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| Tuesday, 9 March 2004 |
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The pharmacist owes the patient a duty The Moving finger by Lionel Wijesiri Prof. Tuly de Silva, President of the Pharmaceutical Society of Sri Lanka and Institute of Chemistry commented recently on the undermining of the role our pharmacist in quality patient care. He said that in many countries the pharmacists would have a dialogue and close relationship with the patient. But in Sri Lanka the relationship was confined to a mere prescription. Thus most patients were getting a bad deal. Prof. de Silva is correct. The practice of pharmacy has undergone tremendous changes in the past few years. The trend has been to move from product dispensers to providers of pharmaceutical care. Among the accepted requirements are that a prospective drug review be performed and that the patient, or the patient's caregiver, be counselled on the proper use of the medication, its common side effects, duration of therapy, refill information, etc. Due to a variety of restraints, Sri Lankan pharmacists and pharmacies have been slow to embrace the current accepted norms. Hundreds of pharmacies have opened up illegally posing real threats to people's health in many ways. It is a real catastrophe to feel that investment can involve any field even at the expense of people's health. Many powerful traders buy licenses from fresh graduates to run pharmacies. In our country the vast multitude of illiterate and semiliterate masses, require appropriate advice for the use of prescribed and non-prescribed drugs. The dispensing of even the OTC (over the counter) drugs by an unqualified so-called pharmacist can often be dangerous and can lead to severe problems. Assurances I remember somewhere in January 2002, Managing Director, State Pharmaceuticals Corporation (SPC), in an interview with "Sunday Observer" said that the government will crack down on all pharmacies and authorised dealers engaged in the sale of spurious drugs and employ unqualified pharmacists. "The owners and dealers of such pharmacies will be prosecuted and their licences cancelled under the Cosmetics, Drugs and Devices Act (CDDA)" he said. In spite of his assurances, the situation remains almost same even after two years. I also remember him saying that there had been a serious dearth of qualified pharmacists in the country. He estimated it around 6000-7000 pharmacists. He further commented that in order to overcome it the Sri Lanka Medical Association (SLMA) had commenced a 2-year course on pharmacology. Looking to the problems we have to face, the progress made during the past two years does not give us any satisfaction. Any health care system should capitalize on the pharmacists' accessibility and skills. Pharmacists are supposed to have expert knowledge of medicines second to none and certainly cannot be approached by any other health professional. It is also an imperative necessity of co-operation and not of confrontation of physicians, pharmacists, patients and the society represented by the politicians. Such understanding is essential if we are to come nearer to an acceptable solution of the enormous problems we are confronted. Presently, co-operation is reduced as everybody is trying to get the utmost out of the system. As I can see it, the physicians are trying to protect their monopoly of being responsible for supervising everything related to health care and are subsequently afraid of having to share personal income and profits. The pharmacists are too much focused on selling drugs and other devices in their shops. They are basically looking for raising turnover and margins from their respective businesses. The patients want everything preferably by paying nothing. And the politicians are unable to undertake appropriate adjustments. They are generally short sighted and only looking up until the next elections. To achieve an optimum outcome of pharmacotherapy and a cost-effective treatment of patients, in the interest of the patients themselves. What we need today is the right type of pharmaceutical care. Medical terminology defines pharmaceutical care as the responsible use of the pharmacist in drug therapy for the purpose of achieving definitive outcomes that improve a patient's quality of life. Pharmacist's role It is relevant to quote here the conclusion arrived by a WHO Consultative Group: "The pharmacist can play a key role in helping people to make informed choices about self-care and in providing and interpreting the information available. This requires a greater focus on illness management and health maintenance, rather than a product selling. Indeed, self-care, does not always require use of a medicine. If, however, there is a need for self-medication in self-care, then the role of pharmacist must be extended. These observations hold truer particularly for a rural setting". What we need today is good training before embarking on pharmaceutical care. The reason is that the term pharmaceutical care is so widely used (and misused) that pharmacists often do not know what they are getting into and they need to go on training programme to find out. Pharmaceutical care basically is, of course, about taking care of patients, and pharmacists needed to learn how to do this before they could go on to the next steps, one of which was to market the service. The problem is that when pharmacists are not dispensing, no one knew they were pharmacists. However, pharmaceutical care is a business. It needed to make money. Pharmacists would have to learn how to market this business to others, which in the first instance probably meant primary care groups. Pharmaceutical care is not something one could afford to do for a hobby or when one had a bit of spare time. It is about changing one's source of revenue from dispensing to patient care. In addition, pharmacists needed to learn how to manage a practice - a pharmaceutical care practice, not a dispensing practice; the two are very different. Moreover, pharmaceutical care had to be practiced consistently both by individual pharmacists and between pharmacists, otherwise there would be confusion. It is dangerous to have unpredictable pharmaceutical services where a patient could get pharmaceutical care from one pharmacist but not from another. In short, everyone had to be singing from the same hymn sheet. Still we have a long way to go to catch up with the standard of pharmacy practice in the developed countries. Our pace is absolutely slow but before long the pharmacy practice here would also be required to have progressed and attained the state of universality. |
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