Sub: Reorganization and opportunities for the Pharm. D 6 year programme in Government Healthcare System (Clinical Pharmacist)-request-reg.

With due respect we are appealing our demands for the justice, 

With an objective of strengthening Indian healthcare system and improving quality patient care, Doctor of pharmacy 6 years course was introduced in the year 2008 as per the Regulations framed under section 10 of the Pharmacy Act, 1948 (8 of 1948). (As approved by the Government of India, Ministry of Health vide, letter No.V.13013/1/2007-PMS, dated the 13th March, 2008 and notified by the Pharmacy Council of India). No.14-126/2007-PCI.― In exercise of the powers conferred by section 10 of the Pharmacy Act, 1948 (8 of 1948), the Pharmacy Council of India. This course is approved as master’s qualification by UGC under section 22(3) of 1956 UGC ACT.

The duration of the course shall be six academic years. The period of six years duration is divided into two phases:

Phase I – consisting of First, Second, Third, Fourth and Fifth academic year. During this period students will get the both theoretical and practical knowledge of the following important subjects related to the human health.

Human Anatomy and Physiology 
Medicinal Biochemistry 
Pathophysiology 
Pharmacology
Community Pharmacy 
Pharmacotherapeutics
Hospital Pharmacy 
Clinical Pharmacy 
Clinical Toxicology 
Clinical Research 

During the first four years every student shall be posted in constituent hospital for a period of not less than fifty hours to be covered in not less than 200 working days. 

In the fifth year, every student shall spend half a day in the morning hours attending ward rounds on daily basis as a part of clerkship. Theory teaching may be scheduled in the afternoon.

Phase II – consisting of internship or residency training during sixth year involving posting in specialty units. It is a phase of training wherein a student is exposed to actual pharmacy practice or clinical pharmacy services and acquires skill under supervision so that he or she may become capable of functioning independently.

After successful completion of this course every student is able to deliver the following clinical pharmacy services to the patients in collaboration with the other healthcare professionals. 

Monitor drug therapy of patient through medication chart review and clinical review; 
Obtain medication history interview and counsel the patients
Identify and resolve drug related problems
Detect, assess and monitor adverse drug reaction
Interpret selected laboratory results (as monitoring parameters in therapeutics) of specific disease states
Retrieve, analyse, interpret and formulate drug or medicine information
 

Though we are expertise in the above, unfortunately we are not getting any recognition and opportunities to prove our skills and improve the patient’s quality care in the Indian healthcare system.

 

National Accreditation Board for Hospitals and Healthcare Providers (NABH) which is a autonomous accreditation body on the lines of quality of the each and every hospital in India through the development and monitoring of the standards required for the quality care.

As per the NABH Guide Book to Accreditation Standards for Hospitals (4th edition), December 2015 Chapter 3 Management of Medication (MOM) objective 4 and 7 clinical pharmacist should be available in the hospital along with other healthcare professionals to improve the quality of the care, according to this standards Private hospitals are already recruiting the Pharm D graduates as a clinical pharmacist. But the government has not yet recognized our 6 years course and skills and not provided any opportunities to the Pharm D graduates. 

Present scenario:

1.      According to 2011 Indian census Doctor patient distribution accounts to 1:1700(Urban) and 1:20000(Rural). As per recommendation by ‘High Level Expert Group (HLEG) for Universal Health Coverage’ constituted by the previous Planning Commission of India about minimum doctor population ratio of 1:1000 but the national figures shows 0.6:1000 (India) whereas developed countries like USA accounts 2.6:1000 , UK 2.3:1000 and Japan 1.9:1000. This figures shows our workforce to deliver proper health facility is less than required.

2.      Pharmacists are known to be drug experts in developed countries whose services extend in delivering rational treatment as pharmacist play vital role in delivering final prescription in association with other Health Care Professionals (physicians, Dentists and Nurses). Where in India pharmacist role is only limited to stocking, distribution and industries. Pharmacists can do a lot in creation of Healthy India.

3.      Pharmacy Act 1948 section 42 , Drugs & Cosmetics 1940 section 65(b), Pharmacy Practice Regulations 2015 rules permit only Registered pharmacists to stock, compound & dispense which is been violated over decades. Out of 27490 pharmacy outlets 40% pharmacies are dispensing without registered pharmacist. There is inappropriate self-medication, sale of prescription medicines without a prescription, due to which irrational dispensing taking place & this is leading to increased drug burden, drug induced toxicity on patient/consumer.

4.      The major section of population has no access to essential medicines due to their economic conditions (i.e., Out of Pocket expenditure) and this population not taking full course of medicine advised by the physician due to incomplete course leading to drug resistance on second exposure. Lots of funds been wasted on irrational medication.

5.      Though Government of India public health expenditure to 2.5% of the GDP with increase in corporate hospitals the treatment costs has gone up and the medical reimbursement of 5 lacs for poor people of India not benefitting on second exposure and this makes difficult to get complete treatment. Presently Aarogyasri, Aarogyamitra, Auyashman Bharat scheme turns golden duck for corporate hospitals instead of spending on medical reimbursements it’s wise to spending government hospitals infrastructure like in Singapore and Germany.

6.      In India many people live villages, Thandas and Agency areas are not even accessible to primary treatment where unqualified quacks practice leading to irrational treatment and leading to lethal effects. Misusage of antibiotics is also very rampant and has created a lot of resistance microorganisms, which often do not succumb to even newer antibiotics.

7.       Presently few health workers like malaria inspector, inspectors, health supervisors and chief health officers are recruited on the basis of any degree qualification.

In this process we request Health Dept of India to utilize our potential. 

.1.      Mid-Level Service Providers: For expansion of primary care from selective care to comprehensive care, complementary human resource strategy is the development of a cadre of mid-level care providers. This can be done through appropriate courses like a B.Sc. in community health and/or through competency-based bridge courses and short courses. These bridge courses could admit graduates from different clinical and paramedical backgrounds like AYUSH doctors, B.Sc. Nurses, Pharmacists, GNMs, etc and equip them with skills to provide services at the sub-centre and other peripheral levels. Locale based selection, a special curriculum of training close to the place where they live and work, conditional licensing, enabling legal framework and a positive practice environment will ensure that this new cadre is preferentially available where they are needed most, i.e. in the under-served areas. Pharm.D Doctors should be considered in the first line for bridge course as the Pharm.D course covers 90% of medicine subjects easy to trained & utilize in Rural India where there is Shortage health providers on the lines of NATIONAL HEALTH POLICY 2017.

2.      Clinical pharmacist position must be created for rational Treatment in all area/district and PHCs: One clinical pharmacist position to be recruited for every 50 beds. This should Replicated in every department pediatric/Geriatric/Cancer/Maternity/Medical colleges/ Teaching Hospitals.

Clinical pharmacist will carry out

·         Drug therapy review to minimize drug related problems and optimize drug therapy and improve medication adherence behavior in patients through medication and disease counseling.

·         Prescription audit which decreases medication errors there by increases patient safety. Which would help to decrease health care cost incurred due to unnecessary medicine

·         Assist physicians in writing evidence-based prescriptions through unbiased drug information

·         Monitor patients for adverse drug events or reactions and report the same to the institutional Pharmacovigilance cell or national Pharmacovigilance program

·         Effective management of medicines procurement and distribution at hospitals/primary healthcare centers.

·         Clinical pharmacists play a vital role in drug utilization evaluation and pharmacoeconomics and assisting in decreasing health care costs mainly in schemes like Aarogyasri, Aarogyamitra, Auyashman Bharat but decreasing unnecessary medications.

3.      Drug information specialist/pharmacist: Pharma clinicians with the authoritative knowledge and practice can ensure the correct dosage with avoidance of adverse drug reaction and drug interactions of lethal effects. one who gives complete information on drug usage and its contradictions. Patient counselling centers and Drug information centers should be developed in every district/mandal where patient education over medication use when to take? How to take? Why to take?  Helps to eradicate life style and infectious diseases through education programs.

4.      Soft loans under self-employment schemes & entrepreneurship development scheme: Government has to provide soft loans to registered pharmacists under self-employment schemes up to 40lacs rural, urban and metropolitan areas to promote young entrepreneurs which helps in increasing pharmacy practice which benefits patients by rational medication and dispensing and also helps in prosperous India. 

5.      Our Government hospitals infrastructure has to modernize: Many people avail medical reimbursements in private and corporate hospitals where majority of funds been diverted government has to develop its own infrastructure for better delivery of welfare schemes.

6.      Skilled work force has to be recruited in National health Programmes: RMNCH+A services, Child and Adolescent Health, Interventions to Address Malnutrition and Micronutrient Deficiencies, Universal Immunization, Communicable Diseases, Control of Tuberculosis, Control of HIV/AIDS, Leprosy Elimination, Vector Borne Disease Control, Non-Communicable Diseases, Emergency Care and Disaster Preparedness. Health workers like malaria inspector, inspectors, health supervisors and chief health officers are recruited on the basis of any degree qualification where clinical trained pharmacists (PharmD Doctors) and nurses can educate better be fitted.

Through Telemedicine medical aid can be provided to villages, Agency areas: PharmD doctors can be used in delivering rural health services in absence of physician with utilization of technology where physicians are connected digitally and they can view diagnosis reports and advice for treatment with the help of PharmD Doctors