If there is one industry that has the potential to replicate the Indian software success story globally, it is pharma. So many things are happening -- biotechnology, the human genome project, genetic mapping, new drug discovery. Is Indian pharmacist aware of the future challenges, changes, and opportunities? Unfortunately Pharmacy practices in India has not been recognized as an integral part of the emerging pharmaceutical challenges and the attention it requires to prepare them to play their role as resourceful Community Pharmacists. This paradoxical situation has to be corrected before it is late.
There is a misconception that in India all medicines, including those falling under Schedule H of the Drugs & Cosmetics Act are freely sold over the counter by pharmacists without prescriptions. In most of the developed countries the system clearly defines the role of physicians prescribing and the pharmacists dispensing, while in India the functions are overlapping mostly in rural areas. There are unqualified doctors in rural areas and qualified doctors prescribe and dispense medicines in their clinics not only to their patients but others too. Historically, the GP and community pharmacist have a common ancestor in the apothecary, an adviser on health and dispenser of medicines.
Merely comparing the pharmacy practices in developed countries and prevailing practices in India without considering certain realities will be a subjective assessment. We have to take an objective approach to change this situation.
The necessity to improve the pharmacy practices on professional scales cannot be ignored nor delayed in the context of emerging changes, when India is becoming a fast developing nation in the world. This calls for innovative marketing dynamics in every industrial activity. In pharmaceuticals as a health care industry, India has already proved its technical competence and capabilities by producing basic drugs and formulations, in every therapeutic segment including preventive medicines for both domestic and global markets. By 2005 Indian drug manufacturers are expected to become major exporters to European countries and in USA, in generics.
This major transformation in R&D, production, marketing etc., however, has not penetrated down the line to -- the vital link in supply chain -- the pharmaceutical Trade. Ensuring quality of medicines till they reach the consumers is as vital as GMP. A well-defined distribution practice right from warehousing, transportation, proper storage, handling and dispensing at the retail counters is therefore a logical extension GMP in supply chain. In this chain - the ultimate and vital link is Community Pharmacy. The need to redefine the pharmacy practices is precisely what we have to focus and as the core issue and in the interest of the customers.
Let us now, analyze the India specific pharmaceutical care with its unique paradoxical environment.
Size of population, second largest in world next to China; vast rural and micro interior penetration required to take the health care needs to the rural and urban masses these are to be viewed from some of the peculiar situations as listed below:
Illiterate rural masses vs. educated enlightened consumers. Non-availability of basic vs. emerging quality medical health care in urban centers. Quackery practice in vs. highly competent medical rural areas profession. Vast number of drug vs. awareness to develop stores/medical pharmacies. Non availability of vs large turnout of qualified pharmacists. Small sector vs large scale Indian/MNC pharma companies. Weak regulatory vs efficient State level Drug agencies in control.
We can add several such contradictory factors but cannot escape from the necessity to look forward to improve the quality in pharmacy practices. Otherwise they will be helplessly witnessing an impressive growth of pharmaceutical Industry vs. outdated, unskilled medicine dealers defeating the very purpose of making the quality medicines available to the public with professional care and advice.
Role of professional & trade associations: In this context it is crucial that we take bold initiative to educate the practicing pharmacists, change their mind set and prepare them as Community Pharmacists by introducing refresher courses at State and district Head quarters with a time frame.
Scope for training: Everyday, the pharmacist is asked by customers for advice about minor ailments. The may require advice on symptoms; may ask for a medicine by brand name; may require general health advice e.g. about dietary supplements, precautions etc. The pharmacist's role in responding to symptoms and overseeing the sale of over-the-counter (OTC) medicines is substantial and requires a mix of knowledge and skills in the area of diseases and their treatment.
Basic knowledge about the drugs and diseases: In the ever growing OTC segments of products, lay press advertisements, self medication, drug abuse, non-compliance of dosage regimen, mixing of OTC medicines with prescription medicines; changing life style and food habits' prevalence of diseases like asthma, tuberculosis, diabetes etc., there is need to educate and advice the consumes on proper and safe use of medicines- and it requires regular refresher courses to prepare the community pharmacists in patient care and counseling.
With the advent of IT, a wealth of information is available through web sites and Drug Information Centers on Drugs, their actions, indications, side effects etc. Community pharmacists must provide a computer in their pharmacies for access to all these information through the Internet and its most essential to maintain a patients' profile for their regular customers, specimen of Community Pharmacy Medication record recommended is given below:
Patient name; Address Physician; Age; Telephone number; Sex M/F;
Phone Number; Allergies; Medication Record; Date; Rx no; Physician; Drug & Strength Quantity; Sig/dosage Refills; Pharmacists' notes & other patient Information - Eg: Date Comment: OTC drugs dispensed/used
Need to maintain proper statutory records: It is in the interest of pharmacists that they buy the medicines from authorized sources with proper purchase records. Maintain sales memos with patients name and address, batch number of the medicines sold, as a legal requirement and to safeguard themselves in the event of any drug found substandard or unsafe requiring recall etc.
Need to provide patient information brochures: Pharmaceutical associations, manufacturers can provide brochures to be distributed to patients at the counters on disease like asthma. diabetes, hypertension, epilepsy even common cold and cough, with Dos and Don'ts etc,.
To provide information: for Immunization and if space permits, vaccination programs can be organized with the help of manufacturers in the pharmacies.
Geriatric care: Elderly patients tend to get confused or forget to take medicines properly. Complementary packs for keeping each medication separately with dosage marked will help them to take medicines as prescribed.
Need to provide basic monitoring/test devices: In the counseling area pharmacists can provide BP apparatus, devices are available to test blood sugar etc
Proper Storage: All medicines are temperature sensitive and to retain their potency and efficacy proper storage is essential, protected from sunlight and heat. While it is recommended that all Community Pharmacies are air conditioned, there is a proposal to amend D&C Rules to provide air conditioners compulsorily.
Access: to Drug Information centres/ reference books/ web-sites on drug information: This is possible by providing Computers and Inter-net connectivity.
Communication skills: As pharmacists, to understand customer needs, it is necessary to develop listening skills, questioning skills. To develop a positive mind set for ethical pharmacy practices, evolving all professional, legal and moral obligations to the society.
These should be basic parameters on which we must introduce a practical approach to Community pharmacy environment in India. Community Pharmacy Division of IPA with All India Organization of Chemists & Druggists with State Pharmacy Councils as nodal centres, can organize jointly, structured programs to train practicing pharmacists in every major towns so that before 2005, we can bring a perceptible change in pharmacy practices in India.
As a supplementary activity, a Journal dedicated to Community Pharmacy is necessary to constantly update their knowledge on new molecules, and this should reach all leading pharmacies in India. Such professional Journals can be sponsored by manufacturers.
-- The author is member, Community Pharmacy Division IPA & Chairman, CPD of IPA Tamil Nadu Branch