Professional Documents
Culture Documents
ABSTRACT
Pharmacies are not same as an average grocery store or jewellery store, customers are not
buying medications for their luxurious needs. Pharmacies deal with products which are
capable of saving lives and at the same time these possess significant risk. If the people
handling these are not qualified, it may even lead to life and death risk to the patients. The
primary objective of this project is to identify the current scenario of retail pharmacy in
Kolkata and to compare with developed countries. For this project, 4 major zones of Kolkata
were chosen and a survey was conducted on the pharmacies of those areas. At the same time
to complement the primary objective, a survey of the customers visiting the pharmacies was
also conducted .The analysis showed that the services provided by the pharmacies in Kolkata
are not up to the mark. It highlighted the scarcity of pharmacists and the presence of under
qualified person operating the shop. Although it was found that some customers want to
know information related to their medication but few pharmacies are willing to or able to
share the information required, due to their lack of knowledge. The results showed
insufficiency in both the competence level and functioning of pharmacies as compared to the
standard. Remedial measures are required for upliftment of the present status.
INTRODUCTION
these shops are under qualified as the data shows then how the person buying
the medication can be sure that the medication given to him by the shop is
authentic? Lives can be threatened if a wrong drug is administered. A pharmacist
is required to be present in the shop at all times, so that the customer gets
proper care and advice from him/her about the medication and usage.
Pharmacist are the second line of defence for the patients, if the doctor misses
some details like allergy history or drug-drug interaction then its the
pharmacists duty to correct this issue as they are the only one with this
capability and knowledge to do it. But as we can see from the data that the
present scenario is quite disturbing. The pharmacies do not have pharmacist
present at the premises in most cases.
FIP guidelines for good pharmacist Competencies:
Pharmaceutical Public Health Competencies
Competencies
Health promotion
Behaviours
Assess the primary healthcare needs (taking into
account the cultural and social setting of the
patient)
Advise on health promotion, disease prevention
and control, and healthy lifestyle
Counsel population on the safe and rational use
of medicines and devices (including the
selection, use, contraindications, storage, and
side effects of non-prescription and prescription
medicines)
Identify sources, retrieve, evaluate, organise,
assess and disseminate relevant medicines
information according to the needs of patients
and clients and provide appropriate information
Compounding medicines
Behaviours
Appropriately select medicines (e.g. according to
the patient, hospital, government policy, etc.)
Identify, prioritise and act upon medicinemedicine
interactions;
medicine-disease
interactions; medicine-patient interactions;
medicines-food interactions
Prepare
pharmaceutical
medicines
(e.g.
extemporaneous,
cytotoxic
medicines),
determine the requirements for preparation
(Calculations,
appropriate
formulation,
procedures, raw materials, equipment etc.)
Dispensing
Medicines
Behaviours
Acknowledge the organisational structure
Effectively set and apply budgets
Ensure appropriate claim for the reimbursement
Ensure financial transparency
Ensure proper reference sources for service
reimbursement
Improvement of service
Procurement
Professional/Personal Competencies
Competencies
Communication skills
Behaviours
Communicate
clearly,
precisely
and
appropriately while being a mentor or tutor
Communicate effectively with health and social
care staff, support staff, patients, carer, family
relatives and clients/customers, using lay
terms and checking understanding
Demonstrate cultural awareness and sensitivity
Tailor communications to patient needs
Use appropriate communication skills to build,
report and engage with patients, health and
social care staff and voluntary services (e.g.
Quality Assurance
workplace
and
Research
in
the
Self-management
Literature review
In spite of the important role that clinical pharmacy services play, patients
receiving drug therapy may still be at a risk of experiencing unintended harm or
injury due to medication errors or from ADRs. Around 10%of all hospital
admissions are due to adverse effects, and medication errors account for onequarter of all the incidents threatening patient safety. A small proportion of
patients are always at a risk of suffering from ADRs even when the prescribed
and administered treatment is correct and there are no visible errors. Clinical
pharmacists in UK play a major role to detect and manage the ADRs and, also,
directly report ADRs to the Committee on Safety of Medicines via the Yellow Card
scheme. Their involvement can help to increase the number of ADR reports
made, particularly those involving serious reaction.
Australia
The community pharmacists and their services are always available in most of
the cases; these services are offered to the people devoid of any monetary
charge and without the need to make an appointment. Irrespective of where they
live, all Australians have the same access to PBS medicines (within 24 hours) at
no financial disadvantage.
Pharmacists are responsible for all the advice and service provided in their
pharmacies. The pharmacist should always be present in his/her pharmacy and
abide by the rules of the Pharmacy Board to have their continuing registration
and approval to dispense medication under the PBS. If a pharmacist is found to
be neglecting and not following the rules then he/she might lose their
registration. A pharmacist who loses registration cannot continue to operate a
pharmacy or even work in one. This is together, a strong public protection and
prevention against any lessening of professional standards.
Pharmacists cultivate good associations with their patients, at times over
generations, as many people avail the benefits of being the client of a single
pharmacy. The stronger the pharmacist-patient relationship, the better the health
outcomes that can be expected.
USA
Current pharmacy practice in USA is substantially more varied in terms of scope
of practice and practice setting.
Traditional roles of the pharmacist to solely dispense medication product have
been greatly expanded. Nowadays in USA the community pharmacists assess
and counsel patients, provide health maintenance information, reduce drug
misadventures through clinical interventions , evaluate patients who access the
health system through community pharmacies, and perform point of care
testing ,administer immunizations (as one of many public health functions),
respond to disaster needs, assume regulatory roles in drug delivery to assure
safety.
Some pharmacists in advanced practice settings are involved with provision of
more extended direct patient care through comprehensive disease management,
CDTM, medication management, health promotion/disease prevention, care
coordination and followup patient care. Many of these services are similar in
scope and complexity to other primary care services delivered in health care
system of USA.
Pharmacist Roles
Currently, pharmacists deliver patient care services in a variety of practice
settings through CPA to manage disease whereby they:
Perform patient assessment (subjective and objective data including
Physical assessment);
Have prescriptive authority (initiate, adjust, or discontinue treatment) to
manage disease through medication use and deliver collaborative drug
Therapy or medication management;
India faces massive challenges in providing health care for its vast and growing
population. Despite many barriers, community pharmacy services are central to
the safe and effective medicines management in advancing health.
After the enforcement of provisions of the Pharmacy Act 1948, pharmacists
working in India must have a pharmacist registration certificate issued by the
state in which they wish to practice. To obtain a registration certificate, the
prospective pharmacist must acquire the minimum diploma (D. Pharm.) from a
pharmacy institute that is recognized by the Pharmacy Council of India4
(PCI).The community pharmacists who actually manage pharmacies today are
mostly D. Pharm. holders (diploma pharmacists).Once qualified, most of these
pharmacists receive little additional training and there is no exposure to up-todate information. Many of these people, who did not succeed in placement in
government hospitals, are currently working as community pharmacists in the
private community pharmacies.
On paper, every community pharmacy must have a diploma pharmacist or B.
Pharm pharmacist onsite. In practice, few pharmacists are onsite in community
pharmacies and the dispensing is undertaken by the owner of pharmacy, a
relative in case of the pharmacy being owned by a pharmacist, or other
supporting person (assistant or attendant) with knowledge of selling medicines.
A majority of pharmacy owners, who are not pharmacists, hire pharmacists on a
token basis and as a result, pharmacists are never available to dispense
medications
One study reported that pharmacists lack proper training to undertake patient
counselling.
The public perception of community pharmacy and the pharmacist is very weak.
The general population considers community pharmacists as drug traders and
obviously not better than the general store owners. Consumers and patients
consider a visit to the medical store to purchase drugs in much same way they
consider a visit to a grocery to buy food items. The educated people consider
the retail pharmacist as a person who has acquired a drug licence to supply the
medicines or a grocer who deals in medicines. They think anyone in our country
can open a stationary shop and a medical store (i.e. pharmacy) also. The
pharmacists are portrayed as poor compounders, who are assistants to doctors
in mainstream films and dramas.
Since the 1980s there has been phenomenal growth of private institutions
offering D. Pharm. course s. However, most of these self- financing institutions
that provide education in pharmacy are away from practice environment
resulting in diploma pharmacists lacking the skills needed for the community
practice setting.
More than a decade has passed since education in clinical pharmacy practice
was introduced in India. Yet, there has been negligible or no improvement in the
practice of the pharmacy profession in Indian hospitals. Despite the introduction
of this field of education, the presence of the clinical pharmacist is minimal to
non-existent in the health-care system. This has led to several drug-related
problems, including the deaths of patients.
Pharmacists should have input into decisions about the use of medicines. A
system should exist that enables pharmacists to report adverse events,
medication errors, defects in product quality or detection of counterfeit products.
This reporting may include information about drug use supplied by patients or
health professionals, either directly or through pharmacists.
The pharmacist should be aware of essential medical and pharmaceutical
information about each patient. Obtaining such information is made easier if the
patient chooses to use only one pharmacy or if the patient's medication profile is
available.
The pharmacist needs independent, comprehensive, objective and current
information about therapeutics and medicines in use.
Pharmacists in each practice setting should accept personal responsibility for
maintaining and assessing their own competence throughout their professional
working lives.
used to ensure that patients are given medicines which are appropriate for the
condition/problem being treated, along with accurate instructions.
To ensure that the right patient receives the appropriate medicine in the correct
dose and form
Records
To facilitate patient care and provide an audit trail:
Research methodology
Data Analysis
For pharmacist data, we approached 63 pharmacies in total and at each
pharmacy we asked the representative of the pharmacy to allow us to present
our questionnaire. Only 39 pharmacies allowed us to present our questionnaire
to them. Among other pharmacies some didnt allow us to present our
During the analysis data received from the pharmacists and from the
patients have been analysed separately
The Pharmacist data analysis
pharmacist
yes
no
23%
77%
Out of the 9 pharmacies in which the person representing the pharmacy and
claimed to be the pharmacist of that shop, we found only 2 person had D.
pharm qualification, which is the basic qualification needed to obtain a license
in India. 2 other person were found to be associated with retail pharmacy for
over 30 years and therefore they may have licenses issued before the
revision of the Law which makes them Pharmacists too.
The rest of the 5 personnel didnt have the qualification required to be a
pharmacist, they were higher secondary pass and graduates.
We have found that none of the pharmacies had any B.Pharm or M.Pharm
qualified personnel present in the premises of the pharmacy during our
survey. The number of D.pharm qualified personnel were 2 which comes to
5%.The graduates present were 9(23%) among which most of them were
from non-science background. The rest 28(72%) were below undergraduate
level, the least of which was class 8 standard.
Only 1 post graduate personnel was found who was a MBA
Prescription Frequency
It was found that 15 pharmacies (38%) claimed that the patients always
purchased medications against a prescription.10 pharmacies (26%) claimed that
patients frequently purchased against prescription.13 pharmacies (33%) claimed
that the patients moderately purchased medications against prescription.1
pharmacy (3%) claimed that the patients seldom purchased medications against
prescription.
It was observed during the survey that they do dispense prescription drugs
without prescriptions. Even when they claimed that they refuse to give out
medication without prescription.
prescription freqency
seldom; 3%
moderate; 33%
always; 38%
frequently; 26%
Medication history
medication history
yes; 8%
no; 92%
no; 36%
yes; 64%
spontaneously
yes; 15%
no; 85%
acceptance level
highest; 3%
moderate; 10%
neutral; 18%
least; 62%
low; 8%
Counselling
counseling
yes; 10%
no; 90%
ADR freqency
frequently; 3%
moderately; 13%
seldom; 8%
never; 64%
rare; 13%
Follow up services
In our survey of 39 pharmacies we found that follow up services is
provided by 7 pharmacies, which is 18%. The rest 32 (82%) pharmacies
offer no follow up services.
follow up
yes; 18%
no; 82%
Home delivery
In our survey of 39 pharmacies we found that 12 pharmacies are
offering home delivery services, which is 31%. The home delivery
services are mostly offered by retail chain pharmacies. Rest 27 (69%)
pharmacies do not offer home delivery services.
home delivery
yes; 31%
no; 69%
Awareness campaign
awareness
yes; 8%
no; 92%
Experience
16
14
12
10
8
6
4
2
0
1-10 years
11-20 years
21-30 years
31-40 years
Experience
Purchased the medicine forOn the basis of our survey conducted we found that 47 patients bought
medicines for personal usage(43%).The rest 63 patients bought
medicines for their family members (mother, father, wife, husband)
Chart Title
The remaining 46 patients were informed nothing about the drug they
are purchasing (even on inquiring)
1%
8%
31%
31%
25%
Special Precaution
How to take
When to take
Storage condition
Others
Nothing
Prescription
Yes; 10%
Follow up
Follow up; 2%
Yes; 98%
Purchase regularly
Yes; 51%
Medication History
On the basis of our survey conducted we found that 109 patients
claimed that they were not inquired about their allergy history or
concurrent medication or disease profile by the personnel present in
the pharmacy.(99%).1 patient claimed to be inquired about his
concurrent medication by the pharmacy personnel
mediction history
Allergy history; 1%
Chart Title
5%
Yes
No
95%
Adviced by
Pharmacist only; 5%
No advice; 4%
Conclusions
Pharmacist conclusion
During the survey we approached the persons operating the shop to allow us to
present our questionnaire to the pharmacist of the shop. The person we
approached then either referred us to another person saying he is the one who
will answer the questionnaire or he himself answered the questionnaire. During
the analysis we found that only 9 person who filled out the questionnaire claimed
to be the pharmacist. The other people didnt claim themselves to be the
pharmacist of the shop in the questionnaire.
From this it is clearly visible that we can say only 23% pharmacy has a
pharmacist present. The other 77% doesnt. When we verified the 23% pharmacy
personnel who claimed themselves to be pharmacist by their qualification
details, we found that only 4 people were eligible to be a pharmacist/competent
person of a pharmacy retail. Because according to the law at least a Diploma
holder in pharmacy course is eligible as a pharmacist except some special cases
such as people who have been granted license before the amendment was
made. (Competent)
Considering the same, from our findings we can say that only in 10% cases,
pharmacists were present to operate the shop at the time of survey. That means
in 90% cases no pharmacist/competent person was present during the time of
survey.
So, in effect only 10% of the pharmacies had the capability to serve the
customers who are buying something as serious as medicines, which has
potential life or death consequences
In the analysis of the pharmacy representative answering the questionnaire, we
didnt find any B. Pharm or M. pharm available to answer the questionnaire at
the time of survey. We found in our analysis that in 78% pharmacy shop the
people operating the pharmacy are even below graduate level and answered our
questionnaire putting himself as the representative of the pharmacy. 23%
pharmacies had representatives (the person answering the questionnaire) who
were graduates and only 5% pharmacy had representatives who were D. pharm,
which is the basic level of educational qualification required to be a registered
pharmacist.
Thus most of the personnel serving the customers and selling the medicines are
below graduate. Moreover we found pharmacies with personnel qualified as low
as eight standard dispensing the medication to the customer. It cannot be
expected from them to explain to the customers about drug food interaction, if
the customer asks for medication information. Even if we take into account the
experience of the personnel, complex and newer data like drug-drug interaction,
which can be life threatening, cannot be explained by them to the customer. By
allowing these personnel to sell medicine we are putting the lives of the patients
at risk and we are giving these personnel free lease to endanger peoples lives.
Most of the time customers come with prescription while buying the medication
as reported by the representatives of the pharmacies. 38% pharmacies reported
that customers always comes with prescription and 26% pharmacies reported
that customers they serve frequently comes with prescription. More than 60% of
the customers come with prescriptions most of the times. Only 3% reported that
the customers seldom comes with prescription. From this its visible that in most
cases the prescription is brought by the customers which is the only requirement
the customer needs to fulfil to be able to buy medication. Its clear from this that
the customers are aware about the necessity of prescription to purchase
medicines.
But when further asked whether the pharmacy personnel checks the prescription
for its correctness or appropriateness, its seen in the analysis that even when
claiming that they do check for the appropriateness of the prescription, they
mostly check names of the doctor, patient and the medicine. Few pharmacy
representative claim to check the batch and MRP. Only 1 pharmacy checks the
formulation. All pharmacies neglect to check whether the medicine given to the
patient is the correct medicine for the person or if the medication is appropriate
for the child.
The dosage or whether there is interaction between the drugs is not checked by
any of the pharmacists. Now if a wrong or higher dose of a Sedative drug is given
and the patient sinks due to this dosage then a life may be lost. If only the
pharmacists were qualified and checked the prescription before dispensing then
such cases can be avoided.
Only 8% pharmacies ask for the medication history of the patient and that too
they check only what the doctor has written under Rx if the same prescription is
being used multiple times (patient card). The rest 92% do not ask for any
medication history before dispensing medicine. During survey it was even
observed that the personnel operating the pharmacy said its not their duty to
ask for the record of patients medication history. In a country like India, we
agree its not possible to keep records like other developed countries, but the
basic process has to start somewhere down the line to make pharmacy
conditions better. Medication history record-keeping and keeping of photocopies
of prescription is very much required. Without proper medication history it is
difficult to determine the medicines which the patient is allergic to or the
concurrent medication the patient is taking.
When asked whether the customers ask for information about medication, then
we found 64% pharmacy personnel replied in the questionnaire that the
customers ask information about how to take and when to take also the reason
for the use of the medication. 36% claimed that the patients have no queries.
The patients ask for minimal information as they dont know about the medicines
much and there is a lack of awareness. The queries of patients are not answered
by the pharmacy personnel in most cases, in cases of confusion they refer to the
doctor. As we established earlier that very few pharmacies have proper
pharmacists, so to play it safe they dont advice the patient they just make the
customer visit the doctor repetitively. The person who is dispensing the medicine
in most cases are under qualified to handle confusion over molecule name, brand
change and dosage. Only a pharmacist can alter dose and change molecule
prescribed by the doctor.
15% pharmacies claimed that they provide medication information and usage on
their own spontaneously. 85% pharmacies provide no information to the patients
about the medication or its usage to the patients that means unless the
customer asks the personnel dispensing medicines do not feel the need to ask
whether the patient need advice or not. They just dispense drugs which can
potentially kill patients, such careless dispensing of medication can cause
accidental overdose if the patient or the person administering the drug is not
advised by the dispensing pharmacist or the doctor about the maximum dose or
other usage guidelines, among many other problems. The personnel are not
inclined to serve the patients. But their willingness is not the only factor. Their
own knowledge is the main factor, as we saw that most personnel dispensing
medicines are below undergraduate level and not qualified to be pharmacist,
they dont know the medication information and usage guidelines on their own.
Therefore they cant provide details.
69% pharmacies reported that the acceptance level of advice among patients
are least and low. But only 15% of the pharmacies claimed to actually give any
advice on their own. So these 69% pharmacies which reported that the
acceptance is least or low provided the information without even giving any
advice.
Only 10% pharmacies reported that they provide counselling to the patients, but
the rest offer no counselling services to the patients. Providing counselling helps
the patients understand his disease or disorder better and to understand the
medication he/she is taking. Without proper understanding of the medication and
usage guidelines of the medication its not safe to administer the medication. In
developed nations we saw that counselling is always offered, but in India very
few pharmacies are providing such services. In most cases this service is
primarily provided by retail chain pharmacies. A staggering 90% pharmacies just
dont counsel the patients, they just dispense and take the money without giving
the necessary services.
Patient CONCLUSION
From our survey of 110 patients from 5 different areas in Kolkata we have
concluded the following about the state of pharmacy services and mentality of
patients
I.
II.
III.
IV.
Patients are well aware of the fact that they should always purchase
medicines against a prescription hence they rarely fail to bring
prescription to the pharmacies. This shows that they are aware about their
duties and are willing to follow them, provided some help is offered from
the pharmacies too. They are serious about their health.
However they are not getting adequate help from the pharmacies in terms
of usage of their purchased medicines .we have seen that only a handful
of pharmacies provide some details as to when to take the medicine and
at what intervals, however this information is substandard. The remaining
details of side effect adverse effect drug food interaction special
precaution maximum daily dose is hardly provided. maximum patients are
just handed the medicines according to their prescription and sent back
without an explanation as to why should the patient take that medicine
The major reason for the lack of responsibility is the absence of a qualified
licensed pharmacist in pharmacies. The people running the pharmacies
are themselves under qualified the least being class 9. They are not
capable of supplying the necessary information to the patients and hence
avoid their questions, sometimes even turn them down rudely. When
asked about their particular behavior the claim that it is not their duty to
cater to the queries of patients as the doctors are available for that. This
shows that most of the people running the pharmacies have no basic idea
about the duties of the pharmacist or the services that should be provided
to the patients. Hence when the curious patients ask questions about their
state of medication they only get replies of ask your doctor.
Since the absence of pharmacist is a common phenomenon, the patients
are not aware that a pharmacist should be always present in pharmacies
V.
VI.
Conclusions compare
From our project certain issues about the current community pharmacy scenario
of Kolkata has come to light. These neglected issues if taken care of can greatly
improve the conditions in Kolkata and help to eradicate patient deaths due to
wrong administration of medicine, lack of information, lack of healthcare
professionals and side effects from medicines. In India the average pharmacist to
patient ratio is one per every 1987 patients. The analysis from our survey clearly
supports this point in which only a single qualified pharmacist was found form
among 35 pharmacies surveyed. Medication prescription and drug monitoring is
done by doctors only which increase the patient load on them. (One every
1700).important services like patient counselling and cross checking of
medications cannot be further performed by doctors as it increase the stress on
them. We need qualified and competent pharmacists for these services which is
absent.
It was observed that most of the pharmacies were run by under qualified and
incompetent personnel having very less knowledge about the duties of a
pharmacist and negligible idea about patient care. It was seen that the average
number of customers purchasing medications against a prescription is high, but
Pharmacists do not check these prescriptions for appropriateness and