Pharmacy as a profession is committed for providing better health care by dispensing quality and suitable medicines for treating various pathological conditions. Functional field of the profession is based on principles of technology for manufacturing drug forms and biological aspects of health and socioeconomic state of the consumer to dispense right medicine. Though pharmacy and medicine professions have common ancestry Apothecaries, in 1231 AD pharmacy was legally separated and emerged as a specialized profession. With rapid industrialization and manufacture of ready to use medicines the practice of compounding slowly became obsolete and dispensing of medicines to the patient became main job. In this shift pharmacist emerged as technocrat responsible for safe treatment and outcome of the treatment for which he is dispensing medicines.
Pharmacy plays a vital base for developing a healthy society. Pharmacists, a professional caretaker of pharmacy, having primary dealing with the people, thereby, contribute to practice known as "community pharmacy". At present, nearly 80 percent of pharmacists are serving humanity by dispensing prescriptions where they give free professional advice and assistance on all aspects of health care and provide education. Another form refers to a popular branch of the profession as hospital pharmacy. But unfortunately this service has not proliferated in India but hospital pharmacists of developed countries monitor prescriptions and advise on correct storage and administration of drugs. They also assist physicians in selecting appropriate treatment for patients. Besides hospital and community pharmacy practice, pharmacist plays multiple responsibilities while serving in pharmaceutical industry. Industrial pharmacist works in the field of research and development, production of bulk drugs and intermediates, drug formulations, quality assurance and quality control, clinical trails and marketing. In addition to this modern world scenario has created newer opportunities to the pharmacists, few of these to name are clinical pharmacy, pharmaceutical biotechnology, regulatory affairs, intellectual property rights, pharma packaging as well as in life insurance sector.
Community and clinical pharmacy:
In developed countries like USA, UK and Australia, majority of the pharmacists work within the community area. Traditionally these have 'Medical Store' like environment where a pharmacist is responsible for the safe supply of prescribed medicines, patient counselling, maintenance of patient medication records and advice on the
management of minor ailments. Patient oriented pharmacy practice is well recognized with pharmacist being accepted by public, health care professionals and government as "Pharma health care provider'. Due to this confidence and faith created by pharmaceutical services in the mind of patients pharmacy is one of most sought and respected profession in the developed world, where they are highly paid with earning of about £ 40,000 pa. On the basis of job opportunity India scenario is almost same with almost 5 lakh retail pharmacies operating and almost 25,000 pharmacy students passing every year join this. However, supply of medicines has been the prime activity of pharmacists in our country owing to which Indian pharmacists are misrepresented and recognized as 'Pharma traders' killing their professional image.
Such poor development of community pharmacy can be briefly linked to sub-standard institutional education, lack of infrastructure, scanty medico-pharmacy relationships, and non-recognition from society as well as medical professionals. In majority cases pharmacist himself is responsible for his non-professional image. India and Sri Lanka are only countries that are still providing Diploma in Pharmacy education and designating as registered pharmacist. These registered pharmacist due to their limited educational background and marginal or no exposure to patient focoused practice cannot face physician or patient confidently. On other side the Bachelor Degree or graduation is more industry oriented due to which B.Pharm. students hardly work as community pharmacist. To change the recognition of Indian pharmacists from 'drug traders' to 'health care providers', the apex bodies such as PCI, AICTE and other pharmaceutical organizations have been taking steps. Education Regulations (ER) 1991 for Diploma Course in Pharmacy has included patient oriented subjects. However, till today pharmacy students of India are reciting Imperial systems of weights and majors and compounding 100 Latin prescriptions. Though this practice is outdated and obsolete from 1969 with ER 91 also recommending reducing its importance, Indian pharmacy teachers are teaching the same. As the same time, the modern methods of dispensing, patient medication records and reading of prescription like important aspects of syllabus are over looked. The reluctance of educators to leave behind outdated practice and accept modern concepts is major reason for non-productive outcome of modern syllabus due to which after a decade period also pharmacy institutes are just increasing number of pharma traders. This gives a representation of pharmacists as 'the person who has ability to read prescription' which has promoted dispensing of medicines by 'English qualified non-pharmacist' instead of 'qualified registered pharmacists'. The standing committee report of Ministry of Chemicals & Fertilizers in 2002 has lashed out on pharmacists, which says "there is no need of pharmacist to sell the drugs but any educated person can be given permission to run the drug store?" To overshadow such mindset of community and government, pharmacists have to establish their need base position in the society and propagate the facilities that he could provide for benefit of patient care. In addition to patient counselling pharmacy shops should maintain patient medication record (PMR) of patients. PMR is a computerized case paper maintained by pharmacist that not only includes past medical history of a patient but all health related information such as allergic reactions, habits, life style, alcohol, smoking etc. After receiving a prescription, registered pharmacist should evaluate the prescription against PMR, check every aspect of suitability of medicine and then dispense medicines. This will help to minimize overdosing of medicines, minimizing drug interactions and it will act as base for patient counselling. PMR will make patient to visit same medical store and thus it will be key to become "Family Pharmacist". Product information leaflet in local language and the use of pictograms for patient counselling is easiest way to educate patients. Pictorial explanation regarding directions to use medicines is most valuable for country like India where majority of population is illiterate and resides in villages.
Except recent example of refresher course for the registered pharmacist by Maharashtra State Pharmacy Council, there is no provision and compulsion of continuous education in India. IPA has setup special task force 'IPA-Community Pharmacy Division' to undertake and propagate the concept of Pharmaceutical Health Care.
The role of pharmacies of 21st century is not only confined to accurate supply of medication, but on the checking that the medication is appropriate for the patient and counselling the patient on its appropriate use. Accuracy to identify and understand health problem of a patient and to reconfirm the need and suitability of prescribed medicines to the patient govern success of dispensing of medication. This paved way for the development of clinical pharmacy practice, where knowledge of therapeutics and clinical pathology is applied for patient care. Pharmacists in developed countries have been providing clinical services and some of them have established themselves as specialist in particular disease, for instance, clinical pharmacist of respiratory disorders or pharmacist specialized for paediatric care etc.
Patient Counselling: Advising patient about drug therapy should be part and parcel of dispensing of medicines. It is not of concern whether the community is literate or illiterate, important is how many of these know about ABCD of medicines.
A. is active ingredient, activity and adverse effect,
B .is bioavailability and bioequivalence of drug forms, brands of drugs,
C .is clinical effectiveness and costing and
D .is doctors' intension and dispensing by pharmacist.
In this context, the most suitable profession for patient counselling is non-other than working pharmacists who running the medical stores.
In the post GATT scenario the days are not far that larger foreign pharmacies such as Boots, Britannia, Merck, Moss Chemists and Indian MNCs like Reliance, Tata would open chain of state-of-art medical stores and this would have far-reaching effect on the pharmacy as service profession. Therefore, the new age Indian pharmacists should be competitive to take challenge of the globalization.
(The author is professor, Poona College of Pharmacy, Pune)