Community pharmacy, globally, is recognized as link between the key health care providers such as doctors and the health care receivers. Pharmacy as profession is been recognized as a service oriented rather than mere commerce. However, in India, since the inception of Pharmacy as a profession, the role of the community pharmacy has been more trade oriented just relating to sale and distribution of medicines.
In a clinical situation, from the patient's perspective, it is important that he should be fully aware of his therapeutic course of medications. For an in-patient, out-patient or an ambulatory patient, there is a common need for medication information and is imperative that adverse drug reactions (ADRs) and/or drug interaction (DI) be avoided. In the present scenario in India, there is little input from health care practitioners towards achieving the patient specific information needs. Globally, community pharmacy and community pharmacists are considered as one spot resource where all the informative and other required therapeutic care can be accessed by the patients. This framework of health care delivery network is non-existing or poorly developed in Indian context.
Community pharmacy is the most structured and advanced in developed countries such as USA, UK and other European countries. This practice is continually developed and is well governed by legislations. The conceptual constitution of the community pharmacy is community pharmacist as centre of structure who is responsible for fulfilling responsibilities such as sale of medicine, medication information, patient record keeping, running health promotion activities such as smoking cessation services, giving advice on health services, family planning, drug misuse and abuse, and other related topics. Community pharmacist strives for most effective, appropriate, safe and economic treatment of the patient. Adoption of Community Pharmacy Practice Technologies such as use of patient care databases, software for identification of ADRs / DI specific to patient medication history, medication therapy management modules, electronic direct prescribing, telephonic/web based prescription / non-prescription drug and/or information requests, digitally secured confidential patient data, has enhanced customer service. These practices of community pharmacy have made this profession recognized as an integral part of health care delivery network.
Need for community pharmacy in India:
Demand for professional services
India's rapid economic growth is transforming the nation from developing to developed nation. The increasing educative environment and urbanization of the population has made people health conscious. People are becoming more cognisant about the drugs and therapeutic services. There is increasing demand for professional services from all health care sectors, especially pharmacy. Community pharmacy sector in India is poorly organized. There needs a development in basic elements of the community pharmacy practice. Only a qualified pharmacist should be responsible for the dispensing the drugs and providing the essential information. In India, still this particular aspects lags and drugs are still being dispensed by non-pharmacists. Recently, there are many legislative changes that have talked about the essential qualification of dispensing pharmacist in community pharmacy. A graduate in Pharmacy has been proposed as a minimum qualification for community pharmacist. This type of changes will uplift the professional image of the community pharmacy. The increasing demands for professional community pharmacy by the transforming socio-economic environment can be met by these types of changes.
Over the counter medications, self medication and community Pharmacy
Over the counter (OTC) drugs are medicines that may be sold without a prescription. Self medication is defined as consumption of medication of self behalf without professional supervision to alleviate an illness or condition, by using an OTC or other preparations. OTCs comprise range of medicines in India from vitamins, herbs to other medicinal products. Commonly used OTCs drugs such as decongestants, expectorants, antihistamines, cough suppressants and analgesics (pain relievers) can lead to various adverse effects such as respiratory depression, cardiac arrest, serious central nervous system (CNS) related problems. These drugs also pose possibility of various drug interactions for prescription drugs. In India, there have been many reports for drug abuse for these commonly used OTCs. Community pharmacies are in position to overview and intervene in the use of OTCs and give a advice on self medications.
In developed countries, awareness about OTCs and self medication is been delegated by the community pharmacy through patient counselling, leaflets and other educational techniques. Community pharmacy set ups in India can improve on the RATIONAL use of these drugs and reduce the related clinical problems. Strong legislative support can enhance the use of these medicines. If a regular customer, community pharmacy can maintain the records of the OTCs usage and can also update the related physician, which will be in his reference for future treatments of that patient.
Increasing demand in chronic care
Chronic diseases such as asthma, diabetes, cardiovascular diseases such as hypertension, Chronic obstructive pulmonary disease (COPD) needs long term medical and pharmaceutical care. There has been alarming increase in the cases of these chronic diseases in India. Many of these clinical conditions are co-exsisting and needs multiple drug interventions and continued medical and pharmaceutical care. The drugs in these categories pose both clinical and pharmacoeconomic challenges. Community pharmacy is an ideal place where patient's and retailer's business aspirations can be matched. Community pharmacies can run various health care programs, patients' disease / medication education programs for its clients where in patients will be benefited for their health and pharmacy would built business through its medication sale. There is tremendous scope for such type of initiatives in community pharmacy.
Lifestyle changes and pharmaceutical demands
Economic growth and socio-structural changes in modern Indian community have rapidly changed the life-style of the community. Along with drugs for disease ailments, there is changing trend in the population for use of life style drugs. Lifestyle drugs are used to treat 'lifestyle illnesses', which in turn is defined as diseases acquired through 'lifestyle choices'. There is increasing demands for therapies such as anti-obesity drugs, anti-ageing cosmetic interventions, erectile dysfunction disorders, anti-oxidants etc. Also, it has been observed that, there has been increasing trend towards consumption of specialized nutraceuticals such as isolated protein supplements and dietary supplements. People access these lifestyle drugs and nutraceuticals at community pharmacy. Many of these products are over the counter products. There needs special input from the community pharmacy and pharmacist towards appropriate use of these medications. The market potential for these types of products is huge and increasing. The necessary knowledge and information relating to the use and adverse events should be disseminated by the community pharmacy.
Medical tourism
Medical Tourism India, also known as Health Tourism India is a developing concept whereby people from world over visit India for their medical and related needs. India has some of the best hospitals and treatment centres in the world with state of the art facilities. In developed countries health care costs including prescription drug prices are sky high. India is encashing this opportunity by providing high level medical services at as low as one tenth of price in developed countries. An estimate suggests that the medical tourism could bring between $1 billion and $2 billion US into the country by 2012 at a growth rate of 30 per cent a year. Considering this fact, there is extreme need for development of community pharmacy and community pharmacy practices in urban developments. Community pharmacy in India includes various systems of the medicines such as allopathy, ayurveda, homeopathy and other herbal therapies. Medical tourists may seek services from these sectors in community pharmacy. A well-structured infrastructure and various allied services may enhance the performance of these establishments and bring professional uplift.
Future need and scope of community pharmacy in India:
With a population of billion, the community pharmacy in India is in demand for its various services. India is a global face of rapidly changing developing nations, which requires to strengthen its professional aspects of community pharmacy. With changing demands from educated and urbanized mass, there needs a reform in the policies and structure of the present community pharmacy setup.
Professional and educational development of the community pharmacist can make an important place in the health delivery network. There needs lot of initiatives from the community pharmacy, which should cater the needs of the increasing demand of the health and drug information support to the local community. This will enhance the public health, leading to more healthy society. However, there also needs a input from the society and other medical practioners towards reorganization of the community pharmacy services, which should compliments the efforts made by the pharmacist towards betterment of the patient care.
Lot is talked about the factors that are responsible for the non-recognition of pharmacy as a profession. However, the fact is, we all need better community pharmacy. There needs a overall efforts from government, regulatory agencies, manufacturers, pharmacy marketing experts, health care professionals, consumers pharmacists towards making a community pharmacy a success.
(The author is research fellow, Clinical and Professional Practice Cluster School of Pharmacy, Queen's University of Belfast, NI, UK)