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Pharmacy emerged as a profession when doctors and nurses started their health care practice in therapeutics. It is not possible even to think of health care practice without medicine. The medicines are manufactured by the pharmacists who engage from concepts like bench to bedside in making a medicine.
Medicines are technical products which needs exclusive knowledge and skill sets while using them. Hence pharmacists are given with responsibility for protecting patients and the public form side effects and drug induced injuries.
Safe and effective use of medicines is a major concern for all stake holders viz. doctors, nurses, pharmacists, regulators, governments, WHO, and other major international bodies. The major challenge is how to motivate patients and health consumers to understand and follow the safety issues and improve the effectiveness of medicines.
It becomes challenging for pharmacists to communicate and educate the patients regarding drug disease and lifestyle. Patient counselling is a legal obligation for the community pharmacist to comply and help patients and health consumers in management of disease and achieve a good quality of life.
Pharmacy, misunderstood by stakeholders
Pharmacy is misunderstood by the community and other stake holders. Most of the health care professional are of the opinion that they can run the health care system even without a pharmacist as pharmacist contribute very less to the health care. Further many of the patients and health consumers think that pharmacist is restricted to a shop where medicine can be bought on Prescriptions of a doctor.
Despite Pharmacy Practice Regulations 2015, was enacted nothing much has changed. Although Doctor of pharmacy was introduced in the country with a hope to start pharmacy practice, which pharmacists have not taken any initiatives to provide services to the patients and health consumer as they feel pharmacy practice is an extra burden without any monetary benefits. However, pharmacist is bound legally to ensure patient safety and quality of life of their client.
Due to the comfort zone preference of pharmacist and non-serious attitude of patients and carelessness of doctors, nurses, and regulators although lapse of regulations everyone is ignoring and turning a blind eye to the outcomes of poor patient safety and drug induced injuries.
One should understand here that if pharmaceutical care is seriously implemented it can prevent many drug induced accidents, save money for patients and avoid hospital admission. It can also improve the patient's compliances along with improved quality of life.
The challenge is to identify each main stake holder mindset lacunae and take steps required to update so that journey of patient-centric care replaces product-centric market.
Pharmacist and patient’s perspective
Pharmacist and patient’s perspective can be deliberated as below. Pharmacists in India although exposed to ethics, seldom practice them and he always is in dilemma as there is no appreciation or recognition for being ethical. He always goes with his peers who want to earn money rather than do a service to the public hence the environment in India resist change, that's why the pharmacist do not show any enthusiasm for patient care and safety.
Patients in India do not take health seriously unless faced challenges due to suffering from disease. Patients are happy to lead a comfortable life without any hardships of exercise and workouts. The myths and belief systems that influence the majority strongly believe that health is inherited and continue to remain healthy irrespective of risks posed.
With such a mindset, callous attitude towards health many persons are becoming victims of lifestyle disease like diabetes and hypertension.
Medicines are very useful materials in mitigating the sufferings of disease conditions. But they carry a burden of various unwanted side effects which are likely to cause serious deleterious effects on health and carry a risk of unwanted and intended adverse drug reactions.
It is mandatory to evaluate the risk benefit analysis before prescribing\ recommending the medicine to any patients\health consumers. The medicines are made out of active pharmaceutical ingredients and additives as per the regulations and are also mentioned in the label which standard book of reference the medicine is manufactured for example Indian Pharmacopeia.
In health care delivery systems, ideally doctors are engaged in diagnosing the disease and select the appropriate medicine for that condition in consultation with pharmacist and nurse. This system is useful as doctors can focus on identifying the disease and in consultation with nurse and pharmacist. This system of practice protocol is convenient and comfortable. This system promotes the team work, and brings best of knowledge from doctor, nurse and pharmacist.
However, in many developing countries where regulations are poorly understood and implementation is also week. We can see deviation in health care professional practice. The practice of medicine is deviated wherein doctors are prescribing the medicine without consulting pharmacist or nurse.
The reasons for this kind of environment are many e.g. large number of patients, negligence about health unless one becomes seriously ill, patients demand quick relief, product centric care etc. Due to practical constraints, the health care system had modified as per connivances of all the stake holders. However, it is reflected very badly on health and quality of life of the patient. There are many accidents happen due to irrational use of medicine.
Precautionary vigilances
It is pharmacovigilance which is identifying and documenting adverse drug reactions recommending the policy makers to take appropriate measures to curtail ill effect of drugs on human and animal’s health. It is always better to take precautionary vigilances.
It is well known that a stitch in time saves nine; if we empower and engage a licensed pharmacists who are supposed to analyze the prescription by interpretation, evaluation and implementation and explain it to the patient.by counseling the patient about drug, disease and life style a patient becomes informed about how to use medicines, how to store in home as well what kind of changes patient can expect while using the medicines, patient becomes very confident and he becomes less anxiety and all his/her self-doubts get resolved.
Although such practice needs investment for training the pharmacist, remunerating the pharmacist, and make the patients agree to listen and understand. However, one needs to understand there is no alternatives available to deal with such a complex situation. This model can be tested with patients for chronic conditions, and there are no alternatives or shortcuts for safety of patients.
Community pharmacists are known to follow such protocol of safe use of medicines as a professional obligation, a however policy, to remunerate the pharmacist for giving inputs of patient safety as mandatory, would boost safe use of medicines and quality of life. For example, in Australia, Pharmacists are supposed to talk to patients about drugs prescribed, how to use and store at home and manage the health. This is documented at national health portal.
The pharmacists are paid by the state AUD 18 per patient per consultation. Such an environment ensures patient safety and quality of life and reduces the burden on hospitals. In long run there are rich dividends for all stake holders. For government, the citizens remain healthy and safe, pharmaceutical industry can switch their products to nutracueticals instead of pharmaceuticals; such a trend is already visible in many leading pharmaceutical industries. Especially after Covid 19 epidemics, many natural nutraceuticals are marketed for boosting the immunity.
The Bible of pharmacological basis of therapeutics through its several editions insists on individual caution while prescribing medicine. It mandates every medicine is a potential hazardous agent and need to evaluate the patient condition on basis of risk benefit analysis and if benefits over weigh the risk, than that medicine be prescribed.
The medicine can cause ill effects if the dose of the medicine exceeds the recommended dose, it may cause idiosyncratic reactions (drug allergy), it may react with other drugs prescribed leading drug\drug interaction or drug\food interactions. Hence it becomes all the important to follow up of patients on prescription medicines which is key for patient safety and quality of life.
Such systems are under evolution stage and across the globe. There is a need to develop pharmacy practice which can resolve many issues caused by medicines, like inappropriate dose, duplication medicine drug\drug, drug\food interactions, exceeding the recommended daily dose due to duplication medicine due to polypharmacy.
Home medication review
Home medication review is one of the latest styles of pharmacy practice. In this model registered pharmacist visit the patient home to monitor the drug therapy and outcomes of therapy and deviation of the standard practice. In this model patient safety and quality of life are covered in a patient-centric approach.
Several studies across world, have indicates that the pharmaceuticals are praised for its effectiveness and benefits. Patients feel at ease as they don’t have to go out for having health care, it is provided at their home itself. We can think of much more in HMR by integrating with Artificial Intelligence. The pharmacists start providing pharmaceutical care in HMR module, the patients and public starts taking notice of pharmacist’s services. There shall be growth in pharmacy practice which is the need of the hour.
If we develop and nurture HMR, it saves lots of money for Government as it can identify early and alert health care team about future risk of a patient. It can lead to early diagnosis of disease which is very important in all diseases especially in chronic diseases like cancer, heart disease, chronic kidney disease. Patients also going to suffer less as pharmacist is monitoring the patient and engaged in patient education and counseling which are very important in pharmacy practice.
In conclusion one can say, without pharmacy practice, health care delivery is incomplete and unable to provide good quality of life to patients. Many preventable causes pose challenges to all stake holders. The patient safety and drug induced morbidity shall be haunting everyone unless pharmacy practice is implemented in health care system.
(The author is President, Association of Community Pharmacist of India, Manipal)
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