The Evolving Role of

the Pharmacist:
What Does It Mean And
Why Does It Matter?

Prof Dr. Zullies Ikawati, Apt

Fakultas Farmasi UGM

1
The Evolving Role of the Pharmacist

From a compounder To a provider of services and

and supplier of information for
pharmaceutical products customer-centered care
1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: © Pavel_Markevych/Shutterstock.com (L), © Syda Productions/Shutterstock.com (R) 2
What Does It Mean?

• Pharmacists have gone from the laboratory to behind the counter

• Now pharmacists must go beyond the counter to beside the customer

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: © Sibrikov Valery/Shutterstock.com (L), © Nestor Rizhniak/Shutterstock.com (R) 3
Why Does It Matter?

• Pharmacists are experts in medicines

• Pharmacists are an accessible and
trusted source of advice and treatment
• Pharmacist services and involvement in
customer-centered care improves health
outcomes
• Pharmacist providers can save the
healthcare system money

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: © FaysalFarhan/Shutterstock.com
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New Dimensions of Pharmacy Practice

Pharmaceutical care • Ensuring appropriate therapy and outcomes

Evidence-based care • Recommending clinically proven therapies

Customer-centered care • Tailoring care to individual customers

• Educating customers on prevention and lifestyle

Chronic customer care • Monitoring adherence and treatment outcomes

Self-medication • Providing guidance and advice

Quality assurance • Complying with good practice principles

Clinical pharmacy • Interacting with the healthcare team

Pharmacovigilance • Ensuring medicine safety

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1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Roles of the Pharmacist1,2

•Pharmacists must provide high-quality care that is integrated and continuous

Caregiver with the healthcare system

•Pharmacists must decide on the most appropriate, efficacious, and cost-

Decision maker effective use of resources

•Pharmacists provide a link between prescriber and customer and are a

Communicator health promoter to the public

•Pharmacists may lead multidisciplinary teams or areas where other

Leader healthcare providers are in short supply

•Pharmacists must effectively manage resources (human, physical, and

Manager fiscal) and information

Life-long learner •Pharmacists must commit to continuing professional education

•Pharmacists have a responsibility to assist with the education and training of

Teacher future pharmacists and the public

•Pharmacists can contribute to evidence base for rational medicine use by

Researcher documenting and sharing information

1.World Health Organization (WHO). The Role of the Pharmacist in the Health Care System. 1997. WHO/PHARM/97/599. Available at:
http://apps.who.int/medicinedocs/en/d/Js2214e/1.html#Js2214e.1. Accessed June 2018.
2.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006. 8
Collaborative Care

Collaborative care entails pharmacists, physicians, and other providers

using complementary skills, knowledge, and competencies and working
together to provide care to a common group of patients based on trust,
respect, and an understanding of each other’s skills and knowledge1

1.Adapted from the Canadian Medical Association. Putting patients first: Patient-Centered collaborative care: Discussion paper; July 2007.
Image source: © Seasontime/Shutterstock.com 9
Collaborative Care: Where Does the Pharmacist Come In?

• The pharmacist is the mediator between the physician or other healthcare

provider and the customer
Pharmacokinetic and
pharmacodynamic
knowledge
Pharmacist
Know customer’s
history, drug profile,
and lifestyle
Lab tests
Imaging
(CT, ultrasound,
etc.)
Physician Customer

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: ©.Stepan Kapl/Shutterstock.com 10
Pharmacists’ Role in Collaborative Care:
Pharmaceutical Guidance

• Talk to the customer,

Listen to the customer1,2
– Build a trusting relationship
– Listen to the customer’s problems and ailments
• Make therapeutic recommendations2
– Preventive measures
– Lifestyle modification
– Medication
• Advise on correct use of medication1
– Dosing, missed doses
– Importance of adherence
– Precautions, interactions, etc.

1.National Council on Patient Information and Education (NCPIE) Enhancing Prescription Medication Adherence: A National Action Plan. Available at:
www.intelecare.com/downloads/ncpie-adherence-report.pdf. Accessed June 2018.
2.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
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Image source: © mangostock/Shutterstock.com
Pharmacists’ Role in Collaborative Care:
Pharmaceutical Care

• Monitor adherence1
– Prescription refills
• Check success of treatment1,2
– Call customers to find out how they
are getting on
• Report any problems to the prescriber2
– Create an ongoing dialog with
local physicians

Always keep the physician and other healthcare providers in the picture 2

1.National Council on Patient Information and Education (NCPIE) Enhancing Prescription Medication Adherence: A National Action Plan. Available at:
www.intelecare.com/downloads/ncpie-adherence-report.pdf. Accessed June 2018.
2.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: © Monkey Business Images/Shutterstock.com 12
Pharmacists’ Role in Collaborative Care

• Pharmacists have an important part

in disease diagnosis and treatment

“Community pharmacists will have the most significant impact

on primary care over the next decade... The potential for pharmacists to fulfil a more
comprehensive role, working alongside GPs and other primary care colleagues, seems to
be absolutely phenomenal – and it’s an unexplored potential”1

1.Greater role for pharmacists suggested in early diagnosis of cancer. Pharm J. 2013;290:75.
Image source: ©.HconQ/Shutterstock.com 13
Effective Collaborative Care

• Good communication between pharmacists and other healthcare providers is

essential for effective collaborative care1
• Care plans must be implemented with the agreement of the customer and in
cooperation with other members of the healthcare team1
• Factors associated with successful collaboration include:
– Regular proactive communication (face-to-face or electronic)2
– Shared perspectives of professional roles and health goals2
– Trust and credibility established by consistent contributions to improve
customer care2,3

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
2.Rathbone AP, et al. BMJ Open. 2016;6:e010488.
3.Snyder ME, et al. Res Social Adm Pharm. 2010;6:304-23. 14
Case Example : Erectile Dysfunction …..

• More than half of men over 40 years of age have some degree of
erectile dysfunction

Some degree of erectile

48% dysfunction
52% No erectile dysfunction

1290 respondents from the Massachusetts Male Aging Study

1.Feldman HA, et al. J Urol. 1994;151:54-61. 15
…But Under-Reported

• Only one in five men with erectile

dysfunction discussed their problem
with their primary care physician1
– 74% were too embarrassed
– 12% thought it was a natural part
of aging
– 5% did not consider the problem
worthy of attention

1.Baldwin K, et al. Int J Impot Res. 2003;15:87-9.

Image source: © amasterphotographer/Shutterstock.com 16
Erectile Dysfunction Is Often Discussed with
Pharmacists First

• Erectile dysfunction is often first

discussed with a pharmacist or
trusted pharmacy technician1
– 60% of men first discussed
erectile dysfunction during a
pharmacy visit
• With appropriate training:
– Pharmacists know to refer for
further assessment in customers
with comorbidity or co-
medication2
Need competence in therapeutic
communication
1.Morales AM, et al. J Sex Med. 2010;7:3153-60.
2.Symonds T, et al. J Sex Med. 2011;8:1463-71.
Image source: © Minerva Studios/Shutterstock.com 17
KOMUNIKASI TERAPEUTIK =
Komunikasi yg menyembuhkan

Hadir dalam Mendengar

Empati
percakapan aktif
(1) HADIR DALAM PERCAKAPAN

Wajah Sikap tubuh Intonasi suara

• Mata lembut • Rileks • Lembut

• Ramah • Terbuka –
• senyum condong pada
klien
 (2) MENDENGAR AKTIF

Verbal
Memahami perilaku
/ komunikasi pasien
Non-verbal
(2) MENDENGAR AKTIF
Memahami bahasa verbal pasien

Mendengarkan dengan penuh

perhatian dan penuh penerimaan,
tanpa menyalahkan atau menghakimi
atas apa yang dipikirkan dan dirasakan
pasien.

Hindarkan komentar seperti:

“Itu salah Anda sih……”
“Andaikata anda tidak …. hal ini tidak
akan terjadi……..”
(2) MENDENGAR AKTIF
Memahami bahasa non verbal pasien

Ekspresi Wajah Perilaku Tubuh

makro kinetik: gerakan tubuh-
bibir, kerut dahi, alis, hidung, tangan-kaki-sikap tubuh
tatap mata dan kesesuaian
antara pandangan mata–bibir-
hidung
Reaksi Fisiologis
Suara Pupil melebar, nafas tersengal,
Intonasi suara, cara wajah merah – pucat,
bicara, jeda kata berkeringat
Penampilan
Cara berpakaian, sikap dalam duduk dan berdiri
 (3) MENDENGAR AKTIF
Memberikan respon

Verbal Non Verbal

•Respon-respon pendek •Anggukan kepala,

sebagai umpan •Menjaga kontak mata
•oh ya ? •Gerakan tangan
•He-em… , •Ekspresi disesuaikan
•lalu, dengan isi cerita
•Maksud Anda….,
•Begitu ya….Kemudian….
YANG HARUS DILAKUKAN SAAT MENDENGAR AKTIF

• Tunjukkan bahwa anda tertarik pada apa yang

dikemukakan (dipikir dan dirasa) pasien
• Bersikap hangat-supportif-empatik
• Nada bicara suara atau bicaranya tidak
menakutkan/ mengecam
• Memperhatikan komunikasi verbal-non verbal
klien
• Merefleksikan apa yang dirasakan dan dipikirkan
pasien
• Membantu pasien untuk mengungkapkan
emosinya dalam suasana aman
• Mendorong pasien untuk menemukan alternatif
pemecahan masalahnya

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Komunikasi Terapeutik
(3) KEMAMPUAN EMPATI

◦ Kemampuan utk menempatkan diri dlm pikiran &

perasaan pasien
◦ Melibatkan pada:
◦ Pikiran: memahami & mengerti pasien
◦ Perasaan: merasakan perasaan pasien
◦ Exp: Saya bisa memahami kesulitan Bapak…
◦ Mampu mendeskripsikan perasaan pasien
◦ Bersumber dari keprihatinan & belas kasih yg
diekspresikan secara verbal & non verbal
◦ Membuat pasien merasa tidak terancam & tidak takut
mengekspresikan diri

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Talking about Erectile Dysfunction
• Ensure confidentiality1
– Talk with men in a private area
– Avoid interruptions by staff
• Listen carefully, show an interest1
• Be positive: “Your erectile dysfunction can be improved”1
• Remain non-judgmental and empathetic1
• Tailor your style of questioning to the individual customer2
• Don’t rush: a well-structured interview need not be overly
time-consuming2
• Avoid information overload: use leaflets2
• If he has significant health problems, refer him to his physician2
Almost EVERYONE with erectile dysfunction can be treated 3
1.Berger B. Counselling the patient with erectile dysfunciton. Communication. 2002:7-10. Available at: https://www.pharmacistsmb.ca/files/2001/Nov-
Dec/Erectile_Dysfunction.pdf. Accessed August 2018.
2.MacLeod-Glover N. The patient interview: a self-study education module. Availalbe at:
http://www.ocpinfo.com/library/qa/download/Patient%20Interview.pdf. Accessed August 2018.
3.Hatzimouratidis K, et al. EAU 2016 guidelines on male sexual dysfunction. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Male-
Sexual-Dysfunction-2016-3.pdf. Accessed June 2018. 26
What can be offered …

• Offer:1
– To check his blood pressure or sell him a blood pressure monitor
– To check his blood sugar
• If you have it, offer him written information about using
PDE5 inhibitors to treat his erectile dysfunction, ensuring appropriate
information on other medications and warnings and precautions of use is also
provided2
• Stress the importance of obtaining medication from a reliable source1

PDE5, phosphodiesterase type 5

1.Hatzimouratidis K, et al. EAU 2016 guidelines on male sexual dysfunction. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Male-
Sexual-Dysfunction-2016-3.pdf. Accessed June 2018.
2.MacLeod-Glover N. The patient interview: a self-study education module. Availalbe at:
27
http://www.ocpinfo.com/library/qa/download/Patient%20Interview.pdf. Accessed August 2018.
Erectile Dysfunction:
Common Questions about Medication

• How long will it take to work?1

• How often can I take it?1
• Will it interact with my other medications?1
• What if it doesn’t work?1
• What are the side effects?1
• How much does it cost?1
• Is it safe to buy online?1

1.Viagra® FAQs. Available at: https://www.viagra.com/questions. Accessed August 2018. 28

Erectile Dysfunction:
Continuing Education and Training

• Pharmacists need to be trained in concepts underlying the diagnosis and

management of erectile dysfunction1
– Educate customers
– Encourage customers to seek further medical care
– Increase chance of early detection of comorbidities such as heart disease
• Continuing Professional Education2
– Keep up to date on new research
and technology
– Network with other healthcare providers

1.Morales AM, et al. J Sex Med. 2010;7:3153-60.

2.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006.
Image source: © CoraMax/Shutterstock.com 29
Collaborative Care: The Results

• A satisfied customer1
• Professional satisfaction2
• Public acknowledgment of pharmacists’ professional
ability1
• Recognition among other healthcare providers1
• Reduced healthcare budget1

1.Giberson S, et al. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office
of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.
2.Skowron A, et al. Pharm Pract (Internet). 2011;9:110-5. 31
Take-home messages

• Collaborative care is the future of pharmacy1

– Ensures the worth and future of the pharmacist
– Increases pharmacist responsibility and improves job satisfaction

1 Listen to the customer

2 Think what you should say
3 React: collaborate with physician

– Endorse your recommendations with a source of literature if possible

1.Mitrany D, Elder R. J Manag Care Pharm. 1999;5:487-491. 32

Summary

• The role of the pharmacist has evolved from a distributor of medicines to a

provider of customer-centered care1

• Pharmacists are an accessible and trusted source of advice and treatment1

• Pharmacists must talk to and listen to customers and advise on the correct
use of medicines1

• Pharmacists must adopt collaborative care and become an active member

of the healthcare team1

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006. 33
Question – Check your understanding

How is the role of the pharmacist changing?

A. Pharmacists direct involvement in distribution of medicines is increasing

B. Pharmacists must assume greater responsibility for the management of

drug therapies

C. Pharmacists contribution to public health education is decreasing

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Answer – Check your understanding

How is the role of the pharmacist changing?

A. Pharmacists direct involvement in distribution of medicines is increasing

B. Pharmacists must assume greater responsibility for the management of

drug therapies1

C. Pharmacists contribution to public health education is decreasing

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006. 35
Question – Check your understanding

Which of the following describes collaborative care?

A. The physician is the mediator between the pharmacist or other healthcare

provider and the customer

B. The pharmacist is the mediator between the physician or other healthcare

provider and the customer

C. The customer is the mediator between the physician or other healthcare

provider and the pharmacist

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Answer – Check your understanding

Which of the following describes collaborative care?

A. The physician is the mediator between the pharmacist or other healthcare

provider and the customer

B. The pharmacist is the mediator between the physician or other healthcare

provider and the customer1

C. The customer is the mediator between the physician or other healthcare

provider and the pharmacist

1.Wiedenmayer K, et al. Developing pharmacy practice – a focus on patient care. Handbook. The Hague: WHO & IPF; 2006. 37
Question – Check your understanding

TRUE or FALSE?

Almost EVERYONE with erectile dysfunction can be treated.

38
Answer – Check your understanding

TRUE or FALSE?

Almost EVERYONE with erectile dysfunction can be treated.1

1.Hatzimouratidis K, et al. EAU 2016 guidelines on male sexual dysfunction. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Male-
Sexual-Dysfunction-2016-3.pdf. Accessed June 2018. 39
Thank you for attention

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