Managing Medicines: A Portrait of the Community Pharmacies in India

Subal C Basak, D Sathyanarayana

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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