Pharmacy practice guidelines 2015: New direction in pharmacy profession

Govt of India has brought a gazette notification on 15th Jan 2015 relating to the Pharmacy Act 1948, inter alia introducing guidelines for pharmacy services as an occupation. These guidelines were much awaited by the pharmacy professionals who are eager to start the pharmacy services as an occupation. The pharmacy practice guidelines empowers all the registered pharmacist to provide patient related pharmaceutical care, which is going to make vast changes in the disease management in the healthcare management.

Let us understand, what is pharmaceutical care and what this guidelines are going to change in the healthcare delivery and how the patient going to be benefited. The pharma care is a brain child of WHO federation of international pharmacy to jointly brought the guidelines of pharma care in the handbook of pharma care.

As per the module, the patient approaches the pharmacist for the prescription from the doctors. The doctors after diagnosing the condition, writes the prescription for the patient. The patient visits the pharmacist for medicine at the pharmacy shop as he is going to get information about how the medicine is to be taken. However, this is found inadequate leading to issues of poor compliance, bioavailability, poor outcome and also the patient safety. This is mainly owing to the fact that the doctors usually get updated regarding a medicine from pharmaceutical medicine. Such move is known for unethical marketing practice which has titled the prescription to product centric. Many attractive skills and kit bag to the prescribers given by the companies is an open secret. Medical Council of India (MCI) has given in a strong worded advertisement cautioning the doctor to desist from having the business relationship or endorsements of the products of any pharmaceutical company. The doctors also in the absence of transparency and accountability are successful in hiding the treatments given and grossly, go unchecked resulting in autocracy and participating in competitive unethical practices. Having said that, it is further noted many doctors started opening medical shops and indulging sale of medicines directly or indirectly to public, consumers or patient trusting the practitioners due to which care practitioners are being cheated and are helpless as there seem hardly any alternatives.

The pharmacy and nursing professionals have become submissive and behave like a mute spectators leading to public apathy. The three pillars of healthcare delivery is based on team work where a doctor to diagnose and inform the nurses to provide medicines by nursing care and the pharmacist to ensure the patient safety and care. It is very well known that all the medicines are known for unique risk and benefits. Classified risks information is available in databases like Micromedex, Cochrane, Medascape, IDIS, Drugdex. It means the doctors should collaborate with clinical pharmacist for drug information and patient should consult the pharmacist how to protect themselves from the harms of the drugs.

The clinical pharmacists are available in the country from 2011 and now in 2015 large number of clinical pharmacist with Pharm D are available in the country for services. The current scenario of drug usage is unscientific and illegal as many of the prescribed drugs are sold so without caring the providence of D&C Act 1940 which really bans the sale of prescribed drugs without a prescription to the public and health consumers. The detailed drug outlets earned and income only by selling the medicines and sales margins are the sole income. The retail shops are behaving like traders rather than professionals. This has resulted in wide spread self medication and competitive trade practices aiming at maximizing the sales backed by pharmaceutical marketing policies and manufacturers.

It is very unfortunate that the consumers or patient are receiving and were all stake holders like retail shop owner, doctor, pharmaceutical industry are beneficiaries. The drug regulators councils and the government are mute spectators.

The new guidelines of pharmacy practice empowers the registered pharmacist practice pharmacy in the public, which one can sell the pharmacy service as counselling the patient, dispensing the medicines, giving information leaflets and charge a professionals fees. There was lot of confusion regarding who can give the pharmaceutical care services {see Box 1}. The guidelines empowers registered pharmacist who may be a diploma in pharmacy, bachelor in pharmacy and Pharm D.  The diploma in pharmacy is of 2 years duration, B. Pharm 4 year duration and Pharm. D is of 6 years duration. To begin with a registered pharmacist was a logical decision to initiate the pharmacy practice guidelines. In due course of time the Pharm. D are likely to lean in pharmaceutical services due to training and background.

Specialised services and ambulatory services in the pharmacy

Disease specific medicine managements • Weight management • Minor ailment services • Smoking cessation • Medication review services • Anticoagulant monitoring • Needle and syringe exchange • Medicine-assessments and compliance support • Home care services • Supervised drug administration • Prescribing services • Supplementary prescribing services • School services • Out of hours services • On demand specialist services • Patient group services • Men’s health check up scheme • Screening for health and diagnostic services • Home delivery services • Chronic disease support services • Methadone dispensing for drug abusers

The pharma care is a programme aiming at identifying the problems the patient may be facing the area of drug disease and lifestyle.  The pharmacist after interacting with the patient is likely to prepare a customize care plan for the patient and implement the care plan by counselling the patient. The patient is advised to come back after the lapse of time, per presumed necessary to identify the outcome changes due to the therapy. The patient is usually asked to meet after 10-15 days if everything has gone fine. If, in case, there is a necessity it is advised to call back on pharmacy. The pharmacist whose background is basic and applied health science but especially Pharm D is able to assess the outcome and is also able to identify the issues with the patient, in case issue is related to the diagnosis and prescription. The pharmacist should communicate to the prescriber in confidential manner and does not meet any open criticism and who cry in front of the patient. This be the professional antiquity needs to be observed. In the similar manner, if there is an issue regarding nursing, he can refer to the nurse. If the issue is of drug lifestyle, diet, pharmacist can update and motivate the patient. The cycle of pharmacist, patient fort night review shall continue till the patient and the consumer or patient becomes confident regarding self management of condition.

The pharmacy practice guidelines has clear objective to utilize the expertise of the pharmacist to add a new dimension of patient safety in healthcare delivery. The pharmacy should develop and maintain a safe, effective, operational and socio-economically acceptable operation system. As far as possible, the chief pharmacist should ensure that medicines and other health care products are readily available in the pharmacy in sufficient quantities. The operational system should be socioeconomically effective, so that the pharmacist financial interests are maintained while providing optimal health and cost benefits to the clients.