Establishing a Professional Retail

Pharmacy Managed by A

Qualified Graduate Pharmacist:

An Experience from a developing

country

Shaukat Muttaqi Assistant Professor / Manger Pharmacy

Dow University Hospital, DUHS

Healthcare systems of Pakistan

Public Health Facilities in Pakistan

2006-2007 Type Number

Hospitals 965

Dispensaries 4916

BHU 4872

Rural health centers 595

MCH centers 1138

TB centers 371

First aid points 1080

Beds in hospitals and dispensaries 105005

Population per bed 1515

Population to health facility ratio 11413 National Health Accounts 2005-6, Govt: of Pakistan Statistics Division

Source: Ministry of Health

National Health Accounts 2005-6, Govt: of Pakistan Statistics Division

Source: Ministry of Health

Healthcare is generally poor in public hospitals, with many suffering filthy conditions.

There are private hospitals and clinics where it is possible to pay for a better standard of care.

Doctors tend to be good but aftercare is deficient.

Limited trained manpower Difficult physical conditions – electricity, water,

sanitation etc

Pakistan Healthcare Scenario

Medication usage scenario in

Pakistan Medical store mostly the first patient encounter

in the country

Rampant over the counter selling of medication

thus promoting self medication enhancing

ADR/ADE

In adequate and Improper storage resulting in

sub therapeutic drugs

Paucity of studies on assessment of standards of

pharmacies

Total lack of audit mechanism

Drug sellers rather than Pharmacists

Selling medicines rather than serving patients or

customers

Quackery galore, unqualified individuals dealing

with drugs/pharmaceuticals

No awareness or knowledge of value added

pharmacy service

Non reliable drug storage, dispensing or drug delivery

Large discount on poor quality drugs, drug samples and counterfeit drugs

Medication usage scenario in

Pakistan

Community pharmacies in Pakistan

Around 50,000 drug retail outlets in Pakistan

Community / Retail pharmacies routinely operate without qualified and trained personnel to store, label and handle medications.

Mostly housed with dispensers often lacking formal education and training

Community pharmacies less attractive for Pharmacists

Lack of standard practices guidelines in community pharmacies

Quality of pharmacies in Pakistan

60%

40%

5% 10%

96%

6%

60%

0%

20%

40%

60%

80%

100%

120%

sold drugs

exclusively

others A/C temperature

monitoring

device

no alternate

pow er supply

License visible vaccine

available

Zahid A. Butt, Anwar, Gilani, Abdul L. Sheikh & Frank White

International Journal for Quality in Health Care 2005 vol 17, 4

Over the counter selling at

Community Pharmacies

Zahid A. Butt, Anwar, Gilani, Debra Nanan, Abdul L. Sheikh & Frank White

International Journal for Quality in Health Care 2005 vol 17, 4

16%

64%

39%

38%

0% 10% 20% 30% 40% 50% 60% 70%

Drug sold with prescription

Septran dispensed as an OTC

Quinolones dispensed

Cephalosporins

Medilink Consultant Clinics (MCC)

Privately owned multi specialty medical center

Established in 2005 at Clifton, Karachi

Housed with 19 medical suites and 60 practicing physicians of different specialties with following services; Pharmacy

Radiology

Ultrasound

Physiotherapy

Laboratory

Dental & Oral Surgeon

Cardiac Facilities (ECG, ETT)

Endoscopy suites etc

Medilink Pharmacy One of its kind, professional retail pharmacy

managed by a qualified, experienced graduate pharmacist established

clinical pharmacist was included in the team

Major job responsibilities of pharmacist included; providing drug information

counseling patients for the proper use of drugs

ensure the compliance of drugs

ensure availability of drugs to patients

recommend brand and/or therapeutic substitutes’ in consultation with the physician

extemporaneous compounding of essential drugs not commercially available in Pakistan

Data collection and analysis

Satisfaction survey based on structured

questionnaire for all the practicing physicians at

Medilink clinics was conducted

Questionnaire focused on comparing

waiting times, availability of drugs, quality of

pharmaceutical support and overall customer

satisfaction.

Pre and post intervention (i.e. placement of

clinical pharmacist) were analyzed

Referrals and intervention data was compared

Results

Significant reduction in response time

Improvements in overall satisfaction of consultant physician

on an average five patients per day for patient counseling by physicians

average of 100 pharmacist interventions per month including; dose adjustments,

brand and therapeutic switches,

drug drug interactions etc

Conclusion

intervention suggested that model of

retail/community pharmacy management

and operated by qualified pharmacists and

staffed with practicing pharmacist

contributed significantly towards the

customer satisfaction and improved

services for ambulatory patients and

should be adopted by community atlarge