PHARMACIST CHALLENGES FACED IN INDIA
PHARMACIST CHALLENGES FACED IN INDIA
The profession of Pharmacy is an integral part
of the healthcare system worldwide. Pharmacies with well-organized practice can
go a long way to ensure quality health care for the patient. In the past,
pharmacists were responsible for dispensing medications only. Slowly, the
traditional role of pharmacists is expanding and now pharmacists are playing a
role as a vital team member in the direct care of patients, especially the new
generation pharmacists who have Pharm. Ds. Pharmacists play a major role in
providing healthcare services by means of community pharmacy services in rural
areas where physicians are not available or where physician services are too
costly for meeting the healthcare necessities. Many reforms are yet needed to
improve job satisfaction among Indian pharmacists such as higher salaries, more
job opportunities in government offices, recognition of pharmacists as health
care professionals, and changes in the Pharm. D and pharmacy curriculum. This
report looks at the current issues with the pharmacy profession in India and
provides possible recommendations to improve job satisfaction among Indian
pharmacists.
Introduction
Pharmacists comprise the third largest
healthcare professionals in the world and the pharmacy profession have been evolving
steadily over the last decade in India.
1.Today, pharmacists have expanded their role from dispensing to pharmaceutical care by maximizing the benefits of
medications and their safety.
2. With the increase in work-related
activities, it has directly or indirectly influenced the quality of work
delivery and job satisfaction in pharmacists. Job satisfaction is defined as the reaction of workers with respect to their roles in the organization that
employs them.
3. It is the degree of favourableness with
which employees view their work and are an important contributing factor towards
a person’s motivation and productivity.
4. It can determine whether an employee
will remain in a position or seek work elsewhere. Furthermore, job satisfaction
can influence the quality of work produced.5 Lower level of job satisfaction is
directly associated with lower life satisfaction and has an effect on an
individual’s life.6 Job satisfaction affects the lives of all workers,
including health workers. Both job satisfaction and motivation play an
important role in job retention and increased productivity of health workers
which in turn improves health system performance.7,8 Difficulty in retaining
clinical staff in low and middle-income countries makes the already inadequate
health care system more fragile. Thus, pharmacists’ satisfaction with their
work affects not only employees and employers, but also patients who receive
the pharmacists’ services.
Salaries and job opportunities
Payscale should be reasonable and
competitive for every specialty of the pharmaceutical field to prevent
exploitation since the salaries are considerably less in private hospitals,
community pharmacies and the industry.10 Pharmacy governing bodies like the
Pharmacy Council of India (PCI) and the All India Council for Technical
Education (AICTE) should stop issuing licenses for opening a new pharmacy
institutions due to the current lack of vacancies for already passed out
graduates and due to the prevailing concern about the quality of education
provided in pharmacy institutions. More job opportunities should be created for
passed out graduates in the government and private sector. All states should
implement the Drug and Cosmetics Act, 1945 like Maharashtra so that more
pharmacists can procure jobs in community pharmacies with a good pay scale. In
addition, PCI should maintain electronic records of registration details and
contacts of pharmacists working across the nation (including academia) as well
as the available job vacancies.
Recognition of pharmacists
Pharmacists can play an important role in
providing quality health care by working along with physicians. A team of 5–6
pharmacists should be appointed in PHCs(Primary Health Centres) at the panchayat
level and in CHCs (Community Health Centres) at the block/tehsil level. There
should be the presence of a pharmacy officer working under a medical officer at the
CHC and PHC level and similarly in each district, there should be the presence of
a chief pharmacy officer (CPO) working under a chief medical officer (CMO).
Drug inspectors must be appointed at the tehsil level in addition to their
appointment at the district or regional level for proper regulation. Pharmacy
teachers and pharmacists working in hospitals and industries should be given
due recognition, especially in the pharmaceutical industry where many art and
science graduates occupy many of the pharmacy-based jobs. The Department of
Pharmaceuticals (DoP) should be recognized as part of the Ministry of Health
and not as part of the Ministry of Chemicals & Fertilizers, both at the
central level and the state level since pharmaceutical products.
Working practice
Pharmacists should be majorly involved in
and employed for manufacturing pharmaceuticals due to their expertise in the
field. Presently, a number of art and science graduates with no basic knowledge
about pharmaceuticals work in pharmaceutical industries.9,10 Some measures to
be taken by PCI to improve pharmacy practice should be prohibiting physicians
from storing medicines in absence of a pharmacist, compulsory mention of the
name of the pharmacist who dispensed the prescription along with the name of
the physician who issued the prescription, prohibiting pharmacists from the sale of
prescription medications over the counter, renaming “medical stores” as
“pharmacies”, making the hiring of pharmacists mandatory in addition to procuring a
pharmacist licensure in pharmacies run by non-pharmacists and trying to limit
working hours for practicing pharmacists to a maximum of 8 hours per day.
Education
The practice of earning a diploma in
pharmacy as the minimum requirement to be a registered pharmacist should be
discontinued and all the students should be compulsorily made to earn a 4 year
degree course in pharmacy since India is one of the few countries that allows
candidates earning both, a 2-year diploma as well as a 4-year degree program in
pharmacy respectively, to practice as independent pharmacists. This practice is
unlike the developed countries, where candidates holding a diploma in pharmacy
do not hold as many powers and responsibilities as candidates holding a 4 year
pharmacy degree. Candidates with a diploma in pharmacy might not have as much
knowledge as the candidates with a 4-year pharmacy degree. Also, the diploma in
pharmacy curriculum is not updated on a regular basis which stresses the
importance of procuring the four-year bachelors of pharmacy (B.Pharm) degree.
B.Pharm must be the preferred qualification for pharmacists instead of D.Pharm.
Pharmacy Council of India (PCI) states that B.Pharm graduates should register
under state pharmacy council and become registered pharmacists after being
issued a certificate from the State Pharmacy Council. However, in spite of
being registered as pharmacists, they are not eligible for pharmacist vacancies
in health care centers.
How pharmacists can help solve medication errors?
In today’s health care system, no one
person – maybe not even you – knows exactly what drugs you’re taking. What’s more,
no one health care provider knows how you, the patient, take your medications, and at what doses. No single, up-to-date record consistently displays all of
this important information.
The lack of an accurate medication list and the associated lack of centralized and expert management of your full drug regimen has serious consequences.
A 2016 study at the Johns Hopkins
University School of Medicine suggested that medical errors are the third
leading cause of death in the United States. Many of these deaths are directly
related to errors associated with medications. The Centers for Disease Control
and Prevention estimates 1 million visits to emergency rooms each year stem
from adverse medication events.
In addition, thousands of people are harmed
by suboptimal medication management, or because they don’t take their
medications as directed. And millions of health care dollars are wasted each
year in the form of duplicated or unneeded drugs and medication-related
hospital readmissions.
As dean of the UCSF School of Pharmacy, a
school defined by science, as well as a researcher who has strived to improve
the effectiveness and safety of medications, I think the key to solving these
problems are to expand the role of pharmacists. My position on this point is based
on accumulating evidence.
Investigating the problem
In a 2015-2016 project, UCSF School of
Pharmacy pharmacists compared the accuracy of the medication lists of 135 newly
discharged patients with the medications the patients actually ended up taking.
Not one of these lists completely reflected medication use at home, despite the
fact that each patient had been recently discharged from a controlled hospital
environment.
Common errors included:
1.
Duplication of therapy (either
getting two of the same medication or two drugs in the same class).
2.
Omitted but necessary
medications.
3.
Unreported use of herbals or
dietary supplements.
The path forward
I am hopeful the results of our pilots
suggest a way forward.
As the above examples suggest, pharmacists
can increase the efficiency and impact of a whole health care team. Pharmacists
have been doing this for years in hospitals, and it’s time for them to do it in
the community as well. For patients, that means having a professional
consistently reviewing the accuracy of their medication lists and ensuring all
drugs are safe and effective.
Pharmacists know how drugs act and interact
in the body. They are experts regarding medication choice and side effects. And
they understand how to work with insurers on behalf of their patients. Their
mission is to ensure the individual patient is receiving the right drugs at the
right time, and that the drugs are safe, effective, and affordable. They’re also
generally adept at determining if the patient is willing and able to take the needed
medication. Pharmacists have the credentials and training to perform all these
critical tasks. They carry doctoral degrees and, of course, must be licensed to
practice.
Some progress has been made in expanding
the role of pharmacists to ensure patients are receiving safe, effective
medication therapy.
I believe the pharmacist is the medication expert that’s needed to implement the complete solution.
And our evidence suggests that this approach is effective.
Let pharmacists do their best work
Ensuring an accurate, managed medication
list for each patient would require a radical change in the business of health
care. The current community pharmacy business model is based upon the volume of
drugs dispensed. In a new patient-centered model, pharmacists would be
reimbursed for dispensing their advice to patients, just as they are for
dispensing drugs. In this model, the pharmacist is a critical member of the
patient’s health care team.
A tectonic shift in business models might
seem like a lot to ask, but empowering pharmacists with the ability to fully
apply their extensive medication knowledge is an obvious next step toward
ensuring patients receive the safest, most effective drug therapy.
Couple the power of an accurate medication
list with the medication expertise and management of the pharmacist, and I see
patient health improving, adverse drug events falling, and health care dollars
being saved in the process.
For the future, a much better solution is
possible: A medication expert will take full responsibility for reviewing your
list with you. This expert will ensure that the medications you’re taking are
safe, work for you, and are affordable. This expert will consider your personal
situation and all your health conditions in relation to the medications and will
address any concerns with fellow providers on your health care team.
4th YEAR B-PHARMACY
GLAND INSTITUTE OF PHARMACUETICAL SCIENCES
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