The Changing Face of

Pharmacies
By
Mar, 2013

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MAY LAWRENCE

As the world continues

to change demographically and socio-economically, new
patterns of healthcare needs have
developed. Consequently, the traditional paradigm of
pharmacies and the perception of pharmacists have
changed.
Pharmacies have become key players in promoting wellness, preventing disease and
contributing to disease management and medicine compliance, in close collaboration with
other healthcare professionals and institutions, such as doctors and hospitals. Pharmacies
also provide accurate and relevant healthcare information. This has seen community
pharmacists assume a new role as providers of patient care.

Evolution
The roots of the pharmacy profession can be traced back nearly 5,000 years ago to
prescriptions written by the ancient Sumerians, who lived in what is now called Iraq. The
art of apothecary then developed over the centuries. Apothecaries both diagnosed
illnesses and dispensed medication. Very often they encroached on the prerogatives of

physicians but they were not allowed to charge for their services only for the medicines
they supplied.
In 1240, Emperor Frederick II, German king and Roman emperor, made a significant
contribution to the history of pharmacy by issuing the Edict of Salerno, which separated the
roles of the physician and apothecary, giving rise to professional pharmacy. This legal
reform also fixed the prices of medicines, becoming the model for pharmacy regulatory
practice throughout Europe.
The 19th-century transformation of pharmacy from art to science accelerated in the 20th
century, along with remarkable advances in chemistry, medicine and pharmacy.
However, the role of pharmacies remained focused on the preparation and dispensing of
medicines. In the past 25 years, this has evolved, with pharmacy practice shifting from a
product focus to a patient-oriented profession providing care, advice and counseling.
This change has brought about the development of community pharmacies, particularly
in countries such as the US, UK, Canada, Australia, Germany, the Netherlands and Finland.

A new paradigm
Such community pharmacists play a much broader role than previously. They may also need
a different set of skills and attitudes to handle the many different functions they now need
to address. To describe the changing paradigm, the World Health Organization (WHO)
introduced the concept of the seven-star pharmacist, which was later taken up by the
International Pharmaceutical Federation (FIP) in 2000 in its policy statement on Good
Pharmacy Education Practice. The concept sees the roles of the pharmacist and their
functions as:
Caregiver: Pharmacists provide caring and high-quality personal services. They know what
kind of health issues their customers experience and individual lifestyle factors in order to
advise accordingly.
Decision-maker: Pharmacists must know the appropriate, efficacious, safe and costeffective methods of medication and support services in consultation with other health
experts, such as doctors and hospitals.
Communicator: The pharmacist is in an ideal position to provide a link between prescriber
and patient, and to communicate information on health and medicines to the public. He or
she must be knowledgeable and confident while interacting with other health professionals
and the public.
Manager: Consumers and patients today are increasingly exposed to a plethora of
medicines and health treatments through various media, ranging from packaging
information and media advertising to the internet. But information may not be entirely
accurate or complete. The pharmacist can be a tremendous source of help to manage
information properly and provide accurate information and advice.

 Life-long learner: New pharmaceutical and healthcare solutions and innovations are
expected to continuously penetrate the market. A good community pharmacist must learn
how to constantly keep knowledge and skills up to date throughout his or her career to be
professionally engaged with the community.
Teacher: The pharmacist has a responsibility to assist the education and training of future
generations of pharmacists and the public.
Leader: Where other healthcare providers are in short supply or nonexistent, the
pharmacist should assume a leadership position in the overall welfare of the patient and the
community. Leadership involves compassion and empathy as well as vision and the ability to
make decisions, communicate, and manage effectively.

International scenarios
Community pharmacies have been well received and recognized in various markets globally,
including the UK, US, Canada, Brazil, Germany and Australia. All these countries have
practiced the separation of prescription and dispensing for many years. Additionally, they
have had support and endorsement from their governments, including allocation of funding
in some cases.
Community pharmacies in the UK play a crucial role in primary care and public health. They
also help to deliver the UKs National Health Service (NHS) pharmaceutical services. In
some districts, patient hospital discharge information for high-risk patients is faxed to
community pharmacists who in turn visit the patients at home for medication reviews, liaise
with the GP practice, and monitor patients progress.
Like the UK pharmacists, Canadian pharmacists also work outside the realm of their own
pharmacies. Apart from providing regular care, they offer additional professional services
such as post-surgical and home care. They may also practice in primary healthcare teams,
long-term personal care homes, or specialize in areas such as geriatrics pharmacy.
In Australia, community pharmacies are represented by the Pharmacy Guild, which
negotiates the reimbursement contract with the Federal Government. The role of Australian
community pharmacists extends beyond dispensing to medication review and disease
management, and their services also embrace residential aged care and domiciliary settings.
The success of community pharmacies in Australia can be attributed to a
multidisciplinary approach, incorporating organizational, policy and educational
interventions.
Similarly in Germany, community pharmacists are supported by a central government body.
In 2003, a nationwide contract was signed with community pharmacy owners to remunerate
pharmacists for the provision of pharmaceutical services. Community pharmacists also have
a central role in the promotion of rational prescription and appropriate use of medicines.

Community pharmacies in Asia

In Asia, community pharmacies are far less formalized and organized than their western
counterparts. While the separation of prescription and dispensing is legislated in most
markets in Asia (except for Singapore, Hong Kong and Malaysia), community pharmacies
are not formally integrated with the public health system nor reimbursed for their services
by the government. Taiwan is the only market where the government has legislated to
release repeat prescriptions for chronic diseases to community pharmacies that are in
turn reimbursed for dispensing repeat prescriptions under the Bureau of National Health
Insurance system.
There is also a large degree of fragmentation as well as the dichotomy of modern and
traditional trade practices in Asia. For example, in Thailand, there are 30,000 pharmacies
that fall into three groups: 1) modern community pharmacies, which must have pharmacists
at all times; 2) old-fashioned drugstores that are operated by business people without
registered pharmacists; and 3) pharmacies run by traditional medicine professionals
providing traditional medicines. Seventy per cent of the market in Thailand is still made up
of traditional, non organized outlets and only 3% of modern community pharmacies are
chain stores. The concept of pharmaceutical care is accepted in Thailand but, unfortunately,
not supported universally across the country.
At the more extreme end of the spectrum is Vietnam. People there already recognize the
value of community pharmacies and it is common to seek medical advice from a pharmacy
rather than a doctor. This is due to limited government healthcare funding, putting state
hospitals under budgetary constraints and resulting in poor public healthcare services.
Pharmacies are thus used as primary health providers. There are 40,000 pharmacies
nationwide with the majority still independent traditional pharmacies. It will take some time
to modernize and organize these pharmacies to meet good pharmacy practices. For
instance, there is no proper distinction between ethical drugs (ETC) and over the
counter (OTC); and ethical drugs can often be purchased without prescriptions. Despite
a national government program to implement Good Pharmacy Practice (GPP),
an international standard for implementing quality patient care, the size and lack
of resources for implementing and enforcing the regulations have proved challenging.
The Malaysian Community Pharmacists Association and Malaysian Pharmaceutical Society
have been lobbying hard for a long time to have community pharmacies formally recognized
as part of the national healthcare system and for the right to dispense medicines. Currently,
there is no separation of prescription and dispensing private medical doctors are still
dispensing to patients 20 years after a Memorandum of Understanding was signed
between the Malaysian Medical Association (representing doctors) and the
Malaysian Pharmaceutical Society (representing pharmacists) to release the dispensing
of medicines to pharmacies.5 Legislation for separation will be a great boost to
the development of community pharmacies in Malaysia.

Drivers for regional growth

Undoubtedly, the establishment of community pharmacies has been more successful in

some markets than others and there are still many challenges to overcome to ensure a
sustainable community pharmacy model. Nonetheless, community pharmacies are, overall,
ideally placed to respond to consumer health needs, especially in disease management. It
has been documented and proven that community pharmacists have delivered successful
outcomes in chronic disease management. There have also been visible
successes, especially in Australia, in implementing healthcare programs such as
smoking cessation, weight and diabetes management.
While Asia still lags behind the development in western countries, opportunities are
immense. Zuellig Pharma believes that there are four key factors that will shape the future
of community pharmacies in Asia.
1. Aging population and extended life expectancy
In 2000, the average age in Asia was 29 but it is predicted that by 2050, this will have
increased to 40. There will be a dramatic shift in the population of children and the elderly.
(Figure 2) Southeast Asia is the furthest along in the population aging process. This will
start to create a burden on national health systems.
2. Rise in chronic diseases
As a consequence of increased life expectancy and urbanization that has changed peoples
lifestyle and behavior, chronic diseases are rapidly on the rise. There is already a growing
demand for care-related conditions, such as cardiovascular disease, cancer, chronic
obstructive pulmonary disease, osteoporosis, vision impairment, and dementia. Community
pharmacists can play a significant role in helping patients monitor their illness and
ensuring that patients are compliant with their medication.
3. Public healthcare systems constraints
In most Asian countries, the majority of patients turn to hospitals first for treatment
because physician visits are fully or in part subsidized by the government. However, the rise
in chronic illnesses and the attraction of free services means that public health systems
will be overstretched. Health systems in various countries are suffering from rapidly growing
costs and frustration at the quality of care. For example, South Koreas national health
insurance has long waiting lists even though it covers only basic care and Taiwans national
health insurance scheme has perennial financial difficulties. With the waiting time at
hospitals, patients will start to trade off the government subsidy for out-of-pocket expenses
to visit pharmacists for minor ailments. Many patients are already starting to self medicate
and frequenting pharmacies for this purpose.
4. Consumer changes
Consumers are becoming more aware of health issues and the need to adopt a preventive
approach to diseases. Zuellig Pharma anticipates that the health industry will transition from
a sickness to wellness paradigm where consumers understand that prevention is better
than cure. Community pharmacies will be more active in advising consumers about overall
healthcare. In addition, Asian consumers are becoming wealthier. By 2030, Asia is expected

to have two-thirds of the worlds middle class. The OECD estimates that middle-class
consumer spending in Asia will increase from US$4.9 trillion in 2009 to more than US$30
trillion in 2020. The wealthy middle class will become savvier and increasingly aware of their
access to healthcare services and products in the next decade, demand will rise for western
drugs and medical devices as well as for improved healthcare services.

Outlook
The new paradigm for pharmacy practice is community pharmacy. Community pharmacies
will become important alternative destinations for patient pharmaceutical care. They are in
an ideal position to respond to consumer healthcare needs, especially when well trained and
with certified health expertise.

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