In India healthcare covers not only medical care but also all aspects of preventive care that are provided by healthcare providers, particularly doctors. In any healthcare system, human resources for health, including pharmacists, are central to the complete success of health advancement. Pharmaceutical care, not known to most health professionals in India, is a concept that deals with the way people should receive and use medication, information about medication and instructions for use. Pharmaceutical care has sparked an enormous amount of debate around the world, particularly the developed nations. Though the term "pharmaceutical care" originated in the United States (US), it has been widely adopted in all the developed nations.
What is pharmaceutical care?
The term "pharmaceutical care" was first defined in the US and used in 1975 to refer to the care that a given patient requires and receives, which assures safe and rational drug use. Helper and Strand formulated widely accepted definition of "pharmaceutical care" and published the concept in 1990. Pharmaceutical care, according to Helper and Strand, is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient's quality of life. The former philosophy of pharmaceutical care aimed at caring patients rather than caring for the pharmaceutical product. However, the later and current philosophy has provided pharmacists with a clear focus on patient care responsibilities. Pharmaceutical care is the determination of drug needs for a given individual and the provision of not only the required drug, but also the necessary services (before, during, or after treatment) to ensure optimally safe and effective drug therapy.
Pharmaceutical care: A revolution in the making
The pharmaceutical care concept was embraced by the International Pharmaceutical Federation (FIP) in 1998. In adopting this definition, the FIP added one significant amendment, "achieving definite outcomes that improve or maintain the patient's quality of life." FIP supports the concept of pharmaceutical care but recognises the individual needs of different countries. This practice model boosted the pharmacists in developed nations as a key member of healthcare team with responsibility for the outcomes of drug therapy.
A popular web medical dictionary defines pharmaceutical care as an evolving concept, in which a pharmacist provides services beyond that which can be reasonably provided by physicians, i.e., reviewing a drug's intended use, counselling points on compliance and optimal use. There is a plethora of information about pharmaceutical care available in the internet. Number of reports or articles discussing pharmaceutical care is unlimited. Using exact phrase 'pharmaceutical care' on Scirus search produces 80,207 within 15 seconds, including 1,429 well established journal articles.
Pharmacy practice in India
The allopathic drug was introduced in India by the British and was available toward the end of 19th century. There was no organised pharmacy profession in India at that time and the drug distribution and dispensing for British was mostly done by British pharmacists. The pharmacy profession was represented by a set of people known as compounders whose status, functions and duties were ill defined and improperly understood. The pharmacy act 1948 marked the beginning of pharmacy practice regulations in India. During this second stage of pharmacy practice, only registered pharmacists were allowed to practice as pharmacists. However, 'first register' for the registration of pharmacists allowed compounders to register their names as pharmacists.
With the enforcement of section 42 of Pharmacy Act from September 1, 1984 pharmacy practice experienced change at least in terms of minimum educational qualifications requirements - D. Pharm - for registration as pharmacists, permitting persons who have attained a minimum standard of professional competence to practice the profession of pharmacy. On various survey reports analysis, pharmacy practice failed to make significant progress at this stage. One of the attempts to move the pharmaceutical care theory into practice occurred in 1987, with the introduction of pharmacy practice education at a post graduate level to graduate skilled pharmacists who can work in clinical settings and provide pharmaceutical care.
Five phases of major evolution in pharmacy practice in India
The emergence of pharmacist's patient care role is reinforced in 2008 when Indian health ministry approved the 6-year Pharm. D. course regulations. And yet, many stakeholders in pharmacy field feel the pharmaceutical care is still a theoretical statement only. It is an interesting topic for discussion in symposium, conference, seminar and continuing educational programme.
Pharmaceutical care & medicine management
The preferred term for the implementation of pharmaceutical care process is now medicine management. However, the two terms have been used interchangeably. The philosophy of this care has achieved great successes in the US, and has been adopted by several pharmacists in most of the developed countries. However, pharmaceutical care or medicines management should be applied differently in every country and culture since there are differences in healthcare systems and differences in pharmacy practice. Most developed countries have developed their own model of practice based on demand for pharmacy services.
With the introduction of Pharm. D. programme, Indian pharmacists have split into two streams: industry oriented side and patient oriented side. Indian pharmacists anticipate that the change will succeed academically and provide opportunities for both pharmacist groups.
(The authors are readers in Pharmacy with Annamalai University, Annamalainagar)