INDIAN PHARMACY UPDATE

The profession and practice of pharmacy did not start in India as a well defined healthcare area of specialization as it is today. Rather, pharmaceutical training was borne from the necessity to provide assistance to expatriate medical officers. As in early 1887 when Dr R Zacchaeus Bailey opened a pharmacy shop for Europeans in Lagos. During the colonial period, those trained to handle drugs were called “dispensers”. Such dispensers functioned as dispensers of medicines, sanitary officers, medical aids and anaesthetists in operating theaters. At that time, the development, and hence the role of the pharmacy professional, followed the pattern in other British colonies and was in line with the developments in Britain. The need to import drugs on a large scale, which led to early development of the wholesale drug trade, resulted in additional role for the pharmacists. Since 1960, many develop-ments have taken place in the education, legislations, and practice of pharmacy in various areas including industries, hospitals and communities. Today, the professional role of the pharmacist in hospitals and community pharmacies is changing from a focus on preparation, dispensing and sale of medications to one in which pharmacists assist the public to get the best possible results from medications through patient education, physician consultation, and patient monitoring. In the 60s and 70s, the roles mainly involved the supply and dispensing of medications, bulk compounding administrative functions (including care and custody of drugs, drug tendering and purchasing, record keeping and accounting), and staff supervision and

management. In the 1980s, the need to ensure the availability of needed drugs in our hospitals at affordable prices led to the interest of hospital pharmacists in the manufacture of drugs within the hospital system. The introduction and acceptance of clinical pharmacy into the practice of pharmacy in India has led some hospital pharmacists to be involved in clinical activities including drug information service and unit dose dispensing.

However, unlike many developed countries, the involvement of pharmacists in India in the application of the emerging roles has not been impressive. Although pharmaceutical care has become a preferred mode of practice, most pharmacists in India are still hardly offer significant patient-oriented services. After almost two decades, patient-oriented pharmacy practice in our hospitals and community pharmacies has suffered from

poor staffing, infrastructure, willingness of the pharmacists to add new evolving roles to their duties, lack of proper coordination of activities, resistance of physicians, lack of proper training for pharmacists, failure of many hospital and community pharmacies to adopt the practice and lack of self confidence. These are also frequently compounded by the continuous resistance of some medical doctors against patient oriented pharmaceutical services, particularly in hospital wards.

The new roles for pharmacists in hospitals and community pharmacies in the provision of pharmaceutical care means that pharmacy profession must begin to address the 

• need for the training of more technicians to assist in dispensing functions - if pharmacists will have the time to effectively provide pharmaceutical care; and
• development and enforcement of areas of specialization for pharmacists in hospital and community practice. 

The path for continuous growth of the pharmacy profession obviously requires expansion, resurfacing and modernization. This justifies the need for new pharmacy programme and curriculum that can produce the manpower required for the new roles.

Thus, the introduction of the new Indian PharmD program being offered in a number of pharmacy schools to 30 students in each intake, has internship or residency training during the sixth year involving posting in speciality units. This internship is defined as a phase of training wherein a student is exposed to actual pharmacy practice or clinical pharmacy services and acquires skill under supervision so that he or she may become capable of functioning independently. The curriculum appears to retain a high pharmaceutical science input, which is crucial for the increasingly important Indian pharmaceutical industry, as well as clinical subjects. However, there is still a shortage of suitably qualified preceptors. A number of Indian schools of pharmacy have been running masters programs in clinical pharmacy for the last decade. However, many of the graduates of these courses, like their BPharm colleagues, have gone to work in the pharmaceutical industry and not in clinical practice as there was no clear career path available to them. This balance will hopefully start to be redressed as the first PharmD students move to clinical practice in 5 years' time. 

 In developing countries, critical indicators would include increased access to, availability of, and appropriate use of safe, efficacious, and quality medicine. It would currently be very difficult to develop a convincing argument to support a relationship between these indicators and the introduction of the PharmD degree. Perhaps we should develop a framework, a set of indicators to measure and monitor and gauge the impact of the PharmD degree and other curricular changes to help countries who are considering whether to introduce a PharmD program. Maybe we should actually view the introduction of the PharmD degree as a transformational process, rather than a one-off event. Perhaps, as in India, the PharmD might be introduced in parallel with the traditional course as the capacity of the health system to support advanced clinical roles is developed. Rather than considering whether countries need a PharmD program or not, maybe steps could be taken to examine what kind of curricular outcomes are required to adequately prepare pharmacists in a particular country. 

To survive, pharmacists must be willing to acknowledge the rapidly occurring changes in health care delivery and accept the reality that the changes will continue. Traditional roles and activities which are no longer needed or valued in the new system must be willingly let go. Pharmacists will be continuously left behind unless they aggressively step into action and become involved in all critical activities that are underway in the system or practice arena in which they find themselves.

Please provide your comments and feedback

Akshaya Srikanth,

Pharm.D Intern

Hyderabad, India