With the advent of large-scale industrial processes to produce high quality drugs and dosage forms, the focus of the pharmacist’s primary role changed in the middle of this century from that of accurate compounding to one of dispensing medications manufactured by the pharmaceutical industry. During this time the scientific basis of industrial drug discovery and development inspired parallel changes in pharmacy education, from empirical and descriptive knowledge focusing on the procurement, preparation, and evaluation of pharmaceuticals, to knowledge organized around scientific paradigms. The resulting divergence of pharmacy practice and pharmacy education led inevitably to a vocational paradox: the average pharmacist, trained as a scientist, did not “do” science in practice.
The concept of clinical pharmacy emerged in the late 1960s as society’s economic base changed from industry to information. Within this model, the pharmacist was to function as a therapeutic consultant: the member of the health care team able to apply knowledge, skills, and values to ensure optimal drug use. In spite of this change, research evidence indicated that a significant percentage of North Americans were not receiving maximum benefit from drug therapy, resulting in adverse drug reactions, sometimes leading to hospital admissions and causing mortality.
In 1990 a new model of Pharmacy practice proposed that the pharmacist accept responsibility for minimizing drug-related morbidity and mortality. Termed Pharmaceutical Care, a patient-centred practice model, requires the pharmacist to work in partnership with the patient and other health care professionals to:
- identify actual or potential drug-related needs of the patient;
- determine how these needs are related to patient’s drug therapy, and;
- work with patients and other health care providers to design, implement, and monitor a pharmacy care plan which will resolve and/or prevent patients’ resulting drug therapy problems.
Therefore, the profession of pharmacy serves society by being responsible for the optimal use of drugs – this is done by ensuring that all of a patient’s medications are indicated, effective, safe and that the patient is able to adhere to therapy. In assuming this responsibility, each pharmacist’s primary responsibility is to individual patients, with the ultimate goal of improving each patient’s quality of life. This patient centred care is achieved by working with the patient to determine if any drug-related needs exist which are preventing the patient from attaining their desired goals related to drug therapy and then working with the patient and their healthcare providers to ensure that their health care goals are met.