Tomorrow's Pharmacist
2007:56-59
January 2007

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Pharmacy in the next ten years

Julia Mainstone looks at the way new technologies, knowledge and regulations are likely to expand the pharmacist’s role in the near future

Julia Mainstone is a fourth-year student at the University of Brighton

• Drug development • Education • Teamwork

Pharmacy is changing rapidly and, over the next 10 years, will play an increasingly important part in health care. At the same time, huge investments by industry in medical research are generating novel treatments and identifying disease mechanisms.

Community pharmacy will become more prominent as the community pharmacy contract continues to allow pharmacies to offer extended services such as blood pressure and smoking cessation clinics. Medicines use reviews, introduced with the contract, will also help to raise the profile of pharmacists in the community.

The growing demand for out-of-hours surgeries and late night pharmacies will create an opportunity for community pharmacy to expand and consider new options such as one-stop health care shops where a GP is based in the same place as the pharmacy.

The Department of Health has enabled independent prescribing by pharmacists and nurses. This will have a huge impact on the different professions within the health care system since it will not only be doctors who will have the right to prescribe. Pharmacists will have an essential skill to provide for the needs of patients.

With independent prescribing will come the creation of a new type of clinical pharmacy role, where pharmacists will make treatment decisions and manage patient care. This is exciting for the profession, since pharmacists’ expertise in drug therapy is becoming increasingly valued.

Pharmacists are now taking on roles that involve managing outpatient clinics, where responsibility is passed on following diagnosis and any necessary surgery. Pharmacists are also now responsible for managing many of the monitoring functions, once the sole responsibility of doctors. Most hospital also have medicines information departments, run by pharmacists, to deal with the increasingly complex questions posed by drug therapy.

Drug development

Drugs are becoming more powerful and effective and are therefore more important in patient care. Our understanding of disease is now at a molecular level due to improvements in imaging techniques and our knowledge of biochemistry.

Industry has responded by designing some drugs specific to receptor subtypes, therefore resulting in fewer adverse reactions, an improved treatment response and greater safety. One example of this is the new group of antipsychotics, where receptor subtype specificity greatly reduces unwanted side effects such as parkinsonian symptoms and tardive dyskinesia.

Newer fields of science such as genetics, biotechnology, nanotechnology and immunology are finding direct applications in medicine. Pharmacogenetics is the study of how a person’s genes affect his or her response to medicine. Its importance has been recognised for some time, but only now is genetic testing filtering down to everyday health care.

This type of screening effectively predicts which groups of patients will respond to certain medicines and who will experience particular side effects. For example, before starting treatment with azathioprine, a powerful immune suppressant, patients are often screened for TPMT-polymorphisms, known to result in immune toxicity. Such testing will become more common and patients will ultimately have a full set of data regarding their genome that prescribers will use to choose their medicine.

Discoveries in fields such as immunology, for example in antibody technology, mean that biological products may need tailoring, perhaps to the individual level. Traditionally this has been the responsibility of the immunologist or protein chemist, but the many pharmaceutical considerations, such as administration, dosage, product quality and patient counselling, make it vital that pharmacists remain well trained and undertake professional development throughout their careers.

The type of products available in pharmacies are expanding steadily. Many diagnostic kits and novel products have become pharmacy items.

Education

The Royal Pharmaceutical Society has already taken the steps to ensure that pharmacy adapts well to changing medical technology. Degree courses now include information and teaching on new areas, such as pharmacogenetics, to ensure pharmacists are in a position to provide accurate and current advice to patients.

Continuing professional development will become mandatory this year, ensuring that all pharmacists stay up to date with changes to disease management protocols and are aware of current changes to technology. This is an essential requirement for registration with the Society.

There is also a need for a better partnership with pharmaceutical companies. There may be an unwillingness to use information provided by industry due to suspicion of a bias towards their products. However, the makers of products often hold the most detailed information. Pharmaceutical companies need to advertise the role that their medical information departments can play in education.

Teamwork

The model for 21st century health care lies with an integrated multi-disciplinary team. Every aspect of a patient’s health is considered by specialists such as doctors, nurses, pharmacists and dietitians, providing a balanced care plan to identify the key health issues affecting the patient.

Pharmacists are in a great position; they are pharmaceutical scientists and health professionals who are well prepared for communicating with patients. No other health care professionals have the same combination of skills, which will make pharmacists even more valuable members of the future health care team.