largely a non-existent practice in Kenya and most of SSA where pharmacists typically only participate in the dispensing of product(14). We sought to assess the feasibility and impact of incorporating these providers within a rural inpatient setting in western Kenya, a rather typical setting for East Africa. Our primary research question was to determine whether North American Doctor of Pharmacy students and Kenyan Bachelors of Pharmacy students could provide similar numbers of interventions in inpatient care.
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The post 1920 period, particularly the 1940 to 1970s, witnessed many scientific developments and achievements in the area of Hospital pharmacy helping the evolvement of Clinical Pharmacy in USA. Clinical Pharmacy denotes the practice of pharmacy near the bed side of the patient. It is practiced by both hospital and community pharmacists. The Doctor of Pharmacy (Pharm.D) degree, is a professional doctor degree in Pharmacy and is a global program in pharmacy education.The first effort to introduce Pharm.D in India was initiated in Trivandrum in 1999 when University of Kerala approved the syllabus and regulations, framed by K.G.Revikumar , the head of Hospital and Clinical Pharmacy, of Trivandrum Medical College. The program could not be started for certain reasons. In 2008 the Pharmacy council of India managed to introduce a six year regular Pharm D and the three year post baccalaureate Pharm.D in India. By 2013 November, the PCI had given approval to over 140 institutions covering states like Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra, Gujarat, Rajasthan, UP and Punjab for starting Pharm.D in India. The first batch of regular Pharm.D will graduate by the end of 2014. The strengths, weakness, opportunities and threats (SWOT) of Indian Pharm.D are critically and scientifically analysed and evaluated in this study paper.
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defined as a discipline concerned with the behavioral sciences relevant to the utilization of medicine by both consumers and healthcare professionals.  The World Health Organization (WHO), through a consulting group pinpointed seven roles to which future pharmacists should aspire, namely caregivers, decision-makers, communicators, leaders, managers, life-long learners, and teachers.  Within this context, there is a need for future pharmacists to be trained in all aspects related to social pharmacy as it provides background for being involved in patient-oriented services.
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Nevertheless, extemporaneous compounding is still a rele- vant pharmaceutical service provided by many pharmacies worldwide [3–8]. The continued need for extemporaneous compounding in the age of pharmaceutical manufacturing is driven by the individualized patient care focusing on the therapeutic needs of patients with rare diseases , pediatric patients [10–12] and patients with requirements for special dosage forms, individualized dosing or active ingredients combination that are not provided commercially [1, 2, 6]. Moreover, from a professional point of view, compounding is a very unique attribute of a pharmacy practice that reflects on the professional status of pharmacists’ provision for patient-specific healthcare needs .