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Abstract: Modern therapeutic medicines are very
powerful, highly specific and have a great potential for
alleviating suffering and curing disease worldwide, but
are also prone to misuse and causing dangerous adverse
effects. The potential of modern medicine to give
benefit is highly conditional and depends on the way it
is used. They are the cornerstone of health care and
often a key factor for the success of a health service
in developing countries. In this context the role of
pharmacies has expanded, incorporating not only
dispensing prescription and all the established
activities, but also medicines management and
pharmaceutical care. Community pharmacists have been
recognized as having a key role to play in ensuring the
safe, effective and rational use of medicines. However
in India most of them have fragmentary knowledge
regarding medicine dispensing, storage and management.
This paper documents the current status of community
pharmacy practice, describes what regulatory and market
forces are causing changes in practice, and discusses
future implications.
Medicines are among the most important and cost
effective tools for alleviation of suffering and
suppression of pain, and for treatment or cure of
disease. In 2007, Global sales on pharmaceuticals
amounted to US $712 billion, showing 6.4% growth over
previous year. Pharmaceuticals account for over 15% of
measured global spending on health. Medicines
expenditures vary widely, from a low of slightly over US
$4 average per capita in low income countries to a high
of nearly US $400 in high income countries. There is
thus nearly a 100 times differential between
pharmaceutical expenditure in the richest and the
poorest countries of the world. Similarly, per capita
health expenditure, in terms of US $ purchasing power
parity (PPP), is widely varied among countries, as
evident from Table 1. More than half of all medicines
expenditures in high income countries are publicly
financed. However, in India like many developing
countries health expenditure is dominated by private
spending with households’ out-of-pocket expenditures
make up a much larger proportion (Table 1).
The responsibilities for ensuring the safe, effective
and rational use of medicines lies with pharmacists.
Around the world, the majority of pharmacists choose to
practise in the community, where traditional role of
dispensing doctors’ prescription has changed. Community
pharmacists today are trained and educated to counsel
patients in the correct use of medicines and to promote
good health.
International experience: The role of community
pharmacists is dictated largely by the socioeconomic,
regulatory and marketing frameworks in which they
operate, and hence takes different forms in different
countries. However, the main functions and
responsibilities of the community pharmacist are common
across countries. The practice of pharmacy is evolving
rapidly toward a patient focused activity that
emphasizes pharmacists’ knowledge to improve patient
health outcomes, and away from simple assurance that the
medicine dispensed is what physician ordered. This
evolution is being characterizing in most developed
nations of the world. The focus of attention today is
firmly the pharmaceutical needs of the patient (medicine
user) than the medicinal product. These patient focused
activities have evolved into the concept of
“pharmaceutical care” which has been defined as ‘the
responsible provision of drug therapy for the purpose of
achieving definite outcomes that improve the patient’s
quality of life’. The pharmaceutical care process, in
some countries, is shared with other health care
professionals, and the term ‘medicines management’ is
preferred. In many occasions, the two terms have been
used in parallel and, to a certain extent,
interchangeably. The pharmaceutical care differs from
the traditional dispensing3,4 that is illustrated in
table 2.
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