Community Pharmacy in India: A Comprehensive Guide
History of Community Pharmacy in India
The genesis of community pharmacy practice in India can be traced back to British India when the profession was primarily business-oriented. Professionals were called drug sellers or drug dispensers. Scotch M. Bathgate opened the first chemist shop in Kolkata in 1811, marking the starting point of pharmacy practice in India. Pharmacy education under British rule began at Madras Medical School in December 1860, offering a 2-year course.
In Goa, under Portuguese rule, Escola Medico started a combined medicine and pharmacy course in 1842. The Indian Pharmacopeia was first published in 1868, and the official Indian Journal of Pharmacy was first released in 1939.
During the pre-independence era, community pharmacy practice was highly unregulated, with no restrictions on practicing pharmacy in India. The standardization of pharmacy education was introduced in 1945. The Indian Pharmaceutical Congress Association held its first annual conference in 1948.
The Pharmaceutical Association, established in 1923, was the first pharmaceutical society in India. It was renamed The Pharmaceutical Society of India two years later.
Development of Community Pharmacy Practice
- Good Pharmacy Practice Compliance
- Skill Development: Pharmacist Assistants
- Availability of Essential Medications
- Quality Pharmaceutical Care
Professional Responsibilities of Community Pharmacists
- Processing Prescriptions: Examining prescriptions from doctors and preparing medications for patients.
- Checking for Drug Interactions: Ensuring that medications and doses are appropriate for the patient, considering their health factors and other medications.
- Dispensing Medications: Labeling medications correctly with instructions for the patient on how to take them.
- Disposing of Medication: Safely disposing of unneeded medications from patients.
- Providing Advice: Educating patients about their health and medications, providing appropriate advice.
- Promoting a Healthy Lifestyle: Supporting patients in making healthier choices, such as consuming nutritious food, exercising regularly, or quitting smoking.
Parts of a Prescription
- Heading
- Date
- Personal Data of Patient (Name, Sex, Age, Address)
- Body
- Superscription (Rx)
- Inscription (Medication Name, Quantity, Instructions)
- Subscription (Directions for Pharmacist)
- Closing
- Signature of Physician (with Address and Registration Number for Dangerous Drugs)
Interactions with Patients (Patient Interview Techniques)
I. Medication History Interview
This is crucial for decision-making. The following information is recorded:
- Currently or recently prescribed medicines
- Over-the-counter (OTC) medicines purchased
- Vaccinations
- Alternative or traditional remedies
- Description of reactions and allergies to medicines
- Medicines found to be ineffective
II. Written Communication
Written communication involves using words to communicate. Regardless of the source used to write and send the message, it is considered written communication.
III. Body Language
Body language is a type of communication that uses physical behaviors instead of words to express or convey information. This includes facial expressions, body posture, gestures, eye movement, touch, and the use of space.
Face Expression: An essential indicator of emotional state.
Benefits of Patient Counseling
- Pharmacists can provide effective doses based on patient information.
- Pharmacists play a crucial role in counseling patients with chronic illnesses.
- Drug interactions and adverse drug reactions can be prevented.
- A therapeutic alliance is built with patients to achieve mutually understood therapy goals.
- Patients become informed, efficient, and active participants in disease treatment and self-care management.
- Pharmacists are perceived as professionals who offer pharmaceutical care.
Stages of Patient Counseling
Stage 1: Introduction
- Introduce yourself.
- Review the patient’s medication record.
- Explain the purpose and importance of counseling.
- Obtain medication history, including allergies and previous incidents.
- Gather drug-related information, such as allergies and herbal medicine use.
- Assess the patient’s understanding of the reasons for therapy.
- Identify any actual or potential concerns or problems important to the patient.
Stage 2: Present Patient Condition
Personal Assessment:
- Note the patient’s name and age.
- Assess the patient’s mental capacity to understand the current situation, including black box warnings.
- Evaluate sensory and physical status.
- Consider cognitive abilities.
- Gauge the patient’s willingness to use medication.
Clinical Assessment:
- Explain how to use the medication.
- Assess the patient’s attitude towards medication.
- Identify potential barriers to adherence.
- Address patient non-adherence.
- Determine the patient’s willingness to adhere to the treatment plan.
Stage 3: Closing the Counseling Session
- Verify the patient’s understanding through feedback.
- Summarize by emphasizing key points.
- Provide an opportunity for the patient to raise any concerns.
- Assist the patient in planning follow-up appointments.
Medication Adherence
Medication adherence, or taking medications correctly, is generally defined as the extent to which patients take medication as prescribed by their doctors. This involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions.
Community Pharmacy Practice
Community pharmacy practice refers to any place under the direct supervision of a pharmacist where pharmacy practice occurs or where prescription orders are compounded and dispensed, excluding hospital pharmacies or limited-service pharmacies.
Patient Counseling
Patient counseling is the process of providing information, advice, and assistance to help patients use their medications effectively. It is an essential responsibility for pharmacists and a valuable learning opportunity for students. Pharmacists are often the only healthcare providers who focus patient education on medication, including how to take it, what to expect, and potential side effects and drug interactions.
Over-the-Counter (OTC) Medications
OTC medications are medications that can be purchased without a prescription from a healthcare provider.
Audits in Pharmacies
Audits in pharmacies are crucial for ensuring the safe and accurate handling and dispensing of medications. They help identify discrepancies in processes, policies, and procedures that may impact patient care quality. The purpose of an audit is to identify issues that need to be addressed to ensure the pharmacy provides safe and effective medication therapy. These issues may include:
- Errors in prescription processing
- Inaccurate or incomplete medication records
- Problems with medication storage or inventory management
- Noncompliance with state or federal regulations
- Inadequate training or supervision of pharmacy staff
mHealth (Mobile Health)
mHealth is a general term for using mobile phones and other wireless technology in medical care.
Tuberculosis (TB)
Tuberculosis is an infectious disease that primarily affects the lungs, caused by a type of bacteria.
Chronic Disease
A chronic disease or condition typically lasts for three months or longer and may worsen over time.
Types of Communication Skills
- Verbal Communication:
- The most basic type of communication, involving a speaker (or writer) to transmit the message and a listener (or reader) to understand it.
- Essential verbal communication skills include:
- Active listening: The ability to listen, understand, and respond to what people say.
- Evaluation: The ability to interpret non-verbal communication and respond in a way that encourages continued interaction.
- Verbal Communication with Patients: Using verbal skills to discuss disease, prescriptions, and other patient needs, encouraging consultative dialogues for positive patient relations.
- Examples of Verbal Communication Skills:
- Anticipating the concerns of others
- Asking for clarification
- Asking open-ended questions to stimulate dialogue
- Calming an agitated customer by recognizing and responding to their complaints
- Emphasizing benefits to persuade
- Noticing non-verbal cues and responding verbally to clarify confusion, defuse anger, etc.
- Non-Verbal Communication:
- Communication without using words, conveying messages through facial expressions, eye contact, gestures, postures, etc.
Effective Procurement
An effective procurement process ensures the availability of the right medicines in the right quantities, at reasonable prices, and at recognized quality standards.
Inventory Control
Inventory control is the process of managing inventory to meet customer demand at the lowest possible cost and with minimal investment.
Medication Adherence
Medication adherence is the extent to which a person’s behavior aligns with taking medication optimally.
Role of Accountancy in Community Pharmacy
- Financial Management: Managing financial operations, including budgeting, cash flow, and inventory management.
- Record-Keeping: Maintaining accurate records for regulatory compliance, tracking financial transactions, and facilitating analysis.
- Tax Compliance: Keeping accurate financial records to comply with tax regulations and minimize liabilities.
- Financial Analysis: Analyzing financial statements and performance metrics to make informed decisions about operations and growth strategies.
- Fraud Detection: Detecting and preventing fraud and embezzlement, protecting the business from financial losses.
Inventory Management
- Set Par Levels: Determine minimum and maximum inventory levels for each medication or supply to ensure timely ordering and avoid stockouts.
- Track Expiration Dates: Implement a system to track expiration dates and remove expired products from inventory to prevent dispensing expired medications or supplies.
- Conduct Regular Inventory Checks: Schedule regular checks to ensure actual inventory matches records, identifying discrepancies and taking corrective action.
- Use a Computerized System: Consider using a computerized inventory management system to track inventory levels, order products, and manage expiration dates, saving time and reducing errors.
- Monitor Trends: Monitor medication usage trends and adjust inventory levels accordingly to avoid overstocking or understocking.
- Work with Suppliers: Establish relationships with suppliers to ensure timely deliveries and quick resolution of any issues.
Introduction to Digital Health
Digital health is the use of digital technologies, tools, and platforms to enhance healthcare delivery, patient care, and public health. It encompasses a wide range of digital tools and services that enable healthcare providers, patients, and caregivers to access, share, and analyze health information. Key topics include Learning Health Systems, Electronic Health Records, mobile applications, wearable technologies, health information systems, telehealth, telemedicine, machine learning, artificial intelligence, and big data.
mHealth and Online Pharmacies
- mHealth (mobile health): The use of mobile devices, such as smartphones and tablets, to support healthcare services and improve health outcomes.
- Online Pharmacies: Digital platforms that allow patients to order medications online and have them delivered to their homes.
- Both mHealth and online pharmacies have the potential to improve access to healthcare and medication for people facing barriers to traditional healthcare services, such as those in rural areas or with mobility issues.
Strategies to Overcome Non-Adherence
Medication non-adherence is often multifactorial, and there is no one-size-fits-all solution. However, educational and behavioral interventions can be effective.
Educational and Behavioral Interventions
Instead of simply telling patients their treatment plan, it’s crucial to explain the decision-making process so they feel ownership of their treatment. This discussion could cover:
- Benefits and adverse effects of available therapies or medical devices
- Alternatives to the chosen treatment or device
- Rationale for the selected treatment (e.g., improves symptoms, encourages weight gain)
- Need for prolonged treatment
- Expected effects (e.g., speed of onset) and side effects
- Possible adjustments needed during treatment
Role of Pharmacists in OTC Medication Dispensing
- Expertise in Medication: Pharmacists possess extensive knowledge of medications, including OTC options, advising patients on appropriate use, dosage, administration, and potential side effects.
- Interactions with Other Medications: Pharmacists can check for potential interactions between OTC and prescription medications, advising on necessary precautions.
- Patient Education: Pharmacists educate patients on the proper use of OTC medications, including recognizing and managing side effects and monitoring symptoms.
- Prevention of Misuse: Pharmacists help prevent OTC medication misuse by ensuring patients understand proper use and potential risks.
- Accessibility: OTC medications are readily available in pharmacies, making them easily accessible to patients. Pharmacists assist patients in choosing the right medication and advise on precautions or warnings.
Legal Requirements to Set Up a Community Pharmacy
Community pharmacies must comply with legal requirements and regulations set by regulatory bodies like the Pharmacy Council of India (PCI). Some of these requirements include:
- Registration: Registering the pharmacy with the PCI, providing necessary documents like proof of ownership, pharmacy layout plan, and pharmacist qualifications.
- Location: Locating the pharmacy in an accessible area with adequate space for storage, dispensing, and patient counseling, at least 200 meters away from another registered pharmacy.
- Infrastructure: Having proper infrastructure and equipment, including air conditioning, refrigeration, computers, and software for inventory and patient record management.
- Pharmacist: Having a qualified registered pharmacist present at all times during working hours, possessing a D.Pharm or B.Pharm degree and a license to practice.
- Drug Storage: Maintaining proper storage facilities for drugs and other products, adhering to temperature and security regulations.
Definitions
- Community Pharmacy: A healthcare facility providing pharmaceutical and cognitive services to a specific community.
- Standard Operating Procedure (SOP): A document outlining how tasks and processes should be carried out within a company.
- Good Pharmacy Practice: The practice of pharmacy aimed at providing and promoting the best use of drugs and healthcare services for patients and the public.
- Dispensing: Providing drugs or medicines as prescribed on a lawful prescription.
- Dispensing Error: A discrepancy between a prescription and the medicine dispensed, including dispensing a medicine with inferior pharmaceutical or informational quality.
- Communication: The sending and receiving of information, either one-on-one or between groups.
- Chronic Obstructive Pulmonary Disease (COPD): A common lung disease causing restricted airflow and breathing problems.
- Patient Package Insert (PPI): Patient labeling that is part of the FDA-approved prescription drug labeling.
- Patient Information Leaflet (PIL): A technical document in every medicine package providing written information about the medication.
- Self-Medication (SM): Taking drugs, herbs, or home remedies without consulting a doctor.
- Customer Relationship Management (CRM) in Pharmacy: A centralized system collecting data from medication makers via various communication channels.
Note: This comprehensive guide provides an overview of community pharmacy in India. For specific legal or regulatory advice, consult with relevant authorities and legal professionals.