Increasing role of pharmacist in patient care

The author in this article focuses on the growing role of clinical pharmacists in India for providing better health care to general public

The profession of pharmacy had not flourished in the ancient India. The source of drugs were from plants, animals and minerals. The drugs were prepared by experienced persons and knowledge of the medicine was kept secret within the confines of the family. The medical system was followed by traditional practitioners and the system was confined to particular families.

There were no scientific methods available for the standardization of drugs. The Indian system of medicine soon declined with the Mughal rule in power. During the Mughal rule the Arabic or the Unani-Tibbi system flourished. Later the allopathic system was followed in India when British traders came to power, who later became the rulers of India.

Initially the allopathic system was meant for the ruling race only but later it descended to general public and became popular by the close of 19th century. Drugs were imported mainly from Europe before 1940. Subsequently some drugs coming under allopathic system, was manufactured in India. The establishment of the Bengal Chemical and Pharmaceutical works in Calcutta (Kolkata) by Acharya P.C Ray in 1901 was one such example of an early drug manufacturing unit. Later a small industrial unit was opened at Parel (Mumbai) by Prof. T K. Gujjar in 1903 for manufacturing of allopathic drugs. Alembic chemical works at Baroda was established in the year 1907.

The import of drugs was withdrawn during the World War-1 and later resumed after the war came to an end. Due to the absence of regulatory agencies in checking the quality of drugs imported, inferior quality medicines and adulterated drugs were dumped into the market by the foreign manufacturers. The market was filled with deleterious drugs with no therapeutic efficacy and was dispensed by people without proper qualifications. But later on a few laws were enforced having indirect bearing on drugs such as Opium Act of 1878, Indian Tariff Act of 1894, Poisons Act of 1919, United Provinces Prevention of Adulteration Act of 1912, Bengal Food Adulteration Act of 1919, Madras Prevention of Adulteration Act of 1919, Prevention of Adulteration Act of 1919 and Punjab Pure Food Act of 1929 etc. These laws were having only indirect link with the drug.

The turning point in the pharmacy profession came when the Govt of India appointed a committee to resolve the problems of pharmacy in India and the committee was headed by Late Col. R . N Chopra in 1930. The committee findings were published in 1931 and found that there is no recognized profession in pharmacy or in compounding of drugs and those who practised drug dispensing were appointed as professionals.

It was after the publication of this report , Prof.M.L.Schroff initiated pharmaceutical education in India. He first introduced the pharmacy education at the university level in Banaras Hindu University in 1932. The pharmacy education was later spread to other universities such as Punjab University, L M College of Pharmacy at Ahmadabad etc. Due to the rapid growth of pharmaceutical industries, the government initiated policies in pharmacy education in India. Now there are more than 1500 educational institution in India offering D Pharm, B Pharm, M Pharm and Doctoral degree in pharmacy. The Govt of India has established NIPER, the first national level institute in pharmacy for advanced studies and research in pharmaceutical sciences in 1998.

Chronology of events in pharmacy profession

• The professional association in the name United Province Pharmaceutical Association was established in 1935 which was later converted into Indian Pharmaceutical Association.
• Subsequently many important initiatives were made in the profession of pharmacy such as Drug Bill to regulate the import, manufacture, sale and distribution of drugs in British India in 1940 which was finally adopted as Drugs Act of 1940.
• Followed by establishment of first Drugs Technical Advisory Board in 1941
• Central Drugs Laboratory in Calcutta.
• Drugs rule under the Drugs Act was established in 1945
• Pharmacy Bill for Standardizing Pharmacy Education in India
• List of drugs used in India was published in Indian Pharmacopoeia in 1946
• Pharmacopoeial Committee was constituted in 1948
• The Pharmacy Act was published in 1948
• Pharmacy Council of India was constituted in 1949
• The Drugs and Magic Remedies Act was passed in 1954 to act against misleading advertisements
• The education regulation comes into effect in some states in 1954.
• First edition of Indian Pharmacopoeia was published in 1955
• Medicinal and Toilet Preparations Act was passed for enforcing uniform duty for all states for preparation containing alcohol in 1955
• Narcotic and Psychotropic Substances Act was passed for protecting the individuals from dangers of addictive drugs
• The Pharmacy council of India drafts the code of pharmaceutical ethics in term of relation to his/her under pharmacist in relation to his job, trade, medical profession and profession.
• Govt of India has constitutes National Pharmaceutical Pricing Authority under the Ministry of Chemicals and Fertilizers for controlling the price of drugs in India.

The profession of pharmacy has now become an integral part of the health care system worldwide. The pharmacists in past were responsible for dispensing, manufacturing and marketing of drugs. The traditional role of the pharmacist has changed and now pharmacist plays a vital role in the direct care of patients. The Pharm D programme in 2008 was introduced to create professional clinical pharmacist in health care system on the grounds of current healthcare scenario.

The clinical pharmacist is trained in biology, chemistry and pharmacology. The clinical pharmacist is an expert in providing detailed information to the health professionals and to the general public. He helps patients to recover from illness or maintain a healthy lifestyle. He serve as a guide in abstracting information from periodic bulletins, newsletters or other pharmacy literature to help the physicians in understanding the latest findings in drug therapy for treating various ailments. He also assists in administrative capacity to achieve economy in hospitals by proper planning of safe drug policy, by choosing quality products from market, by minimizing wastage, antibiotic policy, preventing misuse or pilferage of drugs and preparing future drug requirements based on drug utilization pattern.

The role and responsibilities of a clinical pharmacist in a health care team should be performed with immense care. The clinical pharmacist should interact with patient and maintain their complete medical history. He is responsible for filing the documentation relating to hypersensitivity/allergy to certain drugs, intoxication or drug dependence to certain chemical substances, side effects of some drugs, hypersensitivity or allergy of certain food habits. The clinical pharmacist should check the patient’s medical history for drug related interactions and patient habits after receiving the prescription, since prescribed drugs may interact with certain OTC drugs for implementing accurate medical therapy.

There is immense scope to use drug information’s tools in Indian setup for checking drug interactions. The clinical pharmacist can help in monitoring drug therapy, ensuring the safety and efficacies for drugs with narrow therapeutic index. The clinical pharmacist also observe the pharmacokinetic parameters for checking the plasma concentration of drug, enzymes and also measuring the glucose quantity in blood etc. The clinical pharmacist helps in detecting and reporting of adverse drug reactions of patients with impairment of kidney or hepatic disorders. He serves as a health care professional in designing health and drug policies for assisting health care professional and to public in giving drug information.

The clinical pharmacist plays a key role in providing drug and poison information. Various electronic databases and drug information software are now available for getting latest information regarding medicine and poison. The databases/software gives easy, quick and updated information about drugs/poisons and some used in practice include Clinical Pharmacology (by Elsevier), MICROMEDEX, Medscape etc.

Clinical pharmacists also have an important role in community pharmacy services. The services include dispensing of drug, support for self care, promotion of healthy life styles, review of medicine, providing leaflets relating to the practise involved in usage of drugs, smoking/alcohol cessation, health nutrition programme etc. Though the community pharmacy services are still in its inception stage in India, after the implementation the practice will be very much useful for the common man in India.

Clinical pharmacists have a wider scope for research in community pharmacy in India for the benefit of general public. India being a highly populated country with numerous hospitals, there is not much contribution made in clinical and epidemiological research. Since the concept of clinical pharmacy is in the initial stage, the contribution of clinical pharmacist towards research is negligible. The physicians are not in a position to contribute full of their capacity towards research, since they are over loaded with patients. In this aspect less data from the hospitals are being published.