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 the International
Pharmaceutical Federation (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 to them.
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 seven years
back at its Department of Pharmaceutical Sciences. The course includes a mandatory
practical internship training for six months 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 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.
Need of the hour is that our state government recognizes
the role of pharmacy graduates well in time and creates adequate number of
vacancies for them in all primary, secondary and tertiary care hospitals of the
state. As of now our pharmacy graduates are not even able to apply against any
position of a pharmacist advertised by the govt. because essential
qualification for the same is Medical Assistant diploma and the applications of
our graduates are not even accepted by govt. officials on the pretext that they
are over-qualified for the post. This is a paradox that needs to be addressed.
If we are not able to give suitable opportunities to our pharmacy graduates to
utilize their expertise and offer their services to the patients and if we are
not able to chalk out their clear cut role in patient care, then we and our
government shall be failing in our respective duties and responsibilities
towards our society. Every major hospital in our state needs to have a
full-fledged Department of Pharmacy Practice with adequate infrastructure,
manpower, equipments and funding but unfortunately none of our major hospitals
has taken a leap towards establishing Clinical pharmacy practice departments in
spite of being a compulsory MCI norm. Since this requirement 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.
