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practitioners in our health system.
What we don't have is a comprehensive
re-professionalisation program that
looks from undergraduate training
through to recognition of Advanced
Practitioners, builds on existing services
and develops new pharmacist services
based on community needs, has routine
independent auditing of practitioners
as part of a practice improvement
cycle and ongoing evaluation of
Australian studies examining
characteristics of people who chose
to study pharmacy indicate that core
motivators were that pharmacy is
a health-related science (75%) and
that pharmacists work with, and help
patients (63%). Eighty percent of
graduates believed their pharmacy
course prepared them well for the
delivery of quality patient care, 72%
were ready to provide medicines
information, 70% were ready to
dispense medicines and 68% believed
they could deliver primary health care.
Almost 90% of interns expected that
they would be engaged in dispensing
processes, 95% believed that they would
be involved in patient care and 82%
expected that they would be involved in
providing medicines information.
For many interns, their expectations
were met. All interns reported heavy
involvement in dispensing, 75% were
involved in patient care and 82%
were involved in providing medicines
Unfortunately, in focus group studies
the picture was different. Interns
used terminology such as 'dispensing
monkeys' when describing their
experience in community pharmacies.
Their expectation from their
undergraduate training led them to
believe dispensing was a process where
the pharmacist was examining the
current prescription against the patient's
past medication history, looking for
interactions if new medicines are added
to the existing regimen, considering
the appropriateness of the prescription
and ensuring the patient or carer has
the knowledge and skills to use the
medicines safely and effectively.
A pharmacist care plan should be
developed for the person that includes
regular monitoring of outcomes
associated with the medicines. Focus
groups with more experienced
pharmacists identified four themes --
a lack of knowledge of current health
reform agendas and potential roles
for pharmacists, a strong commitment
to the medicines supply model as
their preferred role, no appreciation
of alternative practice models
and communication barriers (with
pharmacists in different sectors and with
other health professionals)5.
A semi-structured interview with
registered pharmacists who no longer
worked as a pharmacist provided
some insight into reasons for leaving
the profession. Dissatisfaction with
the workplace, lack of a career path
and opportunities, under-utilisation
of knowledge and skills were given as
key reasons for working outside of the
Re-professionalisation programs are
based on well-known characteristics
that define professionalism7.
1. Meeting obligations by attending to
healthcare needs of their community
and broader social needs. For example
pharmacists should take a leadership
role in ensuring patients have access
to needed medicines at a price that
they -- and Australia -- can afford.
2. Subordination which speaks to
pharmacists committing to work for
the interests of the patient above
their own needs. This becomes
difficult when the interests of the
person or organisation that employs
them conflicts with the professional
requirement to work for the interests
of the patient. However the patient's
interest must come first.
3. Beneficence and non-maleficence are
principles that require professionals
to adhere to high ethical and moral
standards. In practice it means the
duty to do the right thing and avoid
doing the wrong thing.
4. Humanistic values such as honesty
and integrity, caring and compassion,
altruism and empathy, respect for
others and trustworthiness are central
to the practice of health professionals.
5. Autonomy and accountability: Health
professionals are usually granted
some degree of autonomy in decision
making in their professional practices.
This privilege however comes with
expectations that health professionals
will maintain high standards of
practice and be accountable for
themselves, and their colleagues in
6. Competency is another critical
element of professional practice.
Maintenance of competency via
continuing professional development
activities must be demonstrated
through mechanisms such as audits.
7. Scholarship should be demonstrated
in a commitment to improving the
knowledge base of the profession and
"INTERNS USED TERMINOLOGY SUCH AS 'DISPENSING MONKEYS'
WHEN DESCRIBING THEIR EXPERIENCE IN COMMUNITY PHARMACIES. "
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