Changing role of pharmacists: Indian scenario

 The Indian pharmaceutical sector has come a long way from being an almost non-existent industry before 1970 to a prominent provider of healthcare products now, meeting almost 95 per cent of the country's pharma needs. The industry today is in the forefront of India’s science-based industries, with wide ranging capabilities in the complex field of drug manufacturing and technology. It ranks very high in the third world in terms of technology, quality and range of medicines manufactured. From simple headache pills to sophisticated antibiotics and complex cardiac compounds, almost every type of medicine is now made indigenously. Playing a key role in promoting and sustaining development in the vital field of medicines, the Indian pharma industry boasts of quality producers and many units approved by regulatory authorities in the USand UK. International companies associated with this sector have stimulated, assisted and spearheaded this dynamic development in the past 53 years and helped to put India on the pharma map of the world. Over the years, the industry has been gaining momentum worldwide.

Redefining the role of pharmacists

Pharmacists play a crucial role in any health system as they are responsible for providing solution related to medication. The rapid growth and diversification of the pharma industry, coupled with the growth of the health sector has thrown open a sea of opportunities for pharmacists. These emerging opportunities have prompted a deeper look into the human resources for the pharmacy sector. The spectrum of pharmacy profession in India is very wide, as it covers a myriad of opportunities in the pharma industry—R&D, manufacturing and retail, healthcare sector, pharmacy education and regulatory bodies. The current availability of pharmacists in terms of pharmacist to population ratio compares favourably with that in a developed country. However, the number of registered pharmacists does not reflect the actual number of pharmacists currently involved in pharmacy practice. The actual number is likely to be much lower due to migration, death, retirement, those getting into other areas of pharmacy profession such as industrial, regulatory, marketing etc.

The demand of pharmacists is further growing with the growth of the industry within the country and outsourcing from abroad. Among the biggest factors fuelling the growth are contract research for pharma R&D and contract manufacturing for global pharma companies. Associated with these are requirement of professionals with expertise in national and international regulatory affairs. The retail sector is witnessing growth due to entry of major retail chains. The growth of national healthcare spending to more than 12 per cent per annum will impact the availability, accessibility and the demand for drugs, which in turn will have a direct impact on the requirement of pharmacists. This will also have an impact on the requirement of hospital pharmacists and those getting into the insurance sector. The shortfall in supply of pharmacists in developed countries such as the US, Canada, Europe etc and lucrative opportunities for employment will give rise to migration of Indian pharmacists to these countries. This will get a further boost with pharmacy institutions getting accredited by foreign bodies. These factors will push the demand for pharmacists.

Besides the demand and supply issues, there are several other areas affecting the pharmacy profession in the country. Pharmacists in India do not have any laid down norms on competencies and quality of services. Unlike many developed countries, there is no system of evaluating a pharmacist’s competency. Hence, the level of competencies and the quality of services provided are likely to vary among Indian pharmacists.

Pharmacists have the potential to fill the gap created due shortage/unavailability of doctors and nursing personnel in health facilities in rural areas. This can be achieved through a policy initiative to redefine the role of pharmacists in the Indian healthcare system so as to better utilise their capabilities.

Pharmacist in the society: Traditional vs modern role

The pharmacy profession is in its transitional state. The health care delivery pattern has been completely transformed and has acquired an all-together different image than what we have been observing traditionally. The present of pharmacy does not lie merely in dispensing of medication, but in the provision of relevant drug information and drug therapy recommendation to the people in the society.

Over a period of time, the pharmacy profession has greatly changed from being focused on managing the production and dispensing of drugs, to being primarily concerned with the safe, effective and appropriate use of medication and enhanced pharmacy services to patients. High technological advancement and information explosion have significantly raised the knowledge and quality level, due to which the pharmacists are now ready to shoulder bigger responsibilities with appreciable sense of sincerity and dedication. The role of pharmacists is now no longer a fixed and rigid one, but has been continuously changing and redefining its meaning and significance in the changing scenario, which is why the bond between a pharmacist and society is becoming stronger day-by-day and acquiring new dimensions.

Pharmacy, as a profession, has been able to make a room for it in the present day society. There are numerous reasons, which are responsible for greater impact and penetration of pharmacists into the societal network irrespective of geographical boundaries. Whether it is a metro city or a remotely located rural area, pharmacists are everywhere, discharging their duties to serve the humanity. The factors responsible for the influential role of pharmacists in the society may be summarised as below:-

1. Thrust on pharmaceutical care to patients - Pharmacists have begun to concentrate on patient care specifically after pharma care had been mandated as a patient centered practice model for pharmacy. Many pharmacists have found themselves challenged by a paradigm shift in their daily practices from product to the patient. Pharma care addresses the patient’s drug-related needs comprehensively through a scheduled outline of tasks, in which the practitioner makes sure that a drug therapy is appropriately indicated, effective, safe, and convenience. Shifting from a dispensing focus to a patient focus has been particularly challenging, which has included offering expanded patient counseling, immunisations, and medication-dependent disease management for persons with certain chronic conditions. Pharmacists are now covering a wide range of clinical and management functions like tracking adverse drug effects, participating in programmes to reduce medication errors, monitoring patients’ compliance with medication use, and conducting medication management programmes.

2. Redesigning the medication-use system - Pharmacists have taken into consideration the need to 're-engineer the medication use system' to reduce preventable drug therapy–related adverse outcomes; to identify well-functioning models and to develop strategies to evaluate and implement additional models; and to encourage inter-professional collaboration. The task is not so easy and they may come across certain kind of problems like lack of patient medical information, patient confidentiality concerns, limited professional communication, multiple approved formularies etc.

3. Continuing professional development (CPD) - Today’s pharmacist believes that professional attitude is an indispensable tool to make the profession just as significant for the society. A pharmacist must maintain his/her competence and effectiveness by keeping up-to-date with changes in pharmacy practice and with relevant knowledge and technology. CPD has been able to bring the society nearer to pharmacists when there comes a question about society welfare.

4. Adherence to pharma code of ethics - Sticking to ethical rules has helped a lot to establish the pharmacy profession as a noble one among the society, and pharmacists are advocating the adherence to the pharma code of ethics more strongly and loudly in the present scenario.

5. Authentic source of pharma information - The information pharmacists give plays a vital role in providing relevant and up-to-date drug information to people as and when required.

6. Adopting new concepts - The changing global scenario has prompted pharmacists to adopt new concepts for the welfare of society. Such concepts include antibiotic pharmacist, retail pharmacist, academic pharmacist, pharmaceutical journalist etc.

Societal network: Enhancing penetration

The need of the hour is that the reflection of the extraordinary good work being performed by pharma professionals should reach the common man, and every segment of society should realise, experience and recognise the beneficial implications of such efforts for the well being of society. Significant strategies and alternatives may be to frequently organise exhibitions and pharmacy fairs for the general public, organise more discussions, talks, seminars and symposia and cover topics directly catering to the society's needs, adequately and appropriately publicise and advertised each and every mass-movement/societal mission launched by pharma professionals so that the rest of the society may also participate and contribute to them, and establish new Pharmaceutical Information Centres (PICs) throughout the nation to impart information about significant pharmaceutical activities to the society.

Education 'wise'

As it has been proposed that chemist shops should have a graduate pharmacist, the existing diplomas should give pharmacists an opportunity to upgrade their knowledge and skills to the level of graduate pharmacists. This task can be undertaken by securing seats in degree courses for those who opt for regular programmes or by developing specifically designed long duration, part-time programmes. Going by the experience of several countries, pharmacy technicians or assistants will be required to assist graduate pharmacists. Therefore, the existing diploma courses should be re-oriented for pharmacy assistants with reduced duration of training. The existing institutions conducting diploma courses should be given the option of upgrading to degree courses or to conduct technician/assistant courses in a phased manner.

In order to cater to both industrial and healthcare aspects of pharmacy, graduate level courses should be separated as B Pharm–Industrial and B Pharm-Healthcare. The curriculum should be re-oriented to fulfill practice requirements in both industrial, as well as healthcare settings.

There exists a mechanism to regularly monitor infrastructure, manpower and other critical inputs for delivering quality education and training, however, Pharmacy Council of India (PCI) and All India Council for Technical Education (AICTE) need to strengthen the implementation of the monitoring mechanism. There also exists a system of teachers training and skill enhancement to develop teaching faculty for short and long-term requirement implemented by AICTE and University Grants Commission (UGC). However, it should be ensured that all teachers in the pharmacy sector should undergo training and skill enhancement on a regular basis. The PCI should initiate measures to make Continuing Pharmacy Education (CPE) programmes mandatory for all practicing pharmacists. This should be linked to periodic renewal of license for practice. PCI should also develop accredited CPE programmes at select centres. The involvement of professional bodies associated with pharmacy besides the PCI will be crucial in establishing and sustaining CPE activities on a long-term basis.

Demand, supply and existing numbers

The government should institute a comprehensive study to map out the existing pharmacy manpower in the country. This data will help in understanding the existing manpower and plan future human resource development. PCI should undertake a drive to update the practice status of registered pharmacists.

Further, licensing should be made compulsory and should be renewed every year or every two years. The renewal would be granted on the basis of certain minimum level of CPE undertaken. This, when enforced strictly, will also help in maintaining and updating data on workforce status in the pharmacy sector. This will help in maintaining an active register of practicing pharmacists.

The orientation of pharmacy courses based on feedback from the industry and health sector professionals should be undertaken on a continuous basis. Promoting affiliation with foreign institutions will also help in updating the curriculum and bringing it to international standards.

PCI should undertake educational planning in order to promote setting up pharmacy institutions in underserved areas so as to remove regional imbalances.

Setting benchmarks

There is a need for establishing benchmarks for availability of pharmacists in different areas of practice, for example, community pharmacists vis-a-vis population, hospital pharmacists as per number of beds etc. This will help in forecasting the future demand. There is also a need for benchmarking performance parameters for services and competency of pharmacists. These benchmarks should be publicised so as make people aware regarding expectations from a pharmacists. This should be supported by a system of monitoring and audit.

Indian healthcare is witnessing a rapid growth and managing the human resources to support this growth will be very critical. The pharmacist is a key component of healthcare and touches patients at every level, from high ended hospitals to the doorstep, where they provide medications in the community. Further, many of them work behind the scenes in areas such as drug research, drug distribution, in regulatory, and teaching and training roles. In order to cater to the growing demand for quality healthcare services in the country, there is a need for concerted efforts from all stakeholder to promote community practice and change peoples perception of a pharmacist from being a trader or shopkeeper to that that of a true health professional as in many developed countries. The pharmacy profession is proving itself as the backbone of the society as far as health aspects are concerned. Pharmacists are establishing new standards of pharma care and redefining their role towards the society. The impact and influence of pharmacy profession has never been recognised and identified so significantly as it is today. The entire credit goes to pharmacists who are now more aware and concerned for the welfare of the society, adopting modern concepts and professional attitude, but not at the cost of pharma ethics, and thus, have been able to penetrate the society, maintaining the traditional sanctity of pharmacy profession.