Contents - FIP

and the education and training of pharmacy undergraduates and postgraduates might
provide a path towards a further consolidation of pharmacy’s place in well co-ordinated
health (and social) care delivery.
However, the main point to stress here is that towards the end of the 20 th century
continuing technical and social change (including the development of computer based
stock control and dispensing systems and electronic individual health records, coupled
with growing consumer demands for personally focused care) created further pressure
for adaptation. Community pharmacy is responding by moving more in the direction of
person centred health service delivery, while maintaining and where possible improving
the efficiency and effectiveness of medicines supply.
Examples of the pharmacy service developments being explored across the world relate
to the identification and management of circulatory disease risks and, as alluded to
earlier, support for adherence and appropriateness in medicines taking. This is especially
important in long term condition related contexts such as asthma, COPD, diabetes and
Parkinson’s disease case management. Such innovations could help assure affordable
future public health improvement, although as the next main section of this analysis
indicates their successful introduction into commonly accepted practice faces many
barriers. They range from legal and regulatory inflexibilities to present (socially defined,
and hence modifiable) public preferences for medically led care. The historical record
also identifies professional resistance to adopting new practices as an additional hurdle
to be overcome in most if not all settings.
The latter may even exist in a proportion of those responsible for pharmacy education.
However, there can be no doubt that during the twentieth century pharmacy has been
able to achieve change. Positive progress has taken place, albeit on occasions at a cost
to not only those professionals least able to accommodate new ways of working but
to members of the public reluctant to accept new service relationships. It would be too
great a task to attempt to report comprehensively on a hundred years of global community
pharmacy adaptation to new needs and opportunities. But the selected examples
below offer an overview of the processes involved, and their impacts upon societies and
people in them.
Changing the face of pharmacy in Russia and Central and eastern Europe
In the two decades leading up to 1917 pharmacists were in a challenged position in
Russia. This was because of growing competition from foreign pharmaceutical manufac-
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