Health Education And Community Pharmacy By Parmar Pdf Writer


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Clinical pharmacists: The major support to Indian healthcare system in near future

Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 16 November Published 23 March Volume Pages 99— Review by Single anonymous peer review. Editor who approved publication: Professor Jonathan Ling. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy.

There is a critical role for emergency contraception EC in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since In , ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods.

One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states.

In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores.

Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.

Keywords: pharmacist, community pharmacy, emergency contraception, levonorgestrel, ulipristal acetate, intrauterine device. Women and couples continue to experience unintended pregnancies at high rates. Such mishaps as these, in addition to contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy.

There is a critical role for emergency contraception EC in preventing unintended pregnancies. EC is any form of contraception, hormonal or nonhormonal, that prevents pregnancy after sexual intercourse.

Previously, there was a dedicated combination EC product and some combination oral contraceptives used in larger doses for EC, known as the Yuzpe regimen. The Yuzpe regimen fell out of favor, because it was less effective than methods available currently and was associated with increased adverse effects, such as nausea, vomiting, and breast tenderness. Notes: a Effectiveness results vary between studies. These values are approximate. To increase knowledge and use of EC, one strategy utilized has been expansion of access points for both prescription and nonprescription products to include pharmacies.

Direct access to prescription drugs from pharmacists is called pharmacist prescribing or pharmacy access. See explanations for the various models of access in Table 2. In eight states, pharmacists are able to prescribe and provide EC directly to women Table 3. This paper aims to review the role of the community pharmacist in EC counseling and delivery in the US.

Historical and current trends are reviewed, then future prospects and opportunities presented. Other possible mechanisms of action include thickening of cervical mucus and prevention of sperm transport. It took several years to overcome politically charged hurdles before approval was obtained in for OTC status for women and men aged 18 years and older with government-issued identification.

With the FDA approval of brand levonorgestrel for OTC sales for consumers aged 18 years and older, the medication itself was kept behind the pharmacy counter and required a visit to a pharmacy and an interaction with a pharmacy employee to purchase it.

In addition, government-issued photo identification was required to prove the age of the consumer. In , following a federal court case, the minimum age to obtain EC OTC was lowered from 18 to 17 years.

Ultimately, after another legal challenge, in the FDA removed the age restriction. See Figure 1 for a timeline of levonorgestrel EC. Figure 1 History of levonorgestrel EC. Data from 65 , Since this time, New Hampshire and Vermont have allowed their legislation to expire; however, the authority may be incorporated into future legislative proposals for pharmacist prescribing of hormonal contraceptives.

Pharmacist prescribing of EC enabled pharmacists who underwent additional training under individual collaborative or statewide protocols to prescribe and dispense EC directly to patients.

Studies examining availability of and access to EC through pharmacist prescribing have shown variable results and persistent barriers to access, in particular for adolescents. A study in California found that English- and Spanish-speaking adolescents who called pharmacies listed as participating in pharmacist prescribing of EC listings on www. While levonorgestrel EC pills have been available with a prescription for over 15 years, multiple studies have shown that physician knowledge and prescribing of EC is not ideal and there is an opportunity for pharmacists to fill the gaps.

Though pharmacists are accessible providers for patients seeking information and care regarding EC, some pharmacists also have knowledge deficits regarding levonorgestrel EC. Past reports in the media and medical literature have described pharmacists as uneducated regarding EC and unwilling to dispense or stock EC. Other literature has been published showing pharmacists as more educated and engaged in the provision of levonorgestrel EC.

Pharmacists as accessible health care providers should be knowledgeable regarding different methods of EC. Women presenting within hours of unprotected intercourse should be offered EC. Women with higher BMI should not be denied levonorgestrel or UPA EC, but should be made aware of the possible decrease in effectiveness and referred for optimal pregnancy prevention. This form of EC works as a progestin receptor antagonist, delaying or inhibiting ovulation when taken.

Given its different mechanism of action compared to levonorgestrel EC, its efficacy does not decrease with time. Therefore, it works equally well on day 1 after unprotected sex as it does on day 4. However, in there were significant UPA access issues when the sole US distributor discontinued this product. The manufacturer then partnered with a new distributor. Additionally, while the company did promote UPA to health care providers once it was readily available through the supply chain again, it is reasonable to assume that some providers and patients were or still are unaware that UPA is again available in pharmacies.

Ultimately, there are many factors that play into pharmacy-stocking practices, but lack of consumer demand for a product is likely a significant component. In a mystery caller study conducted in Hawaii in —, pharmacies were called and only 2. UPA remains prescription only, and seven states allow pharmacists to prescribe it under a collaborative practice agreement or statewide protocol. It is also available through several telemedicine providers and online pharmacies. This option is best for those who want to keep EC on hand for future use, rather than urgent use following an act of unprotected intercourse.

Lastly, studies have found that pharmacists may also benefit from additional training regarding UPA for EC. Contraception is effective immediately after IUD placement. The benefit of using this method of EC is the continued contraception, which lasts 10 years, although evidence suggests that copper IUDs are highly effective up to 12 years. There has been one study evaluating pregnancy rates after the use of levonorgestrel EC and concomitant placement of a levonorgestrel IUD following unprotected intercourse.

Various mechanisms of action have been suggested for the IUD. Prefertilization effects, including decreased sperm motility and viability, change in the speed of ovum transport, and damage or destruction of the ovum, are the likely mechanisms of the copper IUD.

A systematic review reported that copper IUDs are the most effective method of EC, with a failure rate of less than one per thousand. The costs of IUDs have been a barrier to their use, for both patients and providers. The ACA has eliminated these costs for many women. As the scope of practice for delivering clinical services expands for pharmacists, payment for the provision of these services must be received and models for payment sustainable. The concept of payment for chronic care-management services has been addressed by the Centers for Medicare and Medicaid Services, but clarity for EC services has not been provided.

Given that services for EC may not typically involve full medication review or comprehensive medication management , time-dependent reimbursement may be most appropriate. This time would include screening and counseling to identify the most appropriate EC method, instructing patients about the proper use of EC, and potential discussion of routine contraceptive methods.

Pharmacists must have the knowledge and confidence to provide information to patients regarding various methods of EC, their effectiveness, and how to use them properly. Studies have demonstrated gaps in pharmacist knowledge that may result in incorrect information or advice given to patients seeking EC.

These types of educational initiatives have the potential to reduce unintended pregnancies now and in the future. Additionally, advance provision of EC may increase timely use. Pharmacists should be educated to inform women and men of having EC available prior to occasions when sexual intercourse is unprotected or underprotected. EC can be purchased online for privacy and at low cost, but is not a viable option for immediate use. Furthermore, caution should be used with online purchases, as EC products may be fraudulent.

In a systematic review of 17 articles, any use of EC pills was found to be two to seven times greater among women who received an advance supply of EC pills. Since the late s, individual states have taken different paths to expand access to EC. Although access to oral EC has expanded in many ways, access remains restrictive in some areas.

Legislation to expand pharmacist-prescribing authorities in individual states can help increase access to both OTC and prescription EC products.

Legislation at the state level can ensure patient access is prioritized while respecting individual beliefs whenever possible. Community pharmacists can help promote IUD use for EC by providing accurate information, dispelling myths, such as increased risk of pelvic inflammatory disease associated with the no longer-available Dalkon Shield , and counseling about the risks and benefits. Pharmacists can further help by being familiar with local providers that can place IUDs in a timely manner.

The aforementioned UK pilot program, in which trained community pharmacists evaluated women for EC IUD eligibility and referred if appropriate nearly, tripled the uptake of this EC method. Given its safety, efficacy, and cost-effectiveness, the copper IUD should be included in all discussions of possible EC options if feasible and appropriate. See Table 4 for counseling points for EC. Use of EC is increasing over time, due to the wider availability and accessibility of EC methods.

Further, in eight states, pharmacists are able to prescribe and provide oral EC directly to women. Pharmacists play a critical role to access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and patient counseling. There are opportunities to expand access to EC in pharmacies further by implementing legislation expanding pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.

SR is on the clinical advisory board for Afaxys Inc.

Robin J. Harman - Handbook Of Pharmacy Health Education

Download this image for free in HD resolution the choice "download button" below. If you do not find the exact resolution you are looking for, then go for a native or higher resolution. If you are using mobile phone, you could also use menu drawer from browser. Whether it's Windows, Mac, iOs or Android, you will be able to download the images using download button. Pharmacy Books Pharmaceutical Microbiology Book. Health Education Community Pharmacy 2nd Pb Sushma Chaturvedi Neerja Suman.

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Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 16 November Published 23 March Volume Pages 99— Review by Single anonymous peer review. Editor who approved publication: Professor Jonathan Ling.

Clinical pharmacists: The major support to Indian healthcare system in near future

Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy PharmD study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services CPS and to introduce the role of clinical pharmacists CPs. After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system.

Pharmacy Technology and Practice View all 9 Articles. In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists CPs are strategically placed to tackle obesity by providing weight managements services WMS to general public. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS.

Robin J. Harman - Handbook Of Pharmacy Health Education

Fam Pract. Objective: To determine the direct financial impact for patients resulting from Medication Therapy Management MTM interventions made by community pharmacists.

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Handbook of pharmacy healthcare, diseases and patient advice, 2nd Edition: Robin J. Harman and Pamela Mason Eds. Each chapter considers an individual, distinct aspect of medical writing although wherever possible the chapters follow a similar structure. Handbook of Pharmacy Health Education 2nd Revised edition. Harman Editor. ISBN

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Author by : Robin J. Harman Languange : en Publisher by : Pharmaceutical Press Format Available : PDF, ePub, Mobi Total Read : 29 Total Download : File Size : 51,5 Mb Description : Reflecting the continuing changes in the skills required for successful pharmacy practice, and emphasising the need for a basic knowledge of both specific illnesses and of general health issues, the Handbook. Robin J. A new procedure eliminates the need for an incision, decreasing the time for the procedure and the recovery period. Handbook of Pharmacy Health Education: Amazon.

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