1.

“Intersectoral co-ordinations is the key to ensure primary health care in a

community”, explain the statement.
Ans. Inter sectoral coordination for achieving health goals has been accepted as one of the
guiding principles of the health strategy that was adopted at the international conference
on primary health care.
Inter: Inter means with in or itself.
Sector: Sector refers to the different - different areas or they may be different
organizations.
Coordination: Coordination is an administrative process which seeks to bring about unity
of purpose in order to achieve common objectives.
Inter sectoral coordination: Intersectoral coordination refers to the promotion and co-
ordination of the activities of different sectors of health care system to enhance and to
provide a qualitative service to community.
Need for intersectoral coordination:
 There are many governmental departments and agencies working for people whose
activities are closely linked with health, as health itself is a multi-sectoral subject
that needs
 Clean water
 Sanitation
 Pollution free environment
 Economic condition
 Food production etc.
 Earlier health can system focused more on ‘curative’ rather than ‘preventive’
aspects.

Need for coordination in health care delivery system:

 To improve vertical nature of programs.

 To maintain focus on primary health care.
 To provide directionality.
 To promote team work.
 Inter sectoral coordination is the key in primary health care:

 Good nutritional status is associated with lower morbidity. Nutritional status can
be improved through development in agriculture and home economics. Agriculture
sector development can ensure sufficient amount of healthy food for the
community.
 Education sector: Women education and empowerment can improve their
knowledge about nutrition within available resources.
 Plentiful availability of potable water can reduce morbidity and mortality,
particularly among infants and children. Efforts to bring safe water within easy
reach of rural and urban population will have positive effect on health of people.
 Similarly, safe disposal of waste and excreta affects health.
 Housing that is adapted to local climatic conditions (healthful housing) has a
positive effect on health.
 Road connectivity of remote villages will not only improve economic condition by
providing easy market access but also enable health, sanitation and education teams
to reach the rural areas. Transportation of patients to and from referral centers will
be facilitated. Supply of drugs and biologicals to the health facilities can be regular.
 Mass media will improve health education reach the needy, e.g. preventing
mosquito and fly breeding, importance of immunization. Also, disaster warnings
and instructions to safeguard the health during disaster will minimize the loss of
health.
 Bringing about legislation affecting health and many other sectors affect health.
 Industries will provide jobs and hence better nutrition as also overall development
of the area.
2. “Pharmacist should be the purchasing agents in a hospital”, present your opinion in
favor or against the statement.
Ans. Hospital purchasing agent: Any partner to the healthcare industry knows there are
often many decision-makers in the buying process. Often on of the most pivotal roles in
that of a hospital purchasing agent. This position is essential to ensuring a hospital has all
the equipment, tools, parts, supplies or services it needs to operate seamlessly and provide
the best care.
Role of purchasing agent: It is important to know what the duties and responsibilities of
a purchasing agent are. These generally include:
 Evaluating vendors and suppliers, both potential and current.
 Establishing solid relationships with business chosen vendors.
 Analyzing pricing and other data to ensure vendors prices are reasonable
 Negotiating agreements with vendors and monitoring ongoing contracts
 Dealing directly with vendors when issues such as defective goods or delayed
delivery arise

If there is a pharmacist as the Purchasing Agent, then the supplements, if all the
requirements are met, will not be a problem for the patients if they do the Purchasing
knowing the quality of the medicine. And my opinion on favor of pharmacist should
be purchasing agent in a hospital.

All institutional purchasing should be centralized under the guidance of purchasing agent.
According to this system the pharmacist, like all other department heads, requests on a
special form, the item to be purchased.
The selection of the brand and vendor is thereby left to the choice of the purchasing agents,
unless the pharmacist has prepared a list of specifications.
Some institution believe that pharmaceuticals and related items constitute specialities
which require the technical skills of a formally trained individual for their proper selection
and purchase.
ASHSP(The American Society of Health-System Pharmacists) said that the pharmacist
in charge shall be responsible for specifications both as to quality and source for purchase
of all drugs , chemicals , antibiotic ,biological and pharmaceutical preparations used in the
treatment of patients.
Since the pharmacist has the responsibility for the compounding, dispensing and
manufacture of the drugs used in the hospital, he should also have the authority to specify
the drugs used to be purchased.
In large institutions with centralized purchasing the pharmacist and the purchasing agent
should work hand-in-hand, each recognizing the function of each other.
3. Explain the role of pharmacist as a member of Pharmacy and Therapeutic Committee
(PTC).
Ans. Role of pharmacist as a member of Pharmacy and Therapeutic committee: The
Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers
essentially all the matters related to the use of drugs in a hospital including evaluation of
drugs & dosage forms and safe use of investigational drugs. It is responsible for framing
policies and procedures for selection, procurement, dispensing, labeling, availability,
administration, and control of drugs throughout the hospital. This committee is composed
of physicians, pharmacists and other health care professionals selected with the guidance
of the medical staff. It is a policy recommending body to the medical staff and the
administration of the hospital on matters related to the therapeutic use of drugs. It
encourages rational use of drug in the hospital and also monitors issues relating to drug
safety. One of the most important functions of PTC is to prepare and update hospital
formulary, which provides information on various drugs to be used in the hospital. There
has some role of pharmacist, such as:
 Implementation of decision of Therapeutic Committee.
 Dispensing of drugs, pharmaceutical and chemicals to different areas.
 Maintenance of approved stock of emergency drugs and antidotes
 Dispensing of narcotic drugs and accounting.
 Specification for various fluids
 Inspection of drugs at various point of use.
 Preparation of indents, issue and receipt voucher
 Inventory control
 Maintenance of stores, ledgers and records
 Provision of alternate electricity supply
 Inspection and quality control
 Teaching and training of pharmacist.
 Periodic utilization report of pharmacy
 Patient education.
4. Make a comprehensive difference between hospital and community pharmacy.
Ans. Difference between hospital and community pharmacy:
Hospital pharmacy:
 Provide specifications for the purchase of drugs, chemicals, biological etc.
 Proper storing of drugs.
 Manufacturing and distribution of medicaments such as transfusion fluids,
parenteral products, tablets, capsules, ointments, and stock mixtures.
 Dispensing and sterilizing parenteral preparations which are manufactured in
hospital.
 Dispensing of drugs as per the prescriptions of the medical staff of the hospital.
 Filling and labelling of all drug containers from which medicines are to be
administered.
 Management of stores which includes purchase of drugs, proper storage conditions,
and maintenance of records.
 Establishment and maintenance of “Drug Information Centre”.
 Providing co-operation in teaching and research programmers.
 Discarding the expired drugs and containers worn and missing labels.

Community pharmacy:

 The facilitator of personalized care for people long-term conditions

 Enhance and expand services
 Based around principles of medicines optimization
 Personalized care and support plans
 Cost effective use of medicines
 The trusted, convenient first port of call for episodic healthcare advice and
treatment:
 Seamless triage to and referral from community pharmacy.
 Pharmacy first ingrained in people’s behavior
 Ability to add to an individual’s shared care record
 Diagnostics, point of care testing and prescribing within community pharmacy
setting.
  The neighborhood health and wellbeing hub
 Go-to location for support, advice and resources on staying well
 Build on healthy living pharmacy model
 Safe and efficient supply of medicines will remain core but recognized as one
component of services available.
 Conclusions:
 Collective vision established
 Hope that partners in NHS, national and local government recognize
and share this ambition.
 Hope the vision resonates with people who lie behind it – pharmacists
and their teams.
 Hope it reflects the needs and ambitions of service users Now need to
work with others to turn it into reality.

5. How adverse drug reaction is managed in a hospital and which part a pharmacist
should play to manage it.
Ans. Adverse drug reactions (ADRs) are one of the leading causes of morbidity and
mortality. ADRs account for about 5% of the hospital admissions, though 60% of the ADRs
are preventable. Being a medicine expert, the pharmacists in the hospital sectors can play
a significant role in detecting, monitoring, and reporting ADRs. With sound knowledge on
drug therapy and disease management, they are the preferred group of professionals in
ensuring drug and patient safety. Underreporting of ADRs is a serious problem; and the
possible reasons for that include the lack of awareness among healthcare professionals and
inadequate patient education. There is a need for proper training to hospital pharmacists on
ADR reporting. Implementing good pharmacovigilance (PV) practice in the hospital
settings can lead to proper reporting of ADRs. This manuscript reviews the published
literature on the consequences and under-reporting of ADRs, importance of PV, and the
hospital pharmacists' contributions in drug and patient safety.
Definition: An ADR is a response to a medicine which is noxious and unintended, and
which occurs at doses normally used in man.
We can manage adverse drug reaction with clinical diagnose and clinical diagnose is the
part a pharmacist should play to manage adverse drug reaction.
Clinical Diagnosis: The contemporary approach to clinical diagnosis is methodical and
has been developed over centuries. Broadly, the diagnostic process starts with taking a
careful case history, through the standard procedures for physical examination of all of the
body’s organ systems, to selecting and applying the results of various external tests. The
sensitivity and selectivity of both the clinical history description and examination findings,
as well as laboratory investigations that lead to diagnoses, are important. Quality
considerations of all of the evidence used for diagnosis are paramount.
Currently, the development of evidence-based medicine has emphasized the uses and value
of clinical trial and epidemiological data, but such information does not necessarily help
with the individual patient at hand, for a number of reasons. This may be particularly true
of safety information about drug products.
When all of the evidence is assembled and a differential diagnostic formulation is
proposed, there are decisions to be made. Traditionally, clinicians use a heuristic (previous
knowledge- and experience-based) approach to diagnosis to give priorities to what is
hopefully a comprehensive list of possible diagnoses. The clinical heuristic approach is
still the most commonly practiced approach anywhere in the world.
The main disadvantages of clinical heuristic judgement are that:
 The probability of the health professional remembering previous experience or
knowledge of a similar event is very variable.
 The probability of the health professional being able to link the presenting case
information to that experience may be compromised by incomplete or partially
discrepant case information.

The performance of clinical diagnosis can be very heterogeneous, particularly for

supposedly minor illnesses, when there may be only one patient visit, and when
practitioners are generally under time pressure. Increasing fragmentation of medicine into
specialties may lead practitioners to focus only on certain areas of clinical interest in the
heuristics of their clinical evaluation.
On the other hand, clinical diagnosis often operates in a Bayesian fashion for more serious
illnesses. Each part of an often-evolving pattern of findings is usually examined critically
in an iterative way, with new information being used to create a new prior probability. The
process may involve a number of competent health professionals with different
experiences, giving a peer review of the diagnostic process. In these circumstances, the
probability of a correct diagnosis is high, certainly better than notional 50 %.

Differential diagnosis can be partially or even entirely automated, using predictive

algorithms designed and tested for the purpose. These algorithms are increasingly used: the
clinical findings in any particular diagnosis can be compared for their probabilities
(including the presence or absence of component findings) with known, typical information
for any of the possible causes.

In pharmacovigilance, however, one may use other findings as additional support for a
causal association. These include a dose–response finding (a high dose causing a known
pharmacological effect); a known reasonable temporal relationship in the clinical findings;
and de-challenge information. Added to this may be some external knowledge: analogous
drug patterns; experimental evidence; and a plausible mechanism. Some adverse reactions
are predictable from knowledge of the basic pharmacology of the drug concerned, such as
overdose, drug withdrawal syndromes and when there is reduced ability to eliminate the
drug—for example, in patients with progressive liver/renal disease. The valuable guidance
given by Bradford Hill in assessing such factors in causation includes other pointers that
can be taken into account.

Diagnosis of an adverse drug effect is inextricably mixed with management of the patient.
Changing aspects of the patient’s drug therapy is an observable experiment that can
critically alter the probability of a drug causation. The value and problems associated with
this are discussed below.