Monday, September 23, 2013

September 25: World Pharmacist Day and the Continuing Dismal Scenario in J&K

International Pharmaceutical Federation (FIP), a global federation representing three million pharmacists and pharmaceutical scientists worldwide, in its 2009 Council meeting held at Istanbul, Turkey decided to observe ‘World Pharmacists Day’ annually on September 25, the day when FIP was founded in the year 1912. Main objective of the World Pharmacist Day campaign is to raise awareness about the professional activities of a qualified pharmacist and educate the public on the invaluable role and crucial responsibilities of the qualified pharmacists in healthcare system and also to inculcate a sense of pride, solidarity and awareness among the pharmacy professionals on a global level. Given the fact that pharmacists represent the third largest healthcare professional group in the world and India too is home to over ten lakh registered pharmacists, Pharmacy Council of India has also decided to celebrate Pharmacist’s Day from this year onwards.
 
Over the past few decades there has been a trend for pharmacy profession to move away from its original focus on medicine supply towards a more inclusive focus on patient care. The role of the pharmacist has evolved from that of a compounder and supplier of pharmaceutical products towards that of a provider of services and information and ultimately that of a provider of patient care. Number of medication options have also multiplied manifold thus raising the complexity of therapies. Pharmacists have a unique role to play in evaluating these options and utilize their knowledge and skills to prevent, detect, monitor and resolve any medicine related problems. The concept of the seven-star pharmacist, introduced by WHO and taken up by FIP in 2000 in its policy statement on Good Pharmacy Practice, sees the pharmacist as a caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager. However the involvement of qualified pharmacists in J&K state in this regard has remained abysmally low, contrary to trends in other Indian states and developed countries. While seeking medical help, people think of a doctor or a nurse or a medical assistant, but seldom does a pharmacist come to mind probably because even a matriculate is eligible to be registered as a pharmacist in this state and anybody can get a license to sell medicines irrespective of his educational and technical background. Amidst all the mess prevailing in our state, people holding degrees in Pharmaceutical Sciences are jobless and have been left to lurch to fend for themselves. All this needs correction by introducing professional services of Clinical Pharmacy alongwith a novel concept of “Pharmaceutical Care”.
 
Pharmaceutical Care is a patient-centered, outcome-oriented pharmacy practice that requires the qualified pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease and to make sure that drug therapy regimens are safe and effective. Professional Clinical Pharmacy services offered by trained personnel holding graduate and post-graduate degrees in Pharmaceutical Sciences can help a great deal in identifying potential and actual drug-related problems; addressing needs and resolving actual drug related problems; preventing potential drug-related problems and optimizing patient therapy outcomes.  It is a practice in which the pharmacy practitioner assures that all of a patient's drug therapy is used appropriately for each medical condition; the most effective drug therapy available is used; the safest drug therapy possible is used, and the patient is able and willing to take the medication as intended. Patients in our part of the globe have not been able to avail such professional pharmaceutical care services so far as a result of which there is large scale dissatisfaction and disillusionment among them since they largely remain uninformed about various lab investigations conducted upon them and about the necessity for various drug therapies prescribed.
 
Clinical Pharmacy on the whole is in its infancy in the state of Jammu and Kashmir and the concept of Pharmaceutical Care is completely new to most of the physicians, nurses and even pharmacists presently working at the government health facilities. As a result of the patient overload of physicians and some other reasons, they are not in a position to offer detailed counseling, patient education and pharmaceutical care services on individual basis to all their patients. Therefore it is for the trained pharmacy practitioners to step in and fill the void by offering such services with a view to achieve definite therapeutic outcomes that improve a patient’s quality of life. Overall goal of professional Clinical Pharmacy services is to optimize the therapeutic outcome management and decrease the burden of five D’s viz, death, disease, disability, discomfort and dissatisfaction among patients. Clinical, economic and humanistic outcomes will also shift towards the positive side as a result of these integrated and seamless healthcare services rendered by a trained pharmacy practitioner. With these aims and objectives, University of Kashmir started a post-graduate programme in Pharmacy Practice four years back at its Department of Pharmaceutical Sciences. The course includes a mandatory practical internship training for one year in a hospital besides a year-long research work in hospital, clinical or community pharmacy that culminates with compilation and submission of a dissertation.
 
Overall scenario in relation to professional pharmacy services in the entire state of J&K is very dismal where we have mostly unqualified people working as pharmacists in retail pharmacies and dispensing medicines to patients without any technical know-how about the same and without providing any basic information to the patients about the use and possible side-effects of medicines. In government sector too, pharmacies within hospitals, primary health centres and sub-centres are manned by Medical Assistants who have not undergone any formal training as required under norms, specifically in pharmacy. We don’t have any positions available for pharmacy graduates and post-graduates at any level in our government sector. In fact their applications are not accepted for Junior Pharmacist posts advertised by the Directorate of Health and Family Welfare on the pretext of being ‘over-qualified’ for the job. Consequently the services of qualified pharmacists remain completely unutilized in the state, depriving patients of precious information about the use of drugs. Every major hospital in our state needs to have a full-fledged Department of Pharmacy Practice with adequate infrastructure, manpower, equipments and funding. Since that is already well stipulated in the approved drug policy of our state, government needs to start working in that direction in its right earnest.
 
Need of the hour is to design, implement and monitor policies aimed at providing professional Clinical Pharmacy services to the patients at primary, secondary and tertiary care level so that the services of pharmacy graduates and post-graduates can be availed at every level of our healthcare system for the greater benefit of the patients at large. Such services will also pave way for the engagement of trained and qualified pharmacists in providing patient education and counseling services, monitoring drug therapy and suggesting interventions wherever required, reporting any adverse drug reactions and drug interactions, supplying drug information to physicians and nurses, conducting drug-utilization evaluation studies, assist in framing policies, preparing monographs and hospital formularies and in providing poison control services. Trained and qualified pharmacy practitioners should be a part and parcel of the medical team during ward rounds and their assistance must be sought in prescribing best possible drug therapy to the patients. It is time to keep pace with fast changing times and trends and establish clinical pharmacy as a full-fledged profession in the state, ultimate aim of which is to optimize the clinical outcomes of drug therapy and thereby improve patient’s health-related quality of life.
 
(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and is incharge of Masters Degree Programme in Pharmacy Practice. He can be reached at ishaqgeer@gmail.com)