Distribution of Drugs for Effective and Quality Health Care

Major shifts in the methods and processes of medication distribution and the management of the drug supply in most of the European countries are presently being seen. Increased mechanization of the prescription filling process, coupled with extensive application of computer technologies related to labeling, record keeping and creation of patient focused educational materials to accompany prescriptions, are contemporary trends that continue to evolve and refine.

Along with these developments is the ever increasing need for pharmacists to provide direct to patient pharmaceutical care services in both the acute care and ambulatory care setting. New opportunities for pharmacists in the pharmaceutical industry, in the insurance industry, in the computer industry, the mail order pharmacy industry and other areas where the knowledge system of pharmacy ( pharmacie 24h/24 ) can and should be applied also represent opportunities for pharmacy’s future. The growing number and complexity of medical agents places strong demands in most European Countries health care system for a large cadre of clinically competent practitioners. Additionally, there are several major disease areas that represent priority health challenges in most European Countries (e.g. cardiovascular, diabetes, cancer, asthma, neurological). As more initiatives in the treatment of patients with these chronic diseases are brought forward, it goes without saying that more extensive medication treatment will be seen.

If history can be an indicator of the future with respect to the evolution of pharmacy practice in most European Countries, it is probably safe to say that the profession will position itself so that it continues to meet social needs. That positioning will be driven in part by market demands and in pan by evolving social policy regarding the future of European health care system. Positioning will as well be driven by effective academic leadership that is well attuned to pervading social need. It should be noted however, that appropriate positioning will not occur spontaneously. There must be a willingness and effective processes in place to achieve it.

Schools of pharmacy respond to social need within the traditional mission of higher education institutions; namely, educating and training students in professional and graduate degree programs, creating and disseminating new knowledge and providing a diverse and unique set of knowledge-based services to the profession and the public. As might be imagined, the intensity and scope of response to these areas of mission are dependent upon the school’s fiscal, human and physical resources, as well as the mission and strategic direction of the university of which the school of pharmacy is part. As one survey the seventy-nine schools of pharmacy in most European Countries, there is evident diversity in the depth and breadth by which each school responds to social need in the context of it is more traditional mission of education, research and service. This is a valued characteristic and indeed, represents a major strength of pharmacy education in most European Countries.

Schools of pharmacy generally do not adhere to a consistent philosophy of practice and patient care and as a result there is little socialization focus on the development of the ethos and values associated with such a philosophy. Conflicts among faculty members with respect to the definition and application of a philosophy of practice are prevalent. The processes of education that are so prevalent in European  pharmacy education today also augur against the development of a set of values and behaviors that are linked to a caring philosophy so necessary for the delivery of patient care services. Few faculty members work assiduously to be mentors to their charges during the formative stages of professional education. Even fewer faculty members are committed to the constant reform and renewal of pharmacy practice, say nothing of their own curricula.

The latter perspective may be harsh, particularly to those faculty members who are prominent and engaged in mentoring, applying high ideals and stimulating a reconstructive philosophy in education and practice. However, the realities of much of European pharmacy practice are ample evidence of the points previously asserted. High rates of morbidity and mortality associated with medication misadventures are a reality, inappropriate and missing consultation with patients and prescribers on appropriate medication prescribing and utilization are rampant and leadership for assuring improvements and quality enhancements in the medication use system in the United States is scarce.

The current re-engineering and downsizing of many of European health care institutions is beginning to show negative effects on quality of care and more specifically on the quality of pharmacy practice. Fundamental standards of patient safety are being violated when automated dispensing systems no longer rely on the quality checks traditionally provided by pharmacists. Basic standards of sterility and product quality are violated when pharmacists are not directly involved in the preparation of small and large volume parental agents. Long standing societal covenantal commitments are skirted when patients are handed their medications by clerks and are not privately consulted by the pharmacist on the premises. There is indeed a significant gap between what pharmacy education preaches, what pharmacy practice aspires and advocates and the realities of a competitive marketplace in which quality and cost oftentimes negatively compete. While some examples of progress are evident in these regards, substantial challenges still remain.

This paper has been constructed to stimulated discussion, critical analysis and planning. A specific attempt has been made to put forward a number of themes and issues that are not often discussed or acted upon by educational leaders in pharmacy. It is hoped therefore, that a broader view of the linkage between social need and the philosophy, purpose and calling of higher education in pharmacy might emerge. It is clear from the European experience that the role and utilization of the pharmacist as strictly a purveyor of drug products and sundries is time limited. It is equally clear that societies depend on and are owed a rational system for effectively utilizing the applied knowledge of the science and art of pharmacy’s time honored disciplinary strengths. The search for consistent quality in the offering of pharmaceutical services, equity in geographic and economic access to pharmaceuticals and the services of the pharmacist and demonstrated relationships between efficiency and quality still continues. This is a European challenge and a challenge that is evident in many other parts of the world.

There is need to digitize distribution of drugs around the world. It is easy to follow the consignments using relevant technology as well as maintaining effective and timely deliveries the following are reasons why we should digitize drug distribution activities.

Implementation of new technologies

The capabilities of counterfeiters continue to evolve rapidly is because there is no single technology that provides any long-term assurance of drug security. However, a combination of rapidly enhanced “track and trace” technologies and product authentication technologies should provide a much greater level of security for drug products. Similar anti-counterfeiting technologies are being used in other industries to facilitate rapid development and utilization to keep drugs secure against counterfeits.

Modern electronic technology is approaching the state at which it can reliably and affordably provide greater assurances that a drug product was manufactured safely. In addition, there should be an assurance that the medicines were distributed under conditions that did not compromise its effectiveness. The France government has concluded that this approach is a much more reliable direction for assuring the legitimacy of a drug than paper recordkeeping requirements.

Radiofrequency Identification (RFID) tagging of products by manufacturers and implemented by pharmacies in France appears to be the most promising approach to reliable product tracking and tracing. Major feasibility studies and technology improvements are underway to confirm that RFID will provide cost-reducing benefits. This will be done to establish the benefits in areas such as inventory control while also providing the ability to track and trace the movement of every package of drugs from production to dispensing. Most importantly, reliable RFID technology will make the replication of medications either extremely difficult or unprofitable.

Adoption of electronic track and trace technology

At the time government of France recommended for the use of track and trace, manufacturers and 24 hours pharmacies had already experienced practical and administrative challenges. RFID technology, which would provide a de facto electronic pedigree, could surpass the intent of the prior regulations and at a lower cost. The government of France intends to continue to stay its regulations regarding certain existing requirements to allow suppliers to focus on implementing modern effective technologies as quickly as possible.

Implementation and enforcement of anti-counterfeiting laws and regulations

State licenses have an important role in regulating the drug distribution supply chain because they regulate wholesale drug distributors. The government of France is tirelessly working with the National Association of Boards of Pharmacy and Doctors ( sos dentiste garde ) to develop and implement revised state model rules for licensure of wholesale drug distributors. Such rules will make it difficult for illicit wholesalers to become licensed and transact business. In addition, this will make it easier to deter and detect channels for counterfeit drugs. Some pharmacies in France have already reduced counterfeit threats by adopting such measures.

Increased criminal penalties to punish those convicted

Even if increasing criminal penalties would not affect anti-counterfeit regulatory framework, it would provide an added deterrent to criminals who work to counterfeit medications. pharmacies in France should request the government to amend the sentencing guidelines to increase substantially the criminal penalties for manufacturing and distributing counterfeit drugs. This will provide enhanced penalties based on the level of risk to the public health involved in the offense.

Embracing secure business practices in the drug supply chain

Protection against counterfeit drugs includes effective actions by drug producers, distributors, and dispensers. This is because they have the interest to secure their business practices such as ensuring the legitimacy of business partners and refusing to do business with persons of unknown or dubious background. In addition, they may take steps to ensure physical security and identify an individual or team in the pharmacy with primary responsibility for effective implementation of security practices. The wholesalers have already formulated a set of secure business practices. The government will continue to work with major participants in the drug supply chain to develop and implement such business practices. This will be done through steps as such issuing guidance and support the development and growth of industry best practices. The government of France intends to increase its inspection efforts of manufacturers whose operating procedures place them at increased risk for the introduction of counterfeit drugs.

Collaboration with foreign stakeholders to develop counterfeit strategies

Counterfeit drugs have nowadays become a global challenge to all nations. Moreover, criminal counterfeiting operations are increasingly operating across the French borders. The government of France is determined to work with the World Health Organization, other international public health organizations and law enforcement authorities to develop and implement worldwide strategies to combat counterfeit drugs. The steps described in this write up are intended to secure the safety of drug supply which the government regulates. The government of France has the legal authority and resources to assure the safety and efficacy of drugs purchased from 24 hours pharmacies in France. In addition, the government can also regulate the foreign suppliers that affect the French domestic drug distribution system.

A single counterfeit box of medicine can harm or kill several patients. For this reason, pharmacists working at pharmacies in France should be vigilant enough to lower have a zero tolerance of counterfeit medicines. Many people may think that the counterfeiting of currency and consumer products are common problems that governments and manufacturers around the world face. However, the counterfeiting of medications is a particularly menacing practice.

Medicine counterfeiters not only defraud consumers but also deny ill patients the therapies that can lessen suffering and save lives. In some countries the counterfeiting of drugs is endemic. Actually, some patients have a better chance of getting a fake medicine than real ones. In France, counterfeit drugs are also common. However, a relatively comprehensive system of laws, regulations, and enforcement by pharmacy regulatory authorities has kept drug counterfeiting rare. People living in France can now have a high degree of confidence in the drugs they obtain through legal channels.

In recent years, pharmacies in France have seen growing evidence of efforts by increasingly well-organized counterfeiters. This has been backed by increasingly sophisticated technologies and criminal operations.