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To Ascertain the Present Scenario of Pharmacy Services In

Kolkata Compared To Developed Countries

ABSTRACT

Pharmacies are not same as an average grocery store or jewellery store, customers are not

buying medications for their luxurious needs. Pharmacies deal with products which are

capable of saving lives and at the same time these possess significant risk. If the people

handling these are not qualified, it may even lead to life and death risk to the patients. The

primary objective of this project is to identify the current scenario of retail pharmacy in

olkata and to compare with developed countries. !or this project, " major #ones of olkata

were chosen and a survey was conducted on the pharmacies of those areas. $t the same time

to complement the primary objective, a survey of the customers visiting the pharmacies was

also conducted .The analysis showed that the services provided by the pharmacies in olkata

are not up to the mark. It highlighted the scarcity of pharmacists and the presence of under qualified person operating the shop. $lthough it was found that some customers want to

know information related to their medication but few pharmacies are willing to or able to

share the information required, due to their lack of knowledge. The results showed

insufficiency in both the competence level and functioning of pharmacies as compared to the

standard. %emedial measures are required for upliftment of the present status.

INTRD!CTIN

Clinical pharmacy is defned as the area o practice in which pharmacists provide

patient care that optimises medication therapy and promotes health, wellness

and disease prevention.(1) The practice o clinical pharmacy embraces the

concepts o both pharmaceutical care, frst introduced by Helper and Strand,

()and medicines mana!ement, which encompasses the entire way in which

medicines are selected, procured, delivered, prescribed, administered and

reviewed to optimise the contribution that medicines ma"e to producin!

inormed and desired outcomes o patient care.(#)

(1)$merican Colle!e o Clinical %harmacy. The defnition o clinical pharmacy.

%harmacotherapy &&' ' '1*+'1.

()Hepler C, Strand -. pportunities and responsibilities in pharmaceutical care.

$m / Hosp %harm 100& 2##+2#.

(#)$udit Commission. $ Spoonul o Su!ar + 3edicines 3ana!ement in 4HS

Hospitals. -ondon $udit Commission, &&1.

%harmacies are not same as an avera!e !rocery store or 5ewellery store,

customers are not buyin! medications or their lu6urious needs. %harmacy shopsdeal with products which are capable o savin! lives, i the person operatin!



these shops are under 7ualifed as the data shows then how the person buyin!

the medication can be sure that the medication !iven to him by the shop is

authentic8 -ives can be threatened i a wron! dru! is administered. $ pharmacist

is re7uired to be present in the shop at all times, so that the customer !ets

proper care and advice rom him9her about the medication and usa!e.

%harmacist are the second line o deence or the patients, i the doctor missessome details li"e aller!y history or dru!:dru! interaction then it;s the

pharmacist;s duty to correct this issue as they are the only one with this

capability and "nowled!e to do it. <ut as we can see rom the data that the

present scenario is 7uite disturbin!. The pharmacies do not have pharmacist

present at the premises in most cases.

=>% !uidelines or !ood pharmacist Competencies

Pharmaceutical Pu"lic #ealth Competencies

Competencies Behaviours

&ealth promotion $ssess the primary healthcare needs 'taking intoaccount the cultural and social setting of the

patient(

$dvise on health promotion, disease prevention

and control, and healthy lifestyle

)edicines information and advice *ounsel population on the safe and rational use

of medicines and devices 'including the

selection, use, contraindications, storage, and

side effects of non+prescription and prescription

medicines(

Identify sources, retrieve, evaluate, organise,

assess and disseminate relevant medicines

information according to the needs of patients

and clients and provide appropriate information

Pharmaceutical Care Competencies


$ssessment of medicines $ppropriately select medicines 'e.g. according tothe patient, hospital, government policy, etc.(

Identify, prioritise and act upon medicine+

medicine interactions medicine+disease

interactions medicine+patient interactions

medicines+food interactions

*ompounding medicines Prepare pharmaceutical medicines 'e.g.

extemporaneous, cytotoxic medicines(,

determine the requirements for preparation

'*alculations, appropriate formulation, procedures, raw materials, equipment etc.(



*ompound under the good manufacturing

practice for pharmaceutical '-)P( medicines

ispensing $ccurately dispense medicines for prescribed

and/or minor ailments and monitor the dispense

're+checking the medicines(

$ccurately report defective or substandard

medicines to the appropriate authorities

$ppropriately validate prescriptions, ensuring

that prescriptions are correctly interpreted and

legal

ispense devices 'e.g. Inhaler or a blood glucose

meter(

ocument and act upon dispensing errors

Implement and maintain a dispensing error

reporting system and a 0near misses1 reporting

system

2abel the medicines 'with the required and

appropriate information(

2earn from and act upon previous 0near misses1

and 0dispensing errors1

)edicines $dvise patients on proper storage conditions of

the medicines and ensure that medicines are

stored appropriately 'e.g. humidity,

Temperature, expiry date, etc.(

$ppropriately select medicines formulation and

concentration for minor ailments 'e.g. diarrhoea,

constipation, cough, hay fever, insect bites, etc.(

3nsure appropriate medicines, route, time, dose,

documentation, action, form and response for

individual patientsPackage medicines to optimise safety 'ensuring

appropriate re+packaging and labelling of the

medicines(

)onitor medicines therapy $pply guidelines, medicines formulary system,

protocols and treatment pathways

3nsure therapeutic medicines monitoring, impact

and outcomes 'including objective and

subjective measures(

Identify, prioritise and resolve medicinesmanagement problems 'including errors(



Patient consultation and diagnosis $pply first aid and act upon arranging follow+up

care

$ppropriately refer

$ssess and diagnose based on objective and

subjective measuresiscuss and agree with the patients the

appropriate use of medicines, taking into account

patients1 preferences

ocument any intervention 'e.g. document

allergies, medicines and food, in patient

medicines history(

4btain, reconcile, review, maintain and update

relevant patient medication and diseases history

Organisation and Management Competencies


5udget and reimbursement $cknowledge the organisational structure

3ffectively set and apply budgets

3nsure appropriate claim for the reimbursement

3nsure financial transparency

3nsure proper reference sources for service

reimbursement

&uman %esources management Identity and manage human resources and

staffing issuesParticipate, collaborate, advise in therapeutic

decision+making and use appropriate referral in a

multi+disciplinary team

%ecognise and manage the potential of each

member of the staff and utilise systems for

performance management 'e.g. carry out staff

appraisals(

%ecognise the value of the pharmacy team and

of a multidisciplinary team

6upport and facilitate staff training and

continuing professional development

Improvement of service Identify and implement new services 'according

to local needs(

%esolve, follow up and prevent medicines

related problems

Procurement $ccess reliable information and ensure the most

cost+effective medicines in the right quantities

with the appropriate quality

evelop and implement contingency plan for

shortages3fficiently link procurement to formulary, to



push/pull system 'supply chain management(

and payment mechanisms

3nsure there is no conflict of interest

6elect reliable supplies of high+quality products

'including appropriate selection process, cost

effectiveness, timely delivery(6upervise procurement activities

7nderstand the tendering methods and

evaluation of tender bids

6upply chain and management emonstrate knowledge in store medicines to

minimise errors and maximise accuracy

3nsure accurate verification of rolling stocks

3nsure effective stock management and running

of service with the dispensary

3nsure logistics of delivery and storage

Implement a system for documentation andrecord keeping

Take responsibility for quantification of

forecasting

8ork place management $ddress and manage day to day management

issues

emonstrate the ability to take accurate and

timely decisions and make appropriate

judgments

3nsure the production schedules are

appropriately planned and managed3nsure the work time is appropriately planned

and managed

Improve and manage the provision of

pharmaceutical services

%ecognise and manage pharmacy resources 'e.g.

financial, infrastructure(

Professional/Personal Competencies


*ommunication skills *ommunicate clearly, precisely and

appropriately while being a mentor or tutor

*ommunicate effectively with health and social

care staff, support staff, patients, carer, family

relatives and clients/customers, using lay

terms and checking understanding

emonstrate cultural awareness and sensitivity

Tailor communications to patient needs

7se appropriate communication skills to build,

report and engage with patients, health and

social care staff and voluntary services 'e.g.



verbal and non+verbal(

*ontinuing Professional evelopment '*P( ocument *P activities

3ngage with students/interns/residents

3valuate currency of knowledge and skills

3valuate learning

Identify if expertise needed outside the scope of knowledge

Identify learning needs

%ecognise own limitations and act upon them

%eflect on performance

2egal and regulatory practice $pply and understand regulatory affairs and the

key aspects of pharmaceutical registration and

legislation

$pply knowledge in relation to the principals of

business economics and intellectual property

rights including the basics of patentinterpretation

5e aware of and identify the new medicines

coming to the market

*omply with legislation for drugs with the

potential for abuse

emonstrate knowledge in marketing and sales

3ngage with health and medicines policies

7nderstand the steps needed to bring a medicinal

product to the market including the safety,

quality, efficacy and pharmacoeconomic

assessments of the product

Professional and ethical practice emonstrate awareness of local/national codes

of ethics

3nsure confidentiality 'with the patient and other

healthcare professionals(

4btain patient consent 'it can be implicit on

occasion(

%ecognise own professional limitations

Take responsibility for own action and for

patient care

9uality $ssurance and %esearch in the

workplace

$pply research findings and understand the

benefit risk 'e.g. pre+clinical, clinical trials,

experimental clinical+pharmacological research

and risk management(

$udit quality of service 'ensure that they meet

local and national standards and specifications(

evelop and implement 6tanding 4perating

Procedures '64P1s(

3nsure appropriate quality control tests are

performed and managed appropriately

3nsures medicines are not counterfeit and

quality standards



Identify and evaluate evidence+base to improve

the use of medicines and services

Implement, conduct and maintain a reporting

system of pharmacovigilance 'e.g. report

$dverse rug %eactions(

Initiate and implement audit and researchactivities

6elf+management $pply assertiveness skills 'inspire confidence(

emonstrate leadership and practice

management skills, initiative and efficiency

ocument risk management 'e.g. critical

incidents(

3nsure punctuality

Prioritise work and implement innovative ideas

=>% !uidelines or !ood pharmacy practise s

?eception o the prescription and confrmation o the inte!rity o the

communication

$ssessment o the prescription by the pharmacist

.

.

$ssembly o the prescribed items

$dvice to ensure that the patient or carer receives and understands su@cient

written and oral inormation to derive ma6imum beneft rom the treatment

.

=ollowin! up the eAect o prescribed treatments

.

Bocumentation o proessional activities

Some defnitions

Prescription monitoring

The core o pharmacists; contribution to appropriate prescribin! and medicationuse is made whilst underta"in! near:patient clinical pharmacy activities.Chec"in! and monitorin! patients; prescriptions on hospital wards is the startin!point or this process and on most hospital wards the prescription card andclinical observation charts (temperature, pulse rate, blood pressure, and so on)are typically "ept at the end o the patient;s bed. This allows the clinicalpharmacist to interact with the patient whilst reviewin! the contents o theprescription.

Community Pharmacy : The area o pharmacy practice in which medicines andother related products are sold or provided directly to the public rom a retail (or



other commercial) outlet desi!ned primarily or the purpose o providin!

medicines. The sale or provision o the medicine may be either on the order or

prescription o a doctor (or other health care wor"er), or over the counterD

(TC).

Pharmacist : $ person with a ormal hi!her 7ualifcation such as a three:year

(minimum) university de!ree or diploma in pharmacy.

Qualifed Pharmacy Technician/Dispensary Assistant : $ person with ormal

dispensin! trainin! (at a lower level than a pharmacist) involved in the

dispensin! o medicines. (The trainin!, or at least a part o it, would have ta"en

place at a reco!nised trainin! institution and a certifcate or licence would have

been issued.)

Unqualifed Pharmacy Technician/Dispensary Assistant : $ person who is

involved in the dispensin! o medicine, but who has only received on the 5obD or

in houseD trainin!.

Community Health Care Worker : $ person who is trained to provide simple,

low level health care commensurate with the level o trainin!.

Clinical audit Clinical audit is pivotal in patient care it brin!s to!ether

proessionals rom all sectors o healthcare to consider clinical evidence, promote

education and research, develop and implement clinical !uidelines, enhance

inormation mana!ement s"ills and contribute to better mana!ement o

resources + all with the aim o improvin! the 7uality o care o patients.

$iterature revie%

Current scenario o pharmacies in developed countries

Enited Fin!doms

The current community pharmacy services practised in Enited Fin!dom are

%rescription monitorin!.

>n EF pharmacy practise, prescriptions !iven to patients are revised ormedication dosin! errors, correctness o administration route, dru! interactions,prescription ambi!uities, inappropriate prescribin! and many other potentialdi@culties. Garious 7uestions related to medication histories, includin! aller!iesand intolerances, e@cacy o prescribed treatment, side:eAects and adverse dru!reactions ($B?s) are as"ed to the patient. The medical and nursin! staAs arere!ularly present on the ward which allows the pharmacist to communicateeasily with other members o the health care team valuin! the prescription:monitorin! service that clinical pharmacists provide.

3edication errors and adverse dru! reaction reportin!



>n spite o the important role that clinical pharmacy services play, patients

receivin! dru! therapy may still be at a ris" o e6periencin! unintended harm or

in5ury due to medication errors or rom $B?s. $round 1&o all hospital

admissions are due to adverse eAects, and medication errors account or one:

7uarter o all the incidents threatenin! patient saety. $ small proportion o

patients are always at a ris" o suAerin! rom $B?s even when the prescribedand administered treatment is correct and there are no visible errors. Clinical

pharmacists in EF play a ma5or role to detect and mana!e the $B?s and, also,

directly report $B?s to the Committee on Saety o 3edicines via the Iellow Card

scheme. Their involvement can help to increase the number o $B? reports

made, particularly those involvin! serious reaction.

3edication history:ta"in! and medicines reconciliation

The 4ational >nstitute or Health and Clinical J6cellence (4>CJ) and the 4ational

%atient Saety sanctions the crucial role o clinical pharmacists in underta"in!

medicines reconciliation or patients on admission to hospital. >t was reco!nised

that the increased ris" o morbidity, mortality and economic burden to health

services are mainly caused by medication errors and noted that errors occurred

most commonly on transer between care settin!s, mainly at the time o

admission, with unintentional variances o up to &.Kith the increasin! use o

inormation technolo!y, summary care records o patients can be accessed rom

their !eneral practitioner which oAers a timely and accurate method or !ainin!

essential inormation. The patients are 7uestioned by the pharmacists on their

concordance with prescribed treatment and the prescribed medicines are sel:chec"ed by pharmacists to ensure stability or reuse in hospital and sel:

medication. %harmacists also help to identiy whether or not an admission is due

to prescribin! errors or $B?s. %harmacy technicians are increasin!ly involved in

supportin! these roles

%atient education and counsellin!, includin! achievin! concordance

$n a!reement is reached ater ne!otiation between a patient and healthcare

proessional that respects the belies and wishes o the patient in determinin!

whether, when and how medicines are ta"en. This chan!e in approach optimises

the benefts o treatment by helpin! patients and pharmacists collaborate in a

therapeutic partnership. Helpin! patients to understand their medicines and how

to ta"e them is a ma5or eature o clinical pharmacy. Healthcare proessionals are

concerned about %atient adherence to medical re!imen o treatment

recommended by the doctors. $dherence to treatment, particularly or lon!:term

chronic conditions, can be poor and tends to worsen as the number o medicines



and comple6ity o treatment re!imens increase .Concordance is a new approach

to the prescribin! and ta"in! o medicines.

>nte!rated medicines mana!ement

>nte!rated medicines mana!ement is a structure o practise in EF;s pharmacies

which helps to brin! to!ether several undamentals o clinical pharmacy services

which have been proven to be eAective in dealin! with medicines mana!ement

problems, deliverin! additional input at "ey phases o a patient;s stay

admission, inpatient monitorin! and counsellin! and dischar!e.

%roessional and clinical audit

Clinical pharmacists in EF can be involved in many diAerent types o audit. These

may ran!e rom topics includin! audit o clinical services themselves (ore6ample, clinical pharmacy interventions) or may e6amine which treatments are

used and how they are applied within the ramewor" o dru! use evaluations.

$ustralia

The community %harmacy system o $ustralia is amon! the best system o

community pharmacy in the world. >t delivers medicines to the public in a

convenient, aAordable and e7uitable manner.

The $ustralian =ederal Lovernment provides verifed e@cacious prescription

medications at subsidised rate throu!h a networ" o over 2&&&, pharmacist:

owned community pharmacies throu!h the %harmaceutical <enefts Scheme

(%<S). The Community %harmacists competently dispense these subsidised

medications to improve and save the lives o the $ustralian people. >n the

absence o these committed community pharmacists who mana!e the medicine

supply and the %<S the cost o medicines would increase and it would

compromise the health o the people in the community.

>n combination with $ustralia;s uni7ue medicine schedulin! system and the

e@cient ran!e o proessional health services, the %<S orms the mainstay o

community pharmacy in this country.



The community pharmacists and their services are always available in most o

the cases these services are oAered to the people devoid o any monetary

char!e and without the need to ma"e an appointment. >rrespective o where they

live, all $ustralians have the same access to %<S medicines (within hours) at

no fnancial disadvanta!e.

%harmacists are responsible or all the advice and service provided in their

pharmacies. The pharmacist should always be present in his9her pharmacy and

abide by the rules o the %harmacy <oard to have their continuin! re!istration

and approval to dispense medication under the %<S. > a pharmacist is ound to

be ne!lectin! and not ollowin! the rules then he9she mi!ht lose their

re!istration. $ pharmacist who loses re!istration cannot continue to operate a

pharmacy or even wor" in one. This is to!ether, a stron! public protection and

prevention a!ainst any lessenin! o proessional standards.

%harmacists cultivate !ood associations with their patients, at times over

!enerations, as many people avail the benefts o bein! the client o a sin!le

pharmacy. The stron!er the pharmacist:patient relationship, the better the health

outcomes that can be e6pected.

ES$

Current pharmacy practice in ES$ is substantially more varied in terms o scope

o practice and practice settin!. Traditional roles o the pharmacist to solely dispense medication product havebeen !reatly e6panded. 4owadays in ES$ the community pharmacists assessand counsel patients, provide health maintenance inormation, reduce dru!misadventures throu!h clinical interventions , evaluate patients who access thehealth system throu!h community pharmacies, and perorm point M o M caretestin! ,administer immuniNations (as one o many public health unctions),respond to disaster needs, assume re!ulatory roles in dru! delivery to assuresaety.Some pharmacists in advanced practice settin!s are involved with provision omore e6tended direct patient care throu!h comprehensive disease mana!ement,CBT3, medication mana!ement, health promotion9disease prevention, care

coordination and ollowMup patient care. 3any o these services are similar inscope and comple6ity to other primary care services delivered in health caresystem o ES$.

%harmacist ?oles

Currently, pharmacists deliver patient care services in a variety o practicesettin!s throu!h C%$ to mana!e disease whereby they

•%erorm patient assessment (sub5ective and ob5ective data includin!

%hysical assessment)

•Have prescriptive authority (initiate, ad5ust, or discontinue treatment) tomana!e disease throu!h medication use and deliver collaborative dru!

Therapy or medication mana!ement



•rder, interpret, and monitor laboratory tests

•=ormulate clinical assessments and develop therapeutic plans

•%rovide care coordination and other health services or wellness and prevention

o disease

Current scenario of pharmacy in India

>ndia aces massive challen!es in providin! health care or its vast and !rowin!

population. Bespite many barriers, community pharmacy services are central to

the sae and eAective medicines mana!ement in advancin! health.

$ter the enorcement o provisions o the %harmacy $ct 10', pharmacists

wor"in! in >ndia must have a pharmacist re!istration certifcate issued by the

state in which they wish to practice. To obtain a re!istration certifcate, the

prospective pharmacist must ac7uire the minimum diploma (B. %harm.) rom a

pharmacy institute that is reco!niNed by the %harmacy Council o >ndia

(%C>).The community pharmacists who actually mana!e pharmacies today are

mostly B. %harm. holders (diploma pharmacists).nce 7ualifed, most o these

pharmacists receive little additional trainin! and there is no e6posure to up:to:

date inormation. 3any o these people, who did not succeed in placement in

!overnment hospitals, are currently wor"in! as community pharmacists in theprivate community pharmacies.

n paper, every community pharmacy must have a diploma pharmacist or <.

%harm pharmacist onsite. >n practice, ew pharmacists are onsite in community

pharmacies and the dispensin! is underta"en by the owner o pharmacy, a

relative in case o the pharmacy bein! owned by a pharmacist, or other

supportin! person (assistant or attendant) with "nowled!e o sellin! medicines.

$ ma5ority o pharmacy owners, who are not pharmacists, hire pharmacists on a

to"en basis and as a result, pharmacists are never available to dispense

medications



ne study reported that pharmacists lac" proper trainin! to underta"e patient

counsellin!.

The public perception o community pharmacy and the pharmacist is very wea".

The !eneral population considers community pharmacists as dru! traders and

obviously not better than the !eneral store owners. Consumers and patients

consider a visit to the medical store to purchase dru!s in much same way they

consider a visit to a !rocery to buy ood items. The educated people consider

the retail pharmacist as a person who has ac7uired a dru! licence to supply the

medicines or a !rocer who deals in medicines. They thin" anyone in our country

can open a stationary shop and a medical store (i.e. pharmacy) also. The

pharmacists are portrayed as poor compounders, who are assistants to doctors

in mainstream flms and dramas.

Since the 10'&;s there has been phenomenal !rowth o private institutions

oAerin! B. %harm. course s. However, most o these sel: fnancin! institutions

that provide education in pharmacy are away rom practice environment

resultin! in diploma pharmacists lac"in! the s"ills needed or the community

practice settin!.

3ore than a decade has passed since education in clinical pharmacy practice

was introduced in >ndia. Iet, there has been ne!li!ible or no improvement in the

practice o the pharmacy proession in >ndian hospitals. Bespite the introduction

o this feld o education, the presence o the clinical pharmacist is minimal to

non:e6istent in the health:care system. This has led to several dru!:related

problems, includin! the deaths o patients.

Standards for &ood pharmacy practise

Ke have !one throu!h the =>% !uidelines and selected the ones which are most

relevant to our pro5ect

Standards are an important part in the measurement o 7uality o service to the

consumer.

Lood pharmacy practice re7uires that the core o the pharmacy activity is the

supply o medication and other health care products o assured 7uality,

appropriate inormation and advice or the patient, and monitorin! o the eAects

o use.

Lood pharmacy practice re7uires that an inte!ral part o the pharmacistOs

contribution is the promotion o rational and economic prescribin! and o

appropriate use o medicines.

Lood %harmacy %ractice re7uires that the ob5ective o each element o pharmacy

service is relevant to the patient, is clearly defned and is eAectively

communicated to all those involved.



%harmacists should have input into decisions about the use o medicines. $

system should e6ist that enables pharmacists to report adverse events,

medication errors, deects in product 7uality or detection o countereit products.

This reportin! may include inormation about dru! use supplied by patients or

health proessionals, either directly or throu!h pharmacists.

The pharmacist should be aware o essential medical and pharmaceutical

inormation about each patient. btainin! such inormation is made easier i the

patient chooses to use only one pharmacy or i the patientOs medication profle is

available.

The pharmacist needs independent, comprehensive, ob5ective and current

inormation about therapeutics and medicines in use.

%harmacists in each practice settin! should accept personal responsibility or

maintainin! and assessin! their own competence throu!hout their proessional

wor"in! lives.

=>% !uidelines state that all people should have

• $ccess to a community health care wor"er with appropriate

pharmaceutical trainin!

•

$ccess to a person trained to a hi!her level than a community health carewor"er

• $ccess to a 7ualifed pharmacy technician with appropriate trainin!

• $ccess to a 7ualifed pharmacy technician wor"in! under the direct

supervision o a pharmacist

• Birect access to a pharmacist P

P >n developin! countries it is accepted that at present, and or some time to

come in most cases, due to insu@cient numbers o pharmacists, it is not possible

or people in all areas to have direct access to a pharmacist. The level opharmaceutical service that can be oAered will, thereore, lar!ely be determined

by location.

1. . However, the underlyin! principle that has to be adopted is that all people

should have access to an ade7uate pharmaceutical service.

1. #. >n many cases it is perceived that the level o responsibility placed on

health wor"ers is disproportionate to the trainin! that they have received. The

wor"in! !roup recommends that all community health care wor"ers are !iven at

least a basic trainin! appropriate to the level o pharmaceutical service they are

re7uired to render. >t is assumed that at the primary health care level, the

medicines will be relatively simple and ew in number. The community healthcare wor"ers need to be !iven basic trainin! in how these medicines must be



used to ensure that patients are !iven medicines which are appropriate or the

condition9problem bein! treated, alon! with accurate instructions.

To ensure that the ri!ht patient receives the appropriate medicine in the correct

dose and orm

• The ri!ht patient should !et the ri!ht medicine

• %ossible interactions should be avoided. The 7uality and inte!rity o the

medicine should be maintained throu!hout the indicated shel lie

• Correct and clear instructions should be !iven to the patient to ensure

correct and sae use o the medicine, or optimal beneft o the patient in

line with the ob5ective o the treatment

• The patient should be !iven, basic inormation re!ardin! special

instructions or use, warnin!s i applicable, possible adverse9side eAect

and action to ta"e in the event o certain events occurrin!.

?ecords

To acilitate patient care and provide an audit trail

• $ record o all medicines supplied should be "ept detailin! name o

patient, name Q stren!th o medicine, dosa!e, 7uantity supplied, date o

dispensin!

• >ndividual patient medicine records should be maintained in a system,manual or computeriNed, which allows or easy retrieval o patient

inormation

Health inormation, patient counsellin! Q pharmaceutical care

To promote !ood health and prevent ill health, all personnel should be trained

and e7uipped in terms o literature and support material to !ive advice on

!eneral health matters as well as more specifc inormation and services relatin!

to medicines supplied by them.

Research methodolo&y

Data Analysis

=or pharmacist data, we approached *# pharmacies in total and at each

pharmacy we as"ed the representative o the pharmacy to allow us to present

our 7uestionnaire. nly #0 pharmacies allowed us to present our 7uestionnaireto them. $mon! other pharmacies some didn;t allow us to present our



7uestionnaire claimin! that the pharmacist is unavailable at the time o our

survey, some reused to interact with us and ew even acted violently towards

us. (3a"e pieR)

=or patient data, we stood outside the pharmacies and approached the

customers who were comin! out o the pharmacies ater purchasin! the

medication. Ke as"ed them to fll out our 7uestionnaire, most o them allowed us

but ew o them reused to fll out the 7uestionnaire. Some o the customers had

some personal opinions about the survey and also about the pharmacy services

!iven in Fol"ata.

Key'point of Analysis(

)* Pharmacist not availa"le in ma+imum pharmacies

,* In ma+ cases the persons %ere under-uali.ed

/* 0a+ pharmacies did not ask for any medication history from

patients

1* The customers usually ask for information a"out the medication

they are purchasin&2 "ut it is not provided to them "y the

pharmacy personnel*

3* 0ost of the pharmacies do not provide any information

4* No authentic counsellin& is o5ered

6* Pharmacies reported that ADR reportin& is a"sent in most cases

7* 0ost pharmacists do not check appropriateness of prescription

Key point analysis of patients(

)* 0ost customers "uy medicine a&ainst prescription

,* 8ery less medication details is provided "y the pharmacy to the

customers

/* Ne&li&i"le follo% up services provided

1* 9e% pharmacy ask for medication history

3* :uali.ed pharmacist;competent person %as not present in the

premises at the time of survey

4* 0a+imum time the usa&e &uidelines is &iven "y the Doctor or

shopkeeper of the pharmacy2 %ho is not the pharmacist

Durin& the analysis data received from the pharmacists and from the

patients have "een analysed separately

The Pharmacist data analysis



Presence of Pharmacist in the premises

>n our survey we approached #0 pharmacies, out o which, in 0 shops the person

who represented the pharmacy to us claimed to be the pharmacist o the shop,

which comes to # o the total. The personnel present in the rest o

pharmacies said that they didn;t have any pharmacists present at the time o

survey

#

,,

pharmacist

yes no

ut o the 0 pharmacies in which the person representin! the pharmacy and

claimed to be the pharmacist o that shop, we ound only person had B.

pharm 7ualifcation, which is the basic 7ualifcation needed to obtain a license

in >ndia. other person were ound to be associated with retail pharmacy or

over #& years and thereore they may have licenses issued beore the

revision o the -aw which ma"es them %harmacists too.

The rest o the 2 personnel didn;t have the 7ualifcation re7uired to be a

pharmacist, they were hi!her secondary pass and !raduates.



Not Pharmacist< 34=

ist< 11=

8eri9ICATIN 9 P#AR0ACIST C$AI0

ualifcation o the pharmacy representative

Ke have ound that none o the pharmacies had any <.%harm or 3.%harm

7ualifed personnel present in the premises o the pharmacy durin! our

survey. The number o B.pharm 7ualifed personnel were which comes to

2.The !raduates present were 0(#) amon! which most o them were

rom non:science bac"!round. The rest '() were below under!raduate

level, the least o which was class ' standard.

nly 1 post !raduate personnel was ound who was a 3<$

%rescription =re7uency

>t was ound that 12 pharmacies (#') claimed that the patients always

purchased medications a!ainst a prescription.1& pharmacies (*) claimed that

patients re7uently purchased a!ainst prescription.1# pharmacies (##) claimed

that the patients moderately purchased medications a!ainst prescription.1

pharmacy (#) claimed that the patients seldom purchased medications a!ainst

prescription.

>t was observed durin! the survey that they do dispense prescription dru!s

without prescriptions. Jven when they claimed that they reuse to !ive out

medication without prescription.



always( #'

re7uently( *

moderate( ##

seldom( #

prescription fre-ency

0edication history

It %as found that the num"er of pharmacies askin& a"out medication

history of patients %as / %hich comes to 7=*The remainin& /4pharmacies>?,=@ did ask for any medication history of patients*

yes '

no 0

medication history



Do customer ask for information

In our survey of /? pharmacies %e found that ,3 pharmacies>41=@claimed that customers ask information a"out the medicines that they

are purchasin& %hich &enerally involved mostly %hen to take and

ho% to take also the reason of usa&e* The remainin& )1 pharmacies

>/4=@ claimed that patients did not have any -ueries re&ardin& the

usa&e of medication they purchased*

#o%ever the -ueries of patients re&ardin& medication %ere only met

%ith denial from the personnel claimin& that it is not their duty*

yes( *

no( #*

%hether customer ask for information

Provide information spontaneously

e found that the personnel present in // >73=@ pharmacies didnEt

provide any information a"out the medication to the patients on their

o%n* nly personnel present in 4 >)3=@ pharmacies provide medication

information on their o%n*



yes( 12

no( '2

spontaneously

Acceptance of advice "y the patients

In our survey of /? pharmacies2 ,1 pharmacies claimed that the

patients have least acceptance of their advice* hich is 4)= of the

total* 6 >)7=@ pharmacies claimed that patients are neutral to%ards

their advices* 1 pharmacies >)F=@ said that the patients have moderate

acceptance of the advices &iven* / >7=@ pharmacies said patients have

lo% acceptance of their advice* nly ) >/=@ pharmacy said that the

patient have hi&h acceptance of their advice*



hi!hest( #moderate( 1&

neutral( 1'

low( 'least( *

acceptance level

Counsellin&

e found that /3 pharmacies >?F=@ did not provide any counselin& to

patients re&ardin& the medications they are purchasin&* nly 1

pharmacies >)F=@ provided counselin& to the patients2 %hich %e

o"served %as not up to the mark of standard pharmacy practice*

yes 1&

no 0&

counselin&

$evel of ADR reportin&



e found that ,3 pharmacies claimed that they never received any

reports of ADR* hich is 41= of the total* 3 >)/=@ pharmacies claimed

that they rarely receive ADR reports* / >7=@ pharmacies claimed that

they seldom receive ADR reports* 3 >)/=@ pharmacies said that they

moderately receive reports of ADR* nly ) >/=@ pharmacy said they

receive reports of ADR fre-uently*

re7uently( #moderately( 1#

seldom( '

rare( 1#never( *

ADR fre-ency

9ollo% up services

In our survey of /? pharmacies %e found that follo% up services is

provided "y 6 pharmacies2 %hich is )7=* The rest /, >7,=@ pharmacies

o5er no follo% up services*



yes( 1'

no( '

follo% up

#ome delivery

In our survey of /? pharmacies %e found that ), pharmacies are

o5erin& home delivery services2 %hich is /)=* The home delivery

services are mostly o5ered "y retail chain pharmacies* Rest ,6 >4?=@

pharmacies do not o5er home delivery services*

yes #1

no *0

home delivery

A%areness campai&n



In our survey of /? pharmacies %e found that only / pharmacies

conduct a%areness campai&n2 %hich is 7= of the total* The rest /4

>?,=@ pharmacies conduct no a%areness campai&n*

yes( '

no( 0

a%areness

G+perience of pharmacy representative

>n the sample !roup o the #0 surveyed pharmacies, the persons representin!

the pharmacy to us were ound to have sample avera!e 12 years o e6perience.

1* personnel had 1: 1o years o e6perience

12 personnel had 11 + & years o e6perience

* personnel had 1 + #& years o e6perience

%ersonnel had #1 + & years o e6perience



1:1& years 11:& years 1:#& years #1:& years&

*

'

1&

1

1

1*

J6perience

J6perience

$vera!e customer served

ut o the #& pharmacies which !ave data about their customer load, it was

ound that the pharmacies have an avera!e load o 2' patients per shop.

Some pharmacies reported to have more around 1&&& customers per day but it

should be noted that pharmacies which claimed to have over 2&& patient loadwere hour open pharmacy.

Jstablished retail pharmacy chain was ound to have more patient load than the

other pharmacies present in the same area.

%arameters o appropriateness o prescription

nly # pharmacies don;t chec" or the appropriateness o prescription

4ame and date 1

J6piration date '

<atch #

3?% #

3ostly the %harmacy shop representative claims that they chec" the

prescription, but it is ound that they only chec" names o the doctor, patient and

the medicine. =ew pharmacy representative claim to chec" the batch and 3?%

(3a6imum ?etail %rice). nly 1 pharmacy chec"s the ormulation. $ll pharmacies

ne!lect to chec" whether the medicine !iven to the patient is the correct

medicine or the person is appropriate or the child.



Patient data analysis

Purchased the medicine for'n the "asis of our survey conducted %e found that 16 patients "ou&ht

medicines for personal usa&e>1/=@*The rest 4/ patients "ou&ht

medicines for their family mem"ers >mother2 father2 %ife2 hus"and@

%urchased medicine or( #

%ersonal use ( 2,

Chart Title

0edication details received

n the "asis of our survey conducted %e found that only , patients

%ere informed a"out the side e5ects;adverse e5ects of the dru& they

are purchasin&>F=@*1 patients %ere informed a"out the special

precautions to "e taken %hile administration*>/=@*), patients %ere

informed a"out the ma+imum daily dosa&e that can "e administered*

>7=@*14 patients %ere informed a"out ho% to administer the

dru&>/)=@*/6 patients %ere informed a"out %hen to take the dru&

limited to "efore or after meals*>,3=@*



The remainin& 14 patients %ere informed nothin& a"out the dru& they

are purchasin& >even on in-uirin&@

1'

#1

2

#1

Let details about Side eAect9 $dverse eAect Bru!9 =ood interaction

Special %recaution 3a6imum daily dose How to ta"e

Khen to ta"e Stora!e condition .thers

4othin!

Patients "rin& prescription

n the "asis of our survey conducted on ))F people %e found that ??

patients purchased medications a&ainst a prescription2 %hich comes to

?F=*The remainin& )) patients purchased medication %ithout a

prescription* >)F=@



Ies( 1&

Prescription

9ollo% up service o5ered or not

n the "asis of our survey conducted %e found that )F7 patients

claimed that the pharmacies they purchase from does not &ive any sort

of follo% up services*>?7=@*The remainin& , patients claimed that the

pharmacies thy purchase from &ives follo% up services*>,=@

=ollow up

Ies 0'

9ollo% up



Re&ular patients or not

n the "asis of our survey conducted %e found that 31 patients %ere

re&ular customers of the pharmacies from %hich they %ere purchasin&*

>1?=@*The reamin& 34 patients %ere not re&ular customers of thepharmacies form %hich they %ere purchasin&* >3)=@*

%urches re!ularly( 0 Ies( 21

Purchase re&ularly

0edication #istory

n the "asis of our survey conducted %e found that )F? patients

claimed that they %ere not in-uired a"out their aller&y history or

concurrent medication or disease pro.le "y the personnel present in

the pharmacy*>??=@*) patient claimed to "e in-uired a"out his

concurrent medication "y the pharmacy personnel



$ller!y history( 1

Bisease profle( 00

mediction history

Identi.cation of Pharmacists >Hneed

calc@Presence of Pharmacists

n the "asis of our survey conducted %e found that only 3 patients

claimed that the pharmacy from %hich they are purchasin& had apharmacist* >3=@ The remainin& )F3 patients claimed that there %ere

no pharmacists present in the pharmacies from %hich they purchased

their medication

2

02

Chart Title

Ies 4o



0edication usa&e advice

In our survey of ))F patients2 %e have found that 33 patients

reported that they have only received advice a"out the medication

from the doctor and no advice %as &iven "y the shopkeeper* hich is3F= of the total* 14 >1,=@ patients reported that they have "een

advised "y the shopkeeper or the shop attendant alon& %ith the

doctor %ho &ave them the prescription*

3 patients reported that they had "een advised "y the pharmacist of

the shop2 %hom they had identi.ed*

1 patients reported that they %ere not &iven any advice "y anyone*

In all cases %e found that the person purchasin& the medicine kne%

a"out the "asic ho% to take and %hen to take usa&e &uideline2

as it %as provided "y the prescri"in& doctor*

doctor only< 3F=

Shopkeepr Doctor< 1,=

Pharmacist only< 3=

No advice< 1=

Adviced "y

Conclusions

%harmacist conclusion

Burin! the survey we approached the persons operatin! the shop to allow us to

present our 7uestionnaire to the pharmacist o the shop. The person we

approached then either reerred us to another person sayin! he is the one who

will answer the 7uestionnaire or he himsel answered the 7uestionnaire. Burin!

the analysis we ound that only 0 person who flled out the 7uestionnaire claimed

to be the pharmacist. The other people didn;t claim themselves to be the

pharmacist o the shop in the 7uestionnaire.



=rom this it is clearly visible that we can say only # pharmacy has a

pharmacist present. The other doesn;t. Khen we verifed the # pharmacy

personnel who claimed themselves to be pharmacist by their 7ualifcation

details, we ound that only people were eli!ible to be a pharmacist9competent

person o a pharmacy retail. <ecause accordin! to the law at least a Biploma

holder in pharmacy course is eli!ible as a pharmacist e6cept some special casessuch as people who have been !ranted license beore the amendment was

made. (Competent)

Considerin! the same, rom our fndin!s we can say that only in 1& cases,

pharmacists were present to operate the shop at the time o survey. That means

in 0& cases no pharmacist9competent person was present durin! the time o

survey.

So, in eAect only 1& o the pharmacies had the capability to serve the

customers who are buyin! somethin! as serious as medicines, which has

potential lie or death conse7uences

>n the analysis o the pharmacy representative answerin! the 7uestionnaire, we

didn;t fnd any <. %harm or 3. pharm available to answer the 7uestionnaire at

the time o survey. Ke ound in our analysis that in ' pharmacy shop the

people operatin! the pharmacy are even below !raduate level and answered our

7uestionnaire puttin! himsel as the representative o the pharmacy. #

pharmacies had representatives (the person answerin! the 7uestionnaire) who

were !raduates and only 2 pharmacy had representatives who were B. pharm,

which is the basic level o educational 7ualifcation re7uired to be a re!istered

pharmacist.

Thus most o the personnel servin! the customers and sellin! the medicines arebelow !raduate. 3oreover we ound pharmacies with personnel 7ualifed as low

as ei!ht standard dispensin! the medication to the customer. >t cannot be

e6pected rom them to e6plain to the customers about dru! ood interaction, i

the customer as"s or medication inormation. Jven i we ta"e into account the

e6perience o the personnel, comple6 and newer data li"e dru!:dru! interaction,

which can be lie threatenin!, cannot be e6plained by them to the customer. <y

allowin! these personnel to sell medicine we are puttin! the lives o the patients

at ris" and we are !ivin! these personnel ree lease to endan!er people;s lives.

3ost o the time customers come with prescription while buyin! the medication

as reported by the representatives o the pharmacies. #' pharmacies reported

that customers always comes with prescription and * pharmacies reported

that customers they serve re7uently comes with prescription. 3ore than *& o

the customers come with prescriptions most o the times. nly # reported that

the customers seldom comes with prescription. =rom this it;s visible that in most

cases the prescription is brou!ht by the customers which is the only re7uirement

the customer needs to ulfl to be able to buy medication. >t;s clear rom this that

the customers are aware about the necessity o prescription to purchase

medicines.

<ut when urther as"ed whether the pharmacy personnel chec"s the prescription

or its correctness or appropriateness, its seen in the analysis that even when

claimin! that they do chec" or the appropriateness o the prescription, they

mostly chec" names o the doctor, patient and the medicine. =ew pharmacy



representative claim to chec" the batch and 3?%. nly 1 pharmacy chec"s the

ormulation. $ll pharmacies ne!lect to chec" whether the medicine !iven to the

patient is the correct medicine or the person or i the medication is appropriate

or the child.

The dosa!e or whether there is interaction between the dru!s is not chec"ed by

any o the pharmacists. 4ow i a wron! or hi!her dose o a Sedative dru! is !iven

and the patient sin"s due to this dosa!e then a lie may be lost. > only the

pharmacists were 7ualifed and chec"ed the prescription beore dispensin! then

such cases can be avoided.

nly ' pharmacies as" or the medication history o the patient and that too

they chec" only what the doctor has written under ?6 i the same prescription is

bein! used multiple times (patient card). The rest 0 do not as" or any

medication history beore dispensin! medicine. Burin! survey it was even

observed that the personnel operatin! the pharmacy said it;s not their duty to

as" or the record o patient;s medication history. >n a country li"e >ndia, we

a!ree it;s not possible to "eep records li"e other developed countries, but the

basic process has to start somewhere down the line to ma"e pharmacy

conditions better. 3edication history record:"eepin! and "eepin! o photocopies

o prescription is very much re7uired. Kithout proper medication history it is

di@cult to determine the medicines which the patient is aller!ic to or the

concurrent medication the patient is ta"in!.

Khen as"ed whether the customers as" or inormation about medication, then

we ound * pharmacy personnel replied in the 7uestionnaire that the

customers as" inormation about how to ta"e and when to ta"eD also the reason

or the use o the medication. #* claimed that the patients have no 7ueries.

The patients as" or minimal inormation as they don;t "now about the medicinesmuch and there is a lac" o awareness. The 7ueries o patients are not answered

by the pharmacy personnel in most cases, in cases o conusion they reer to the

doctor. $s we established earlier that very ew pharmacies have proper

pharmacists, so to play it sae they don;t advice the patient they 5ust ma"e the

customer visit the doctor repetitively. The person who is dispensin! the medicine

in most cases are under 7ualifed to handle conusion over molecule name, brand

chan!e and dosa!e. nly a pharmacist can alter dose and chan!e molecule

prescribed by the doctor.

12 pharmacies claimed that they provide medication inormation and usa!e on

their own spontaneously. '2 pharmacies provide no inormation to the patientsabout the medication or its usa!e to the patients that means unless the

customer as"s the personnel dispensin! medicines do not eel the need to as"

whether the patient need advice or not. They 5ust dispense dru!s which can

potentially "ill patients, such careless dispensin! o medication can cause

accidental overdose i the patient or the person administerin! the dru! is not

advised by the dispensin! pharmacist or the doctor about the ma6imum dose or

other usa!e !uidelines, amon! many other problems. The personnel are not

inclined to serve the patients. <ut their willin!ness is not the only actor. Their

own "nowled!e is the main actor, as we saw that most personnel dispensin!

medicines are below under!raduate level and not 7ualifed to be pharmacist,

they don;t "now the medication inormation and usa!e !uidelines on their own. Thereore they can;t provide details.



*0 pharmacies reported that the acceptance level o advice amon! patients

are least and low. <ut only 12 o the pharmacies claimed to actually !ive any

advice on their own. So these *0 pharmacies which reported that the

acceptance is least or low provided the inormation without even !ivin! any

advice.

nly 1& pharmacies reported that they provide counsellin! to the patients, but

the rest oAer no counsellin! services to the patients. %rovidin! counsellin! helps

the patients understand his disease or disorder better and to understand the

medication he9she is ta"in!. Kithout proper understandin! o the medication and

usa!e !uidelines o the medication it;s not sae to administer the medication. >n

developed nations we saw that counsellin! is always oAered, but in >ndia very

ew pharmacies are providin! such services. >n most cases this service is

primarily provided by retail chain pharmacies. $ sta!!erin! 0& pharmacies 5ust

don;t counsel the patients, they 5ust dispense and ta"e the money without !ivin!

the necessary services.

%atient C4C-ES>4

=rom our survey o 11& patients rom 2 diAerent areas in Fol"ata we have

concluded the ollowin! about the state o pharmacy services and mentality o

patients +

>. %atients are well aware o the act that they should always purchase

medicines a!ainst a prescription hence they rarely ail to brin!

prescription to the pharmacies. This shows that they are aware about their

duties and are willin! to ollow them, provided some help is oAered rom

the pharmacies too. They are serious about their health.>>. However they are not !ettin! ade7uate help rom the pharmacies in terms

o usa!e o their purchased medicines .we have seen that only a handul

o pharmacies provide some details as to when to ta"e the medicine and

at what intervals, however this inormation is substandard. The remainin!

details o side eAect adverse eAect dru! ood interaction special

precaution ma6imum daily dose is hardly provided. ma6imum patients are

5ust handed the medicines accordin! to their prescription and sent bac"

without an e6planation as to why should the patient ta"e that medicine>>>. The ma5or reason or the lac" o responsibility is the absence o a 7ualifed

licensed pharmacist in pharmacies. The people runnin! the pharmaciesare themselves under 7ualifed the least bein! class 0. They are not

capable o supplyin! the necessary inormation to the patients and hence

avoid their 7uestions, sometimes even turn them down rudely. Khen

as"ed about their particular behavior the claim that it is not their duty to

cater to the 7ueries o patients as the doctors are available or that. This

shows that most o the people runnin! the pharmacies have no basic idea

about the duties o the pharmacist or the services that should be provided

to the patients. Hence when the curious patients as" 7uestions about their

state o medication they only !et replies o as" your doctorD.

>G. Since the absence o pharmacist is a common phenomenon, the patientsare not aware that a pharmacist should be always present in pharmacies



and hence have compromised. (P needs to be verifed)Khen as"ed i they

were !iven any details rom the pharmacy they say that it is the 5ob o a

doctor to provide them details and not the %harmacist. =rom this

statement we can identiy the i!norance o patients about the rules o

pharmacies and its duties. Bue to this ideals patients have started as"in!

less and less 7uestions to the pharmacy personnel;s in ear o bein!

turned down. <ut the patients cannot be blamed as the person whose duty

is to attend to the shop is not present, the shop is operated by

shop"eepers who are incompetent. The patients eel as"in! or advice

rom these persons are not !ood because they are not 7ualifed, which is

true.G. The absence o pharmacist leads to no medication history bein! as"ed

rom patients beore purchasin! o medication. This may lead to the wron!

administration o a dru! to the patient. Their aller!y history or concurrent

medication details which provide valuable inormation as to what type o

dru! to prescribe to patients is hardly ever as"ed or. Jven the ollow upservices provided are nil.

G>. The state o pharmacies in Fol"ata is ar rom an ideal one. Jven the basic

services that should be provided to every purchasin! customer is absent

in almost all o the pharmacies. The most basic step that can be ta"en to

improve the state o pharmacies is the recruitment o 7ualifed

personnel;s9pharmacist who are able enou!h to "now their duties and

provide services to patients. However this also re7uires a chan!e o

mentality o patients rom a doctor avored attitude to a balanced one.

Kithout the help o patients, pharmacists cannot !ain control and ri!hts.

$nother ma5or step that can be ta"en is settin! up o awarenesscampai!ns to educate people about the duties o a pharmacist so that

they become well aware beore purchasin!.

Conclusions compare

=rom our pro5ect certain issues about the current community pharmacy scenario

o Fol"ata has come to li!ht. These ne!lected issues i ta"en care o can !reatly

improve the conditions in Fol"ata and help to eradicate patient deaths due to

wron! administration o medicine, lac" o inormation, lac" o healthcare

proessionals and side eAects rom medicines. >n >ndia the avera!e pharmacist to

patient ratio is one per every 10' patients. The analysis rom our survey clearly

supports this point in which only a sin!le 7ualifed pharmacist was ound orm

amon! #2 pharmacies surveyed. 3edication prescription and dru! monitorin! is

done by doctors only which increase the patient load on them. (ne every

1&&).important services li"e patient counsellin! and cross chec"in! o

medications cannot be urther perormed by doctors as it increase the stress on

them. Ke need 7ualifed and competent pharmacists or these services which is

absent.

>t was observed that most o the pharmacies were run by under 7ualifed and

incompetent personnel havin! very less "nowled!e about the duties o a

pharmacist and ne!li!ible idea about patient care. >t was seen that the avera!e

number o customers purchasin! medications a!ainst a prescription is hi!h, but%harmacists do not chec" these prescriptions or appropriateness and



authenticity. The customers do not receive any medical counsellin! or

inormation on the side eAects or adverse eAects. >n >ndia the e6trapolated f!ure

or death due to adverse dru! reaction every year is &&,&&& and yet there;s is

no well:defned system or $B? reportin! or patients. 4ot only does our health

inrastructure ails to "eep up with the ever !rowin! population o patients but

also the demand or the 5ob o a pharmacist is allin! steadily due to a very lowcompensation and hi!h wor"in! hours.it is no lon!er a service but has become a

proession.

>n Fol"ata the avera!e literacy rate is '2 and yet most patients are unaware o

the duties and services they should be receivin! rom a pharmacist. This

i!norance doesn;t limit to patients only as it was seen none o the pharmacy

personnel themselves were aware o the duties they should be providin! to a

patient. Some patients do not !et any relevant inormation even ater they

en7uire about it in the pharmacy. This shows that there is a need or awareness

in orms o campai!n and other media on the topic o healthcare and pharmacy

services to enli!hten both patients and pharmacists. 3ore and more peopleshould be encoura!ed to 5oin the healthcare service and ta"e up the pharmacist

5ob.

mother beta 4.5

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