According to the World Health Organization, health is a state of complete physical, mental and social well-being and not merely absence of any illness. With the availability of more than thousand drug combinations in India, it is difficult to find whether a drug is spurious, duplicate or adulterated. Hence only a pharmacist can take up the challenge of providing better healthcare.
Pharmacists are professional drug specialists, who play an important role in the healthcare sector. In India, at present they are responsible for preparing, manufacturing, distributing medicines and giving information about them. In countries like USA, Australia and UK, pharmacist work in hospitals, clinics or community drug stores and their roles are given below.
Role of hospital pharmacist
Hospital pharmacist plays an important role in hospital service for patients which may include arrangements for treatment with community services. Hospital pharmacist ensures that medicines are managed safely and effectively so that they are appropriate for the age, sex, body weight and clinical status of the patient. Hospital pharmacists work in close proximity to medical staff, who are readily accessible. They have an important role in advising junior doctors on prescribing and on writing prescriptions. Most hospital pharmacists also have the benefit of working alongside colleagues who can advise and support them.
Hospital pharmacists also contribute to the economic aspects of drug use – controlling purchasing costs and working with clinicians on formularies, treatment protocols, review,evaluation of drug use and medical and clinical audit.
Role of clinical pharmacist
Clinical pharmacy is a branch of pharmacy where the pharmacist role is to provide patient care. Clinical pharmacist is an important part of the healthcare team. The pharmacist works in co-ordination with the doctors for the better patient healthcare. They have very specific roles which aim at ensuring patient safety. Some of the roles are as follows:
Patient medication history interview
Medication order review
Patient counselling regarding safe and rational use of drug
Adverse drug reaction monitoring
Drug interaction monitoring
Therapeutic drug monitoring
Participating in ward rounds
Providing information at the drug information and poison information centre
Participation in medical emergencies.
Participation in clinical drug investigation along with other medical staff members.
Within the system of healthcare, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals. Clinical pharmacists provide scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications. The clinical pharmacist helps the physician by recording patient medication histories, monitoring drug therapy, patient education and counselling.
Role of community pharmacist
The community pharmacist is a professional who directly interacts with the public and dispenses medicines with a prescription and in certain cases without a prescription like OTC drugs. The community pharmacist can take part in health promotion campaigns, locally and nationally on a wide range of drug related and health related topics. A community pharmacist could play an important role in the following areas of health care.
Providing information on nutritional aspects during medication and during a particular disease, pregnancy etc.
Providing guidance to woman during pregnancy, breast feeding and woman of older age.
Providing information on rational use of drugs by following good pharmacy practices. Advising on the administration of the medication, providing information on the storage of the medication and wherever necessary, counselling the patient. Drug information system can be set up and access to adverse drug reaction system can be made.
Organizing drug information awareness programmes to make people aware of side effects of certain OTC drugs.
Helping in enhancing the availability of essential drugs.
Counselling patients on important diseases like AIDS
Advising on stopping smoking, alcoholism and drug abuse.
Providing information on family planning.
Participating in immunization programmes
A community pharmacist can set up a separate consultation room for counselling patient. He can store the details of patient history, allergies and other details necessary for therapy so that the concept of individualization of drug therapy could be implemented. Thus the community pharmacist with the above skills becomes an indispensable partner in healthcare system of a nation.
It is essential that educational standards of the pharmacists in India is improved. Since pharmacy as a technical and professional field is undergoing globalization, profession of pharmacy has to undergo radical changes with a greater thrust on its public mission. Hence it had become essential that pharmacy education needs tremendous improvement in order to keep pace with the emerging trends in pharmacy field.
Pharmacy education should satisfy the needs of today and tomorrow for continuous professional development. The education should be skill- based so that a pharmacist can be a pharmaceutical care providers, communication counsellors, information providers etc. Finally a pharmacist should be patient oriented rather than product- oriented, so that he can be a total healthcare provider.
In the US , the basic qualification required for clinical pharmacist is Doctor of pharmacy (Pharm D) degree. During this course the students are trained extensively in the biomedical, pharmaceutical, socio behavioural, and clinical sciences. The clinical pharmacist after the completion of the bachelor’s course can undergo one or more years of post graduate training of general or speciality pharmacy residency programme.
The options available after Pharm D are many. A clinical pharmacist can choose to become a Board certified Pharmacotherapy specialist (BCNP), a Board Certified Oncology Pharmacist (BCOP), Board certified Nuclear Pharmacist (BCNP), Board Certified Nutrition Support Pharmacist (BCNSP), or a Board certified Psychiatric specialityy (BCPP) through the Board Pharmaceutical specialties (BPS) which was organized in 1976 as an independent agency of APhA (American Pharmacists Association). There are other sub specialties such as cardiology and infectious diseases and these are added qualifications.
In India we can expect this kind of healthcare with the advent of the Pharm D course and already many colleges have started the course. The first batch students will come out in 2014. The pharmacy curriculum in India is now becoming practice-oriented. The Indian Health Ministry vide dated March 3, 2008 has approved the Pharm. D regulation. Curriculum for the course is finalized, which will include regular subjects as well as sufficient exposure in clinical pharmacy practices (Hospital rounds and partial clinical training in 4th and 5th year and complete one year training in the hospital in last year of the course). The course is framed in such a way that, it can meet international standards. The clerkship, coupled with project work covering drug utilization reviews, pharmacoepidemiology, pharmacovigilance or pharmacoeconomics, will bring a great change.
But unfortunately the role of community pharmacist is not so much recognized till today in India. Until and unless the link between the people and the pharmacist does not get its due recognition, any dream of making India a healthier nation will remain a pipe dream. Since community pharmacist is essential for providing better healthcare, steps should be taken by the government and the pharmacist himself to project himself in the community as a crucial link health care.
In India, still people do not know who is a pharmacist and what is his role. The National pharmaceutical associations like Indian Pharmacists Organization, Federation of Indian Pharmacists, Indian Hospital Pharmacists Association and All India Organization of Chemists and Druggists etc. will have to be committed to change and use their influence to convince community and the government that pharmacists can play a significant role in national healthcare programmes.
For moving forward , the knowledge provided by highly educated, motivated, and accessible professional people should be well recognized, not only by its clients but also by doctors and by the policy makers.
The Pharma Vision 2020 is a charter organized by the 55th Indian pharmaceutical congress. The charter was inaugurated by Dr. A.P.J. Abdul Kalam, To attain this vision one has to improve upon the production of drugs and its import. Preventive medicine needs to be encouraged to the maximum extent possible. Fields such as compliance monitoring to standardise SOP and vaccine production have to be recognized and supplemented.
Community pharmacy needs to be encouraged in these areas. Mobile health care units have to be developed. Trust in patients about the efficacy of the system and government policies requires improvement. Safety in clinical trials also needs to be looked into. Along with this, the natural system of medicine also needs development.
With all this, 2020 is not just a vision but should be the reality. In the year 2020, pharmacist and pharmaceutical scientist working within various discipline of pharmacy will be well established and recognized as the medicine expert and will be an expert in health promotion and disease prevention. Indian pharmacist will be actively involved in national health programmes and perform individualized therapy. Pharmacists will be able to interface in an electronic, interoperable health care system to provide the best possible quality of care to patients as in the US. The information obtained through interoperability will help pharmacists ensure patient adherence to their medication regimens, reduce medication related errors and enhance medical decision making.
The author is Director, Agnihotri College of Pharmacy, Wardha, Maharashtra |