According to the World Health Organization (WHO), research over the past decades has identified many areas of inappropriate medicine use that have a negative impact on health of consumers, especially in developing countries where community pharmacies freely supply medicines over-the-counter (OTC). However, pharmacy is a health profession that has the responsibilities to protect the well-being of patients through ensuring safe, effective and rational use of medicines.
Important role of community pharmacist
Today, community pharmacists play an important role in any country as they take responsibility for consumer’s medicine related needs. These community pharmacists in developed country go beyond simply dispensing medicines. They work together with patients to help improve quality of life and identify and resolve on a plethora of medicine use problems. Health care reform, growing medicines numbers and medicine requirements of an increasing population are putting the community pharmacy (especially private community pharmacy) under increasing pressure, with economic difficulties continuing to increase but role of government sector remaining static.
Private community pharmacy in India
Only supply of medicines from community pharmacies remain the core activities of community pharmacists. Furthermore, majority of pharmacies function without pharmacists. According to current regulations, a physician of a clinic can set up his own medical store. However, the person in charge of such clinic attached medical store is usually a non-pharmacist. The most notable reason of failure to stop anybody without pharmacy qualification from mimicking pharmacy services at community pharmacy/medical store is an intellectual inadequacy. General population can not easily differentiate informal and professional service providers at the counter of community pharmacy. Since these services are provided in community pharmacies are very limited in scientific and professional rigour and therefore this can be easily provided by anybody.
What went wrong?
It is undeniable fact that our curriculum of D Pharm revised way back in 1991 (Educations Regulations 1991) and that, perhaps, failed to change its focus towards patient-centered care through their judicious and safe use of medicines. The world around us is dynamic and changing at a required pace and so are the pharmacy profession and its curriculum. Pharmacy faculty members, as trainers of D Pharm holder pharmacists, should introspect at not only the limited exposure of our D Pharm graduates to patient-centered care role but also the fact that the major percentage of curriculum components (that last revised in 1991) remains outdated and obsolete.
Pharm D programme
An abstract of recently concluded FIP pharmacy congress in Hyderabad has argued that “to strengthen pharmacy practice in India, in 2008, Pharmacy Council of India (PCI) has started the six years Pharm D professional doctorate programme and Pharm D (PS) programme for the pharmacy graduates. These pharmacists are trained to offer pharmaceutical care services to patients both in hospital and community pharmacies”. However, the Pharm D holder pharmacists may not help the community pharmacy sector and apprehension has been raised regarding the utilization of this programme as a tool for the pharmacists to be employed internationally or as a sole instrument of professional status. Today there are 79 academic institutions (76 private and 3 public) offering Pharm D programme, with a yearly intake capacity of 2370 students. Only 35 of these offer post-baccalaureate Pharm D, which provides only 350 places. All of these institutions except 3 are privately funded and 74 are located in South India, with 3 in Maharashtra and 1 each in Punjab and Gujarat. Therefore, much hyped Pharm D programme failed to move academicians across the length and breadth of North India.
Community pharmacy in India - the way ahead
Health and pharmaceutical problems faced by India are different from the developed nations (particularly the United States). The role, responsibility and stringent duty of a community pharmacy in the United States have come to limelight in the wake of a recent news report, ‘A community pharmacist (Indian origin) was shot dead by a teenager student after he refused to supply a prescription medicine to the boy without a valid prescription’. Walking into a community pharmacy in India and asking for a medicine is likely to be rare event to be asked for a prescription for any medicine (prescription or OTC).
Consumers’ expectation from community pharmacist
Our consumers’ expectations from community pharmacist are that the medicine should be effective, safe, available and affordable. Despite many deterrents, community pharmacy services are central to effective medicine management in advancing health in our country. The pharmacy profession has to show its value at community pharmacy counter so that nobody without training can mimic the pharmacy services. Indian pharmacy curriculum should respond to these needs. The mainstay of pharmacy curriculum needs urgent revision. A change in pharmacy education and a new learning approach are needed to produce diploma holders who are competent to render patient care services. Change is also needed in policy, regulation, implementation in utilizing human resources having exposure to practice setting. The challenge lies with pharmacy curriculum continuous revision and revaluation, and rest are related to the way the curriculum is implemented.
The author is associate professor,
Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu 608 002