A Comprehensive Review on Pharmacist Contributions and Challenges in Disease Prevention and Management

Abstract

Noncommunicable diseases (NCDs), often known as chronic diseases, are long-lasting conditions caused by a confluence of behavioural, physiological, environmental, and genetic variables, according to the World Health Organisation. The threat posed by noncommunicable diseases (NCDs), including diabetes, cancer, heart disease, and long-term respiratory conditions. Diseases that can be transmitted from one person to another, from an animal to a human, or from a surface or food are known as communicable diseases. Diseases can be spread by respiratory droplets from a sick person's cough or sneeze, direct touch with an infected person, and the air. Compared to other causes, such as trauma, infectious diseases during an emergency situation can increase the fatality rate by 60 times. The purpose of this review is to explore the critical role of pharmacists in the prevention and management of noncommunicable diseases (NCDs) and communicable diseases, emphasizing their unique position as accessible healthcare providers. With over 36 million deaths attributed to NCDs annually, the escalating burden of these diseases poses significant challenges, particularly in low- and middle-income nations. Pharmacists contribute to healthcare through various functions, including screening and monitoring for NCDs, providing medication therapy management, offering patient counselling on medication adherence, enhancing medication accessibility, and engaging in health education initiatives. Furthermore, their involvement in managing communicable diseases such as COVID-19, Pertussis, HIV/AIDs, and Tuberculosis is highlighted. Despite their potential, pharmacists face several barriers including inadequate training, resource limitations, misleading information, and cultural communication challenges. Addressing these obstacles is essential to optimize the pharmacist’s impact on global health.

Keywords

Non communicable diseases, Chronic diseases, Communicable diseases, Medication therapy management, Medication adherence, Medication accessibility.

Introduction

The World Health Organisation states that noncommunicable diseases (NCDs), often known as chronic diseases, are long-lasting conditions brought on by a confluence of behavioural, physiological, environmental, and hereditary variables. Cancer, diabetes, cardiovascular conditions (heart attacks, strokes, and congestive heart failure), and chronic respiratory conditions (asthma and chronic obstructive pulmonary disease) are the primary categories of noncommunicable diseases (NCDs). More than three-quarters of all NCD deaths worldwide occur in low- and middle-income nations, where these diseases disproportionately affect people ⁽¹⁾.

Over 36 million people die each year from non-communicable diseases (NCDs), accounting for over 60% of all fatalities globally, with 15 million of those deaths occurring before the age of 70, according to the World Health Organisation (WHO)⁽²⁾ The NCD epidemic threatens to overburden health services and has catastrophic health effects on people, families, and communities. The prevention and control of noncommunicable diseases (NCDs) is a critical development imperative for the 21st century due to the socioeconomic implications associated with these diseases. The goal of WHO is to lead and provide the evidence base for global efforts to monitor, prevent, and control noncommunicable diseases. To reach international targets to lessen the burden of NCDs, the government must act immediately ⁽³⁾_. One of the most accessible healthcare providers in the world, chemists are frequently the first medical professionals that people turn to when they need assistance. Pharmacists are in a unique position to offer care and guidance across communities, particularly for disadvantaged people in settings with limited resources, because many pharmacies are open twenty-four hours a day without an appointment. Pharmacists are becoming more and more acknowledged in industrialised nations, where they participate in public health initiatives like disaster preparedness, policy creation, and disease prevention and control programs. For the efficient planning of public health services, agencies including the World Health Organisation (WHO), Public Health England, and the Centres for Disease Control and Prevention (CDC) are urging community organisations and other medical professionals to collaborate with chemists. However, there hasn't been the same support or use of chemists in public health initiatives in developing nations ⁽⁴⁾.

DISSCUSSION:

Role of pharmaceutical chemist:

It has been demonstrated that the efficient application of chemists' expertise enhances the provision of healthcare services. Pharmacists' responsibilities now go beyond simply preparing, distributing, and packaging medications. Pharmacists actively participate in many aspects of healthcare delivery in both developed and developing nations, assuring the safe and high-quality use of medications, promoting public health, offering primary healthcare services, and providing palliative care. Pharmacists can help by promoting public health, offering pharmaceutical therapy management services, coaching patients on medication adherence, screening and tracking noncommunicable diseases, and facilitating better access to reasonably priced, high-quality medications. Below is a discussion of several possible areas in which chemists can make a significant contribution to the fight against NCDs.

1.Screening And Monitoring NCDs

By screening patients for NCDs and tracking their progression, pharmacists are already significantly improving the healthcare system. Research from numerous nations demonstrates that community pharmacists are well-positioned and sufficiently qualified to screen for a variety of illnesses, such as diabetes, heart disease, asthma, COPD, breast cancer, colon cancer, and many more. There is enough proof to conclude that monitoring programs run by pharmacist’s aid in the management and prevention of NCDs. Pharmacists have taken an active role in monitoring lung function, blood pressure, blood lipid profiles, blood glucose levels, and anticoagulant medication ⁽⁵⁾.

2. Medication Therapy Management

 In order to maximize medication therapy and enhance therapeutic results for patients, pharmacists offer this type of professional care, frequently in conjunction with other medical professional experts. Medication therapy reviews (MTRs), personal medication records (PMRs), medication-related action plans (MAPs), and interventions are the five main parts of MTM.   

MTR is a methodical procedure that takes place during the pharmacist-patient interaction to gather information on the patient's medications. The creation of each patient's own medication record comes next. Pharmacists create action plans and detect medication-related issues based on the PMR. Pharmacists create action plans and detect medication-related issues based on the PMR.

Pharmacists can engage with patients on their own (e.g., by adding over-the-counter medications and offering adherence counselling) or they can refer them to other qualified medical specialists (if an intervention is outside the pharmacist's area of expertise). In the case of NCDs, MTM can offer services that are specifically tailored to each patient, perhaps improving how well they respond to their treatment regimen. MTM is used in many nations and calls for pharmacists with extensive training and expertise ⁽⁶⁾.

3.Patient Counselling on Medication Adherence

Patient medication counselling and education is a crucial tool for attaining pharmaceutical care and is one of the greatest strategies to increase medication adherence for patients with NCDs. It is described as giving patients or caregivers medication-related information verbally, in writing, or by the use of other appropriate demonstration tools. This information may include instructions for usage, advise on side effects, safety measures, and storage conditions, as well as dietary and lifestyle changes ⁽⁷⁾.

4. Improving Medication Accessibility and Affordability

In recent decades, new medications have altered the normal course of diseases like HIV and several types of cancer in addition to increasing survival rates and quality of life for a large number of patients worldwide. Due to anti-retroviral treatments, HIV has changed from a grave illness to a chronic condition that can be managed, and the once-day single-tablet regimen has made patients' daily lives easier. From an industrial perspective, pharmacists may play a critical role in providing high-quality medications for patients with noncommunicable diseases (NCDs) by conducting ongoing research and developing solutions for the unique needs of these patients. These could include technologies that allow patients to have their medications tailored to meet their unique needs ⁽⁸⁾.

5.Health Education and Awareness

Encouraging people to take charge of and improve their health is known as health promotion, and it is quickly becoming a vital area of public health. Because they are widely available and regarded by the public as reliable specialists, pharmacists can act as conduits for the advancement of public health. The public views pharmacists as excellent health instructors. Pharmacists promote health in a variety of ways. Pharmacists can play a significant role in the prevention and treatment of NCDs by organizing mass education campaigns on lifestyle modification, blood pressure, breast cancer screening, tobacco cessation programs, and diabetic education programs, to name a few health promotion initiatives ⁽⁹⁾.

6.Optimal Medication Management

According to a recent meta-analysis of the usage of self-medication in developing nations, more than 38% of patients self-diagnose and treat, which adds to the rising global burden of antibiotic resistance. In order to enhance health outcomes, pharmacists can address this by creating the best possible treatment plans based on the resources at their disposal, doing medication reviews, and educating patients about their medications. At the individual and systemic levels, pharmacists can help improve drug use and other global health challenges. In developing nations, managing the double illness burden of communicable and non-communicable diseases will require the prudent use of pharmaceuticals ⁽¹⁰⁾.

The Pharmacist's Contribution to Global Health: Communicable Diseases

Pharmacists are crucial to the prevention and management of communicable diseases in public health because they raise awareness through welfare programs, provide the right vaccinations, and instruct patients on how to control them of diseases that spread. There is a brief discussion of the pharmacist's duty to advise patients and other clients about alternate preventative measures (such as hand washing, disinfection, and nasal spray vaccination) and available treatments.

Examples of communicable diseases are: -Tuberculosis, Hepatitis, Typhoid, Amebiasis,

Malaria, Leprosy, Syphilis, Gonorrhoea, AIDS.

COVID 19:

Pharmacists should advise people to take the following precautions against COVID-19:

• Avoid close contact with sick people. 
• Refrain from using unwashed hands to contact your mouth, nose, or eyes. 
• Spend at least 20 seconds washing your hands with soap and water. If soap is unavailable, use an alcohol-based sanitizer with 60% alcohol. 
• Maintain social distance in public settings. 
• Wear a mask to prevent viral contamination. 
• Obtain a vaccination 
• Steer clear of crowded and poorly ventilated areas.  Surfaces that are often touched should be cleaned and disinfected ⁽¹¹⁾.

AIDS/HIV 

Prevention consists of two parts:

Education:

• It is advised to use condoms and to refrain from careless sexual behaviour.
• It is best to refrain from using shared tooth brushes and razors.
• Users of intravenous drugs should be made aware of the dangers of sharing syringes and needles.
• People should be educated on AIDS, including its causes, symptoms, and prevention, through all forms of mass media.

Preventing HIV transmission by blood:

• Individuals in high-risk categories should be advised not to donate blood, organs, sperm, or other tissues. Prior to transmission, all blood samples must to undergo HIV1 and HIV2 screening. It is best to use strict sterilizing procedures. One should prevent infections.
• Antiretroviral therapy: There are three types of antiretroviral medications. These include non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors, and nucleoside analogues ⁽¹²⁾.

Chicken Pox

When someone has chicken pox, the pharmacist should advise them to do the following:

• After rashes start to emerge, isolate for a week.
• When a healthy person comes into contact with an infectious person, he or she is immunized.
• He or she advocates for the regular MMR immunization for children.
• Adults who believe their immunity is poor should be advised to receive at least one dose of MMR.
• By washing hands often and maintaining proper hygiene, one can help stop the spread of chicken pox.
• Gloves or short nails might reduce the chance of subsequent infection and stop scratching.
• Minimize your contact with those who have chickenpox. Clean the items that the sufferer uses ⁽¹³⁾.

Whooping Cough (Pertussis):  Pertussis, or whooping cough, can be effectively prevented by active vaccination with the DPT vaccine. A substantial family history of epilepsy is a contraindication to the pertussis vaccine. Separating cases and contacts using erythromycin as a treatment ⁽¹⁴⁾.

Tuberculosis: The development of nodules, or tubercles, in the tissues, particularly     the lugs, is a defining feature of this contagious bacterial illness.
Preventive Actions: Pharmacists ought to inform individuals about the following:

• Steer clear of alcohol as it may increase the risk of liver damage from certain of the medications used to treat T.B.
• Refined foods like sugar, white bread, and white rice should be limited.
• Red meat with high fat and cholesterol should be avoided in favor of foods high in protein. sources such as fish, chicken, legumes, and tofu.
• Low housing, overcrowding, population growth, undernutrition, lack of education, large families, early marriages, and low quality of life are some of the socioeconomic factors contributing to the disease's spread.
• By recognizing and addressing issues related to medication use, they offer pharmaceutical care based on patients' needs while actively working to encourage and involve patients in taking charge of their own health.
•  By assuring the prudent use of anti-TB medications and helping to avoid the establishment of drug resistance, pharmacists can support other public and private health care professionals. ⁽¹⁵⁾

Challenges In Prevention and Management of Communicable and Non-Communicable Diseases:

1. Inadequate clinical training for pharmacists: Pharmacists might lack the education or expertise necessary to offer health promotion services
2. Pharmacy resource constraints:  Pharmacies might not have the employees, space, or managerial backing to offer these and other services.
3. Deceptive health information: Patients' self-management may be impacted if they are misinformed about medicines and vaccinations.
4. Gaps in pharmacist support services: Pharmacists may feel unsupported by health care authorities.
5. Limited patient awareness of pharmacist roles: Patients might not approach pharmacists for services related to health promotion.
6. Lack of interprofessional collaboration with pharmacists: There may be a lack of coordination between pharmacists and other medical professionals.
7. Cultural and language barriers: Pharmacists may face challenges in communicating with patients from diverse cultural and linguistic backgrounds.
8. Regulatory and administrative burden: pharmacists may face challenges in navigating regulatory and administrative requirements, such as those related to prescribing and dispensing medications ⁽¹⁶⁾.

CONCLUSION: 

Pharmacists play a crucial role in preventing and managing noncommunicable and communicable diseases. Their contributions include screening and monitoring NCDs, medication therapy management, patient counselling, improving medication accessibility, health education, and optimal medication management. Pharmacists also combat tropical diseases and provide advice on COVID-19, PERTUSSIS, CHICKEN POX ,AIDS/HIV and TB precautions. Challenges include inadequate training, resource constraints, deceptive health information, support service gaps, limited awareness, interprofessional collaboration issues, cultural barriers, and regulatory burdens. Efforts to address these challenges are necessary to fully leverage pharmacists' potential in disease prevention and management.

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