philosophy of patient care is a wide and complicated topic of literature. That
is elaborated by different health institution to harmonize their local clinical
activities. Undoubtedly, that is working successfully to satisfy patients,
fulfill the requirement of clinicians and cover maximum mutual benefits within
officially allocated budget. However, patient care has different comprehension
in different demographic and socio-political setting. But, in general, the
meaning, understanding and composition of clinical and pharmaceutical patient
care may be same all over world. The pharmacists, clinicians and administration
adopt, exercise and emphasize on certain parts depending upon the type of
challenges, kind of patients and available health care facilities.
the health care is an emerging field that always remained under consideration.
The local and international experts like to work, contribute and improve it to
enhance the public health. Even some time judiciary, parliament and local
intelligentsia focus and emphasize to address some particular health related
problems. So, we may need to elaborate the comprehension to satisfy the
literature and logical need of health and medicine including identification of
problems, designing treatment protocol and handling the complication of
therapy. That may potentially improve the overall outcomes and maximize the
patient’s benefit. [2,4] After twenty five years the definition of pharmaceutical
care is still unsatisfactory. The confusion remained about what this term
comprises and how to distinguish it from other terms. The board of the
Pharmaceutical Care Network Europe (PCNE) felt essential to rephrase
pharmaceutical care and to answer the question: "What is Pharmaceutical
Care ".  The patient care is not perfectly incorporated into the health
care system in most part of the world. However, pharmacy practice has shown
positive attitudes toward patient care provision. Thus, an advanced working
should focus to improve the understanding the concept of patient care and
overcome barriers. 
a scientific and logical paraphrase definitions of patient care is needed using
the standardized syntax. That should focus on the subject, activities,
provider, recipient and outcomes in clinical practice. The professional
activities and/ or event may potentially help to define the intended and
applicable parts of clinical and pharmaceutical patient care. These should
cover the potential challenges of representative work setting and validate
internal or external obligations.[1,2] In addition of that the basic components
of clinical pharmacy practice i.e. prescription, administration and
documentation of drugs should be delivered perfectly. That helps to improve the
overall professional services of drug reviewing, counseling and prevention of
medication errors. Whereas, the most current scope of pharmacy practice also
include the drug information, drug consumption, drug assessment and selection,
medication therapy management, formal education and training program, disease
state management and application of Electronic Data Processing (EDP).  Moreover, the pharamcovigilance,
pharmaco-economics, therapeutical monitoring, bio-safety, drug information, and
aseptic dispensary also improve the quality of patient care. 
there are certain obligations regarding clinical and pharmaceutical care of
patients. That helps us to mitigate the drug interactions, wrong prescription,
misjudgment and inaccurate diagnosis. So, the pharmacy professional work
collectively to achieve the common goals of improving the health standards,
mitigation of drug abuse and rationalization of prescriptions.  Moreover,
the new protocols, techniques and procedures i.e. bio-safety, therapeutical
monitoring, medication review are adopted gradually to assure safety of
patients.  The new legislations and drug jurisprudence helps to offer a
balanced health practice that harmonize the collaborative working of the judiciary,
civil society and political leadership. [6,9]
COLLECTION AND INTERPRETATION
scientific information collected form Medline, Embase, PubMed, Cochrane Central
Register of Controlled Trials, International Pharmaceutical Abstracts, Cumulative
Index to Nursing, and Allied Health Literature and Latin American &
Caribbean Literature on Health Sciences databases. The research article and
databases were searched from inception to get more relevant and current
knowledge of this field. The duplications deleted and titles or full texts were
screened to obtain the exact scientific information. The lists reference
citations were reviewed for any additional studies. We also contact the authors
to collect any possible or missing information and/ or clarification.
PHARMACEUTICAL PORTFOLIO IN
are approximately 42,500 licensed pharmacists working in community, clinical,
regulatory, research and teaching institutions of Canada. More than 10,000
pharmacies are offering the clinical, pharmaceutical care all over the country.
If we further analyze the data of pharmacy professional, it is concluded that
approximately 70% are working in community pharmacies, 15% are working in
hospitals, and 15% are working in other settings i.e. regulatory bodies,
government authorities, drug production (industry), professional associations,
academics institution and degree awarding universities. [10,13, 15]
new role of the pharmacist has been evolved. That is more patient oriented
instead of only focusing the prescribed medication only. Currently, pharmacists
are valued as the drug specialists of the health care team. They interact with
patients, collaborate with their families, involve in clinical situations and
become an essential part of health care providers. That maximized the benefit
the patient and Canadians health care institutions or authorizes. Hence the
traditional role of the pharmacist is expanding. They deliver a range of
advanced services across Canada including medication analyses, chronic disease
controlling, immunization services and wellness programs. Most provincial
governments have approved the pharmacist role to prescribe medicine with
variable scopes of authority. [11, 12]That complements the health care provided
by a physician and may potentially result convenience for patients to get their
refills in minimum time spent dealing with prescription changes and combined
medication management. [14,16]
role of the pharmacist has changed a lot over the last twenty year. A widely
expansion in scope of practice has gone far beyond a traditional dispensing.
Pharmacists are working more for their patients than ever before and are
playing a larger role in Canadian health care system. 
Canada is the Federal department accountable for serving Canadians to maintain
and improve their health, while regarding individual choices and conditions.
The Minister of Health is responsible for conserving and improving the health
of Canadians. This is supported by the Health Portfolio which comprises Health
Canada, the Public Health Agency of Canada, the Canadian Institutes of Health
Research, the Patented Medicine Prices Review Board and the Canadian Food
Inspection Agency. The Health Portfolio consists of approximately 12,000
full-time equivalent employees and an annual budget of over $3.8 billion. 
The general composition of Health Canada is given in Figure 1.
Canadian Food Inspection Agency (CFIA) is working to mitigate
the risks regarding the safety of foods. The health and safety of Canadians
residents are the highest priority of CFIA's. That is the driving force behind
the design and development of their programs. Hence, the CFIA is working in
collaboration with consumers, industry and federal, provincial or municipal
organizations. Their partnership continues to work towards protecting Canadians
from preventable health risks related to food, contagious, zoonotic and
Figure 1. Health
Canada's organizational chart. 
(Adopted from Health Canada)
Canadian Institutes of Health Research
is another Canada's leading federal agency for health research. Its objective
is to produce new information that can be translated into improved health for
Canadians, more active health services and products and a reinforced health
the Patented Medicine Prices Review
Board is a quasi-judicial body that defends consumers and contributes to
health care by confirming that the manufacturers' prices of patented medicines
are not too much.
the Public Health Agency of Canada provide
the Government of Canada's commitment to help look after the health and safety
of all Canadians. Its actions focus on controlling chronic diseases, like
cancer and heart disease, avoiding injuries and reacting to public health
emergencies and infectious disease outbreaks.
Health Canada worked to renovate and update the regulatory system for food and
health products. The regulation that considerably supports the activities,
health and welfare of Canadians are disseminated, revised and applied i.e. Food
and Drugs Act Liaison, Classification of Health Products at the Device-Drug
Interface, Health Products & Food Regulatory Modernization, Information
about Nanotechnology Based Health Products and Food, Chemical Substances Portal
ACTS AND REGULATIONS
are many pieces of legislation introduced and enforced by Health Canada
administers. They have designed regulations under legislation that have a
direct impact on the Canadian’s health and safety. The officials of regulatory
authorities consult with the local industry, drug experts, public
representatives, Non Governmental Organizations and other relevant parties.
They also prepares guidelines to interpret and clarify the legislation and
regulations i.e. Pest Control Products Act, Agriculture and Agri-Food
Administrative Monetary Penalties Act (to issue executive monetary penalties to
implement compliance with provisions of the Act and associated Regulations),
Canada Health Act (describe the criteria and conditions to receive the
contributions under the Canada Health Transfer), Canada Consumer Product Safety
Act, Canadian Environmental Protection Act 1999, Cannabis Act (received Royal
Assent on June 21, 2018, and will come into force on October 17, 2018),
Controlled Drugs and Substances Act, Department of Health Act (define the
powers, duties and functions of the Minister regarding the promotion or
preservation of the health over which Parliament has jurisdiction), Financial
Administration Act, Food and Drugs Act, Hazardous Materials Information Review
Act, Hazardous Products Act (elaborate the supplier label and safety data sheet
requirements of the Workplace Hazardous Materials Information System, WHMIS),
Patent Act, Pest Control Products Act, Radiation Emitting Devices Act, and
Tobacco and Vaping Products Act. [2,6]
CORPORATE DRUG CHAIN OF PHARMACEUTICAL BUSINESS
Canadian pharmaceuticals industry is currently the second largest health
expenditure in Canada. The drug stores
and pharmacy working in community and retail business are raising the drugs
prices to generate considerable revenue. Whereas, some provincial drug programs
have restricted prescription prices to cut healthcare costs to consumers,
hurting industry operators. However, there are following main brands offering
pharmaceutical care in Canada.
Brunet Pharmacy was introduced in 1855 in Quebec City of Quebec.
Wilfrid-Étienne Brunet founded the first Brunet pharmacy, that was largest one
at the time. Whereas, during 1982, four other branches were started in same
city. In 1987 it was launched in Montreal QC and later expanded to most of the
province of Quebec and now includes 182 branches.
Drug Store Pharmacy was initially founded in 1916
with the brand of Loblaw Groceterias Limited, store in Toronto, Ontario. Loblaw
Companies Limited is now a big Canadian corporate and franchise business that
offer pharmaceuticals, grocery, electronics, financial services and apparel.
The main brands of Loblaw include President's No Name, Choice, T&T, Joe Fresh,
Seaquest, Exact, Azami, and Teddy's Choice. They have approximately 136,000
full time and part-time employees in
Familiprix was started by Médico-Prix in 1977 in Eastern
Quebec. This brand name of Familiprix was introduced in October 17, 1979.
Whereas, it was extended to Montreal during 1990. Currently, Familiprix has =
250 braches in Quebec and New Brunswick. Their head office located in Quebec
City with additional office in Montreal.
Jean Coutu founded in 1969 by Jean Coutu and Louis Michaud as
a pharmacy outlet in the east side of the Montreal QC. That was officially
incorporated in 1973 under the name of Services Farmico, enticed. That name was
then changed in 1986 to its current existing name of Jean Coutu Group (PJC) Inc.
So, they entered into the New Brunswick market in 1982 and afterward in the Ontario
market in 1983. Their headquartered is located in Varennes, Quebec and now
having =400 branches in New Brunswick, Ontario and Quebec.
is maintained by the Sobeys Group of Stellarton, Nova Scotia with a head office
located in Dartmouth, Nova Scotia. Lawtons has =67 branches operating
throughout Atlantic Canada, in the provinces of Newfoundland New Brunswick,
Nova Scotia Labrador, and Prince Edward Island.
London Drugs was founded by Sam Bass during 1945 in Vancouver,
British Columbia. In 1976 London Drug Store extended for the first time, beyond
the provincial border into Edmonton Alberta. During the next ten years, London
Drugs increased the number of outlet branches. They also began increasing the
variety of products. Afterward, in 1981, London Drugs expanded services
introduced the computer in 1983. The headquarters of London Drugs is located in
Richmond, British Columbia and have 78 stores in the provinces of Alberta,
Saskatchewan, Manitoba and British Columbia.
The PharmaChoice founded in 1999. This is
a member owned cooperative of Canadian pharmacies. They have =740 independent
pharmacies across Canada, generating =$2B in retail practice.
Pharmasave was introduced in 1981 by the merging of two local
brands of Western Drug Mart and United Pharmacy in British Columbia. They are
now located all over the Canada.
is the merger of Essaim and Santé Services, on August 2004. Whereas, the
Proximed banner was officially introduced created on February 2007. They have
31 branch locations working under the brand name of Proximed. On June 19, 2008,
McKesson Canada acquired Proxim.
founded in 1903. The "Rex" in the name came from the common Rx
abbreviation for medical prescriptions. It is a Boston based American
drugstores. In Canada the over the counter products are operated by McKesson
Corporation, and of health supplements in the United States since 1985.
However, until about 1977, the US Chain did have Rexall drug stores in Canada.
Shoppers Drug Mart or Pharmaprix was established by Murray
Koffler in Toronto Ontario in 1962. He
generated the Associate Concept to delivers individual pharmacists the
opportunity to combine self-governing business ownership, professional practice
and supportive services under one brand, with the provision of a commercial
entity. This visualization endures to be the foundation of Shoppers Drug Mart
and the Associate-owners have helped build a brand that is identical with
extraordinary service, worth and trust. Over the past 50 years, the retail
format is persistent to progress and the Company’s drug store network has grown
through procurements and new construction, helping Shoppers Drug Mart become
Canada’s leading drug store retailer. Today, there are =1,307 Shoppers Drug
Mart and Pharmaprix stores across the country. In 2014 Loblaw Companies Limited
acquired Shoppers Drug Mart Corporation for $12.4 billion in cash and stock.
The Uniprix pharmacy chain was founded in
1977 in Quebec, Canada. It is mainly based in Saint-Leonard, Montreal, Quebec
and operates under four brands: Uniprix, Unipharm, Clinique Santé and
Uniclinique. Combining its four brands, Uniprix is the 2nd largest
pharmacy chain in Quebec after Jean Coutu and is mutually exclusive with the
Pharmasave chain in English Canada.
Value Drug Mart known as Value Drug Mart Associates Ltd. was
founded by pharmacist Barry Katz in in 1978. Since 1983, Value Drug Mart also
supports the local vents.
Canadian health professionals may also collaborate and coordinate with
international organizations. That may be bilateral or trilateral to help and
support the institution, patients and/ or working professional. The compliance
and enforcement become more useful to provide fruitful outcomes. Thus, the main
institution that can mutually share the information with Canadian professionals
are Food and Drug Administration (FDA ) USA, Therapeutic Goods Administration
(TGA) Australia, Agence Francaise de Securite Sanitaire des Produits de Sante –
France, Medical Product Agency – Sweden, Medicines Control Agency - United
Kingdom, European Commission - Enterprise DG Pharmaceuticals - Regulatory frameworks
/ Market authorizations and European Agency for the Evaluation of Medicinal
Products. [13,15, 17]
PROFESSIONAL BODIES AND REGULATORY AUTHORITIES
The Canadian Minister of Health is working
excellently to offer, improve and maintain the best possible health facilities
for Canadian residents. The health institutions are working effectively to
achieve the goals and objectives. The Health Portfolio that comprised of Health
Canada, the Canadian Institutes of Health Research, the Public Health Agency of
Canada, the Canadian Food Inspection Agency and the Patented Medicine Prices
Review Board have good collaboration and coordination. Thus, the Health Canada has
=$3.8 billion annual budget along with
approximately 12,000 permanent employees. 
the Canadian Pharmacists Association
(CPhA) is potentially contributing in the overall health care system. The
qualified pharmacist and health care professionals are improving and creating
new opportunities. They are ambitious to offer better patient care in the country.
Hence, CPhA has charted the course through many developments in pharmacy since
1907. This is a national, non-profit organization and continues to be the
national voice of Canadian pharmacists.
the Canadian Society of Hospital Pharmacists
(CSHP) provides the clinical and pharmaceutical care to the indoor (admitted)
and outdoor patients. This national voluntary organization of pharmacists
committed to offer the active use of medication in hospitals, advancement of
safety and collaborative patient in healthcare settings. They help and support
through education, advocacy, promotion of best practices and sharing of
knowledge and current information.
the National Association of Pharmacy
Regulatory Authorities (NAPRA) is another national institution. That
comprised of a voluntary association of local, provincial and territorial
pharmacy regulatory bodies and the Canadian Forces Pharmacy Services. NAPRA was
founded in 1995 to offer national governance in pharmacy regulatory practices
that enhance patient care and public protection. That regulates the pharmacy
practice and implements the standards to reassure quality health facilities.
Their primary instruction is to protect the public assure by organizing the
operations of pharmacy professionals in their respective jurisdictions. Hence,
NAPRA provides a platform to talk about their concerns and problems. That help
to build a national approach to address the common issues in hospital setting
and community pharmacy practices.
Canadian Association of Pharmacy Students and
(CAPSI) comprised of =3500 pharmacy students and internees members in Canada.
Their National Council, Executives and Locals members are representatives of
the pharmacy profession. The elected executives from any Canadian Pharmacy
faculty and two Local candidates represent their respective Pharmacy institution.
They work to provide the digital, electronic and scientific support to offer the
best possible information and guidance to new pharmacy graduates. 
REPLICATION AND ADAPTATION OF MODEL SYSTEM
international community may potentially simulate and replicate this model of
clinical care. That will help to shape the future and rationalize the
resources. Particularly the developing countries of the world including middle
east, central Asian states and far east part of the world may get benefit by designing
effective strategies to improve the public health. Moreover, the academic staff
of teaching institutions, community and/ or clinical pharmacists can play the
key role build the foundation at gross root level. That brings more conclusive
improvements in overall health care system. Particularly the drug regulatory
officers, law enforcement agents and policy makers may help to address certain
specific segment of pharmaceutical care. Thus, the exchange of tools,
technologies and information is another option for developing countries to
obtain benefit for their public.
the organizing and participation in certain professional and scientific events i.e.
conferences, exhibitions, training sessions, webinars, etc may potentially help
to understand, introduce and implement the new tools and features. The relevant
professionals may then able deliver to improve the local health care
facilities. Whereas, the corporate businesses may sign mutual memorandums and agreements
to address the particular component of clinical and pharmaceutical care.
the diplomatic relationships can potentially enhance the mutual understanding.
The ambassadors and consulate can work to maximize the benefit. The different
countries and nations obviously have their own particular health related problems
and challenges. They might have different inclinations and preferences. But, the
health experts, public representatives and government officials may work
jointly to figure out the flaw in health care system. That will help to decide
the ultimate goals and objectives. So, an effective and rational plan will
assure the successful adaptation and replication of Canadian health care model.
conclusion, the Canadian clinical and pharmaceutical care for patients is a
model system for health professional of the world. The pharmacists, physicians
and paramedics are constantly working to improve their skills and deliver best
possible professional services. Additionally, the successful joint effort of public
legislature, health professionals and government institutions has improved the
overall quality of patient’s health care. Hence, the research institutions,
pharmaceutical manufacturers and corporate businesses are continuously contributing
to assure the rational and effective treatment of emerging clinical challenges.
Most of the Canadian health departments are integrated to exchange the
permissible data and relevant information to handle potential challenges more
efficiently and rapidly. So, this kind of exceptional effort of Canadian health
professionals may be a model of collective team work. That has successfully gained
the respect, recognition and scientific value all over the world. That is an
adoptable model for other advanced and developing countries to assure the
safety of patients, correct use of resources and protection of
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