Next Article in Journal
Prevalence and Duration of Use of Medicines Recommended for Short-Term Use in Aged Care Facility Residents
Previous Article in Journal
The International Pharmacists-as-Immunizers Partnership (IPIP)—Advancing Research on Pharmacist-Administered Immunizations Worldwide
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Pharmacy
Volume 7
Issue 2
10.3390/pharmacy7020054
pharmacy-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Perspective

The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives

by
M.H.F. Sakeena
1,2,*,
Alexandra A. Bennett
3 and
Andrew J. McLachlan
2
1
Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya KY 20400, Sri Lanka
2
Sydney Pharmacy School, The University of Sydney, New South Wales 2006, Australia
3
NSW Therapeutic Advisory Group, New South Wales 2010, Australia
*
Author to whom correspondence should be addressed.
Pharmacy 2019, 7(2), 54; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy7020054
Submission received: 5 April 2019 / Revised: 21 May 2019 / Accepted: 21 May 2019 / Published: 5 June 2019
Browse Figure
Review Reports Versions Notes

Abstract

:
The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession’s role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists’ roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists’ roles have had a significant positive cost-effective impact on the population’s health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans.

1. Introduction

Pharmacy is a major health discipline that contributes to the development of a country [1]. Pharmacists play a vital role in pharmaceutical manufacturing, marketing and regulation of medicines [2], providing pharmaceutical care services [3], and disseminating their knowledge through academia and research [2,3]. Furthermore, pharmacists are important members of the multidisciplinary healthcare team caring for patients and playing a major role in ensuring the judicious use of medicines [4,5]. Expanded clinical pharmacists’ roles contribute to cost-effective therapeutic outcomes [6]. These roles are well-recognised and considered integral parts of many countries’ healthcare systems [6,7,8], including those of some developing countries [9]. However, at present, pharmacists are not yet an integral part of the multidisciplinary healthcare team in Sri Lanka, and their role is currently limited to drug dispensing, compounding and providing limited medicine information to patients [10].
In order to achieve the ultimate goal of improving the healthcare services of a nation, the pharmacy profession should be committed to continuously improving its knowledge and quality of practice. The aim of this chapter is to highlight the need to strengthen the roles of pharmacists in Sri Lanka. Further, this chapter will describe the importance of pharmaceutical care services, the current scenario of pharmacists’ roles in hospital and community pharmacies in Sri Lanka and how further augmentation of pharmacy education can produce competent pharmacists able to deliver enhanced pharmaceutical care across all Sri Lankan healthcare settings and ultimately optimised patient self-management of medicines.

2. Pharmacists’ Roles in Sri Lanka: The Current Scenario of Pharmaceutical Care Service Delivery

The role of the pharmacist around the world has evolved greatly over the last decades, expanding from dispensing activities to enhanced direct patient-care tasks, administrative activities and public health functions. Pharmaceutical care aims to provide responsible and careful medication therapy to achieve optimal medication outcomes and increase patient satisfaction in an integrated health system that ultimately improves the quality of a patient’s life [11]. However, in many developing countries, qualified pharmacists have historically played a more pharmaceutical industry-oriented role rather than a patient-oriented perspective [2]. Similarly, in Sri Lanka, pharmacists are well recognised and well remunerated for their activities in the pharmaceutical industry. Furthermore, pharmacy services in the hospital and community in Sri Lanka tend to be limited to medicines procurement, medication supply and dispensing, inventory control and storage [12]. Compared to many countries, the pharmacists’ role in Sri Lanka is under-recognised and underutilised, and pharmaceutical care is yet to be recognised as a field of pharmacy practice [13]. This is despite evidence that improved pharmaceutical care services can be delivered in the Sri Lankan healthcare setting [14].
Official Sri Lankan reports have made recommendations for the improvement of pharmaceutical care services in both hospital pharmacy and community pharmacy settings, albeit with little fruition [15]. Currently, dispensing of prescriptions is the primary duty of hospital and community pharmacists in Sri Lanka. Compounding is also undertaken in most hospitals and a few community pharmacies. Registration to practise as a pharmacist is obtained from Ceylon Medical Council after awarding of a certificate of proficiency in pharmacy, a certificate of efficiency in pharmacy a diploma in pharmacy or a degree in pharmacy from a recognised institution or university in Sri Lanka or abroad.

2.1. Hospital Pharmacy

Pharmaceutical care services in the hospital setting promote appropriate medicine use and cost-effective prescribing and enhance medication safety [16]. Enhanced hospital pharmacy activities have helped to optimise treatment, promote rational prescribing and reduce inappropriate medicines use and preventable medication related harms and improve patient outcomes [17,18]. A variety of pharmacist-led interventions to improve medicine use in the hospitals have been established [19]. These programs usually involve multidisciplinary teamwork and often incorporate pharmacists with postgraduate training to facilitate appropriate medicines use in hospitalised patients [20]. Many countries have achieved success with the implementation of clinical pharmacy programs [21], resulting in improved clinical and economic outcomes [6]. However, clinical pharmacy services are not widely available in many developing countries [22]. The reasons for a lack of clinical pharmacist-led activities in hospitals in these countries are complex but may reflect the emerging nature of the pharmacy profession in these countries, professional isolation and a lack of recognition of the role of clinical pharmacy within the healthcare system [23].
In recent years, developing countries such as Malaysia [24], Taiwan [25], Brazil [26], Kuwait [27], Sudan [28], Nigeria [29] and Ethiopia [30] have realised the importance of pharmaceutical care service delivery in hospitals and implemented clinical pharmacy programs. Empirical studies reveal that implementation of clinical pharmacy services reduce the length of hospital stays and produce significant cost savings, both medication costs and total inpatient expenditures [22,31]. These developments have the potential to lead to improved patient quality of life, better use of healthcare resources and a reduced rate of mortality [31]. Importantly, clinical pharmacy programs are emerging in some South Asian countries. For example, clinical pharmacy programs have been reported in a South Indian hospital [32] and two hospitals in Pakistan (Shaukat Khanum and Agha Khan hospitals) [33]. Furthermore, the International Pharmaceutical Federation (FIP) Basel Statements [34] cover all areas of medication management in a hospital setting, including procurement, preparation and delivery, as well as prescribing, administration and the monitoring of patient outcomes and human resources. This FIP guideline represents an important opportunity to identify gaps in Sri Lankan hospital pharmacy practice according to international standards and to identify priority areas for implementation and workforce development.
There are only a few studies and reports in the literature discussing Sri Lankan hospital pharmacy and pharmaceutical care service delivery. Currently, only a small number of pharmacists are employed in Sri Lankan hospitals [13], and pharmacists are typically not a part of the multidisciplinary healthcare team [14]. In the Sri Lankan hospital setting, the pharmacy department is usually divided into “outpatient” and “inpatient” pharmacies. The outpatient pharmacy dispenses medicines to clinic patients and patients from the outpatient department, while the inpatient pharmacy distributes medicines to the hospital wards and inpatients. As the hospital adopts a ward-stock method of medication distribution, pharmacists in the inpatient pharmacy do not come into direct contact with patients, prescribers and prescriptions. The pharmacist’s activities in hospitals are limited to drug procurement, distribution, inventory control and drug dispensing for both types of pharmacies, with additional activities such as limited medicines information provision and compounding for patients [14,35]. A ward-based clinical pharmacy services does not currently exist in Sri Lankan public hospitals [14]. However, a recent report suggests that there are significant opportunities for pharmacists to provide pharmaceutical care services in Sri Lankan hospitals [10]. Furthermore, this study found positive attitude from doctors regarding the inclusion of a ward-based clinical pharmacist to the healthcare team in Sri Lanka.
A high prevalence of preventable medication errors (35.5%) related to incorrect dosing regimens and inappropriate documentation for prescribed or administered medications inpatient records has been reported in Sri Lankan hospitals [36]. This represents a major safety concern for inpatients’ treatment in hospital [36]. Further studies from Sri Lanka have concluded that error-prone abbreviations and inappropriate, unapproved abbreviations may be frequently used in prescription writing [37], as well as incomplete outpatient handwritten prescription writing [38], leading to medication errors. Another study from Sri Lanka found that patients who lacked their medication record or possessed an incomplete record posed a significant barrier to appropriate medication use among the elderly patients [39]. Thus, patient safety and the health and quality of life of Sri Lankan hospital patients currently appear compromised. Implementation of pharmaceutical care or clinical pharmacy services is a highly feasible solution to overcome these health challenges and, as has been previously shown, may lead to reduced preventable harms, improved quality use of medicines in Sri Lankan hospitals and reduced total healthcare costs.
Using pharmacists to provide pharmaceutical care services in hospitals and recognising them as part of the healthcare team may improve access to comprehensive medicines information for patients and clinicians and enhances the ability for pharmacists to develop close collaborative relationships with prescribers and other healthcare professionals [40]. Further, pharmacists can assist in optimising medication management, direct patient care, public health initiatives, population management activities and the provision of expert drug information and education for other primary healthcare team members [41,42]. Counselling of patients by pharmacists about appropriate medicine use is an important role for pharmacists [43] and can help to improve medication adherence [44]. Pharmacists with good communication and change behaviour skills can also improve adherence to clinical therapeutic guidelines. These positive outcomes would be achievable in Sri Lanka by strengthening the role of pharmacists and pharmaceutical care services provision. The international evidence supporting the role of the hospital pharmacists in improving healthcare provides a strong rationale for calling on government authorities to take action to introduce and implement enhanced pharmacy services in hospitals nationwide.

2.2. Community Pharmacy

Community pharmacists play a vital role in healthcare provision [45]. Community pharmacists are often the first contact person for patients seeking advice on common health complaints [46]. They also provide advice on the self-management of minor ailments [47] or provide triage and referral to other health professionals. Furthermore, pharmacists may be the last contact person before the patient commences any medication for treatment, so they have a role in checking for drug allergies, reinforcing the messages regarding appropriate use of medicines, ensuring adequate monitoring, providing guidance on adverse drug effects as well as drug interactions, and improving patients’ medication adherence [48].
In developed countries, community pharmacy services are well recognised and utilised [49], and the community pharmacists’ role is integrated into the healthcare system [8,46]. For example, in the USA, community pharmacists are a readily accessible primary healthcare provider [7]. In Australia, community pharmacists are considered educators regarding the quality use of medicines for the public [46], and in Canada, community pharmacists play a proactive role as providers of primary healthcare services [49]. Further, to promote self-care and to improve the management of chronic health conditions, the United Kingdom has introduced the New Medicine Service (NMS) to be delivered by community pharmacists [50].
By contrast, community pharmacy services offered in developing countries are typically confined to traditional practices of dispensing with a business-oriented approach [2] and a limited emphasis on patient health and welfare [3]. Community pharmacists are also known as drug retailers [51,52]. Community pharmacists have a definite role in improving the quality use of medicines and the quality of life of their customer; however, it has been observed that community pharmacies in most low-income settings are often underutilised, and the standard of care and services tend to be variable and often suboptimal [53]. As a consequence, inappropriate dispensing procedures such as dispensing prescription-only medicines without an authentic prescription occur in most of the pharmacies in developing countries [54].
In Sri Lanka, privately-owned community pharmacies are the main source of medicines, and dispensing is mostly undertaken by pharmacists and drug retailers [55,56]. Currently, Sri Lankan community pharmacists are involved in procurement of medication, extemporaneous compounding, dispensing of prescriptions and selling of medicines [57]. Pharmacists are not commonly involved in providing pharmaceutical care services. Patients with chronic diseases often visit the pharmacies for their prescription refills; however, their disease conditions are not followed up or monitored by the community pharmacist, in a similar manner to many other developing countries [58]. Adverse drug reaction (ADR) reporting by pharmacists is now well established in many countries [59]; however, pharmacists are not involved in ADR reporting in Sri Lanka, despite their high prevalence [60]. Inappropriate labelling and insufficient information for patients during the dispensing of medications at community pharmacies [57] has been an ongoing challenge for many years.
The absence of a qualified and trained pharmacist in the community pharmacy setting is the mains reason for many of the observed inappropriate dispensing practices in Sri Lankan community pharmacies. Remuneration and recognition are two concerns for qualified pharmacists to seek work opportunities elsewhere [61]. Guidelines for community pharmacy practice issued by the National Medicines Regulation Authority (NMRA), Sri Lanka [62] stipulates that community pharmacies should have legally qualified pharmacy professionals at all times during opening hours. However, this rule is not strictly enforced; most pharmacies dispense medications without the presence of a qualified pharmaceutical professional [63]. A recent study conducted in Sri Lanka revealed that antibiotics can be purchased without prescriptions in different districts of Sri Lanka [64]. Moreover, this study found that the presence of a qualified pharmacist was associated with reduced nonprescription dispensing practices of antibiotics by Sri Lankan community pharmacies. Hence, enforcement of appropriate staffing in licensed pharmacists during business hours should be undertaken in order to ensure the high quality of medications and services. All pharmacy personnel should undergo formal training in dispensing of medicines, participate in continued professional development program and adhere to legal obligations related to the supply of medicines.
There is a considerable need for healthcare services provided by community pharmacies in Sri Lanka and an urgency to undergo reforms to meet the changing needs of medicines users and align with international standards of practice. Apparently, most of the medication use and supply occurs in community-based settings [65], so it is important to understand pharmacists’ current role in patient care, and their perception of the quality of patient care services available in real-world community-based pharmacies. A recent systematic review highlighted that community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control [66].
Furthermore, community pharmacists can play a key role in optimising medicines use to help achieve the quality use of medicines in the community. Importantly, pharmacists’ contributions to healthcare need to be recognised. There is an urgent need to strengthen community pharmacists’ role in Sri Lanka. To achieve this, policy changes in the healthcare system for pharmacists should be considered for adoption in Sri Lanka. Remuneration and recognition for the extended roles that a pharmacist can play (beyond supplying medicines) are critical in order that qualified pharmacists achieve their full scope of practice in community pharmacies.
Figure 1 [45,46,67,68,69,70,71,72] represents the expanded pharmacists’ role delivered through different pharmaceutical care services to provide optimum healthcare outcomes. Th diagram shows that pharmacists’ role has enhanced to provide services in different sectors of healthcare delivery.

3. Pharmacy Education

Pharmacists with the appropriate education and training can assist both healthcare professionals and patients in using medications wisely [73,74,75]. Furthermore, comprehensive and relevant education and training on the quality use of medicines is essential for pharmacists to take a leading role in changing behaviours around medicines consumption and their appropriate use in the community [76].

3.1. From Science to Patient Care

Pharmacy undergraduate education in Sri Lanka is a predominantly science-based university course. If pharmacy education is to keep pace with current and future changes in practice, then pharmacy training must become more patient-focused, embracing elements of clinical and therapeutics training. There is a necessity to provide knowledge and skills on pharmaceutical care through pharmacy curriculum at undergraduate level [77]. A primary focus of pharmacy teaching should be on patient centred-care, training future pharmacists to lead quality use of medicines initiatives and patient-oriented pharmaceutical care services. Problem-based learning methodologies [78] can assist students in developing skills in clinical reasoning, patient safety and clinical accountability, ensuring that shared decision making, documentation and reporting are implemented in practice. To excel in pharmacy practice, pharmacy students should have greater exposure to first-hand clinical practice [79]. Pharmacy students should be able to practise and work within multidisciplinary environments [80]. Therefore, undergraduate pharmacy education in Sri Lanka should include the core subject of clinical pharmacy practice and instil the attributes of life-long learning to ensure pharmacists in practice maintain currency of their therapeutics skills and knowledge.

3.2. Postgraduate Training and Future Leaders

The next imperative is to provide postgraduate (PG) level training for pharmacists in Sri Lanka. These PG courses can be introduced as M. Pharm in Clinical Pharmacy or M. Pharm in Hospital Pharmacy or PhD in Pharmacy. Postgraduate courses focusing on the management of diseases and the development of quality use of medicines in Sri Lankan universities could be an additional strategy. Currently, pharmacy graduates undertake PG studies in allied fields, such as chemistry, since graduates do not have access to research or PG studies in the field of pharmacy or pharmacy practice. There are currently no academic institutions in Sri Lanka that offer postgraduate degrees in the pharmacy discipline, and this has meant Sri Lankan qualified pharmacists who wish to further their postgraduate pharmacy career need to undertake postgraduate studies abroad. To date, relatively few pharmacists have obtained Masters or PhD qualifications in pharmacy. This hampered development of pharmacy leaders with a wider range of competencies, knowledge and skills necessary for the development of future healthcare services in Sri Lanka presents pharmacy graduates with a significant barrier to their future academic and professional development and is a major challenge for the development of Sri Lankan pharmacy practice. It is essential that research and PG programmes in pharmacy-related fields are introduced. These future initiatives will not only provide benefits for the graduate pharmacists but will also have an important impact on the future development of pharmacy leaders and the pharmacy profession in Sri Lanka and optimise the appropriate, safe and effective use of medicines by Sri Lankans.

3.3. Pharmacy Curriculum

It is also equally important to analyse the contents of pharmacy curricula of undergraduate and postgraduate pharmacy programmes in other countries, which excel in pharmacy practice, such as Australia [81]. Australia has a number of requirements to ensure that educational standards are attained by all universities delivering courses for pharmacist qualification. These include mandated components in the university pharmacy curricula, an accreditation requirement for university courses every 5 years, and demonstration of professional competencies for registration as a pharmacist, overseen by a national pharmacy council [82]. These strategies should be considered by Sri Lankan academics and policy makers to raise the quality of pharmacy education and the performance of the pharmacy profession in Sri Lanka.

3.4. Continuing Professional Development

Additionally, continuous professional development courses and programs for practising pharmacists are another important strategy requiring establishment in Sri Lanka. Continuous professional education, using workshops, seminars and online courses is another important means to improve appropriate medication use and dispensing practices in Sri Lanka. These educational strategies could have a direct influence on patient-centred practices of pharmacists in Sri Lanka. If pharmacists are to consider providing enhanced pharmaceutical care services in future, then using the teaching and training of pharmacy practice at undergraduate level as well as maintaining the currency of their skills and knowledge through continuous professional courses will help to strengthen the role of pharmacists in Sri Lanka.

4. Conclusions

In Sri Lanka, pharmacists are currently underutilised, and their potential roles in patient-care can be viewed as a missed opportunity for optimising the health of the nation’s population. There is a greater need for Sri Lankan pharmacists to extend their services to offer pharmaceutical care. This could lead to the identification and resolution of drug-related problems, improved medication adherence, improved medication safety and enhanced patient care. To effectively and continually offer these services, national policies will need to be developed and enacted to provide some remuneration and recognition for the service. Several studies have demonstrated that the expanded role of pharmacists delivering cost-effective optimal patient care has a significant impact on the healthcare system of a nation. Therefore, the pharmacist’s role should be strengthened to deliver pharmaceutical care services in Sri Lanka.

Author Contributions

M.H.F.S., A.A.B. and A.J.M. were involved in the development of the proposal and study design. M.H.F.S. drafted the manuscript. M.H.F.S., A.A.B. and A.J.M. revised and approved the submission of the final manuscript.

Acknowledgments

M.H.F. Sakeena is supported by an Australian Government Endeavour Postgraduate Scholarship (ID: 4565_2015) for her PhD studies at Sydney Pharmacy School, The University of Sydney.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Saavedra-Mitjans, M.; Ferrand, É.; Garin, N.; Bussières, J.-F. Role and impact of pharmacists in Spain: A scoping review. Int. J. Clin. Pharm. 2018, 40, 1430–1442. [Google Scholar] [CrossRef]
  2. Basak, S.C.; van Mil, J.W.; Sathyanarayana, D. The changing roles of pharmacists in community pharmacies: Perception of reality in India. Pharm. World Sci. 2009, 31, 612–618. [Google Scholar] [CrossRef] [PubMed]
  3. Fang, Y.; Yang, S.; Zhou, S.; Jiang, M.; Liu, J. Community pharmacy practice in China: Past, present and future. Int. J. Clin. Pharm. 2013, 35, 520–528. [Google Scholar] [CrossRef] [PubMed]
  4. Moussavi, K.; Nikitenko, V. Pharmacist impact on time to antibiotic administration in patients with sepsis in an, E.D. Am. J. Emerg. Med. 2016, 34, 2117–2121. [Google Scholar] [CrossRef] [PubMed]
  5. Pawluk, S.; Jaam, M.; Hazi, F.; Al Hail, M.S.; El Kassem, W.; Khalifa, H.; Thomas, B.; Abdul Rouf, P. A description of medication errors reported by pharmacists in a neonatal intensive care unit. Int. J. Clin. Pharm. 2016, 39, 88–94. [Google Scholar] [CrossRef] [PubMed]
  6. Marra, C.; Johnston, K.; Santschi, V.; Tsuyuki, R.T. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can. Pharm. J. 2017, 150, 184–197. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  7. Schimmelfing, J.T.; Brookhart, A.L.; Fountain, K.M.; Goode, J.K. Pharmacist intervention in patient selection of nonprescription and self-care products. J. Am. Pharm. Assoc. 2017, 57, 86–89. [Google Scholar] [CrossRef]
  8. Krass, I.; Armour, C.L.; Mitchell, B.; Brillant, M.; Dienaar, R.; Hughes, J.; Lau, P.; Peterson, G.; Stewart, K.; Taylor, S.; et al. The Pharmacy Diabetes Care Program: Assessment of a community pharmacy diabetes service model in Australia. Diabet. Med. 2007, 24, 677–683. [Google Scholar] [CrossRef]
  9. Brink, A.J.; Messina, A.P.; Feldman, C.; Richards, G.A.; Becker, P.J.; Goff, D.A.; Bauer, K.A.; Nathwani, D.; van den Bergh, D. Antimicrobial stewardship across 47 South African hospitals: An implementation study. Lancet Infect. Dis. 2016, 16, 1017–1025. [Google Scholar] [CrossRef]
  10. Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Mamunuwa, N.; Dawson, A.H.; De Silva, H.A. Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: A descriptive cross-sectional study from a tertiary care hospital in Sri Lanka. BMC Health Serv. Res. 2017, 17, 46. [Google Scholar] [CrossRef]
  11. Woolf, R.; Locke, A.; Potts, C. Pharmacist prescribing within an integrated health system in Washington. Am. J. Health Syst. Pharm. 2016, 73, 1416–1624. [Google Scholar] [CrossRef] [PubMed]
  12. Hettihewa, L.M.; Isuru, A.; Kalana, J. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective. J. Pharm. Bioallied Sci. 2011, 3, 298–301. [Google Scholar] [CrossRef] [PubMed]
  13. Coombes, I.; Coombes, J.; Dawson, A. Clinical pharmacy in Sri Lanka: Translating training into practice. J. Pharm. Pract. Res. 2015, 45, 392–393. [Google Scholar] [CrossRef]
  14. Perera, D.M.P.; Coombes, J.A.; Shanika, L.G.T.; Dawson, A.; Lynch, C.; Mohamed, F.; De Silva, H.A.; Jayamanne, S.F.; Peters, N.B.; Myers, B.; et al. Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: An observational, prospective, cohort study. J. Pharm. Pract. Res. 2017, 47, 121–130. [Google Scholar] [CrossRef]
  15. Coombes, I.D.; Fernando, G.; Wickramaratne, D.B.M.; Peters, N.B.; Lynch, C.; Lum, E.; Coombes, J.A. Collaborating to develop Clinical Pharmacy Teaching in Sri Lanka. Pharm. Educ. 2013, 13, 29–35. [Google Scholar]
  16. Harris, I.M.; Baker, E.; Berry, T.M.; Halloran, M.A.; Lindauer, K.; Ragucci, K.R.; McGivney, M.S.; Taylor, A.T.; Haines, S.T. Developing a business-practice model for pharmacy services in ambulatory settings. Pharmacotherapy 2008, 28, 285. [Google Scholar] [CrossRef] [PubMed]
  17. Mol, P.G.; Wieringa, J.E.; Nannanpanday, P.V.; Gans, R.O.; Degener, J.E.; Laseur, M.; Haaijer-Ruskamp, F.M. Improving compliance with hospital antibiotic guidelines: A time-series intervention analysis. J. Antimicrob. Chemother. 2005, 55, 550–557. [Google Scholar] [CrossRef]
  18. Dellit, T.H.; Owens, R.C.; McGowan, J.E., Jr.; Gerding, D.N.; Weinstein, R.A.; Burke, J.P.; Huskins, W.C.; Paterson, D.L.; Fishman, N.O.; Carpenter, C.F.; et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. 2007, 44, 159–177. [Google Scholar] [CrossRef]
  19. Okada, N.; Fushitani, S.; Azuma, M.; Nakamura, S.; Nakamura, T.; Teraoka, K.; Watanabe, H.; Abe, M.; Kawazoe, K.; Ishizawa, K. Clinical Evaluation of Pharmacist Interventions in Patients Treated with Anti-methicillin-Resistant Staphylococcus aureus Agents in a Hematological Ward. Biol. Pharm. Bull. 2016, 39, 295–300. [Google Scholar] [CrossRef]
  20. Courtenay, M.; Castro-Sanchez, E.; Deslandes, R.; Hodson, K.; Lim, R.; Morris, G.; Reeves, S.; Weiss, M. Defining antimicrobial stewardship competencies for undergraduate health professional education in the United Kingdom: A study protocol. J. Interprof. Care 2018, 32, 638–640. [Google Scholar] [CrossRef]
  21. Kaboli, P.J.; Hoth, A.B.; McClimon, B.J.; Schnipper, J.L. Clinical pharmacists and inpatient medical care: A systematic review. Arch. Intern. Med. 2006, 166, 955–964. [Google Scholar] [CrossRef] [PubMed]
  22. Skjøt-Arkil, H.; Lundby, C.; Kjeldsen, L.J.; Skovgårds, D.M.; Almarsdóttir, A.B.; Kjølhede, T.; Duedahl, T.H.; Pottegård, A.; Graabæk, T. Multifaceted pharmacist-led interventions in the hospital setting: A systematic review. Basic Clin. Pharmacol. Toxicol. 2018, 123, 363–379. [Google Scholar]
  23. Azhar, S.; Hassali, M.A.; Ibrahim, M.I.M.; Ahmad, M.; Masood, I.; Shafie, A.A. The role of pharmacists in developing countries: The current scenario in Pakistan. Hum. Resour. Health 2009, 7, 54. [Google Scholar] [CrossRef] [PubMed]
  24. Hassan, Y.; Aziz, N.A.; Awang, J.; Aminuldin, A.G. An analysis of clinical pharmacist interventions in an intensive care unit. J. Clin. Pharm. Ther. 1992, 17, 347–351. [Google Scholar] [CrossRef] [PubMed]
  25. Yen, Y.H.; Chen, H.Y.; Wuan-Jin, L.; Lin, Y.M.; Shen, W.C.; Cheng, K.J. Clinical and economic impact of a pharmacist-managed i.v.-to-p.o. conversion service for levofloxacin in Taiwan. Int. J. Clin. Pharm. Ther. 2012, 50, 136–141. [Google Scholar] [CrossRef]
  26. Reis, W.C.; Scopel, C.T.; Correr, C.J.; Andrzejevski, V.M. Analysis of clinical pharmacist interventions in a tertiary teaching hospital in Brazil. Einstein (Sao Paulo) 2013, 11, 190–196. [Google Scholar] [CrossRef] [PubMed]
  27. Katoue, M.G.; Al-Taweel, D. Role of the pharmacist in parenteral nutrition therapy: Challenges and opportunities to implement pharmaceutical care in Kuwait. Pharm. Pract. (Granada) 2016, 14, 680. [Google Scholar] [CrossRef]
  28. Elsadig, H.; Weiss, M.; Scott, J.; Laaksonen, R. Exploring the challenges for clinical pharmacists in Sudan. Int. J. Clin. Pharm. 2017, 39, 1047–1054. [Google Scholar] [CrossRef] [Green Version]
  29. Auta, A.; Strickland-Hodge, B.; Maz, J. Challenges to clinical pharmacy practice in Nigerian hospitals: A qualitative exploration of stakeholders’ views. J. Eval. Clin. Pract. 2016, 22, 699–706. [Google Scholar] [CrossRef]
  30. Bilal, A.I.; Tilahun, Z.; Gebretekle, G.B.; Ayalneh, B.; Hailemeskel, B.; Engidawork, E. Current status, challenges and the way forward for clinical pharmacy service in Ethiopian public hospitals. BMC Health Serv. Res. 2017, 17, 359. [Google Scholar] [CrossRef]
  31. Polgreen, L.A.; Han, J.; Carter, B.L.; Ardery, G.P.; Coffey, C.S.; Chrischilles, E.A.; James, P.A. Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control. Hypertension 2015, 66, 1145–1151. [Google Scholar] [CrossRef] [PubMed]
  32. Parthasarathi, G.; Ramesh, M.; Nyfort-Hansen, K.; Nagavi, B.G. Clinical pharmacy in a South Indian teaching hospital. Ann. Pharmacother. 2002, 36, 927–932. [Google Scholar] [CrossRef] [PubMed]
  33. Hussain, A.; Jamshed, S. Pharmacy Practice in Pakistan. In Pharmacy Practice in Developing Countries; Wertheimer, A.I., Ed.; Academic Press: Cambridge, MA, USA, 2016; Chapter 6; pp. 97–115. [Google Scholar]
  34. Vermeulen, L.C.; Moles, R.J.; Collins, J.C.; Gray, A.; Sheikh, A.L.; Surugue, J.; Ranjit, E. Revision of the International Pharmaceutical Federation’s Basel Statements on the future of hospital pharmacy: From Basel to Bangkok. Am. J. Health Syst. Pharm. 2016, 73, 1077–1086. [Google Scholar] [CrossRef] [PubMed]
  35. Shanika, L.G.T.; Jayamanne, S.; Wijekoon, C.N.; Coombes, J.; Perera, D.; Mohamed, F.; Coombes, I.; De Silva, H.A.; Dawson, A.H. Ward-based clinical pharmacists and hospital readmission: A non-randomized controlled trial in Sri Lanka. Bull. World Health Organ. 2018, 96, 155–164. [Google Scholar] [CrossRef] [PubMed]
  36. Thirumagal, M.; Ahamedbari, M.A.R.; Samaranayake, N.R.; Wanigatunge, C.A. Pattern of medication errors among inpatients in a resource-limited hospital setting. Postgrad. Med. J. 2017, 93, 686–690. [Google Scholar] [CrossRef] [PubMed]
  37. Samaranayake, N.R.; Dabare, P.R.L.; Wanigatunge, C.A.; Cheung, B.M.Y. The Pattern of Abbreviation Use in Prescriptions: A Way Forward in Eliminating Error-Prone Abbreviations and Standardisation of Prescriptions. Curr. Drug Saf. 2014, 9, 34–42. [Google Scholar] [CrossRef] [PubMed]
  38. De Silva, K.I.M.; Sudeshika, S.H.T.; Gunawardhana, C.B.; Sakeena, M.H.F. Investigation of medication errors: A prescription survey from Sri Lanka. Trop. J. Pharm. Res. 2015, 14, 2115–2120. [Google Scholar] [CrossRef]
  39. Premadasa, S.P.K.; Siripala, U.G.S.; Samaranayake, N.R.; Wanigatunge, C.A. Appropriateness of medications in prescriptions of elderly patients in a selected area and in a selected government hospital [Abstract]. In Proceedings of the Annual Scientific Sessions 2015 of the Pharmaceutical Society of Sri Lanka, Colombo, Sri Lanka, 1 August 2015. [Google Scholar]
  40. Freeman, C.; Cottrell, W.N.; Kyle, G.; Williams, I.; Nissen, L. Integrating a pharmacist into the general practice environment: Opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s. BMC Health Serv. Res. 2012, 12, 229. [Google Scholar] [CrossRef]
  41. Benson, H.; Lucas, C.; Kmet, W.; Benrimoj, S.I.; Williams, K. Pharmacists in general practice: A focus on drug-related problems. Int. J. Clin. Pharm. 2018, 40, 566–572. [Google Scholar] [CrossRef]
  42. Weber, Z.A.; Skelley, J.; Sachdev, G.; Kliethermes, M.A.; Haydon-Greatting, S.; Patel, B.; Schmidt, S. Integration of pharmacists into team-based ambulatory care practice models. Am. J. Health Syst. Pharm. 2015, 72, 745–751. [Google Scholar] [CrossRef]
  43. Gilmer, A.; Sweeney, L.; Nakajima, S. Pharmacists’ role in a hospital’s initiative to become a certified primary stroke center. Am. J. Health Syst. Pharm. 2016, 73 (Suppl. 1), S1–S7. [Google Scholar] [CrossRef] [PubMed]
  44. Bubalo, J.; Clark, R.K., Jr.; Jiing, S.S.; Johnson, N.B.; Miller, K.A.; Clemens-Shipman, C.J.; Sweet, A.L. Medication adherence: Pharmacist perspective. J. Am. Pharm. Assoc. 2010, 50, 394–406. [Google Scholar] [CrossRef] [PubMed]
  45. Essack, S.; Bell, J.; Shephard, A. Community pharmacists-Leaders for antibiotic stewardship in respiratory tract infection. J. Clin. Pharm. Ther. 2018, 43, 302–307. [Google Scholar] [CrossRef] [PubMed]
  46. Emmerton, L.M.; Smith, L.; LeMay, K.S.; Krass, I.; Saini, B.; Bosnic-Anticevich, S.Z.; Reddel, H.K.; Burton, D.L.; Stewart, K.; Armour, C.L. Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia. BMC Health Serv. Res. 2012, 12, 164. [Google Scholar] [CrossRef] [PubMed]
  47. Westerlund, T.; Marklund, B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J. Clin. Pharm. Ther. 2009, 34, 319–327. [Google Scholar] [CrossRef] [PubMed]
  48. Lingenfelter, E.; Drapkin, Z.; Fritz, K.; Youngquist, S.; Madsen, T.; Fix, M. ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI. Am. J. Emerg. Med. 2016, 34, 1600–1603. [Google Scholar] [CrossRef] [PubMed]
  49. Laubscher, T.; Evans, C.; Blackburn, D.; Taylor, J.; McKay, S. Collaboration between family physicians and community pharmacists to enhance adherence to chronic medications: Opinions of Saskatchewan family physicians. Can. Fam. Physician 2009, 55, e69–e75. [Google Scholar]
  50. Wells, K.M.; Thornley, T.; Boyd, M.J.; Boardman, H.F. Views and experiences of community pharmacists and superintendent pharmacists regarding the New Medicine Service in England prior to implementation. Res. Social. Adm. Pharm. 2014, 10, 58–71. [Google Scholar] [CrossRef]
  51. Rathnakar, U.P.; Sharma, N.K.; Garg, R.; Unnikrishnan, B.; Gopalakrishna, H.N. A study on the sale of antimicrobial agents without prescriptions in pharmacies in an urban area in south India. J. Clin. Diag. Res. 2012, 6, 951–954. [Google Scholar]
  52. Hussain, A.; Ibrahim, M.I.M.; Malik, M. Assessment of disease management of acute respiratory tract infection at community pharmacies through simulated visits in Pakistan. Lat. Am. J. Pharm. 2012, 31, 1435–1440. [Google Scholar]
  53. Chang, J.; Ye, D.; Lv, B.; Jiang, M.; Zhu, S.; Yan, K.; Tian, Y.; Fang, Y. Sale of antibiotics without a prescription at community pharmacies in urban China: A multicentre cross-sectional survey. J. Antimicrob. Chemother. 2017, 72, 1235–1242. [Google Scholar] [CrossRef] [PubMed]
  54. Sakeena, M.H.F.; Bennett, A.A.; McLachlan, A.J. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: A systematic review. Int. J. Antimicrob. Agents 2018, 52, 771–782. [Google Scholar] [CrossRef] [PubMed]
  55. Rathish, D.; Bahini, S.; Sivakumar, T.; Thiranagama, T.; Abarajithan, T.; Wijerathne, B.; Jayasumana, C.; Siribaddana, S. Drug utilization, prescription errors and potential drug-drug interactions: An experience in rural Sri Lanka. BMC Pharmacol. Toxicol. 2016, 17, 27. [Google Scholar] [CrossRef] [PubMed]
  56. Manchanayake, M.G.C.A.; Bandara, G.R.W.S.K. Samaranayake, N.R. Patients’ ability to read and understand dosing instructions of their own medicines—A cross sectional study in a hospital and community pharmacy setting. BMC Health Serv. Res. 2018, 18, 425. [Google Scholar] [CrossRef] [PubMed]
  57. Athuraliya, N.; Walkom, E.J.; Dharmaratne, S.; Robertson, J. Assessing medication packaging and labelling appropriateness in Sri Lanka. J. Pharm. Policy Pract. 2016, 9, 38. [Google Scholar] [CrossRef] [PubMed]
  58. Smith, F. The quality of private pharmacy services in low and middle-income countries: A systematic review. Pharm. World Sci. 2009, 31, 351–361. [Google Scholar] [CrossRef]
  59. van Grootheest, K.; Olsson, S.; Couper, M.; de Jong-van den Berg, L. Pharmacists’ role in reporting adverse drug reactions in an international perspective. Pharmacoepidemiol. Drug Saf. 2004, 13, 457–464. [Google Scholar] [CrossRef]
  60. Gunawardena, S.; Ranganathan, S.S.; Fernandopulle, R. Pharmacovigilance through consumer feedback (reporting) in the mass treatment of lymphatic filariasis using diethylcarbamazine and albendazole in two districts of Sri Lanka. Trop. Med. Int. Health 2008, 13, 1153–1158. [Google Scholar] [CrossRef]
  61. Sakeena, M.H.F.; Bennett, A.A.; McLachlan, A.J. Enhancing pharmacists’ role in developing countries to overcome the challenge of antimicrobial resistance: A narrative review. Antimicrob. Resist. Infect. Control 2018, 7, 63. [Google Scholar] [CrossRef]
  62. National Medicines Regulatory Authority (NMRA) Colombo, Sri Lanka. Available online: http://nmra.gov.lk/index.php?option=com_content&view=article&id=87&Itemid=85&lang=en (accessed on 12 February 2019).
  63. Wolffers, I. Drug information and sale practices in some pharmacies of Colombo, Sri Lanka. Soc. Sci. Med. 1987, 25, 319–321. [Google Scholar] [CrossRef]
  64. Zawahir, S.; Lekamwasam, S.; Aslani, P. Antibiotic dispensing practice in Sri Lankan community pharmacies: A simulated client study. Res. Soc. Adm. Pharm. 2018, 15, 584–590. [Google Scholar] [CrossRef] [PubMed]
  65. Cooksey, J.A.; Knapp, K.K.; Walton, S.M.; Cultice, J.M. Challenges to the pharmacist profession from escalating pharmaceutical demand. Health Aff. (Millwood) 2002, 21, 182–188. [Google Scholar] [CrossRef] [PubMed]
  66. Milosavljevic, A.; Aspden, T.; Harrison, J. Community pharmacist-led interventions and their impact on patients’ medication adherence and other health outcomes: A systematic review. Intern. J. Pharm. Pract. 2018, 26, 387–397. [Google Scholar] [CrossRef] [PubMed]
  67. Khalil, V.; deClifford, J.M.; Lam, S.; Subramaniam, A. Implementation and evaluation of a collaborative clinical pharmacist’s medications reconciliation and charting service for admitted medical inpatients in a metropolitan hospital. J. Clin. Pharm. Ther. 2016, 41, 662–666. [Google Scholar] [CrossRef] [PubMed]
  68. Puspitasari, H.P.; Aslani, P.; Krass, I. Australian community pharmacists’ awareness and practice in supporting secondary prevention of cardiovascular disease. Int. J. Clin. Pharm. 2013, 35, 1218–1228. [Google Scholar] [CrossRef] [PubMed]
  69. Elliott, R.A.; Martinac, G.; Campbell, S.; Thorn, J.; Woodward, M.C. Pharmacist-led medication review to identify medication-related problems in older people referred to an aged care assessment team. Drugs Aging 2012, 29, 593–605. [Google Scholar] [CrossRef] [PubMed]
  70. Stafford, L.; Peterson, G.M.; Bereznicki, L.R.; Jackson, S.L.; van Tienen, E.C.; Angley, M.T.; Bajorek, B.V.; McLachlan, A.J.; Mullan, J.R.; Misan, G.M.; et al. Clinical outcomes of a collaborative, home-based postdischarge warfarin management service. Ann. Pharmacother. 2011, 45, 325–334. [Google Scholar] [CrossRef] [PubMed]
  71. Stone, M.C.; Williams, H.C. Clinical pharmacists in general practice: Value for patients and the practice of a new role. Br. J. Gen. Pract. 2015, 65, 262–263. [Google Scholar] [CrossRef]
  72. Rutter, P.; Brown, D.; Howard, J.; Randall, C. Pharmacists in Pharmacovigilance: Can Increased Diagnostic Opportunity in Community Settings Translate to Better Vigilance? Drug Saf. 2014, 37, 465–469. [Google Scholar] [CrossRef]
  73. Sneddon, J.; Gilchrist, M.; Wickens, H. Development of an expert professional curriculum for antimicrobial pharmacists in the, U.K. J. Antimicrob. Chemother. 2015, 70, 1277–1280. [Google Scholar] [CrossRef]
  74. Hirano, R.; Sakamoto, Y.; Kitazawa, J.; Yamamoto, S.; Tachibana, N. Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant Staphylococcus aureus infections: A single institution experience. Infect. Drug Resist. 2016, 9, 243–252. [Google Scholar] [CrossRef] [PubMed]
  75. Zhou, Y.; Ma, L.Y.; Zhao, X.; Tian, S.H.; Sun, L.Y.; Cui, Y.M. Impact of pharmacist intervention on antibiotic use and prophylactic antibiotic use in urology clean operations. J. Clin. Pharm. Ther. 2015, 40, 404–408. [Google Scholar] [CrossRef] [PubMed]
  76. Hale, A.; Coombes, I.; Stokes, J.; Aitken, S.; Clark, F.; Nissen, L. Patient satisfaction from two studies of collaborative doctor-pharmacist prescribing in Australia. Health Expect. 2016, 19, 49–61. [Google Scholar] [CrossRef] [PubMed]
  77. Sakeena, M.H.F.; Bennett, A.A.; Jamshed, S.; Mohamed, F.; Herath, D.R.; Gawarammana, I.; McLachlan, A.J. Investigating knowledge regarding antibiotics and antimicrobial resistance among pharmacy students in Sri Lankan universities. BMC Infect. Dis. 2018, 18, 209. [Google Scholar] [CrossRef] [PubMed]
  78. Salinitri, F.D.; O’Connell, M.B.; Garwood, C.L.; Lehr, V.T.; Abdallah, K. An Objective Structured Clinical Examination to Assess Problem-Based Learning. Am. J. Pharm. Educ. 2012, 76, 44. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  79. Plaza, C.M.; Lofgren, B.D.; Draugalis, J.R. Curricular Evaluation Using Clinical Practice Guidelines: A Hypothyroidism Exemplar. Am. J. Pharm. Educ. 2004, 68, 59. [Google Scholar] [CrossRef]
  80. Kolluru, S.; Lemke, T.L. An Assessment Model for Multidisciplinary, Team-Taught Integrated Pharmacy Courses. Am. J. Pharm. Educ. 2012, 76, 157. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  81. Sakeena, M.H.F.; Bennett, A.A.; Carter, S.J.; McLachlan, A.J. A comparative study regarding antibiotic consumption and knowledge of antimicrobial resistance among pharmacy students in Australia and Sri Lanka. PLoS ONE 2019, 14, e0213520. [Google Scholar] [CrossRef] [PubMed]
  82. Pharmacy Board of Australia. Available online: https://www.pharmacyboard.gov.au/accreditation.aspx (accessed on 15 January 2019).
Pharmacy 07 00054 g001 550
Figure 1. Expanded pharmacists’ role delivered through different pharmaceutical care services to provide optimum healthcare outcomes.
Figure 1. Expanded pharmacists’ role delivered through different pharmaceutical care services to provide optimum healthcare outcomes.
Pharmacy 07 00054 g001

Share and Cite

MDPI and ACS Style

Sakeena, M.H.F.; Bennett, A.A.; McLachlan, A.J. The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives. Pharmacy 2019, 7, 54. https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy7020054

AMA Style

Sakeena MHF, Bennett AA, McLachlan AJ. The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives. Pharmacy. 2019; 7(2):54. https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy7020054

Chicago/Turabian Style

Sakeena, M.H.F., Alexandra A. Bennett, and Andrew J. McLachlan. 2019. "The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives" Pharmacy 7, no. 2: 54. https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy7020054

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop