Added Value of Pharmacists

in the Public Health

Dr. Nirmal K. Gurbani

Public Health Training Institute, Jaipur
Member Secretary
Rajasthan State Essential Medicines List Committee
Rajasthan State Standard Treatment Guidelines Group
Pharmacists Availability: India
♦ Nearly 500,000 trained pharmacists
♦ Almost 75% engaged in CP and HP
♦ Elsewhere Pharmacists - considered
as experts in medicine management
and health care
♦ Large pool of HRH remained
unutilized as service provider by the
government, society or allied health
professionals
♦ Working in isolation rather than as a
member of the health care team
 Changing Paradigm of
Pharmacy Practice
♦ Traditional role of pharmacists to
manufacture and supply medicines has
undergone a sea change
♦ Community pharmacy practice evolved in
the post Second World War period
♦ Forced the evolution of the pharmacist’s
role into a more patient centred approach
Pharmacy in a New Age (PIANA)
The New Horizon has identified 4 major Area

1. Managing Prescribed Medicines

2. Managing Chronic Conditions

3. Managing Common Ailments in giving

patients (reassurance and advise with
or without use of Non-Rx Med)

4. Public Health - promoting &

supporting Healthy Lifestyles
(helping people to protect their
own health)
Major Breakthrough
WMA and the FIP joint statement
on working relationship between
physicians and pharmacists aims
to demonstrate that each have
♦ complimentary and supportive
roles and
♦ responsibilities
WHO Recognition Pharmacist
WHO and FIP have also jointly identified
seven-core expectations from the
pharmacists as:

♦ Communicator
♦ Care Giver & Quality Drug Supplier
♦ Trainer & Supervisor
♦ Collaborator
♦ Health Promoter
♦ Leader & Manager
♦ Life-long learner
 Good Pharmacy Practices
Activities to be addressed:
♦ Promotion of good health
(prophylaxis & care)
♦ Self care (Diabetes, HT, OA,
etc.)
♦ Managing supply of medicines and other
items
♦ Rational Use of Medicines (influencing
prescribing & medicine use)
Access to Primary Health Care
♦ PHC : first contact that a patient
has with a health care professional
to diagnose or/& treat his/ her
complaints, including prevention
(Health Education)

♦ Pharmacist is usually first

contact with majority of
Population in times of sickness
and quest for health
Untapped Manpower in NHP
An ANM/HW with bare 10+18m training
♦ A crucial partner of Healthcare team (NHP)
- direct contact, communication, IEC
♦ Managing SC with about 5000 population
♦ Advising, educating & prescribing 20-30
products to the community
Pharmacists have better educational
background in Health Education,
National Programmes and RCH,
but are not exploited under NHP
Current Public Health
Concerns in India
Some of the public health challenges we
face today are
♦ Communicable, Non-Communicable,
Vector-born Diseases (NVBDCP), All NPs
♦ Malnutrition (Vit A & D Def., Anaemia)
♦ RCH
♦ Sedentary Lifestyle/Improper diet
♦ Sexual Behavior/STD’s, HIV-AIDS
♦ Substance Abuse: Alcohol,Tobacco,Drugs
♦ Family Violence
Evidence base for Pharmacist
in Public Health
A practical guide for Community Pharmacists- Jointly prepared by Pharmaceutical Services
Negotiating Committee, National Pharmaceutical Association, Royal Pharmaceutical Society
of Great Britain; www: PharmacyHealthLinl

♦ Smoking cessation ♦ Mental health

♦ Coronary heart ♦ Obesity
disease ♦ Accidental injury
♦ Skin cancer prevention prevention
♦ Drug misuse ♦ Folic acid and
♦ Sexual health pregnancy
(including emergency ♦ Asthma
hormonal ♦ Diabetes
contraception) ♦ Nutrition and physical
♦ Immunisation activity
♦ Head lice management ♦ Multi-topic health
♦ Oral health promotion campaigns
Desired Qualities of
Public Health Professionals
♦ Excellent Communication Skills
♦ Trustworthy
♦ People Oriented
♦ Easily Accessible
♦ Experts in providing health care
information
♦ Good rapport with other healthcare
providers
Pharmacists Qualifies All Desired
Qualities
Some Areas Suited to Pharmacist
Volunteerism in Public Health 

♦ Smoking Cessation – IPA NPW :

Pharmacists for Tobacco Free Society
♦ Youth Counseling – Drug Abuse, STD’s
♦ HIV-AIDS : SEARPharm Forum Guiding
Principles for Fight Against HIV-AIDS
♦ Elder Outreach – Nursing Home
Activities
♦ Active Lifestyle/Diet Modification
Activities
LACK OF PATIENT’S KNOWLEDGE &
NON ADHERANCE TO TREATMENT
REASONS
➧ Inappropriate attitudes and poor communication
skills of providers
➧ Patient’s fear of asking questions, esp doctors
➧ Inadequate consulting time
➧ Lack of access to printed information about
drugs (leaflets or labels)
➧ Inability to pay for prescribed medicines
➧ Complexity and duration of treatment
particularly in chronic diseases
 IMPACT OF PROVIDING DRUG INFORMATION
TO THE PATIENTS ON PATIENTS KNOWLEDGE
Delhi Study (DSPRUD)
Knowledge of the patient (Mean + SD)
Parameters Control group (n=114) Study group (n=118)

Pre Post Pre Post

Primary Indicators
Purpose 1.07 (1.53) *1.45 (1.69) 1.32 (1.70) **3.42 (2.04)
Dose 3.49 (1.97) *3.78 (1.75) 2.88 (2.02) **4.22 (1.97)
Frequency 3.54 (1.94) *3.75 (1.75) 2.95 (2.09) **4.27 (2.00)
Duration of treatment 3.14 (2.66) 3.21 (2.60) 2.21 (12.42) **3.83 (2.22)

Sum of primary indicators 11.25 (5.86) *12.21 (5.44) 9.36 (6.39) **15.66 (7.33)
score

Supplementary Indicators
Next appointment 3.40 (2.75) 3.42 (2.80) 3.14 (2.10) **4.15 (2.18)
Adverse effects 0.04 (0.39) 0.01 (0.09) 0.05 (0.41) **2.47 (1.87)
Precautions 0.09 (0.45) 0.11 (0.36) 0.08 (0.46) **2.89 (2.07)

Sum of supplementary 3.52 (2.78) 3.52 (2.76) 3.27 (2.67) **9.52 (5.21)
indicators score

Missed doses (Mean +SD) 1.6 (0.7) 1.9 (.4)

Regular 12 3
Occasional 19 7
Not missed 83 108
Pharmacists : Patient Information
Use of Patient Information Leaflets (PILs) in
Mumbai (2004-2006)
♦ Leaflets : KM Kundnani Pharmacy Polytechnic
in collaboration with Delhi Pharmaceutical Trust
♦ Distributed to 3500 patients in Mumbai and
Thane area through 50 retail pharmacists
♦ PILs were for Atenolol, Cefadroxil,
Atorvastatin, Diclofenac and Glibenclanmide
♦ In the present study respondent’s medication
taking behaviour (compliance) was improved in
91% cases compared to the 36% prior to the
intervention
Pharmacists Fight against TB
♦ TB Patients buy medicines from pharmacists
♦ Importance of Compliance - not been fully
emphasised by prescribers, leading to MDR and
XDR
♦ Pharmacists as valuable resource was hardly
tapped under the TB Control Programme
♦ A TB Fact Card project was launched by IPA in
2005 in Mumbai as collaborative project with
CPA, IPSF, Maharashtra State Chemist &
Druggists Association & Mumbai District TB
Control Society
♦ Students of 6 Pharmacy Colleges, 5000 patients
♦ Compliance established
♦ Another major breakthrough - participation of
some Pharmacists as DOTS providers-an
excellent example of PPP
Pharmacists Fight against TB
Spanish Study : Provision of directly observed
treatment short course (DOTS) through
community pharmacies in Spain resulted in
improved treatment completion and cure rates
when compared to self-administered treatment
(Reference: Juan G, Lloret T, Perez C, et al. Directly observed
treatment for tuberculosis in pharmacies compared with self-
administered therapy in Spain. Int J Tuberc Lung Dis
2006;10:215–221)

♦ Collaboration between community pharmacists

and local TB units of the RNTCP could provide a
continuum of care for patients navigating their
way from diagnosis to treatment

♦ Strategies that involve greater public and

private sector collaboration could lead to
significant improvements in TB control.
 Pharmacists in Malnutrition
♦ In Satara (Maharashtra) – PPP; Pharmacists, their
association, IMA, Government & other associations/
individuals
♦ Each year Health camp for children but no follow up
♦ Pharmacists played important role in finding cases of
malnourished children with the help of Aanganvadi workers
♦ 84 children in age 6 months to 6 year Malnutrition
category 3 & 4 identified and enrolled in the programme
♦ In a year, on each first day of the month -medical check
up by IMA doctors and pharmacists distributed free
medicines Many other individuals & associations (grocers,
food merchants) joined
♦ Now most of the children have shown significant progress &
weight gain of 5 to 7 kgs.
Government’s Role
♦ Considering prevailing unmet need of trained
HRS in achieving the targets under NHPs -
Redefine National Health Policy and augment
the workforce by including Pharmacist as HRH
♦ Draw appropriate training manuals for
empowerment of pharmacists in all NHPs like
Training Manuals for doctors, nurses, HWs,
Aanganwadis, etc
♦ Treat CP outlets as distribution & display point
for HE literature for public and HE posters
♦ Implement and Regulate GPP Guidelines with
same fervor as GMPs under Schedule M
 Pharmacists Action Needed
♦ Commitment of Pharmacists, Pharmaceutical
Associations & Organizations on consensus
♦ Collaboration ­ PCI, IPA, IPGA, APTI, IHPA, 
AICDO, IPO, etc and Social Clubs & Org. 
Lion, Rotary, etc.
♦ Transforming trading mentality to
professional services mindset
♦ Focus from product to patient
♦ PCI initiating a NEED BASED Curriculum
Designing for appropriate empowerment
Roles of Pharm Organizations
♦ Awareness of Community pharmacy and Role
of a Pharmacist
♦ Encourage Ph for display of HE posters and
distribution of HE literature in their outlets
♦ Collaboration and Partnerships with other
health professionals; eg WMA v FIP
IPA v IMA; PCI v MCI
♦ Working together for various national and
international days, events and compaigns,
instead of only working in isolation for a week
in NPWs
♦ PCI:Open up - encorage DHOs as faculty in
HE & doctors in medically oriented subjects
♦ Advocacy and Networking
CONCLUSIONS
Pharmacist is circumcenter of a triangle with
physicians, patients and nurses at the corners
♦ He has direct contact with patients and
Community
♦ Patient finds much more in comfort with
Pharmacist than a physicians
♦ Pharmacist is under utilized in PH and NHPs
♦ Steps should be taken by the Government and
the pharmacist together to play a significant
role in NHPs
♦ Pharmacy Associations need to work in
collaboration and Partnerships, A & N