The pharmacy profession is responsible for resolving all the issues concerning medicine in a broader outlook. The pharmacist is entrusted with the responsibility of drug discovery to pharmaceutical care, involving various divisions of professional practice.
The key professional practice in an order can be described as research and development, manufacturing and quality assurance, regulation and drug control, distributions and sale. Pharmacy practice is an emerging field comprising of clinical, hospital and community pharmacy services.
The globalization of economics has created new opportunities in pharmacy profession. The demand for drugs and formulations is ever increasing along with the growth in population. The technology with gadgets has replaced the physical activity which has made people lazy and prone for new set of disease conditions collectively named as life style diseases. The life style diseases have increased the burden on health care systems and are leading causes of morbidity and mortality.
The new challenge of burden of life style diseases has a paradigm effect on industrial practice. The opportunities of prevention are accentuated as the life style diseases can be managed with existing drugs with improved practice of diet and physical activity. The public ignorance and conventional approach by the pharmaceutical industry and lack of enthusiasm by government are postponing interventions with changed scenario of pharmacy practice. The new age pharmacists should be able to interact with patients, doctors and nurses engaged in educating the patients in a collaborative care model.
The model of pharmacy profession in developed countries has shifted from product centric to patient centric due to surveillances and implementation of drug laws favoring patient safety and acceptable efficacy. On the contrary in India, the pharmaceutical industries are engaged in fierce competition and promotion of drugs and formulations. The major objection is violation of rule of thumb of therapeutics itself which emphasizes the benefit should be more than the risk while prescribing any medicines. The lack of transparency, accountability and documentation of treatments given has acted as a shield for writing prescription to patients in order to oblige the industrial favors received by doctors. The pharmaceutical industry spends lavishly on doctors to promote the sales. The government is seriously thinking on how to curb unholy nexus between medical profession and pharmaceutical industry.
The Government of India is seriously thinking of putting a cap on high price for commonly used essential medicine. Drug Price Control order by the National Pharmaceutical Pricing Authority of India and Jan Aushadhi (promotion of generic medicines) are some of the efforts. The 4th National Formulary was launched by the Government in 2011 which shows the government’s commitment to ensure safe, simple, patient centric pharmacy for public. It may not be strange in case government makes it mandatory to use NFI as a guideline for practice of medicine in India. The United Kingdom, British National Formulary is revised every four months and all the healthcare delivery and prescriptions are to be based on convention of practice. The promotion of Jan Aushadhi outlets by central government is a strong commitment of the government to control the high medication costs. In many diseases government is giving subsidy to the patients on purchase of medicine e.g. TB and AIDS.
The tragic death of 10 women due to administration of counterfeit medicine in mass sterilization camps recently has caused public outcry and anguish all over the country. The public is becoming sensitive and responding heatedly against unfairness and social crimes. These issues can influence and cause the electoral reversal on account of debacle caused by counterfeit medicines. It has compelled the governments to take action against the culprits and improve the regulatory functioning.
The menace of counterfeit medicine is mainly due to laxity in drug administration and poor enforcement of the law of the land. The drug enforcement departments are responsible for controlling the distribution and sales of prescription medicine. The firmness of regulations will lead to better management and control of the distribution and sale of fake medicines. The continuous surveillances are essential to identify and control the counterfeit medicine in the open market. The counterfeit medicines not only cause the aggravation of disease condition but erode the faith and trust of common man on health care system. The systems to control the distribution, logistics, inventory and retail sale are check points which are vulnerable for marketing counterfeit medicines. The proper audit and surveillance of distribution and sale of medicines are mandatory for effective management and supply of quality medicine.
The direct sale of medicine by the prescriber himself is a controversial provision in drug laws. The condition for the provision was made due to shortage of registered pharmacists to dispense in the country. It has given a chance to doctors to buy and sell medicines directly to patients, eliminating the pharmacist from health care services. The private clinicians are buying medicines in bulk directly from industry, prescribing and selling them to the patients for profit.
In the absence of monitoring system and with unquestionable authority to prescribe, the doctors are likely to neglect patient’s interest and focus on profits. This dangerous trend in health care practice now a days on large scale has led to warning by Medical Council of India on erring doctors. MCI has strictly warned of legal penalty and withdrawal of registration to practice on erring doctors for having an unethical liaison with pharmaceutical industry. The issue of shortage of pharmacists is effectively resolved due to reforms and boom in pharmaceutical education in the country. A large number of pharmacists are made available in the country.
The reform in retail pharmacy can be a mindset changer for registered pharmacist. Currently, the majority of the retail pharmacists are the registered pharmacists with diploma in pharmacy qualifications. They are divided into private pharmacies and government sectors. It is always felt that the qualifications of registered pharmacists to be upgraded to bachelor of pharmacy.
When Phamracy Council of India proposed the up gradation of qualification, the AIOCD (All Indian Origin Chemists & Distributors) and other chemists and druggists associations across the country opposed the move. They were concerned about the currently practicing D Pharm registered pharmacists. The Pharmacy Council of India’s initiative to offer a three year B.Pharm (Pharmacy Practice ) for retail pharmacist and government in service pharmacist focuses on upgrading the quality of pharmacy practice in the country. The Pharm D and Pharm D (PB) graduates are already available for practice.
The clinical pharmacy and pharmacy practice are essential services required in corporate hospitals, government hospitals and teaching hospitals. The clinical pharmacists collaborate with doctors, nurses and patients in order to safeguard the patient safety and optimize customized outcomes. They also head drugs and therapeutics committee which is responsible for developing the hospital formulary for a particular hospital. This would encourage the hospitals to save expenditure on drugs and manage the drug related problems like ADRs.
The pharmacy practice department can cater the needs of drug information which is essential for practice of evidence based medicine. It is impossible to think the absence of clinical pharmacist in big hospitals as they are very useful members of a therapeutic team in the model of collaborative care. Further, the services of therapeutic drug monitoring, pharmacovigilance, poison information center, patient counselling and discharge medication review are adding value to the health care delivery.
In our country, these changes are expected to be initiated as PCI has brought out the Pharm D and Pharm D (PB) education regulations. There are 160 institutions offering this program across the country. However, large number of institutions are opened in south Indian states like Seemandhra, Telangana, Karnataka, Tamil Nadu and Kerala. The pharmacy practice which is new to the health care system needs to be implemented in an acceptable form. The practice of pharmacy does not involve prescribing the medicine to patients but interacting and comforting the patients by clearing the doubts and taking care on issues of patient safety.
One of the major hurdles to change is to fund the patient counseling. In developed countries the provision is made either by charging the patients for duration of counseling or providing incentive to pharmacists by government for patient counseling services. Presently in India, the earnings of pharmacy is linked to the sale of medicine. There is no incentive or benefit for the pharmacist for providing pharmacy services to the patient. As a result of this no pharmacists in India are taking interest in patient education and counseling. There is a need to establish drug information centers, patient counseling centers and pharmacy practice centers which can cater the need of the public in the matters of drug usage, informed self-medication and generic drugs. Such an attempt was launched by a group of pharmacists in India as a limited liability company which offers franchises for individual pharmacists to establish stand-alone patient counseling centres under the banner of ANN Pharmacare LLP. The company promotes the young Pharm D interns to take up a six month pharmaceutical care internship where they are tied up with a local guide and an international mentor. This program encourages the development of community pharmacy practice in the country.
(Anantha Naik Nagappa and Asim Priyendu are faculty, Manipal College of Pharmaceutical Sciences, Manipal and Vaishnavi Naik is faculty,Karnataka College of Pharmacy, Bengaluru )