Throughout the world, a paradigm shift in profession of pharmacy in general and pharmacy practice in particular is occurring. Over the last few decades, the role of pharmacist has changed from that of a compounder and dispenser to one of the drug therapy manager, though real change is yet to occur in the Indian set up. But a beginning has already been initiated.
The quality of professional service a profession provides to the society largely depends on professional competency acquired during education and training. Pharmacy is no exception. The higher pharmaceutical education in India has two different approaches: on one side there are conventional bachelor degree in pharmacy (B. Pharm.) and master of pharmacy (M. Pharm.) and on the other side there is doctor of pharmacy (Pharm. D.) and Pharm. D. (Post Baccalaureate).
Basically the pharmacy programme at degree level is industry oriented with little component of healthcare. This is because the industries are the major employers for these graduates. B. Pharm. and M. Pharm. programmes come under the dual control of All India Council for Technical Education (AICTE) of Ministry of Human Resource Development and Pharmacy Council of India (PCI) of Ministry of Health and Family Welfare. The AICTE approval is mandatory for starting the programmes but PCI approval is necessary for registration of qualified graduate pharmacist as registered pharmacists.
The curriculum both at degree and master level is not uniform throughout the country and varies from university to university. On the other hand, the newly introduced Pharm. D. and Pharm. D. (Post Baccalaureate) programmes come under the sole control of PCI and the course curriculum is uniform throughout the country. These programmes are introduced to generate pharmacists for providing better patient care in the health system. The minimal qualification prescribed under the pharmacy act for registration as pharmacist is Diploma in Pharmacy (D. Pharm.) and is viewed as grossly inadequate to provide patient care as drug therapy manager. Even the education and training is inadequate to adopt mere good dispensing practices.
The number of medicines available for health care has increased significantly over the last few decades. While it offers wide choice, it also offers many challenges: there are quite large number of irrational combinations in the market (fortunately now some regulatory measures have been initiated in this regard) as well as advanced delivery systems requiring better patient understanding on the use of medicines.
By the time the first batch of such qualified persons come out of universities and colleges (six years from now), a strong policy and regulation must be in place to accept them as a part of clinical team in healthcare system. Professional associations, academics and regulatory authorities like pharmacy council of India must work together to apprise the government of the need of pharmaceutical care services in health set up. The government makes policy decision based on evidence and it is necessary to establish evidence through documentation and research that the introduction of pharmaceutical care services benefit not only the patients but also the whole health system through promoting appropriate use of medicines which would reduce the over all cost of the system. In a resource constrained healthcare system, introducing a new service provision (pharmaceutical care) requires investment and this investment must be able to contribute economic gain besides better patient care.
The regulations are made not just to protect the profession but for purpose in serving the public interest. Education regulations develop guidelines or requirements prescribing minimum standards required or to be acquired before entering into the pharmaceutical practice. But professional regulations are required to maintain the minimum practice standards in the society. It is necessary to ensure that the pharmacists provide safe and reliable services to the patients. Professional regulation needs to sustain the confidence of both the public and profession in addition to sustaining, improving and assuring the professional standards and maintenance of competence.
The concept of seven star pharmacists has been recognised internationally. The role of pharmacists is described as care giver, decision maker, communicator, manager, life long learner, teacher and leader. With significant change occurring in the pharmacy profession worldwide, there is more need of continuing professional development programmes to update the current developments. Being a lifelong learner, there must be provisions for the pharmacists to be aware of current trends and research, and able to embrace information technology and continuing education opportunities and integrate them into pharmaceutical care practice. In recent times several initiatives have been made: The good pharmacy practice training manual prepared by community pharmacy division of Indian Pharmaceutical Association and pilot project on accreditation of community pharmacy services experimented with the support from World Health Organisation are examples. Similar initiatives are necessary for hospital and clinical pharmacy services and at least the good pharmacy practice standards need to be established.
While in the industrial pharmacy sector, India is second to none in terms of competency and delivering quality products, the pharmaceutical practice is lagging behind. The newly introduced Pharm. D. programme would help create future pharmacists in the same competency level as the pharmacists of the developed world. Though we have quite strong education regulation, there is scope for developing professional guidelines/regulations for improving pharmacy practice. The adequate regulation would not only help in reducing incompetent, impaired or unethical professional practice but also would promote high professional patient care.
(The authors are with Department of Pharmacy, Annamalai University, Annamalai Nagar)