Pharmacists, the vital link between physicians and patients, are viewed
differently by different stakeholders in the healthcare business: the
common man thinks of the pharmacist as a businessman or a shopkeeper,
while a doctor views the pharmacist as a promoter of self-medication and
drug substitution. On the other hand, policy makers are yet to
concretely define the role of the pharmacist. Since pharmacists are an
integral part of our healthcare system, it is imperative that their
roles and responsibilities be reviewed and restructured.
While
the popularity of self-medication has been growing worldwide because of a
number of factors such as socio-economic considerations, lifestyle,
accessibility, demographic and epidemiological factors, one should keep
in mind that medicines—allopathic, ayurvedic, herbals, or any other
preventive medicines — need to be taken with caution. Self-medication is
of no benefit to the consumer if he or she falls ill because of it.
Pharmacists can play a very important role in self-care and self
medication by providing the patients with necessary information about
drugs and dosage, especially in the case of OTC products.
As
mentioned by Felkey (2005) the pharmacist's role in patient services
should include counselling, building awareness about new products,
providing detailed information on the effects of these products on the
human body, recommending dosages, and doing follow ups of patients for
their ailments. In case of neutraceuticals and dietary supplements, the
role of the pharmacist is crucial owing to the lack of standardization,
essential details such as dosage and composition are not available for a
number of so-called `wonder drugs' (Shashidhar, 2003).
There is
an urgent need for pharmacists to boldly accept these challenges, so
that they can ensure that medicines are used appropriately even during
self-care and self-medication.
In a country like India, where the
majority of the population lives in rural areas, hospitals and/or
specialist doctors may not be accessible in everywhere, but the
pharmacists' network covers all such regions to provide services.
Hence,
in order to improve the healthcare delivery system through pharmacists,
Project Concern, an initiative of the AIDCOC (All India Drugs Control
Officers Confederation), was launched in the year 2009 with the help of a
few community pharmacists in selected towns of Maharashtra, as a pilot
project. The following disease segments were the focus of this project:
diabetes, blood pressure, and tuberculosis.
Objectives of the study
? To assess the improvement in the healthcare delivery system through the participation of pharmacists.
? To establish the value added to disease management by the participation of pharmacists.
Methodology of the study
?
The following centres were shortlisted as locations at which Project
Concern would be carried out: Mumbai, Thane, Pune , Raigad , Kolhapur ,
and Aurangabad.
? 10 pharmacists from each location were selected.
? MSCDA trained selected Pharmacists with the help of eminent faculty.
? Pharmacists were provided a weighing balance, measuring tape, digital BP apparatus, and a glucometer with strips.
Sample Size Sample size by location :
Tasks assigned to the pharmacists :
? To identify 5 patients from selected disease segments.
? To measure the patients' BP, calculate the patients' BMI, fix appointment for Blood sugar checking .
? To record readings in reporting format.
? To visit the residences of patients to measure the BP and blood sugar and calculate the BMI of all family members.
? To hand over information leaflets and a brief list of do's and don'ts.
?
To record BP, blood sugar, as well as BMI at specified after 30 days
and after 60 days for patients, once only for family members.
? To submit a complete report on the interventions.
Observations and findings of the study
Of
the pharmacists from 6 cities, 25 pharmacists from only 3
cities—Mumbai, Thane, and Aurangabad—submitted a complete report, and
hence, only these reports were considered for analysis. Similarly, while
tuberculosis patients were also chosen as subjects, along with
diabetics and hypertensives, analysis was not possible in their case
because of the following reasons:
? TB patients were reluctant to speak to the pharmacists due to social stigma associated with tuberculosis.
? Data on only 37 patients was received; which was statistically insignificant to coclude.
Within 60 days, 31 pharmacists checked 1000 patients and relatives, of which 307 patients were checked thrice.
The
following table lists the number of patients checked in each desease
catagory and monitored over a 60-day period, along with the effect of
monitoring on their respective parameters.
Effectiveness of pharmacist's network in patient monitoring
The results listed in the table show that
? 135 confirmed diabetic patients had high blood sugar, even though they were on medication.
? 99 (74%) of the confirmed diabetic patients showed better control of their blood sugar level during the study.
? Similarly, 135 confirmed hypertensive patients had relatively high BP, even though they were on medication.
? 114 (84%) confirmed hypertensive patients showed better control of their BP during the study.
During
the screening activity carried out by chemist in case of patient’s
relatives, it was observed that out of a total of 611 relatives checked,
pharmacists diagnosed 38 new cases of hypertension and 28 new cases of
diabetes. In remaining 34 patients out of 100, neither blood pressure
nor blood sugar was under control.
Conclusion
These
results clearly reveal how pharmacists can have a great impact on
patients. Trained pharmacists can help in early diagnosis, facilitating
better control of the clinical parameters, and in disease management .
Currently, as the healthcare system and its components are changing,
alternate therapies including ayurveda, naturopathy, herbal therapy,
homeopathy, and therapy based on nutrition and nutraceuticals are
receiving a lot of attention from stakeholders.
Many Indian
pharmaceutical companies have ventured into the production of
nutraceuticals which are novel products therefore, once a product
reaches the market, it is the role of the retailer that can make a large
difference in consumer perception of the product as well as company
sales figures. But in India, nutraceuticals are yet to be appreciated,
both at the consumer level and at the retailer level. As most of the
companies follow prescription or pharmaceutical route, many a times
pharmacists act as retailers in the nutraceutical business also Hence,
It is important to educate pharmacists on the market size, customer
types, various products, recommended dosage, the benefits and side
effects of nutraceuticals on the human body, and the level of
self-medication in the community, as they are the link between the
customer and the company.
In a small study conducted in Mumbai
where pharmacists were interviewed to understand their perspectives on
this upcoming market, it was observed that though the owners of these
shops were well qualified in their domain, the employees working under
them were not so qualified and therefore had limited knowledge about the
nutraceutical products. Only 40% retailers could correlate correct
dietary supplements with specific lifestyle-related unhealthy conditions
like overweight / obesity, diabetes, hypertension, cardiovascular
diseases, etc. Only at Himalaya Herbal Healthcare, Thane branch, the
person handling sales was fully aware of all the products and their
applications. This may be because the Himalaya product line is solely
devoted to dietary supplements or nutraceuticals.
On the whole,
the observations from the study indicate that for the growth of the
nutraceutical business, training and educating retailers should be one
of the major strategies of a pharmaceutical and/or nutraceutical
company. It has been observed in the UK that out of 6 million visits
made per day to 12,500 registered pharmacists; around 1 million were
related to medication enquiries, either to have prescription dispensed
or to seek advice. Pahwa et al. (2008) have mentioned that over the past
3 decades, the role of the pharmacist has gained considerable
attention. He is now no longer merely a supplier of medicinal products
but is a co-ordination centre between different members of healthcare
teams and patients. Hence, the exact role and involvement of a
pharmacist in any healthcare programme becomes very crucial.
The author is a nutritionist and a Ph.D. in management
Courtesy :Interlink Insight