Pharmacist is a professional who fills prescriptions for the patients. The compounding pharmacist, has to make the prescription itself. Pharmacists are familiar with medication ingredients, drugs interactions, cautions and hints and are experts on drugs and therapeutic goals. Thus, they are trained to prepare and distribute medicines and to give information about them.
The pharmacists are also experts in formulations, on adverse effects and the potential drug interactions. They must remain people oriented, rather than preserving the profession as just a drug oriented one. They are intended to consider both the medication and the patient to ensure that the patient has the right drug in the right amount, for the right length of time, with minimum of adverse effects.
Result of such a conceptual pharmacist in society is the improved health care, contained costs and a high measure of health security. Love of people is a necessary quality for any successful pharmacist, since much of their time will be spent asking and answering questions.
The purpose of the pharmacist is to provide excellent pharmaceutical care to the public or community. To provide excellent pharmaceutical care, pharmacist must have the most complete, up-to-date drug information available. The need for drug information has intensified because of the increased rate of new drugs entry (new drug approvals). He should also refer the publication of many consensus therapeutic guidelines and must recognize the complex nature of the interactions of drugs with other drugs, nutrients and herbal medicines.
The responsibility of pharmacist is increasing in the present healthcare scenario, particularly because the health care consumers are more educated about the drugs than ever before. They expect their medication regimen to be as safe as possible. So the pharmacists are challenged with assembling a diverse array of facts about drugs like rational approach, individualising a therapeutic regimen in light of patient-specific factors, maximizing therapeutic benefits, reducing the risk of adverse effects etc.
To face this facts effectively, pharmacists need to access to the most current drug information available along with drug-use guidelines that have been constructed from knowledgeable and authoritative sources. The pharmacists must have the thorough knowledge about indications and dosages of drugs, pharmacodynamics, which explains the mechanism and effects of the physiologic action of drug, pharmacokinetics which deals with the absorption, distribution, metabolism and excretion of the drug, mainly specifies peak levels and half life as appropriate, contraindication and precaution, the lists of conditions associated with special risks in patients who receive the drug and drug interactions which specifies the clinically significant addictive, synergistic or antagonistic effects that result from combined use of the drug with other drugs.
The pharmacist must also have a thorough knowledge about effects on diagnostic tests, the significant interference with a diagnostic test or its result by direct effects on the test itself or by systemic drug effects that lead to misleading test results, adverse drug reaction which is the undesirable effects that may follow use of the drug, overdose and treatment, therapeutic monitoring with recommendations for monitoring the effects of drug therapy, patient counselling in which patient teaching guidelines to be used during drug therapy.
Legal aspects
Pharmacy profession is regulated by two major Acts (1) the Drugs & Cosmetics Act, 1940 & Rules 1945 and (2) The Pharmacy Act 1948.
The Drugs & Cosmetics Act, 1940 And Rules 1945 remarks that, as per Rule 65 (15) (c)(1) Registered Pharmacist means "a person who is a registered pharmacist as defined in clause (1) of section (2) of The Pharmacy Act, 1948". As per Rule 65 (1) any drug shall, if compounded or made on the licensee's premises be compounded or made by or under the direct and personal supervision of a registered pharmacist.
Community Pharmacy
Today there is a lack of any unbiased drugs information throughout the country. Medical practitioners today are burdened with a large number of patients and hence concentration on drug advice is reduced. There is a lack of awareness about side effects and after effects of drugs throughout the country. Storage of drugs, which plays a main role in preserving the potency of drugs, is in most pathetic state. The situation calls for dedicated community pharmacists in the country.
Problems of self-medication and drug abuse can be overcome by community pharmacy. Significant involvement of pharmacist is necessary to execute his role in maintaining the health care system and improve the quality of life of the people. Due to pharmacist's intense knowledge on drugs and healthcare, he can guide the physician for rational use of drugs for better patient care.
Irrational and unnecessary prescription is common and antibiotic resistance is wide-spread. Due to many spurious, duplicating and adulterated drugs in the market, it is in the hands of the pharmacist, who can have better pharmaceutical care of the patient. The consultative groups of World Health Organization met in Vancouver in 1997 had summarized the role of pharmacist as caregiver, decision maker, communicator, leader, manager, life long learner and teacher.
A community pharmacist is the professional who would be in direct access to the public and whose duties are widely sought after by the public and patients. In this concept, the pharmacist dispenses medicines (prescription drugs), supplies medicines (OTC drugs), educates the public on public health matters, advice on the administration of the medicine, provides information on the storage of medicine, counsel the patient and helps the physician for rational prescribing.
Pharmaceutical Care
"Pharmaceutical Care" is a philosophy, which has a patient care process and management system. To provide better pharmaceutical care, pharmacist should be equipped with the therapeutics knowledge and effective communication skills.
In this scenario, the parameters for the upgrading the pharmacist to professional are need of changing regulation, re-imbursement, education, physical structure of pharmacies, practice. Pharmaceutical care contributes in preventing the drug related morbidity are mortality. Drugs may make the people sick as well as better. Pharmaceutical care prevents unnecessary health care costs from lost working days to therapy due to hospitalization.
There are some specific principles and practices for pharmaceutical care. Pharmacists should establish and maintain a good professional relationship with the patient, evaluation of patient specific model information and designing during therapy plan with the patient, collection, organization, recording and maintenance of patient medical information and continuous reviewing, monitoring and modifying of the therapeutic plan with the patient and healthcare team, to accomplish the pharmaceutical care.
State Pharmacy Councils should come out with the standards for practicing pharmacists and should conduct regular continuing professional development program to update the knowledge of practicing pharmacists as per their convenience. Steps should be taken to legalise the patient counselling and health screening services and allow pharmacists to charge prescribed professional fee (as recommended by Kalkar Committee). It should also be ensured that suitable changes are made in the curriculum highlighting more about pharmacy practice at undergraduate level. Specialisation at undergraduate level shall be considered seriously to provide world class education and training in pharmacy practice.
The pharmacy profession in our country is still in developing stage. In many states there are lack of pharmacists or insufficient number of pharmacists available. In all the developed countries the minimum qualification for registration is Degree in Pharmacy, and those countries provides suitable legislations to practice in community pharmacy.
In India the phar-macy profession is yet to achieve to be inclu-ded in the health team/health services as provided in other developed countries. For that we have to achieve many more things including (1) minimum qualifications for registration as Degree in Pharmacy (2) professional status on par with medical profession (3) suitable legislations permitting practice of pharmacy. Unless to bring these changes in our legislation, it will be very difficult to get recognition of pharmacist in health profession.
- (The author is Registrar, Pharmacy Council, Tamil Nadu)