Medicines play a crucial role in saving lives, restoring health and preventing diseases and epidemics. However, what generally is not realised that for a human body, medicines are essentially foreign substances and therefore, if not used with care they can do more harm than good. Hence, medicines need to be of good quality, safe, efficacious and should be used rationally. The role of pharmacist has been emerging continuously over the past three decades so as to cater the modulating needs of society. The pharmacist is now no longer merely a supplier of medicines and a concocter of medicinal products. In the present scenario, the pharmacist is a coordination centre between different members of healthcare team and the patients. Hence, proper role and involvement of a pharmacist in safe use of medicines and overall healthcare programme becomes very crucial.
Patient medication counselling
Patient counselling is an interpersonal communication between the pharmacist and the patient/patient party regarding the disease, medication and lifestyle modifications. It deals with providing information, advice and assistance about medication and therapy either orally or in written form to the patients or to their representatives.
Generally, a physician who is preoccupied with patient diagnosis and treatment may not spare enough time for advising patients regarding safe use of medicines, alternative therapy, moral supporting etc. A pharmacist can set up a separate consultation room for counselling the patients. He can maintain details of patient history, allergies and other necessary informations for the therapy. Moreover, pharmacist advises the patients to take the doses in proper time so as to prevent any adverse consequences, such as missed dose of a glaucoma drug can lead to optic nerve damage and even blindness. Moreover, a pharmacist can enable the patients to pose educated queries and suggestions regarding medication to the healthcare provider which can in turn help in generating better prescriptions.
Rational use of medicines
In current scenario, the rational use of medicines is an utmost issue. WHO defines it as "rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirement for an adequate period of time, at the lowest cost to them and their community". The National Health Policy 2002 of India also gives thrust on rational use of drugs so as to optimize various aspects of the healthcare. A pharmacist is one of the inevitable members of healthcare team who can help in achieving the goal of rational use of drugs by following good pharmacy practices. Common types of irrational use of drugs include non-compliance with health provider prescription, self medication with prescription drugs, overuse and misuse of antibiotics, overuse of relatively safe drugs, use of needless luxurious drugs such as lifestyle drugs etc. Promoting the rational use of medicines will result in improved quality and increased accessibility of drugs leading to better quality of life for the community.
Specialist in preventing drug/medicine abuse
Medicines have confined not only immense benefits but also number of harms to mankind. Abuse of medicines is a serious global issue. Pharmacist can play a key role in preventing drug abuse by providing clear information and advices about the adverse effects of medications. Drug abuse may arise due to one of the following reasons such as wrong diagnosis, inappropriate drug selection, wrong dosage schedule, situations where indications are not specified, unwarranted prophylactic use, poly pharmacy and drug interaction, drug-nutrient interaction, self medication with OTC/prescription drugs, lack of facilities in rural/poverty areas. Misuse of new amphetamines, tranquilizers, diazepam, phensidyl cough syrup etc. is found to be common among drug addicts. Hence, these drugs find their way into the illicit drug market over the world. Pharmacists have been chosen as key persons against drug abuse in USA because of their education, accessibility and trustworthiness. A national programme known as "Pharmacist against Drug Abuse" was launched in 1982 in USA. However, in India, pharmacy education systems have yet to recognise the potential of pharmacists in public health. Pharmacy students should be made more patient oriented and well acquainted to act as a role model in preventing medicine abuse.
Hence, it is the prime responsibility of a pharmacist to take an active role in helping the drug abusers to avoid abuse of drugs. Pharmacist can also play an integral role in instructing drug abuse counsellor and other health care professionals about pharmacology and mechanism of action of abused substances and of medication used to treat substance use disorders.
Role in self care and self medication
Self medication is the selection and use of medicines by individuals to treat their self recognised illness or symptoms. It is an accepted fact that self care is the primary source of healthcare system. Large proportion of population in the world is getting inclined towards self medication due to a number of factors such as socio-economic considerations, lifestyle, accessibility, demographic and epidemiological factors. But, one should keep in mind that medicines are not candies, which need to be taken with caution. Pharmacist can play a very important role in self care and self medication of the patient by providing them the necessary information about the drugs, especially over the counter (OTC) drugs. The need of the hour is that, pharmacist accept these challenges boldly and courageously to ensure safe use of medicines even during self care and self medication. He cannot be a helpless spectator.
Combating counterfeit drugs
According to WHO, counterfeiting in relation to medicinal products means the deliberate and fraudulent mislabelling with respect to the identity, composition and/or source of a finished medicinal product, or ingredient for the preparation of a medicinal product. Counterfeiting can be applicable to both generic and branded products and also to the traditional remedies. Counterfeiting is attractive because relatively small quantities of counterfeit medicines can provide huge profits to the counterfeiter, and trading them is seen to carry less risk than trafficking addictive drugs. Worldwide counterfeiting of drugs is believed to be a more common problem. According to World Health Organization (WHO), about 7 per cent to 8 per cent of the drugs worldwide are counterfeit. The scourge of counterfeits is particularly bad in Asia. India is fast becoming the capital for counterfeit drugs, accounting for one-third of the counterfeit drugs produced worldwide. Everyone has an influential role to play in combating this menace in general, and pharmacist should play an important role in particular. He should assert to implement WHO/FIP, or national good pharmacy practice guidelines for combating counterfeit drugs. As a community/hospital pharmacist, he/she should procure medicinal products only from reputed vendors. A pharmacist is expected to be alert and abreast in differentiating the quality of package/label of authentic pharmaceutical products from the spurious ones, and should isolate and withhold supply of the drug, once suspected to be counterfeit. Moreover, government can make use of WHO recommendations and apply them so as to step forward in the fight against counterfeiting and thus eradicating this deadly trade not only from India but globally.
Evidence based medicines
The use of herbal medicines is getting widespread in India and abroad as an important alternate therapy in healthcare. However, similar to synthetic medicines, the herbal remedies would also undergo long, expensive and complex randomized clinical trials. It should be carefully monitored by a well acquainted pharmacist having critical attitude, so as to evident the therapeutic benefits of such medicines.
Preventing drug interactions
Some medicines can interact with other medicines, foods and dietary supplements. As a result, they don't show their expected effects or may cause unpleasant and adverse reactions. To prevent drug interactions, there should be a healthcare management which must be followed by a pharmacist.
● Patient profile should be reviewed thoroughly including drug history and patient risk factors.
● Complex therapeutic regimens should be avoided.
● Probability of a clinically significant drug interaction should be determined.
● Patient profile should be re-evaluated when changing drug therapy.
It is imperative for a pharmacist to keep an updated account on possible drug interactions especially of new drugs, so that potentially harmful effects can be avoided.
Geriatric and infant care - welfare of special patient groups
The pharmacist delivers attentive services for welfare of special patient groups like pregnant women, elderly patients, those having visual and hearing impairments or those taking multiple medications. More accurate and safe use of medicines should be done in case of children, older people and pregnant women. Paediatric drug therapy challenges the pharmacists as children are more delicate and different from adults. Many of the assumptions in drug therapy do not apply to these special age/patient groups because of their modified pharmacokinetic parameters. Hence, in such cases, drug therapy monitoring by a dexterous pharmacist becomes very essential, as selection of appropriate medicine, its dose and dosage intervals keeps on changing.
Drug information centres - a new horizon
With the advent and emergence of new Information Communication Technology (ICT), information of libraries and literature is now available at our desktops. In recent past, a number of drug information centres (DICs) have been established in India, where pharmacists are playing very important and crucial roles in disseminating unbiased drug information. The information provided by DICs is reliable, evidence-based and current, that leads to enhanced quality of patient care and improved patient outcome. The information about medicines as provided by the company representatives to the prescribers is very often biased and may not be current or evidence-based because of business dimensions to the information. Provision of independent (unbiased) information is, therefore, essential. Therefore, the pharmacists at drug information centres play a significant role in improving rational use of drugs, and also indirectly leading to better healthcare services.
Improved patient compliance
Patient compliance is defined as the extent to which a patient's actual dosing history corresponds to the prescribed drug regimen. In fact, almost half of the patients leaving a physician's office with a prescription, do not take the medicine as directed, leading to the failure of even the best treatment plan. For such patients, non-compliance, therefore, has been recognised as a challenge to the successful delivery of healthcare. This not only worsens the quality of life but also adds to the cost of therapy. The leading cause of patient non-compliance is the lack of patient education. This is most probably due to poor patient-doctor communications. To prevent such undesired events, there is a need to improve patient compliance. The community pharmacists here act as a link between the patient and the doctor. He educates the patients appropriately. He provides sufficient information to the patients about various effects of the medicines that the patient is going to consume. Pharmacist communicates the correct way to take the medication in correct dosage and for a correct duration of time. He explains to the patients, the benefits of complying with the medication and also the adverse consequences of non-compliance.
Conclusion
Proper role and involvement of pharmacist in medicine management and overall healthcare programme, therefore, becomes very crucial. Wide range of drugs and healthcare products need to be properly stored and distributed by a qualified pharmacist so that they can be appropriately used by a patient. In the emerging scenario, it is logical that society would be happy to rely upon pharmacist to enhance the quality of drug therapy by identifying inappropriate prescribing, pharmaceutical delivery, patient compliance, patient idiosyncrasy and appropriate monitoring of drug therapy. However, pharmacist will have to develop their pharmaceutical expertise and facilities in order to deliver high-tech and individually-tailored medicines in the primary care settings. Hence, if pharmacists do not rise to the occasion and accept these challenges to serve mankind by ensuring safe use of medicines, they will be blamed forever for the disastrous results.
(The authors are with Institute of Pharmaceutical Sciences, Kurukshetra University, Kurukshetra 136 119, Haryana).