A community pharmacy, mostly the chemists and druggists in India, is the place where medicines are stored and dispensed or sold. The general population usually calls community pharmacies as "medical stores." Pharmacists working in the community practice setting are called as community pharmacists. They are registered pharmacists, defined in the clause (i) and section (2) of the Pharmacy Act, 1948, whose presence is legally required during dispensing and selling of medicines according to Rule 65(15) of the Drugs and Cosmetics Rules, 1945.
60 years ago, there were no restrictions on the practice of pharmacy in India. The practice of prescribing and dispensing was an integral unit performed by doctors. In addition, most doctors trained their clinic assistants to dispense medicines and assist in compounding of medicinal preparations. The assistants were popularly known as "compounders." As in the case of many Asian countries, pharmacy profession in India, therefore, developed from the concept of extemporaneous preparations and selling of medicines.
Pharmacy regulation
After the enforcement of provisions of the Pharmacy Act, 1948, pharmacists working in India must have a pharmacist registration certificate issued by the state in which they wish to practice. To obtain registration certificate, the prospective pharmacist must acquire minimum diploma from a pharmacy institute that is recognized by the Pharmacy Council of India (PCI). However, prior to 1984, persons without any pharmacy educational qualification were able to register their names as pharmacists in the First Register, who had only five years of experience in the compounding and dispensing of drugs in a hospital or a clinic. In addition, section 32B provisions (related to displaced persons or repatriates) of the pharmacy act had been misused during 1980s and a large number of persons, without any recognised education or training, were reported to have been registered their names as pharmacists. Many of these people are currently working as community pharmacists.
International scenario
The practice of pharmacy has changed significantly in recent years. The majority of pharmacists practise in community pharmacies. Europe has the highest percentage of pharmacists in the community pharmacy setting - about 71 per cent. About 61 per cent of the pharmacists work in the community pharmacy in the US in independently owned or part of a drug store chain and grocery shop or department store. They distribute drugs prescribed by physicians and provide information to patients about medications and their use. They advise physicians on the selection, dosages, interactions and side effects of medicines. They also monitor health and progress of patients. Community pharmacy is ranked as one of the respected professions in US and Europe.
Currently, in order to become a licensed pharmacist in US, one should acquire a six-year Pharm.D. degree from an accredited pharmacy programme and pass NAPLEX and multistate pharmacy jurisprudence examination (MJPE), besides practical experience of 1500 intern hours. Therefore, even after graduation, the prospective pharmacist must demonstrate the competency to practice pharmacy. NAPLEX is used to assess the knowledge and proficiency, while MJPE tests pharmacy laws. Many states have established continuing competency to re-licensure. According to a report published in 2004 (www.bls.gov), majority of the US pharmacists from 89 accredited schools of pharmacy preferred working as community pharmacists whose average annual earnings were 84,900 USD. The job openings over the decade are projected to far exceed the number of pharmacy degrees.
Indian community pharmacy
Registered community pharmacists in India, unlike in US or Europe, is a diploma holder with only 500 intern hours. Once qualified, most of these pharmacists receive little additional training and there is no exposure to up-to-date information. They are comfortable in selling rather than dispensing medicines without providing significant advisory services. Clear statistic is not available on community pharmacy. Number of reports or articles discussing Indian community pharmacy is limited. For example, using 'community pharmacy in India' on Google search produces only six hits. There are no initiatives to develop minimum acceptable guidelines. The community pharmacists' job primarily involves satisfying regulatory requirements for pharmacies. There are no opportunities for pharmacists to assume greater role as incentives for such services are non-existent. Medicines are sold/dispensed by assistants (illegally?) with little or no training. Even enforcements of existing rules continue to be very weak. Consequently, community pharmacy has failed to contribute significantly to national healthcare. As a result, In India, majority of consumers, patients and other healthcare professionals are yet to embrace the concept of community pharmacist as a key member of the healthcare system.
Facing the reality
Standard of education of any discipline determines the outcome of its practice and application. Good pharmacy education leads to good pharmacy practice. Perhaps our curriculum (presently D.Pharm) has failed to change its focus from preparative and compounding pharmacy towards patient care and to include societal perspectives to pharmacy. The content and the subjects in B.Pharm programme also do not have the clinical, community and social aspects of pharmacy. The Institute of Pharmacy, Jalpaiguri in West Bengal is the first D.Pharm institute in India established as a consequence of Pharmacy Act, 1948. As far as my knowledge is concerned, earlier in this institute, pharmaceutics was taught by an M.Pharm (Chemistry) staff and chemistry by an M.Pharm (pharmacognosy) staff. Remaining staff were diploma holders. However, the PCI stipulates minimum qualifications for teachers as either M.Pharm. or B.Pharm with 3 years of teaching experience. This is the sole reason of staff deficiency in diploma colleges even today. Whereas, engineering graduates are appointed as staff in degree colleges with advance incentives. Both D.Pharm and B.Pharm courses lack clinical and community oriented syllabus. The additional subjects in the B.Pharm, as compared to D.Pharm are just an extension of many extra-biological papers. It is also a fact that there is lacuna of teachers to teach clinical pharmacy and drug policy issues.
The PCI is constituted from amongst registered pharmacists of states, majority of whom are non-practising. Practising registered pharmacists might be more relevant in assessing pitfalls and making recommendations. In almost all the countries, after gaining degree, prospective candidates have to undertake a compulsory competency test to acquire pharmacist registration. In addition, registered pharmacists need to acquire credits in continuing education to stay registered. Our graduates are registered with SPCI without even apprenticeship. This practice needs to be changed, as pharmaceutical information is ever changing field and pharmacists are to be trained accordingly to meet the challenges.
Endless opportunities
Community pharmacists are vital for all types of healthcare systems. They are the most accessible healthcare professionals. Community practice offers endless options to interact with patients and help them to achieve good quality of life. There are many important roles for community pharmacists in helping patients make better use of their medications.
If there is an area that has potential to replicate IT industry, it is delivering pharmaceutical care (identify, resolve and prevent medication related problems) during sale, dispensing and management of medicines in community pharmacy (setting). Medicines are produced in a clean and controlled environment in a manufacturing unit with the objective of retaining its potency and preventing deterioration and contamination. These medicines must be treated in similar fashion during their distribution, handling and storage in pharmacies. And the number of new drugs and information on new and existing drugs is exploding. A second revolution in drug distribution and retailing is needed to create a situation, where community pharmacy is managed by highly trained pharmacists in well-equipped pharmacies in the community. Even though challenges remain, the future of community pharmacy education and practice has to reach a position where the benefits will be for everyone - patients, community pharmacists and the retail healthcare industries.
(The author is reader in pharmacy with Annamalai University)