Pharmacy education and practice is undergoing changes worldwide, with more focus on clinically oriented and patient-centered outcomes.
In Qatar, the country’s only College of Pharmacy is responding to these changes with integrated learning and a new curriculum.
“Previously, the focus of pharmaceutical education was the drug itself and its chemical specifications. Now the focus is more on patient care,” Feras Alali, dean of the College of Pharmacy, Qatar University, said. “This has resulted in a fundamental change in pharmaceutical education.”
In 2017, the college began a comprehensive review of its curriculum. The process resulted in restructuring of the bachelor’s degree curriculum into a series of integrated modules that cut across traditional subject areas. Each module revolves around a certain body system, rather than a specific discipline.
The changes, taking effect this academic year, are intended to reduce repetition in teaching and make educational experiences coherent, relevant, and more patient-centered.
“A professor is no longer teaching a subject alone. Instead, all those involved in the integrated unit of the curriculum work together and plan how to teach in a holistic manner,” Alali said.
The change was not easy for professors. It “requires a great deal of work, cooperation and openness among faculty members in educational content and assessment methods,” according to Alali.
Closer to Real-Life Situations
Nadeem Zia, a researcher and former pharmacist at Sidra Medicine, a women’s and children’s medical center in Qatar, thinks that this approach makes pharmacy education closer to what happens in real-life situations.
“A professor is no longer teaching a subject alone. Instead, all those involved in the integrated unit of the curriculum work together and plan how to teach in a holistic manner.”Feras Alali
Dean of the College of Pharmacy, Qatar University
“Collaborative practice is the norm now,” Zia said. “The pharmacist will work in an integrated team and should be learning modules with all other professionals.”
The collaboration between pharmacists and other members of the health-care team is prominent in a branch of the profession called clinical pharmacy. The American College of Clinical Pharmacy defines clinical pharmacy as “a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, and disease prevention.”
Manal Al Zaidan, the director of pharmacy at Qatar’s Primary Health Care Corporation, established the clinical pharmacy departments in at least three Qatari public hospitals. She said that today clinical pharmacists are an integral part of the multidisciplinary team in local hospitals. Doctors don’t start their rounds of patients unless the clinical pharmacist has arrived.
Al Zaidan said that once stakeholders understand the benefits of clinical pharmacy and the role of the clinical pharmacist, trust can be easily established.
“I think it’s all about trust, whether between the doctor and clinical pharmacist or between the clinical pharmacist and patient,” she said. “The choice of qualified pharmacists with good skills, a positive approach and excellent communication skills is key.”
Expanded Roles for Pharmacists
Today clinical pharmacists perform important tasks such as reviewing medication history of the case and counseling the physician about dosage adjustment and medication contradictions. They also provide patient education, counselling, and care plans.
“Several research studies showed that if the pharmacist provides inpatient discharge counselling, this improves medication adherence, reduces hospital re-admission and thus reduces pressure and costs on the health care system.”Nadeem Zia
A researcher and former pharmacist at the Sidra Medicine center in Qatar
“Several research studies showed that if the pharmacist provides inpatient discharge counselling, this improves medication adherence, reduces hospital re-admission and thus reduces pressure and costs on the health care system,” Zia said.
However, he pointed out that while clinical pharmacy practice is well established in Qatar’s hospitals, the real deficiency is in community pharmacies.
“Patients currently don’t benefit from the pharmacists at community pharmacies as they should, because these pharmacists don’t have the time or resources that allow for extended pharmacy services,” he said.
A study to explore counselling practices among community pharmacists in Qatar using simulated patients concluded that patient counselling was substandard, with the majority of community pharmacists focusing on the name of the medication.
The study mentioned that pharmacists rarely assessed patient’s medical history or medication use. Disease management and problem-solving skills of pharmacists were suboptimal, with many referring patients back to the physician.
Another study found that the community pharmacy services provided in Qatar are mostly traditional with no extended pharmacist roles or cognitive services.
Difficulties in Implementation
Zia said that there are factors particular to Qatar that hinder the full implementation of extended pharmacy roles in community pharmacies.
“The choice of qualified pharmacists with good skills, a positive approach and excellent communication skills is key.”Manal Al Zaidan
Director of pharmacy at Qatar’s Primary Health Care Corporation
“Health care providers in Qatar come from every part of the world and there’s a high turnover. The non-Qatari patients are from different countries as well, so there are language and communication barriers. This makes consultation time consuming and challenging,” he said.
For pharmacists in private pharmacies to be able to provide extended services, they need access to a centralized drug database, as well as financial incentives, Zia said.
He also points out that pharmacists in Qatar have different levels of experience and skills and come from different educational backgrounds.
“In Qatar, we need customized solutions based on the country’s needs and the gap in the health-care system,” he said. “The College of Pharmacy can support pharmacy practice outside of hospitals through continuous education, training programs and education modules that cater to different levels of knowledge, skill and experience.”
The College of Pharmacy already identifies this gap, and Qatar’s National Health Strategy calls for facilitating the necessary infrastructure and legislation to allow pharmacists to practice according to their full scope.
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According to Alali, the college is cooperating with partners in Hamad Medical Corporation, the main provider of specialised medical care in Qatar, and the Ministry of Health to develop the clinical approach within the community pharmacies. The goal is to change the culture of the community about the type of services offered at pharmacies.
“Clinical pharmacy is not a luxury anymore,” Alali said. “Our ambition is for clinical practice to be fully activated in health centres and community pharmacies within the limits of local laws and legislation.”