When used appropriately, formularies can help manage drug costs imposed on the insurance policy. [ 7 ]  However, for drugs that are not on formulary, patients must pay a larger percentage of the cost of the drug, sometimes 100%. Formularies vary between drug plans and differ in the breadth of drugs covered and costs of co-pay and  premiums . Most formularies cover at least one drug in each drug class, and encourage  generic  substitution (also known as a  preferred drug list ). [ 8 ]  Formularies have shown to cause issues in hospitals when patients are discharged when not aligned with outpatient drug insurance plans. [ 9 ]


In the UK, the  National Health Service  (NHS) provides  publicly funded   universal health care , financed by  national health insurance . Here, formularies exist to specify which drugs are available on the NHS. The two main reference sources providing this information are the  British National Formulary  ( BNF ) and the  Drug Tariff . There is a section in the Drug Tariff, known unofficially as the " Blacklist ", detailing medicines which are not to be prescribed under the NHS and must be paid for privately by the patient. Recommendations for additions to the NHS formulary are provided by the  National Institute for Health and Care Excellence . [ 10 ]


In addition to this, local  NHS hospital trusts  and  Primary Care  ( General Practitioners )  Clinical Commissioning Groups  (CCGs), produce their own lists of medicines deemed preferable for prescribing within their locality or organisation; such lists are usually a subset of the more comprehensive BNF. These formularies are not absolutely binding, and  physicians  may prescribe a non-formulary medicine if they consider it necessary and justifiable. Often, these local formularies are shared between a Primary Care Organisation (PCO) and hospitals within that PCO's jurisdiction, in order to facilitate the procedure of transferring a patient from  primary care  to  secondary care , thus causing fewer "interfacing" issues in the process.


As in the United States, the NHS actively encourages prescribing of generic drugs, in order to save more of the budget allocated to them by the  Department of Health .


A national formulary contains a list of medicines that are approved for  prescription  throughout the country, indicating which products are interchangeable. It includes key information on the composition, description, selection, prescribing, dispensing and administration of medicines. Those drugs considered less suitable for prescribing are clearly identified.


Examples of national formularies are:


Hirudiculture  is the culture, or  farming , of  leeches  in both natural and artificial environments.  This practice drew the attention of  Parisian  savants and members of the French Société Zoologique d'Acclimitation in the mid-to-late 19th century as a part of a larger interest in the culture of  fish  and  oysters . [ 1 ]   Leech culture was seen as a solution to growing demand for medicinal leeches throughout the world.


The use of leeches for medicinal purposes, or  hirudotherapy , has been revived by contemporary medicine. [ 2 ]


This  annelid -related article is a  stub . You can help Wikipedia by  expanding it .


This  agriculture  article is a  stub . You can help Wikipedia by  expanding it .


HOSPI  is a  hospital delivery robot  manufactured by  Panasonic . HOSPI service robots were originally developed to be used in healthcare amid Japan's rapidly aging society. [ 1 ]  It features  autonomous navigation  capabilities, which allows it navigate using onboard sensors instead of obtrusive rail systems or delineated routes. [ 1 ]


The HOSPI robot was launched in 2004. It was built to move autonomously through the pre-installed mapping information within them. It is installed with an on-board sensor and an advanced collision-avoidance system that helps it to move around avoiding obstacles, and stop if a person suddenly runs in front of it. [ 2 ]  At IREX in 2013, Panasonic introduced a new version of the robot and began to conduct  hospital  trials of it. Those trials were declared successful and Panasonic began to sell the robots. [ 3 ]


In January 2017, the Crowne Plaza ANA Narita hotel began using HOSPI robots primarily for serving drinks and clearing the tables. [ 4 ] [ 5 ] [ 6 ]   Panasonic also announced in the same year that there are four hospitals in Japan that use the HOSPI technology. [ 2 ]  In the same period,  Narita International Airport  also became the location of the first demonstration experiment of a HOSPI variant designed as an autonomous signage robot. [ 7 ]  This experiment is designed to evaluate the value of the signage robot in such a setting.


Capabilities


Hospi has security features that prevent theft, its contents from being stolen.


Hospi is able to deliver loads that are timely and loads that humans are incapable of carrying.


Hospi is programmed and equipped with sensors to efficiently and flexibly navigate a hospital layout. Hospi is able to do this also do this all autonomously


Real Implementation


Changi general hospital uses hospi as part of the hospitals’ porter management system


In 2017, Hospi was tested at a hotel call ANA Crowne Plaza Narita hotel and in Narita International Airport.


This robotics-related article is a  stub . You can help Wikipedia by  expanding it .


The  Human Medicines Regulations 2012   in the United Kingdom were created, under statutory authority of the  European Communities Act 1972  and the  Medicines Act 1968  in 2012. The body responsible for their upkeep is the  Medicines and Healthcare products Regulatory Agency . The regulations partially repealed the  Medicines Act 1968  in line with  EU  legislation. [ 1 ] [ 2 ] [ 3 ] [ 4 ]


In October 2020, the regulations were amended to expand the workforce eligible to administer COVID-19 vaccines, so enabling additional healthcare professionals to vaccinate the public.  This was a temporary provision, but in January 2022 it was announced that this would be made permanent as would the provision for community pharmacy contractors to provide COVID-19 and flu vaccines “away from their normal registered premises”. [ 5 ]


Regulation 174 provides an exemption to the requirement for authorisation of Regulation 46, allowing for the sale or supply of any medicinal product to be temporarily authorised by the licensing authority (MHRA) in response to the suspected or confirmed spread of pathogenic agents, toxins, chemical agents or nuclear radiation. [ 6 ]


Pharmaceutical marketing  is a branch of  marketing  science and practice focused on the  communication , differential  positioning  and commercialization of  pharmaceutical products , like specialist drugs,  biotech drugs  and  over-the-counter drugs . By extension, this definition is sometimes also used for marketing practices applied to  nutraceuticals  and  medical devices .


Whilst rule of law regulating  pharmaceutical industry  marketing activities is widely variable across the world, pharmaceutical marketing is usually strongly regulated by international and national agencies, like the  Food and Drug Administration  and the  European Medicines Agency . Local regulations from government or local pharmaceutical industry associations like  Pharmaceutical Research and Manufacturers of America  or  European Federation of Pharmaceutical Industries and Associations (EFPIA)  can further limit or specify allowed commercial practices.


Marketing to health-care providers takes three main forms: activity by pharmaceutical sales representatives, provision of drug samples, and sponsoring  continuing medical education  (CME). [ 1 ]  The use of gifts, including pens and coffee mugs embossed with pharmaceutical product names, has been prohibited by PHRMA ethics guidelines since 2008. [ 2 ] [ 3 ]
Of the 237,000 medical sites representing 680,000 physicians surveyed in SK&A's 2010 Physician Access survey, half said they prefer or require an appointment to see a rep (up from 38.5% preferring or requiring an appointment in 2008), while 23% won't see reps at all, according to the survey data.  Practices owned by hospitals or health systems are tougher to get into than private practices, since appointments have to go through headquarters, the survey found.
13.3% of offices with just one or two doctors won't see representatives, compared with a no-see rate of 42% at offices with 10 or more doctors.
The most accessible physicians for promotional purposes are allergists/immunologists – only 4.2% won't see reps at all – followed by orthopedic specialists (5.1%) and diabetes specialists (7.6%). Diagnostic radiologists are the most rigid about allowing details – 92.1% won't see reps – followed by pathologists and neuroradiologists, at 92.1% and 91.8%, respectively. [ 4 ]


E-detailing is widely used to reach "no see physicians"; approximately 23% of primary care physicians and 28% of specialists prefer computer-based e-detailing, according to survey findings reported in the 25 April 2011 edition of American Medical News (AMNews), published by the American Medical Association (AMA). [ 5 ]


The  Pharmaceutical Research and Manufacturers of America  (PhRMA) released updates to its voluntary Code on Interactions with Healthcare Professionals on 10 July 2008. The new guidelines took effect in January 2009. [ 6 ]


In addition to prohibiting small gifts and reminder items such as pens, notepads, staplers, clipboards, paperweights, pill boxes, etc., [ 6 ]  the revised Code:


Free samples have been shown to affect physician prescribing behavior.  Physicians with access to free samples are more likely to prescribe brand name medication over equivalent generic medications. [ 2 ]   Other studies found that free samples decreased the likelihood that physicians would follow the standard of care practices. [ 2 ]


Receiving pharmaceutical samples does not reduce prescription costs. Even after receiving samples, sample recipients remain disproportionately burdened by prescription costs. [ 7 ]


It is argued that a benefit to free samples is the "try it before you buy it" approach. Free samples give immediate access to the medication and the patient can begin treatment right away.  It also saves time from going to a pharmacy to get it filled before treatment begins. Since not all medications work for everyone, and many do not work the same way for each person, free samples allow patients to find which dose and brand of medication works best before having to spend money on a filled prescription at a  pharmacy . [ 7 ]


Hours spent by physicians in industry-supported  continuing medical education  (CME) is greater than that from either  medical schools  or professional societies. [ 2 ]


Currently, there are approximately 81,000  pharmaceutical sales representatives  in the United States [ 8 ]  pursuing some 830,000 pharmaceutical prescribers. A pharmaceutical representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200–300 physicians with 120–180 targets that should be visited in 1–2 or 3 week cycle.


Because of the large size of the pharmaceutical sales force, the organization, management, and measurement of effectiveness of the sales force are significant business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness. A few pharmaceutical companies have realized that training sales representatives on high science alone is not enough, especially when most products are similar in quality.  Thus, training sales representatives on relationship selling techniques in addition to medical science and product knowledge, can make a difference in sales force effectiveness.  Specialist physicians are relying more and more on specialty sales reps for product information, because they are more knowledgeable than primary care reps.


The United States has 81,000 pharmaceutical representatives or 1 for every 7.9 physicians. [ 2 ]  The number and persistence of pharmaceutical representatives has placed a burden on the time of physicians. [ 9 ]  "As the number of reps went up, the amount of time an average rep spent with doctors went down—so far down, that tactical scaling has spawned a strategic crisis.  Physicians no longer spend much time with sales reps, nor do they see this as a serious problem."


Marketers must decide on the appropriate size of a sales force needed to sell a particular portfolio of drugs to the target market. Factors influencing this decision are the optimal reach (how many physicians to see) and frequency (how often to see them) for each individual physician, how many patients with that disease state, how many sales representatives to devote to office and group practice and how many to devote to hospital accounts if needed. To aid this decision, customers are broken down into different classes according to their prescription behavior, patient population, their business potential, and event their personality traits. [ 1 ]


Marketers attempt to identify the set of physicians most likely to prescribe a given drug. Historically, this was done by drug reps 'on the ground' using zip code sales and engaging in recon to figure out who the high prescribers were in a particular sales territory.  However, in the mid-1990s the industry, through third-party prescribing data (e.g., Quintiles/IMS) switched to "script-tracking"  [ 10 ]  technologies, measuring the number of total prescriptions (TRx) and new prescriptions (NRx) per week that each physician writes. This information is collected by commercial vendors. The physicians are then "deciled" into ten groups based on their writing patterns. Higher deciles are more aggressively targeted. Some pharmaceutical companies use additional information such as:


Physicians are perhaps the most important component in sales. They write the prescriptions that determine which drugs will be used by people.  Influencing the physician is the key to pharmaceutical sales.  Historically, by a large pharmaceutical sales force. A medium-sized pharmaceutical company might have a sales force of 1000 representatives. [ citation needed ]   The largest companies have tens of thousands of representatives around the world. Sales representatives called upon physicians regularly, providing clinical information, approved journal articles, and free drug samples. This is still the approach today; however, economic pressures on the industry are causing pharmaceutical companies to rethink the traditional sales process to physicians. The industry has seen a large scale adoption of Pharma CRM systems that works on laptops and more recently  tablets . The new age pharmaceutical representative is armed with key data at his fingertips and tools to maximize the time spent with physicians.


Pharmaceutical and medical device companies have also paid physicians to use their drugs, which could affect how often a drug is prescribed. For example, one study that looked at physician payments and pimavanserin found that "extensive physician payments have been associated with increased pimavanserin prescription volume and Medicare expenditures." [ 12 ]


More specifically, drug reps help to create a culture of gifting, or the "pharmaceutical gift exchange," where actual monetary transactions are rare.  In reality, gifts, both large and small, ranging from cups of coffee to travel to medical conferences are exchanged on a routine basis with high prescribers in an effort to shift their obligations from patients to prescriptions and have proven effective. [ 13 ] [ 14 ]


Key opinion leaders (KOL), or "thought leaders", are respected individuals, such as prominent medical school faculty, who influence physicians through their professional status. Pharmaceutical companies generally engage key opinion leaders early in the drug development process to provide advocacy and key marketing feedback. [ 15 ]


Some pharmaceutical companies identify key opinion leaders through direct inquiry of physicians (primary research). Recently, pharmaceutical companies have begun to use  social network analysis  to uncover thought leaders; because it does not introduce respondent bias, which is commonly found in primary research; it can identify and map out the entire scientific community for a disease state; and it has greater compliance with state and federal regulations; because physician prescribing patterns are not used to create the social network. [ 16 ]


Physicians acquire information through informal contacts with their colleagues, including social events, professional affiliations, common hospital affiliations, and common medical school affiliations. Some pharmaceutical companies identify influential colleagues through commercially available prescription writing and patient level data. [ 17 ]
Doctor dinner meetings are an effective way for physicians to acquire educational information from respected peers and to influence the so-called "no-see" physicians - those that are reluctant to engage directly with pharmaceutical reps through detailing but may come to a dinner program where a local or national expert is talking. [ 18 ]   These meetings are sponsored by some pharmaceutical companies.


Legal cases and US congressional hearings have provided access to  pharmaceutical industry documents  revealing new marketing strategies for drugs. [ 19 ]   Activities once considered independent of promotional intent, including  continuing medical education  and  medical research , are used, including paying to publish articles about promoted drugs for the medical literature, and alleged suppression of unfavorable study results. [ 20 ]


Public and private insurers affect the writing of prescriptions by physicians through  formularies  that restrict the number and types of drugs that the insurer will cover. Not only can the insurer affect drug sales by including or excluding a particular drug from a formulary, they can affect sales by tiering, or placing bureaucratic hurdles to prescribing certain drugs. In January 2006, the United States instituted a new public prescription drug plan through its  Medicare  program. Known as  Medicare Part D , this program engages private insurers to negotiate with  pharmaceutical companies  for the placement of drugs on tiered formularies.


Only two countries as of 2008 allow  direct to consumer advertising  (DTCA): the United States and New Zealand. [ 21 ] [ 22 ] [ 2 ]  Since the late 1970s, DTCA of prescription drugs has become important in the United States. It takes two main forms: the promotion or creation of a disease out of a non-pathologic physical condition or the promotion of a medication. [ 2 ]  The rhetorical objective of direct-to-consumer advertising is to directly influence the patient-physician dialogue. [ 23 ]  Many patients will inquire about, or even demand a medication they have seen advertised on television. [ 21 ]  In the United States, recent years have seen an increase in mass media advertisements for pharmaceuticals.
Expenditures on direct-to-users advertising almost quadrupled in the seven years between 1997 and 2005 since the FDA changed the guidelines, from $1.1 billion in 1997 to more than $4.2 billion in 2005, a 19.6% annual increase, according to the United States  Government Accountability Office , 2006). [ 2 ]


The mass marketing to users of pharmaceuticals is banned in over 30 industrialized nations, but not in the US and  New Zealand , [ 21 ]  which is considering a ban. [ 24 ]  Some feel it is better to leave the decision wholly in the hands of medical professionals; others feel that users education and participation in health is useful, but users need independent, comparative information about drugs (not promotional information). [ 21 ] [ 24 ]  For these reasons, most countries impose limits on pharmaceutical mass marketing that are not placed on the marketing of other products. In some areas it is required that ads for drugs include a list of possible side effects, so that users are informed of both facets of a medicine.  Canada 's limitations on pharmaceutical advertising ensure that commercials that mention the name of a product cannot in any way describe what it does. Commercials that mention a medical problem cannot also mention the name of the product for sale; at most, they can direct the viewer to a website or telephone number operated by the pharmaceutical company.


Reynold Spector has provided examples of how positive and negative hype can affect perceptions of pharmaceuticals using examples of certain cancer drugs, such as  Avastin  and  Opdivo , in the former case and  statins  in the latter. [ 25 ]


In the United States, pharmaceutical companies often provide  drug coupons  to consumers to help offset the  copayments  charged by health insurers for prescription medication. These coupons are generally used to promote medications that compete with non-preferred products and cheaper, generic alternatives by reducing or eliminating the extra out-of-pocket costs that an insurers typically charge a patient for a non-preferred drug product. [ 26 ]  But sometimes coupons for brand-name drugs could potentially distort the market and leading to higher overall healthcare costs since they encourage the overuse of more expensive drugs over generic alternatives. Consumers often realize too late that the continued use of these drugs without coupons necessitates either switching to a cheaper generic or facing steep out-of-pocket expenses. [ 27 ]


Pharmaceutical company spending on marketing exceeds that spent on research. [ 28 ] [ 2 ]   In 2004 in Canada $1.7 billion a year was spent marketing drugs to physicians and in the United States $21 billion were spent in 2002. [ 29 ]   In 2005 money spent on pharmaceutical marketing in the United States was estimated at $29.9 billion with one estimate as high as $57 billion. [ 2 ]   When the US number are broken down 56% was free samples, 25% was detailing of physicians, 12.5% was direct to users advertising, 4% on hospital detailing, and 2% on journal ads. [ 29 ]  In the United States approximately $20 billion could be saved if generics were used instead of equivalent brand name products. [ 2 ]


Although pharmaceutical companies have made large investments in marketing their products, overall promotional spending has been decreasing over the last few years, and declined by 10 percent from 2009 to 2010. Pharmaceutical companies are cutting back mostly in detailing and sampling, while spending in mailings and print advertising grew since last year. [ 30 ]


In the European Union, marketing of pharmaceuticals is regulated by EU (formerly EEC)  Directive 92/28/EEC . [ 31 ]  Among other things, it requires member states to prohibit off-label marketing, and direct-to-consumer marketing of prescription-only medications.


In the United States, marketing and distribution of pharmaceuticals is regulated by the  Federal Food, Drug, and Cosmetic Act  and the  Prescription Drug Marketing Act , respectively.  Food and Drug Administration  (FDA) regulations require all prescription drug promotion to be truthful and not misleading, based on "substantial evidence or substantial clinical experience", to provide a "fair balance" between the risks and benefits of the promoted drug, and to maintain consistency with labeling approved by the FDA. The FDA Office of Prescription Drug Promotion enforces these requirements.


In the 1990s, antipsychotics were "still seen as treatments for the most serious mental illnesses, like hallucinatory schizophrenia, and recast them for much broader uses". Drugs such as  Abilify  and  Geodon  were given to a broad range of patients, from preschoolers to octogenarians. In 2010, more than a half-million youths took antipsychotic drugs, and one-quarter of nursing-home residents have used them. Yet the government warns that the drugs may be fatal to some older patients and have unknown effects on children. [ 32 ]


Every major company selling the drugs— Bristol-Myers Squibb ,  Eli Lilly ,  Pfizer ,  AstraZeneca , and  Johnson & Johnson —has either settled recent government cases, under the False Claims Act, for hundreds of millions of dollars or is currently under investigation for possible health care fraud. Following charges of illegal marketing, two of the settlements in 2009 set records for the largest criminal fines ever imposed on corporations. One involved Eli Lilly's antipsychotic  Zyprexa , and the other involved  Bextra . In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic,  Geodon ; Pfizer settled that part of the claim for $301 million, without admitting any wrongdoing. [ 32 ]


The following is a list of the four largest settlements reached with  pharmaceutical companies  from 1991 to 2012, rank ordered by the size of the total settlement. Legal claims against the pharmaceutical industry have varied widely over the past two decades, including  Medicare and Medicaid fraud ,  off-label  promotion, and inadequate manufacturing practices. [ 33 ] [ 34 ]


The emergence of new media and technologies in recent years is quickly changing the pharmaceutical marketing landscape in the United States. Both physicians and users are increasing their reliance on the Internet as a source of health and medical information, prompting pharmaceutical marketers to look at digital channels for opportunities to reach their target audiences. [ 39 ]


In 2008, 84% of U.S. physicians used the Internet and other technologies to access pharmaceutical, biotech or medical device information—a 20% increase from 2004. [ citation needed ]  At the same time, sales reps are finding it more difficult to get time with doctors for in-person details.  Pharmaceutical companies are exploring online marketing as an alternative way to reach physicians. Emerging e-promotional activities include live video detailing, online events, electronic sampling, and physician customer service portals such as PV Updates, MDLinx, Aptus Health (former Physicians Interactive), and  Epocrates .


Direct-to-users marketers are also recognizing the need to shift to digital channels as audiences become more fragmented and the number of access points for news, entertainment and information multiplies. Standard television, radio and print direct-to-users (DTC) advertisements are less relevant than in the past, and companies are beginning to focus more on  digital marketing  efforts like product websites,  online display advertising ,  search engine marketing ,  social media  campaigns, place-based media and  mobile advertising  to reach the over 145 million U.S. adults online for health information.


In 2010, the  FDA 's Division of Drug Marketing, Advertising and Communications issued a warning letter concerning two unbranded consumer targeted Web sites sponsored by  Novartis  Pharmaceuticals Corporation as the websites promoted a drug for an unapproved use, the websites failed to disclose the risks associated with the use of the drug and made unsubstantiated dosing claims. [ 40 ]


The  Medication Appropriateness Tool for Comorbid Health conditions during Dementia  ( MATCH-D )  criteria  supports clinicians to manage medication use specifically for people with  dementia  without focusing only on the management of the  dementia  itself. [ 1 ] [ 2 ]


The MATCH-D were developed by medical practitioners and pharmacists at Australian  Group of Eight Universities .  It was led by Dr Amy Theresa Page at the Western Australian Centre for Health and Ageing at the  University of Western Australia . The MATCH-D Criteria were developed through a consensus panel of experts using the  Delphi method . The criteria were originally published in the Internal Medicine Journal in 2016. [ 2 ]  The protocol explaining the rigorous methods used to develop the criteria were originally published in the  BMJ Open  in 2015. [ 3 ]  The systematic review that informed the criteria were published subsequently in 2018 and updated in 2022. [ 4 ]   [ 5 ]


The MATCH-D is presented in categories of recommendations for all stages of dementia, as well as divided into specific recommendations for early, mid and late-stage dementia. [ 6 ]  The recommendations are groups as: medication side effects, principles for medication use, medication review, treatment goals, preventative medications, symptom management, psycho-active medications and medications to modify dementia progression.


The MATCH-D attracted media attention as it was under development, and as it was released.  Page was interviewed on the ABC national radio's science show during its development. [ 7 ]  The health media picked up the story as soon as it was published. [ 8 ]


Respected organisations such as the British Geriatrics Society incorporated into their own medicines management guidelines. In New Zealand, the NZ Health Quality & Safety Commission have shared it in their communications. [ 9 ]


It is cited and promoted by influential professional bodies in many countries including:


- the British Geriatrics Society's End of Life Care in Frailty guidelines [ 10 ]


- New Zealand's Health Quality & Safety Commission's medication management work [ 11 ]   [ 12 ]


- Australia's Royal Australian College of General Practitioners (RACGP) aged care clinical guide known as the Silver Book [ 13 ]


- Australia's Pharmaceutical Society of Australia (PSA) Choosing Wisely series


- Australian Commission on Safety and Quality in Health Care  [ 14 ]


- Australian Deprescribing Network (ADeN)


- Australia's NPS MedicinesWise recommended it in their Medication Management Review Reports: Best practice recommendations program and Changed Behaviour in Dementia. [ 15 ] [ 16 ]


- New South Wales' Therapeutic Advisory Group (TAG)


Consumers considered the MATCH-D to be a useful tool for prompting and supporting conversations about their preferences for medication use. They would prefer that these conversations began as early as possible so that their treating health professionals knew their preferences. General practitioners, pharmacists and nurses stated they often felt less comfortable discussing these issues as they were concerned that it may cause distress to the consumer.  Health professionals and consumers alike thought that using the MATCH-D as a conversation starter could assist with these conversations. [ 17 ]


It is incorporated in to the TaperMD decision support tool and the PIMSPlus platform.  This incorporation has hastened the uptake of the criteria in both long term care facilities and community in Canada.


More than one-quarter of Australian consultant pharmacists state that they use the MATCH-D during Home Medicine Reviews. [ 18 ]  This figure is suggestive of high uptake given that most Home Medicine Reviews are most likely undertaken for people who are not living with dementia.


Translational research was undertaken with consumers, general practitioners, nurses and pharmacists to explore the enablers and barriers to using the MATCH-D in practice. [ 17 ]  This research showed the need for a website (since launched at  MATCH-D.com.au ), checklists (available at the website) and educational resources. These stakeholder roles have shown that there is a strong need for support and collaboration to improve medication use. [ 19 ]


Research at King's College London explored the hazards of suboptimal prescribing and polypharmacy in medicines use for people with dementia. They determined that each year there are globally up to 10 million people living with dementia require hospital treatment (emergency department or hospital admissions) related to medicines related harm for people with dementia. [ 20 ]   They concluded that, if the MATCH-D were successfully implemented that the relative hazards of medicines use for people with dementia would need to be re-evaluated.


The  National Health and Medical Research Council  (NHMRC) are currently funding a randomised controlled trial implementing the MATCH-D using pharmacists embedded in general practice. [ 21 ]


The Dementia Training Australia funding an interactive online education package for deprescribing in dementia centered around the MATCH-D. It was a joint collaboration between the University of Western Australia, University of Tasmania, La Trobe University, Monash University, Alfred Health and FireFilms. This education package launched in mid-2019. [ 22 ]  This online course is suitable for consumers and health professionals, with a target audience of nurses working in residential aged care facilities.  The training package was in the format of a documentary film, with its original developer, Dr Page featured as narrator and interviewer.  It includes simulated patient encounters and expert interviews, interspersed with interactive activities.


The MATCH-D and the training package by Dementia Training Australia have now been incorporated into undergraduate degrees for health professionals including the University of Tasmania's second year Bachelor of Nursing curriculum and Monash University's Bachelor of Pharmacy (Honours) curriculum.


A  medicine chest  is a container or  cabinet  for storing  medicine .  All  ships  governed by the  regulations  of the  International Maritime Organization  must have medical supplies and suitable storage for them such as  refrigeration  and  locks . [ 1 ]


In Canada medicine chest has a related, symbolic meaning. Under the terms of  Treaty 6  between the Canadian government and several bands of First Nations people ("Indians"), the government was required to supply each  Indian reserve  with a medicine chest. That has been interpreted as an ongoing responsibility for the government to provide  healthcare  to First Nations people. [ 2 ]


In  pharmaceutics ,  micromixing  is a process in which ingredient particles rearrange to form a  blend .  Development of  pharmaceutical formulations  requires understanding how the ingredients blend with each other and how the blending progresses through different stages.  It is also important to establish in a scientific manner when the blending is considered complete, establishing the margins of blending performance, so that in production the blending is complete before the blending process stops.


In order to achieve optimal  blending , the micromixing process must be studied to determine mixing parameters such as blending time, blending speed, type and size of blender.  When blending is performed too long, overblending may occur, with particles re-aggregating, resulting in segregation of the previously ideal blend. [ 1 ]


Formulation  scientists  and  technologists  need tools to select ingredients for new formulations.   Tablets  contain multiple ingredients beyond the active pharmaceutical ingredients (API) such as fillers, tableting agents,  disintegrants , and  absorption  enhancers or agents that slow down and control absorption.  Choice of materials is important to assure the flow characteristics, potency, and absorption of specific formulations.  In addition, proper particle size grades of the ingredients must be selected to produce an optimum blend for capsule filling.


In order to study the rate and uniformity of blending, destructive analytical methods, such as  dissolution  followed by  chromatographic   separation  and detection are often used.  These methods require samples to be pulled from the blend, followed by time-consuming laboratory analysis.  In production, such analysis delays may lengthen time required for production formulation development.


Near- infrared   hyperspectral imaging  can show the distribution of ingredients in pharmaceutical tablets.  In addition to  laboratory analysis , imaging of near line pull-samples has been used to indicate whether the mixing endpoint has been achieved.  However, such  measurements  were performed once blending was completed, and therefore, did not yield information about the progression of micromixing during the blending process. [ 2 ]


Nuclear pharmacy , also known as  radiopharmacy , involves preparation of  radioactive  materials for patient administration that will be used to diagnose and treat specific diseases in  nuclear medicine . It generally involves the practice of combining a  radionuclide tracer  with a pharmaceutical component that determines the biological localization in the patient. [ 1 ] [ 2 ]   Radiopharmaceuticals  are generally not designed to have a therapeutic effect themselves, but there is a risk to staff from  radiation exposure  and to patients from possible contamination in production. [ 3 ]  Due to these intersecting risks, nuclear pharmacy is a heavily regulated field. [ 4 ] [ 5 ]  The majority of diagnostic nuclear medicine investigations are performed using  technetium-99m . [ 6 ]


The concept of nuclear pharmacy was first described in 1960 by Captain William H. Briner while at the  National Institutes of Health  (NIH) in  Bethesda, Maryland . Along with Mr. Briner, John E. Christian, who was a professor in the School of Pharmacy at  Purdue University , had written articles and contributed in other ways to set the stage of nuclear pharmacy. William Briner started the NIH Radiopharmacy in 1958. [ 7 ] [ 8 ]  John Christian and William Briner were both active on key national committees responsible for the development, regulation and utilization of radiopharmaceuticals. A  technetium-99m generator  was commercially available, followed by the availability of a number of Tc-99m based radiopharmaceuticals.


In the  United States  nuclear pharmacy was the first  pharmacy  specialty established in 1978 by the  Board of Pharmacy Specialties . [ 9 ]


Various models of production exist internationally. Institutional nuclear pharmacy is typically operated through large  medical centers  or  hospitals  while commercial centralized nuclear pharmacies provide their services to subscriber hospitals. They prepare and dispense radiopharmaceuticals as unit  doses  that are then delivered to the subscriber hospital by nuclear pharmacy personnel.


A few basic steps are typically involved in technetium based preparations. First the active technetium is obtained from a  radionuclide generator  on site, which is then added to a non-radioactive kit containing the pharmaceutical component. Further steps may be required depending on the materials in question to ensure full  binding  of the two components. These procedures are usually carried out in a  clean room  or isolator to provide radiation shielding and sterile conditions. [ 10 ] [ 11 ]


For  Positron Emission Tomography  (PET),  Fludeoxyglucose ( 18 F)  is the most common radiopharmaceutical, with the radioactive component usually obtained from a cyclotron. [ 11 ]  The short half life of  Fluorine-18  and many other PET  isotopes  necessitates rapid production. PET radiopharmaceuticals are now often produced by automated computer controlled systems to reduce complexity and radiation doses to staff. [ 12 ]


Radiopharmacy is a heavily regulated field, as it combines several practices and fields which may come under the purview of multiple  regulators  and legislation. These include occupational exposure of staff to  ionising radiation , preparation of medicines, patient exposure to ionising radiation, transport of radioactive materials, and environmental exposure to ionising radiation. [ 13 ]  Different regulations may cover the various stages involved in radiopharmacies, ranging from production of "cold" (non-radioactive) kits, to the marketing and distribution of final products. [ 14 ]


Staff working in nuclear pharmacies require extensive training on aspects of  good manufacturing practice ,  radiation safety  concerns and  aseptic dispensing . In the  United States  an authorised nuclear pharmacist must be a fully qualified pharmacist with evidence of additional training and qualification in nuclear pharmacy practice. [ 15 ]  Several  European Union   directives  cover radiopharmaceuticals as a special group of medicines, reflecting the wide range of types of producers and staff groups that may be involved. [ 16 ]  In the UK qualified pharmacists may be involved along with clinical scientists or technologists, with relevant training. [ 17 ]


Nutraceutical  is a marketing term used to imply a  pharmaceutical  effect from a compound or food product that has not been scientifically confirmed or approved to have  clinical benefits . [ 1 ] [ 2 ]  In the United States, nutraceuticals are  considered and regulated as a subset of foods (such as  dietary supplements ) by the  Food and Drug Administration  (FDA). [ 3 ] [ 4 ] [ 5 ] [ 6 ]


There are no internationally defined properties of nutraceuticals. [ 2 ]  Due to the vague, undiscriminating evidence for the biological effects of nutraceutical products, experts have proposed abandoning the term. [ 1 ]  The word "nutraceutical" is a  portmanteau , blending the words "nutrition" and "pharmaceutical." [ 1 ]


Nutraceuticals are treated differently in different jurisdictions.


Under Canadian law, a nutraceutical can be marketed as either a food or a drug; the terms "nutraceutical" and "functional food" have no legal distinction, [ 7 ]  as both refer to "a product isolated or purified from foods that is generally sold in medicinal forms not usually associated with food [and] is demonstrated to have a physiological benefit or provide protection against chronic disease."


The term "nutraceutical" is not defined by the FDA. [ 8 ]  Depending on its ingredients and the claims with which it is marketed, a product is regulated as a drug,  dietary supplement , food ingredient, or food. [ 8 ]


In the global market, there are significant product quality issues. [ 1 ] [ 2 ]  Nutraceuticals from the international market may claim to use  organic  or  exotic  ingredients, yet the lack of regulation may compromise the safety and effectiveness of products. Companies looking to create a wide  profit margin  may create unregulated products overseas with low-quality or ineffective ingredients.


Nutraceuticals are products derived from food sources that are purported to provide extra health benefits, in addition to the basic nutritional value found in foods. Depending on the jurisdiction, products may claim to prevent  chronic diseases , improve health, delay the  aging  process, increase  life expectancy , or support the structure or function of the body. [ 7 ]


In the United States, the Dietary Supplement Health and Education Act (DSHEA) of 1994 defined the term "dietary supplement": "A  dietary supplement  is a product taken by mouth that contains a 'dietary ingredient' intended to supplement the diet. The 'dietary ingredients' in these products may include: [ 8 ]   vitamins ,  minerals ,  herbs  or other botanicals,  amino acids , and substances such as  enzymes , organ tissues, glandulars, and  metabolites . Dietary supplements can also be extracts or concentrates, and may be found in many forms such as  tablets , capsules, softgels,  gelcaps , liquids, or powders." [ 9 ]


Dietary supplements do not have to be approved by the FDA before marketing, but companies must register their manufacturing facilities with the FDA and follow current good manufacturing practices (cGMPs). [ 8 ]   With a few well-defined exceptions, dietary supplements may only be marketed to support the structure or function of the body, and may not claim to treat a disease or condition, and must include a label that says: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” The exceptions are when the FDA has reviewed and approved a health claim. In those situations the FDA also stipulates the exact wording allowed. [ 8 ]


Functional foods  are  fortified  or enriched during  processing  and then marketed as providing some benefit to consumers. Sometimes, additional complementary nutrients are added, such as  vitamin D  to milk.


Health Canada defines functional foods as "ordinary food that has components or ingredients added to give it a specific medical or  physiological  benefit, other than a purely nutritional effect." [ 10 ]  In Japan, all functional foods must meet three established requirements: foods should be (1) present in their naturally occurring form, rather than a capsule, tablet, or powder; (2) consumed in the diet as often as daily; and (3) should regulate a biological process in hopes of preventing or controlling disease. [ 11 ]


Nutraceuticals have been considered as possible adjuncts to therapies for clinical disorders. [ 12 ] [ 13 ]


The modern nutraceutical market developed in Japan during the 1980s. In contrast to the natural  herbs  and  spices  used as  folk medicine  for centuries throughout Asia, the nutraceutical industry grew alongside the expansion of modern technology in the early 21st century. [ 14 ]


The market for nutraceuticals is projected to grow to about 614 billion  euros  (approx. US$675 billion; 2023) by the year 2027. [ 15 ]


The word "nutraceutical" is a portmanteau of the words "nutrition" and " pharmaceutical ", coined in 1989 by Stephen L. DeFelice. [ 16 ]


Because nutraceuticals are unregulated, these supplements are sold by  marketing hype  rather than being based on actual  clinical evidence . [ 1 ] [ 8 ] [ 17 ]  There is no compelling evidence for efficacy in nutraceuticals. [ 1 ] [ 17 ]  After scientists disputed the benefits of nutraceuticals, such as  probiotics  in yogurt,  Danone  was forced to pay a large financial penalty for falsely claiming its products  Actimel  and Activia boosted the  immune system . [ 18 ]


Over-the-counter counseling  (or  OTC counseling ) refers to the counseling that a  pharmacist  may provide on the subject of initiating, modifying, or stopping an  over-the-counter  (OTC) drug product. [ 1 ]  OTC counseling requires an assessment of the patient's  self-care  concerns and drug-related needs. The types of drugs that are involved in OTC counseling are, for example, used to treat  self-diagnosable  conditions like heartburn, cough, and rashes, though  prescription drugs  and professional  diagnoses  are also relevant to the recommendation process. [ 1 ]


The aim of OTC counseling is to empower patients to take control of their healthcare-related needs for conditions that do not require an appointment with a  medical doctor . This benefits the healthcare system by reducing unnecessary physician visits. [ 2 ]  The pharmacist can also use OTC counseling to ensure the highest likelihood of success for the patient's self-care attempt and minimize the risk of any drug-related problems. [ 3 ]


Although OTC drugs are generally regarded as safe for use without a prescription (by definition), medication errors still occur. For example, patients sometimes misuse OTC products by taking larger than recommended doses, in order to bring about symptomatic relief more quickly, or even intentionally abuse them for unlabeled indications. [ 4 ]  Even when a patient is instructed not to use OTC products without speaking with their  primary care physician , patients can still fail to identify products as OTC medications worth avoiding. [ 5 ]


A pharmacist can use both  open-ended  questions (that start with the word  who ,  what ,  how ,  why  or  where ) as well as close-ended questions (that start with the word  will ,  can ,  do  or  did ) which are to be used only if the former do not get the appropriate response in order to obtain relevant information about a patient's potential needs for treatment or potential drug-therapy problems. [ 6 ]


Pharmacists ask patients about  comorbidities  to avoid any drug-disease state contraindications. [ 6 ]


Although OTC counseling does not necessarily involve the use of a formal framework, various frameworks have been proposed: [ 7 ] [ 8 ]


The QuEST approach has been described as both "short" and "systematic." [ 2 ]  It takes the form of the following: [ 2 ]


As above, with the following addition: [ 2 ]


The WWHAM method is not strict; there is no requirement that the OTC counseling follow the exact order of the mnemonic. [ 9 ]  It takes the form of the following: [ 7 ]


The ASMETHOD has been attributed to the London pharmacist, Derek Balon. [ 10 ]  It takes the form of the following: [ 10 ] [ 7 ]


The ENCORE method helps pharmacists focus intently on the patient's presenting symptoms while considering the appropriate OTC recommendation. It takes the form of the following: [ 11 ] [ 7 ]


For the selection of OTC proton-pump inhibitors (PPIs), pharmacists must first determine whether or not a patient is likely to benefit from self-care for the treatment of their  acid reflux  symptoms. Examples of exclusions to self-care treatment of acid-reflux symptoms include a positive family history of gastrointestinal cancers, since their symptoms may reflect a more serious, underlying condition, and patients that present with so-called "alarm symptoms," which require a prompt evaluation by a  diagnostician . [ 12 ]


The available PPIs labeled for OTC use varies by country. As of October 2015, in the United States, available OTC proton-pump inhibitors include  omeprazole ,  lansoprazole , and  esomeprazole , whereas the UK approves the OTC use of omeprazole, esomeprazole,  pantoprazole , and  rabeprazole . [ 12 ]


Whether or not pharmacists should be involved with selling dietary supplements, which are not approved for the treatment or prevention of any disease or disorder, is the subject of much ethical debate. However, a 2009 review of the literature found that the common perception was that pharmacists should be involved in the OTC counseling process for dietary supplements where dietary supplements are sold. [ 13 ]  As experts in drug therapies that cause vitamin depletion, there are several recommendations that pharmacists commonly make. For example, pharmacists sometimes advise patients on long-term  metformin  therapy to supplement with  vitamin B12  to treat or prevent diabetic  peripheral neuropathy . [ 14 ]


While there are currently no OTC medications available for the treatment of  cancer  in the United States, there are specific OTC recommendations that apply to cancer patients that do not apply to the general population. Even a common OTC medication like  acetaminophen  may pose a risk to cancer patients by masking the presence of fever, which is an important sign of a serious side effect of some  chemotherapy  regimens called  febrile neutropenia . [ 5 ]


During OTC counseling, pharmacists differentiate between self-care appropriate upper respiratory tract infections, like the  common cold , and potentially devastating infections like the  flu . [ 10 ]


Pharmacists can offer non-pharmacological,  behavioral counseling  for patients with  urinary incontinence . This includes teaching patients about the important behavioral interventions that can reduce their symptoms and improve quality of life. This can include recommending daily  Kegel exercises , and instructing patients on the proper technique. In addition, pharmacists can provide resources for patients to learn more about how to control their symptoms. In terms of medications, pharmacists can help patients identify medications that may be worsening or causing their urinary incontinence, or offer recommendations for prescription medications for patients to take to their physicians. [ 15 ]


OTC counseling patients about self-care and non-prescription drugs does not follow the same format as counseling for  prescription drugs . [ 6 ]  A pharmacist who counsels for a prescription drug can view a patient's profile, which includes their current list of concurrent medications and allergies to medications. However, an OTC counseling session may occur in the aisle of the store, forcing pharmacists to elicit the necessary information from patients directly. [ 6 ]


Pharmaceutical care  is a pharmacy practice model developed in the 1990s [ 1 ]  that describes patient-centered medication management services performed by pharmacists.


There are many definitions for "medication management service." The following definition was proposed in the 2012 textbook  Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management :


"Medication management services are the professional activities needed to meet the standard of care which ensures each patient's medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the medical condition being treated, that the medication is being effective and achieving the goals established, that the medication is safe for the patient in the presence of the co-morbidities and other medications the patient may be taking, and the patient is able and willing to take the medications as intended." [ 2 ]


Pharmaceutical care as a pharmacy practice model developed out of the need to re-professionalize pharmacy.


It is thought the first mention of pharmaceutical care came from Dr. Donald Brodie's 1973 lecture shared at The Ninth Annual  Rho Chi  Lecture in  Boston ,  MA ,  USA . [ 3 ]  Dr. Brodie defined pharmaceutical care as "the care a given patient requires and receives which assures safe and rational drug usage." It was then popularized in 1990 after the  American Journal of Health-System Pharmacy  (AJHP) published an article by Drs. Charles Hepler and Linda Strand entitled ‘ Opportunities and responsibilities in pharmaceutical care'. [ 1 ]


The concept was endorsed by  American Society of Health-System Pharmacists  (ASHP) and the  American Association of College of Pharmacy  (AACP) in 1991. [ 4 ] [ 5 ]  In 1992, the  American Pharmacists Association  (APhA) followed suit. [ 6 ]


In 1993, ASHP issued a statement in response to members seeking a standardized definition of pharmaceutical care. [ 7 ]  In this statement they defined pharmaceutical care as "the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life." [ 8 ]


In 1998, the textbook  Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management  was first published. [ 9 ]  This included a definition of pharmaceutical care informed by the research of Drs. Robert Cipolle, Linda Strand, and Peter Morley that spanned 5 years and involved 20 different community pharmacy practice sites and 54 practicing pharmacists. [ 9 ]


The  American Medical Association (AMA)  approved relevant reimbursement codes in 2004. [ 2 ]


In 2013, a European organization, the Pharmaceutical Care Network Europe (PCNE), created a new definition that could satisfy experts from a multitude of countries. After a review of existing definitions, a number of options were presented to the participants and in a one-day meeting consensus on a definition was reached: Pharmaceutical Care is the pharmacologist/pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes. [ 10 ] [ citation needed ]


"The philosophy of pharmaceutical care practice consists of:


A philosophy of practice is expected when working with medicine and nursing and is practiced by all health care professionals." [ 2 ]


The patient care process is a cognitive process in which the drug-related needs of patients are approached systematically and comprehensively.


"The patient care process, which must be consistent with the patient care processes of the other health care providers, consists of:


A principle of the patient care process is  patient-centeredness .


The patient care process was initially called the "Pharmacists Workup of Drug Therapy" and served as a means to document drug therapy decisions. [ 11 ]


"The practice management system includes all of the resources required to bring the service to the patient. Physical space, the appointment system, documentation, reporting, evaluation, payment for the service, and much more are included in the management of a service." [ 2 ]


The ultimate goal of pharmaceutical care (optimize medicines use and improving health outcomes) exists in all practice settings and in all cultures where medicines are used. It involves two major functions: identifying potential and manifest problems in the pharmacotherapy (drug therapy problems, or DTPs), and then resolving the problems and preventing the potential problems from becoming real for the patient and his therapy outcomes. This should preferably be done together with other health care professionals and the patient through a review of the medication (and diseases) and subsequent counselling and discussions. [ citation needed ]


Pharmaceutical ink  is an ingestible form of  water -based ink used on most medicine  pills  to indicate which drug it is, and/or how many  milligrams  the pill contains.


The first U.S. patent for pharmaceutical inks was filed on 28 June 1966, and its method involved  ethyl alcohol ,  shellac ,  titanium dioxide  and  propylene glycol .


Most pharmaceutical inks since the early 1990s eliminate ethyl alcohol in favour of faster ink drying times, and may include  methyl alcohol  and  isopropanol  in addition to the traditional ingredients titanium dioxide and propylene glycol.


Pharmacocybernetics  (also known as  pharma-cybernetics ,  cybernetic pharmacy  and  cyberpharmacy ) is an upcoming field that describes the science of supporting drugs and medications use through the application and evaluation of informatics and internet technologies, so as to improve the  pharmaceutical care  of patients. [ 1 ]  It is an interdisciplinary field that integrates the domains of  medicine  and  pharmacy ,  computer sciences  (informatics, cybernetics, interactive digital media, human-computer-environment interactions) and  psychological sciences  to design, develop, apply and evaluate technological innovations which improve drugs and medications management, as well as prevent or solve drug-related problems.


"Pharmaco" originates from the Greek word "pharmakon", which means drugs or poisons; [ 2 ]  while " cybernetics " originates from the Greek word "kubernetes", which means "the art of steering". [ 3 ]   Norbert Wiener  first defined cybernetics as the science or study of "control and communication in the animal and the machine". [ 3 ] [ 4 ]  Since then, the  American Society for Cybernetics  has further described this field as "the design or discovery and application of principles of regulation and communication". [ 4 ]


Cybernetics  has been applied to many fields, such as  anthropology ,  sociology ,  systems theory ,  psychology ,  biology ,  computer science  and  engineering . The defining characteristic of a cybernetic system is its relationship between endogenous goals and the external environment. [ 5 ]  In the 1970s, cybernetics was applied in healthcare as a means of setting positive outcome goals for patients who were not satisfied with their  plastic surgeries . [ 6 ]  The emergence of " new cybernetics " or " second-order cybernetics " further expanded this concept to include the interactions between cybernetic systems and the people interacting with them, as well as to society as a whole. [ 7 ]


Cybernetics also includes the concept of " cyberspace ", which is described by the science fiction author  William Gibson  as a virtual representation of information in varying states of accessibility that is linked to various people and organizations in his book  Neuromancer . [ 8 ] [ 9 ] [ 10 ]  This concept is also reiterated in the movie " The Matrix " and its sequels, which revolves around  Neo  ( Keanu Reeves ), a computer programmer, who lives in a simulated matrix world created by sentient machines but perceived by humans as reality. The term "cyberspace" is now used ubiquitously to describe anything that is associated with computers, informatics and internet technologies, and also user experiences through interactions with these technologies.


The increased popularity of informatics and internet technologies in healthcare has led to the development of various software, tools and applications for healthcare professionals and patients to improve pharmaceutical care and health-related outcomes.  Pharmacoinformatics  (or  pharmacy informatics ) is a field within  e-health  that targets drug-related problems through the use of informatics and internet technologies. [ 11 ]  Pharmacocybernetics goes one step further by merging the science of technology with human-computer-environment interactions, so that technological innovations can be designed, developed, applied and evaluated in relation to supporting medicines and drugs use, as well as to reduce or prevent drug-related problems. Pharmacocybernetic approaches target patient care and safety, and they take into account the flow of information and knowledge between users and cybernetic systems or the environment, the actions taken by users to achieve their goals, user interactivity, as well as feedback. [ 1 ]  This field requires clinical knowledge and experience, as well as advanced skills and expertise to deal with technologies and human-computer-environment interactions in relation to the management of medicines and drug therapies. [ 1 ]


Pharmaceutical care  involves the identification, solving and prevention of medication/drug-related problems with regards to patients' drug therapies. [ 12 ]  These problems are classified into various categories, which differ slightly between the American and European systems.


The  American Society of Health-System Pharmacists  classifies drug-related problems into eight major categories: [ 12 ]


The Pharmaceutical Care Network Europe classifies them by problems and causes: [ 13 ]


Classification by problems :


Classification by causes :


The rapid adoption of  cybermedicine  has led to several other associated medication/drug-related problems. [ 11 ]  These include:


Pharmacocybernetics approaches target the whole  digital healthcare  innovation cycle from identifying the healthcare problem, designing, developing, applying and evaluating the technological innovations that aim to address these drug-related problems. These technological innovations tend to be based on  user-centered ,  experience-centered  and  activity-centered  designs.


The types of environments that are relevant to pharmacocybernetics approaches follow  Urie Bronfenbrenner’s   Ecological Systems Theory . [ 1 ] [ 14 ]  These environments, when applied to healthcare (for example, when a patient with a chronic disease searches the internet for information regarding his drug therapy), are as follows:


Four pharmacocybernetic maxims have been defined for designers and developers of pharmaco-informatics tools and applications that provide information on medications and drug therapies. [ 1 ] [ 15 ] [ 16 ]  These design principles are in relation to:


Pharmacognosy  is the study of  crude drugs  obtained from  medicinal plants ,  animals ,  fungi , and other natural sources. [ 1 ]  The  American Society of Pharmacognosy  defines pharmacognosy as "the study of the physical, chemical,  biochemical , and biological properties of drugs, drug substances, or potential drugs or drug substances of natural origin as well as the  search for new drugs  from natural sources". [ 2 ]


The word "pharmacognosy" is derived from two  Greek  words:  φάρμακον ,  pharmakon  ( drug ), and  γνῶσις   gnosis  ( knowledge ) or the  Latin  verb  cognosco  ( con , 'with', and  gnōscō , 'know'; itself a  cognate  of the  Greek  verb  γι(γ)νώσκω ,  gi(g)nósko , meaning 'I know, perceive'), [ 3 ]  meaning 'to conceptualize' or 'to recognize'. [ 4 ]


The term "pharmacognosy" was used for the first time by the German physician  Johann Adam Schmidt  (1759–1809) in his published book  Lehrbuch der Materia Medica  in 1811, and by  Anotheus Seydler  in 1815, in his  Analecta Pharmacognostica .


Originally—during the 19th century and the beginning of the 20th century—"pharmacognosy" was used to define the branch of  medicine  or commodity sciences ( Warenkunde  in German) which deals with  drugs  in their crude, or unprepared form.  Crude drugs  are the dried, unprepared material of plant, animal or mineral origin, used for medicine. The study of these materials under the name  Pharmakognosie  was first developed in German-speaking areas of Europe, while other language areas often used the older term  materia medica  taken from the works of  Galen  and  Dioscorides . In German, the term  Drogenkunde  ("science of crude drugs") is also used synonymously.


As late as the beginning of the 20th century, the subject had developed mainly on the botanical side, being particularly concerned with the description and identification of drugs both in their whole state and in powder form. Such branches of pharmacognosy are still of fundamental importance, particularly for botanical products (widely available as dietary supplements in the U.S. and Canada), quality control purposes, pharmacopoeial protocols and related health regulatory frameworks. At the same time, development in other areas of research has enormously expanded the subject. The advent of the 21st century brought a renaissance of pharmacognosy, and its conventional botanical approach has been broadened up to molecular and  metabolomic  levels. [ 5 ]


In addition to the previously mentioned definition, the  American Society of Pharmacognosy  defines pharmacognosy as "the study of natural product molecules (typically secondary metabolites) that are useful for their medicinal, ecological, gustatory, or other functional properties." [ 6 ]  Similarly, the mission of the Pharmacognosy Institute at the University of Illinois at Chicago involves plant-based and plant-related health products for the benefit of human health. [ 7 ]  Other definitions are more encompassing, drawing on a broad spectrum of biological subjects, including  botany ,  ethnobotany ,  marine biology ,  microbiology ,  herbal medicine ,  chemistry ,  biotechnology ,  phytochemistry ,  pharmacology ,  pharmaceutics , clinical  pharmacy , and  pharmacy practice .


All plants produce  chemical compounds  as part of their normal  metabolic  activities. These  phytochemicals  are divided into (1)  primary metabolites  such as  sugars  and  fats , which are found in all plants; and (2)  secondary metabolites —compounds which are found in a smaller range of plants, serving more specific functions. [ 8 ]  For example, some secondary metabolites are  toxins  used by plants to  deter predation  and others are  pheromones  used to attract insects for  pollination . It is these secondary metabolites and pigments that can have therapeutic actions in humans and which can be refined to produce drugs—examples are  inulin  from the roots of  dahlias ,  quinine  from the  cinchona ,  THC  and  CBD  from the flowers of  cannabis ,  morphine  and  codeine  from the  poppy , and  digoxin  from the  foxglove . [ 8 ]


Plants synthesize a variety of  phytochemicals , but most are derivatives: [ 9 ]


A typical protocol to isolate a pure chemical agent from natural origin is  bioassay-guided fractionation , meaning step-by-step separation of extracted components based on differences in their physicochemical properties, and assessing the  biological activity , followed by next round of separation and assaying. Typically, such work is initiated after a given crude drug formulation (typically prepared by solvent extraction of the natural material) is deemed "active" in a particular  in vitro  assay. If the end-goal of the work at hand is to identify which one(s) of the scores or hundreds of compounds are responsible for the observed  in vitro  activity, the path to that end is fairly straightforward:


In vitro  activity does not necessarily translate to biological activity in humans or other living systems.


In the past, in some countries in  Asia  and Africa, up to 80% of the population may rely on  traditional medicine  (including  herbal medicine ) for primary health care. [ 10 ]  Native American cultures have also relied on traditional medicine such as ceremonial smoking of tobacco, potlatch ceremonies, and  herbalism , to name a few, prior to European colonization. [ 11 ]  Knowledge of traditional medicinal practices is disappearing in indigenous communities, particularly in the Amazon. [ 12 ] [ 13 ] [ 14 ]


With worldwide research into  pharmacology  as well as  medicine , traditional medicines or ancient herbal medicines are often translated into modern remedies, such as the anti-malarial group of drugs called  artemisinin  isolated from  Artemisia annua  herb, a herb that was known in Chinese medicine to treat fever. However, it was found that its plant extracts had  antimalarial  activity, leading to the Nobel Prize winning discovery of artemisinin. [ 15 ] [ 16 ]


Microscopic evaluation is essential for the initial identification of herbs, identifying small fragments of crude or powdered herbs, identifying  adulterants  (such as insects, animal feces, mold, fungi, etc.), and recognizing the plant by its characteristic tissue features. Techniques such as microscopic linear measurements, determination of leaf constants, and quantitative microscopy are also utilized in this evaluation. The determination of leaf constants includes stomatal number, stomatal index, vein islet number, vein termination number, and palisade ratio. [ 17 ]


The stomatal index is the percentage formed by the number of  stomata  divided by the total number of  epidermal cells , with each stoma being counted as one cell.


S
 .
 I
 .
 =

 S

 E
 +
 S

 ×
 100

 {\displaystyle S.I.={\frac {S}{E+S}}\times 100}


S.I. is the stomatal index


S is the number of stomata per unit area


E is the number of epidermal cells in the same unit area. [ 18 ]


Pharmacotoxicology  entails the study of the consequences of  toxic  exposure to  pharmaceutical   drugs  and agents in the  health care  field.  The field of pharmacotoxicology also involves the treatment and prevention of pharmaceutically induced  side effects . Pharmacotoxicology can be separated into two different categories:  pharmacodynamics  (the effects of a drug on an organism), and  pharmacokinetics  (the effects of the organism on the drug).


There are many mechanisms by which pharmaceutical drugs can have toxic implications. A very common mechanism is covalent binding of either the drug or its metabolites to specific enzymes or receptor in tissue-specific pathways that then will elicit toxic responses. Covalent binding can occur during both on-target and off-target situations and after  biotransformation .


On-target toxicity is also referred to as mechanism-based toxicity. This type of adverse effect that results from pharmaceutical drug exposure is commonly due to interactions of the drug with its intended target. In this case, both the therapeutic and toxic targets are the same. To avoid toxicity during treatment, many times the drug needs to be changed to target a different aspect of the illness or symptoms.  Statins  are an example of a drug class that can have toxic effects at the therapeutic target ( HMG CoA reductase ). [ 1 ]


Some pharmaceuticals can initiate allergic reactions, as in the case of  penicillins . In some people, administration of penicillin can induce production of specific antibodies and initiate an immune response. Activation of this response when unwarranted can cause severe health concerns and prevent proper immune system functioning. [ 1 ]  Immune responses to pharmaceutical exposure can be very common in accidental contamination events.  Tamoxifen , a  selective estrogen receptor modulator , has been shown to alter the humoral adaptive immune response in gilthead seabream. [ 2 ]  In this case, pharmaceuticals can produce adverse effects not only in humans, but also in organisms that are unintentionally exposed.


Adverse effects at targets other than those desired for pharmaceutical treatments often occur with drugs that are nonspecific. If a drug can bind to unexpected proteins, receptors, or enzymes that can alter different pathways other than those desired for treatment, severe downstream effects can develop. An example of this is the drug  eplerenone  (aldosterone receptor antagonist), which should increase aldosterone levels, but has shown to produce atrophy of the prostate. [ 3 ]


Bioactivation  is a crucial step in the activity of certain pharmaceuticals. Often, the parent form of the drug is not the active form and it needs to be metabolized in order to produce its therapeutic effects. In other cases, bioactivation is not necessarily needed for drugs to be active and can instead produce reactive intermediates that initiate stronger adverse effects than the original form of the drug. Bioactivation can occur through the action Phase I metabolic enzymes, such as  cytochrome P450  or  peroxidases . Reactive intermediates can cause a loss of function in some enzymatic pathways or can promote the production of  reactive oxygen species , both of which can increase stress levels and alter homeostasis.


Drug-drug interactions can occur when certain drugs are administered at the same time. Effects of this can be additive (outcome is greater than those of one individual drug), less than additive (therapeutic effects are less than those of one individual drug), or functional alterations (one drug changes how another is absorbed, distributed, and metabolized). [ 4 ]  Drug-drug interactions can be of serious concern for patients who are undergoing multi-drug therapies. [ 5 ]  Coadministration of  chloroquine , an anti-malaria drug, and statins for treatment of cardiovascular diseases has been shown to cause inhibition of  organic anion-transporting polypeptides  (OATPs) and lead to systemic statin exposure. [ 5 ]


There are many different pharmaceutical drugs that can produce adverse effects after biotransformation, interaction with alternate targets, or through drug-drug interactions. All pharmaceuticals can be toxic, depending on the dose. [ 6 ]


Acetaminophen  (APAP) is a very common drug used to treat pain. High doses of acetaminophen has been shown to produce severe  hepatotoxicity  after being biotransformed to produce reactive intermediates. Acetaminophen is metabolized by CYP2E1 to produce  NAPQI , which then causes significant oxidative stress due to increased  reactive oxygen species  (ROS). [ 7 ]  ROS can cause cellular damage in a multitude of ways, a few of which being DNA and mitochondrial damage and depletion of antioxidant enzymes such as  glutathione . In terms of drug-drug interactions, acetaminophen activates  CAR , a nuclear receptor involved in the production of metabolic enzymes, which increases the metabolism of other drugs. This could either cause reactive intermediates/drug activity to persist for longer than necessary, or the drug will be cleared quicker than normal and prevent any therapeutic actions from occurring. Ethanol induces CYP2E1 enzymes in the liver, which can lead to increased NAPQI formation in addition to that formed by acetaminophen. [ 7 ]


Aspirin is an  NSAID  used to treat inflammation and pain. Overdoses or treatments in conjunction with other NSAIDs can produce additive effects, which can lead to increased oxidative stress and ROS activity. Chronic exposure to aspirin can lead to CNS toxicity and eventually affect respiratory function. [ 8 ]


Anti-depressants have been prescribed since the 1950s, and their prevalence has significantly increased since then. There are many classes of anti-depressant pharmaceuticals, such as  selective serotonin reuptake inhibitors  (SSRIs),  monoamine oxidase inhibitors  (MAOIs), and  tricyclic anti-depressants . Many of these drugs, especially the SSRIs, function by blocking the metabolism or reuptake of neurotransmitters to treat depression and anxiety. Chronic exposure or overdose of these pharmaceuticals can lead to serotonin and CNS hyperexcitation, weight changes, and, in severe cases, suicide. [ 8 ]


Doxorubicin  is a very effective anti-cancer drug that causes congestive heart failure while treating tumors. [ 7 ]  Doxorubicin is an uncoupling agent in that it inhibits proper functioning of complex I of the electron transport chain in mitochondria. It then leads to the production of ROS and the inhibition of ATP production. Doxorubicin has been shown to be selectively toxic to cardiac tissue, although some toxicity has been seen in other tissues as well. [ 7 ]  Other anti-cancer drugs, such as  fluoropyrimidines  and  taxanes , are extremely effective at treating and reducing tumor proliferation, but have high incidences of cardiac arrhythmias and myocardial infarctions. [ 9 ]


The  Ghana Pharmacy Council  is a statutory regulatory body established by an Act of  Parliament of Ghana , the pharmacy Act, 1994(Act 489)Part IV of The Health Professions Regulatory Bodies Act, 2013 (Act 857). It is located in  Accra , the capital of  Ghana .Its core function is to secure public interest in the highest standards in the practice of  pharmacy [ 1 ]


The Vision of the Council is “To guarantee the highest levels of pharmaceutical care”. [ 2 ]  The Council’s Mission is “To secure the highest level of pharmaceutical care by ensuring competent pharmaceutical care providers who practice within agreed standards and are accessible to the whole population. In addition we shall collaborate with related local agencies and international pharmaceutical organizations to enhance our effectiveness and our contribution to rational drug use in the nation. This mission shall be carried out with dedication, integrity, and professionalism.” [ 3 ]


This article about  government  in  Ghana  is a  stub . You can help Wikipedia by  expanding it .


The  pharmacy management system , also known as the  pharmacy information system , is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.


These systems may be an independent technology for the pharmacy's use only, or in a hospital setting, pharmacies may be integrated within an inpatient hospital  computer physician order entry (CPOE)  system. [ 1 ]


Necessary actions for a basic, functioning pharmacy management system include a user interface, data entry and retention, and security limits to protect patient health information. [ 2 ] [ 3 ]  Pharmacy computer software is usually purchased ready-made or provided by a drug wholesaler as part of their service. Various pharmacy software  operating systems  are common place throughout the many practice settings. [ 4 ] [ 5 ] [ 6 ]


The pharmacy management system serves many purposes, including the safe and effective dispensing of pharmaceutical drugs. During the dispensing process, the system will prompt the  pharmacist  to verify the medication they have is for the correct patient and has the correct quantity, dosage, and information on the prescription label. Advanced pharmacy management systems offer  clinical decision support  and may be configured to alert the pharmacist to perform clinical interventions, such as an opportunity to offer verbal counseling if the patient's prescription requires additional education in the pharmacy.


Pharmacy management systems should also serve the pharmacist throughout the Pharmacists’ Patient Care Process, a cycle developed by the  Joint Commission of Pharmacy Practitioners (JCPP) . The process details the steps pharmacists take to practice tangible, proven care to their patients.


The JCPP's pharmacist patient care process consists of five steps:  collect ,  assess ,  plan ,  implement , and  follow-up. [ 7 ]  Ideally, the pharmacy management system assists with each of these practices. The pharmacy system should  Collect  data at intake and continue to store and organize information as the pharmacist learns more about the patient's medications, their history, goals, and other factors that may affect their health. The technology within the pharmacy information system should allow the pharmacists to  Assess  the collected information to form a  Plan  and  Implement  creative strategies that address the patient's issues. After implementing a plan, the pharmacist should routinely  Follow-Up  with the patient and make adjustments as needed to further progress.


Outpatient  pharmacies typically are retail pharmacies that offer patient care services outside of hospitals and treatment facilities. Outpatient pharmacies, also known as community pharmacies or independent pharmacies, offer care in the form of  medication therapy management (MTM) , patient education, and clinical services.


Developed in Florida in 1980, Rx30 is a multi-platform software that offers automated pharmacy processes, vendor integrations, and compounding functionality. [ 8 ]  The Core Services include Accounts Receivable, Point of Sale, and Virtual Pharmacist, a feature that automates the refill process. On October 6, 2016, Rx30 announced its merger with Computer-Rx. [ 9 ]


Inpatient  pharmacies operate within hospitals and dispense medications to admitted patients receiving treatment. Inpatient pharmacists manage patient health alongside doctors and nurses, and the pharmacy management system must integrate with the various systems operating throughout the hospital to maintain accurate Electronic Medical or Health Records (EMR, EHR).


Epic , named for the long-form poems chronicling hero's lives, began in 1979 by founder  Judith R. Faulkner . Epic software currently manages over 200 million patient electronic records. The Willow Inpatient Pharmacy System, when combined with other Epic systems, allows pharmacies access to  medical administration records (MAR)  and links all aspects of the ordering and dispensing process to simplify collaboration amongst all parties involved in patient care management. [ 10 ]


Cerner Corporation  has provided  health information technology (HIT)  to hospitals and healthcare systems since 1979. Cerner PharmNet enables pharmacists to automate their workflow processes and center care around the patient, not the encounter. This software allows pharmacists and doctors to manage prescriptions and verification from the same order in order to streamline medication management. [ 11 ]


Datascan was started back in 1981 by Alex Minassian focused on providing pharmacy management software to independently owned community pharmacies.  Initially, Datascan modified the code it had purchased and began selling its DOS based version of the software.  In the early 2000's Winpharm was written and released as an updated Windows version of the software, which continued the ability to quickly fill prescriptions using only the keyboard as part of the fill screen. Back in 2009, Kevin Minassian stepped in to purchase Datascan.  Today, over 40 years later, Datascan continues to serve the needs of independent pharmacies nationwide with a focus on technology and support.   [ 12 ]   [ 13 ]


Pharmacy practice research , also known as  pharmacy research , is a specialty field within the wider area of  health services research , which focuses on examining how and why people access  pharmacy  services, how much care costs, and what happens to patients as a result of this care. Its aim is to support  evidence-based policy  and practice decisions where  pharmacists  are employed or  medicines  are prescribed or used. [ 1 ] [ 2 ] [ 3 ]


The goals of pharmacy practice research are to support the clinical and effective use of  medicines , while ensuring that the risks of  adverse drug reactions  are minimised. It is generally concerned with the delivery of and equitable access to  pharmaceutical care  and other services delivered by pharmacists and related  health care providers . It is undertaken by researchers, often based in universities, from a wide range of health care disciplines. These may include  multidisciplinary  groups of pharmacists together with  statisticians , physicians, nurses, health psychologists,  social scientists ,  health economists  and  epidemiologists , among others. [ citation needed ]


Areas of pharmacy research may include, for example: [ 4 ]


The approaches taken in pharmacy research can be summarised under the broad areas of understanding and describing the way care is accessed and delivered, identifying areas for improvement and evaluating new service models using rigorous research approaches. [ citation needed ]


Pharmacy practice research often challenges traditional  professional boundaries , reflecting the shift in the balance of care currently observed in health care delivery. [ citation needed ]   For example, many conditions that were once primarily managed solely in a hospital setting are now managed in  primary care  settings, and many roles particularly delivered by doctors are now being delivered by other health care professionals including pharmacists. Pharmacy research aims to understand the clinical, humanistic and economic impact of these changes from the perspectives of pharmacists, patients and other health care professionals.


Findings from pharmacy practice research have supported  health policy  changes affecting pharmacy. In some instances they have been the driver for a new service to be delivered through pharmacy, such as smoking cessation or repeat dispensing. [ 5 ] [ 6 ]  In other instances they have provided evidence to underpin a policy change (e.g. pharmacist prescribing) or to evaluate a newly implemented initiative and make recommendations for continuation or change of the service (e.g. new Community Pharmacy Contractual Framework, [ 7 ]  Medicine Use Reviews, [ 8 ]  or New Medicines Service [ 9 ] ).


A  pharmacy technician (PhT)  performs  pharmacy -related functions including but not limited to filling out  prescription medications . Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in some countries regionally as well as by employer. [ 1 ]


Pharmacy technicians are healthcare professionals trained in the technical aspects of supplying medicines and medical devices to patients since the 1950s. Pharmacy technicians work in a variety of locations (usually in community, retail, and hospital pharmacies), but can also work for long-term care facilities, pharmaceutical manufacturers, third-party  insurance  companies, computer software companies, in government, the military, or in teaching. Job responsibilities often include dispensing  prescription drugs  and other  medical devices  to patients and instructing them on their use. They may also perform administrative duties in a pharmaceutical practice, such as reviewing prescription requests with medical practices and insurance companies to ensure correct medications are provided and payment is received. Additionally, pharmacy technicians handle inventory related tasks such as  cycle counts  and returning expired and damaged medications back to the manufacturers. [ 2 ] [ 3 ] [ 4 ]  Pharmacy technicians may take on the role of compounding supervisor, overseeing day to day sterile and non-sterile medicines preparation while meeting standards required by regulatory bodies. [ citation needed ]


In recent times, pharmacy technicians also speak directly with the patients on the phone to aid in the awareness of taking medications on time. In many countries, the relative importance of pharmacy technicians within the pharmacy workforce has been amplified in recent years, largely as a reaction to pharmacist shortages, resulting in an increase in their numbers and responsibilities. [ 5 ] [ 6 ] [ 4 ]


The  Pharmacy Examining Board of Canada  administers the Pharmacy Technician Qualifying Examination. Pharmacy technicians are required to be registered with a provincial or a national regulatory body or council. In provinces and jurisdictions where pharmacy technician is a regulated occupation,  liability insurance  is required to practice. [ 7 ] [ 8 ]


According to a 2007 profile of the pharmacy technician workforce, 43% of technicians work in hospitals and other related facilities, 37% in chain or franchise community pharmacies, and 16% in independent community pharmacies. [ 9 ]  Most (62%) obtained pharmacy technician training from a career college or community college, some (16%) had only a high school education and no formal pharmacy training, while about 20% had some university education. A very small proportion (2%) had trained and worked abroad as either pharmacists or pharmacy technicians. [ 10 ]  The wide range of technical training and educational attainment likely reflects in part the variety of training programs for pharmacy technicians currently available in the different provinces and territories of the country. [ 9 ]  Accredited pharmacy technician diplomas, certificates and college programs are offered in the Ontario, Alberta, British Columbia, Nova Scotia, Manitoba, Saskatchewan and New Brunswick. [ 11 ]  The Canadian Association of Pharmacy Technicians is a professional organization of pharmacy technicians in Canada.


According to the German Statistisches Bundesamt, 66,867 pharmacy technicians ("Pharmazeutisch-technische Assistenten") were working in 2011. About 90% were working as employees in community pharmacies. Their salary (approx. 1,837 – 2,400 Euros) is part of agreements between employers associations and  Adexa .


Pharmacy technicians are known as assistant pharmacists. Several universities offer programs of three and half years of education and training. This occupation appeared due to the lack of pharmacists in Saudi Arabia in 1990, a reason they are commonly confused with pharmacists. Pharmacy regency technicians are regulated and monitored by the  Saudi Commission for Health Specialties .


According to the MOH Statistics, there were about 8,471 of pharmacy technicians working in MOH Saudi Arabia 2015.


In 2010, the Minister of Health, Abdullah Al-Rabiah, issued a decision to stop the teaching of pharmacy technicians immediately.


In Sri Lanka, the government agency National Apprentices and Industrial Training Authority (NAITA) has developed National Competency Standards (NCS) leading to the award of the NVQ Level 4 certification as pharmacy technician for pharmacy employees who have above four years of experience. The NCS is approved by the  Tertiary and Vocational Education Commission  in 2016 and is presently being implemented.
The one-year training consists of subject areas in compounding, dispensing, stock management, housekeeping practices and customer care development. The first batch of 154 certified pharmacy technicians are already employed in the community pharmacy sector. [ clarification needed ]


In 2009, a  World Health Organization  assessment identified a total of 918 practising pharmacy technicians or technologists (1 per 25,600 residents) and 1,642 medicine counter assistants (1 per 14,300 residents).


In regards to training, the assessment identified only one pharmacy technologist training school in the country (enrolling 70 students in the Higher National Diploma program). [ 12 ]


R.C.S.M. Govt Medical College and CPR Hospital, Kolhapur  provides training for pharmacy technicians in India. To be a pharmacy technician, completion of this program is 10+2 or diploma. [ clarification needed ]  There are two batches a year that intakes approximately 40 students per batch.


Pharmacy technicians in Nigeria make up 75% of pharmaceutical work force.  Pharmacists Council of Nigeria  refused to allocate responsibilities that will give them right to practice at community level interdependently. The case was in court and the court ruled against PCN on December 3, 2008.


Nigerian pharmacy technicians in collaboration with  National Board for Technical Education  (NBTE) are currently saving Nigerian Economy and Nigerians from the professional monopoly played by PCN which led to abundant fake drugs due lack of manpower. This exposed Nigerian to a lot of problems which lead reduction in productivity leading to sustainable poverty.
Nigerian pharmacy technicians in collaboration with NBTE are able to achieve these by introducing ND/HND in pharmaceutical technology. PCN is doing everything possible to stop this training to sustain its monopoly, demanding Federal ministry of education to direct NBTE to stop accrediting the polytechnics while these course are offered in Ghana, Sudan and other countries. The meeting called at the instance of NBTE on 25 May 2016 where the PCN, representative of the Honourable Minister of Health,  Federal Ministry of Education ,  Pharmaceutical Society of Nigeria  (PSN) and National Association of Pharmaceutical Technologists and Pharmacy Technicians of Nigeria were in attendance; certain issues bothering on the nomenclature Pharmaceutical Technologists, the curriculum and the accrediting body for polytechnic graduates of pharmaceutical Technology were raised. There it was made clear that the nomenclature (Pharmaceutical Technologist) is not new in Nigeria as the training of people bearing the name were trained at the former School of Pharmaceutical Technologists between 1981 and 1985. The premises of the school is being used as the liaison office of the PCN today. It was also established that NBTE is saddled with the accreditation of courses offered by Polytechnics and Monotechnics in the Federal Republic of Nigeria. As for the curriculum, findings revealed that NBTE is in line with the legal instrument that established the Board. Meanwhile, it was unanimously agreed that all relevant bodies should come together to review the complaints of the PCN.


Tanzania has two pharmacy technician schools: one is a public sector institution under the  Ministry of Health and Social Welfare  and accredited by  Muhimbili University of Health and Allied Sciences , and the other is affiliated with a  faith-based organization  located in Kilimanjaro which offers diploma training. [ citation needed ]  The practice of pharmacy technician is regulated by Pharmacy Council Tanzania, which enrolls and enlists them. In 2010, the country had 0.11 registered pharmacy technicians per 10,000 population. [ 13 ]


The main job duties of Tanzanian pharmacy technicians include dispensing, stock management, compounding, quantification of pharmaceutical formulations, and laboratory work. In some areas of the country facing acute  shortage of physicians  and other clinicians, pharmacy technicians have also been found prescribing medicine. [ 13 ]


In the UK, the title  Pharmacy Technician  is a protected title. A prospective technician has two pathways that must be completed. One must complete both a  General Pharmaceutical Council -recognised course  and  a  SVQ  competence qualification  or  an accredited combined qualification and course. [ 14 ]  A period of time of working as a trainee or student pharmacy technician is needed before final qualification and compulsory registration with GPhC (formerly the Royal Pharmaceutical Society of Great Britain) is required before commencing work as a pharmacy technician. The period of on-the-job training is usually done concurrently whilst completing the course and typically over a two-year period. Pharmacy technicians may counsel patients on their medication (under the supervision or direction of a pharmacist, though counselling is not one of the learning outcomes for pharmacy technician training) [ 15 ]  as well as general dispensing of prescriptions. In community pharmacy, it has been recognised that the role is difficult to distinguish from that of a dispensing assistant with an NVQ2 qualification. Additional training is available to qualified pharmacy technicians and can include accuracy checking of dispensed prescriptions (though there is no legal requirement that a person be qualified as a pharmacy technician before undertaking an accuracy checking course), medicines management (hospital or PCT), participation in the running of hospital clinics such as  anticoagulant  clinics, dosing  warfarin  patients under dose banding guidance, [ citation needed ]  or other duties traditionally done by pharmacists.


Training providers in the UK require a first degree subject, For example University of East Anglia requires
2:1 or above undergraduate degree in a Life Science, Biomedical Science, Sport Science or Healthcare subject, 4 GCSEs or equivalent in English Language, Mathematics, Biology and Chemistry with one A Level or equivalent in a Science subject. Under exceptional circumstances, experience in healthcare practice may contribute/compensate absent the above requirements. [ 16 ]


In the  National Health Service  (NHS) pharmacy technicians work under the direct supervision of a senior or specialist pharmacy technician and is accountable to the chief pharmacy technician or lead pharmacist even if not in a dispensary. Technicians work mainly in one of two areas,  hospital pharmacy  or  community pharmacy . [ 17 ]  Some also work in doctors' general practices and in  primary care trusts .


A pharmacy dispenser cannot call themselves or work as a pharmacy technician or register with the GPhC as one.


Pharmacy technicians in hospitals are graded on the same  Agenda for Change  banding as audiovisual technicians, dental nurses and theatre support workers. [ 18 ]  They start on a set percentage of a Band 4 (usually 75% – an average annual wage of £26,530  [ 19 ] ) as a trainee pharmacy technician completing 1,260 hours of clinical placement education moving on to Band 5 when newly qualified PhT and can work their way to a Band 8b in charge of a department/area. A Band 8b is the equivalent of a nurse lead/senior nurse manager in nursing or other head of department in the NHS. Although Band 8b is possible, a successful pharmacy technician can reasonably expect to reach Band 7a in the latter stage of his/her career, earning an average of £54,320. [ citation needed ]


Registered pharmacy technicians in the NHS may be responsible for the training and development of pharmacy support workers and pre-registration trainee pharmacy technicians. Further training and qualifications after initial registration enable them to perform this mentoring role. Pharmacy technicians in the UK (as with other countries e.g. Canada) are now referred to by some as professionals, although registered pharmacists are still considered experts in the pharmaceutical field and pharmacy technicians are subordinate to pharmacists. [ 20 ] [ 21 ]


A report was published by the  Pharmacists' Defence Association  in 2019 making proposals for the development of pharmacist and pharmacy technician roles and career frameworks symbiotically in community pharmacy. It also outlined various impediments and governance issues and called for these to be addressed. [ 21 ]  The Association of Pharmacy Technicians United Kingdom is a professional organisation for pharmacy technicians in the UK.