ROLE OF PHARM.D
IN BRINGING UP THE PHARMACY PROFESSION TO THE GLOBAL LEVEL; RISING HOPES AND UNCERTAINTIES OF PHARM.D IN INDIA
Doctorate
in Pharmacy or Pharm.D programme was the brainchild of various professionals
from the Pharmacy Council of India, who has taken initiatives in bringing this
internationally acclaimed course of study to India, in the year 2008. In some
countries, it is a first prerequisite for licensing to exercise the profession
of pharmacist. As per new amendments the course structure of 6 years comprises
5 years of academics including project, followed by a year of residency
training in a 500 or above bedded hospital.
The 50 year –old Pharmacy profession in India has been seeing a
topsy-turvy growth, while there is an increasing number of institutions
starting various courses in pharmacy (M.pharm, B.pharm or D.pharm) and a good
number of students aspiring for higher education in pharmacy (PhD and
M.pharm).The graduate and post graduate
courses in pharmacy deals mainly
with pharmaceutical industry ,marketing
and academics ,it had become
the need of the hour to upgrade the quality of pharmacy education to focus on
clinical aspects also .In order to focus the clinical aspect of the pharmaceutical
studies Pharm. D is introduced in India, Pharm.D raises both hope as well as
skepticism, for the pharmacy world in India. It does serve as a hope for
strengthening the role of pharmacists in the pharmaceutical care in the health
care system of India, which presently has been almost zero .But there are
still uncertainties about what the job market- both within the country and
abroad, can offer for to these graduates.
THE
SCENARIO ABROAD
The reason for
introducing the course in India is to bring India to the forefront even in the
field of pharmacy, where most of the nations abroad have already established a
well-setup pharmacy system. In the United States, this course is as old as 60
years, and is presently mandated that a doctor of pharmacy degree would be the
first-professional degree of qualification for a pharmacist. Currently all
accredited schools and colleges of pharmacy in the US offer the Pharm.D degree.
In the USA, legal
requirements to becoming a pharmacist includes
·
Graduating with a Doctor of Pharmacy
(Pharm.D) degree from an accredited college of pharmacy
·
Serving an internship under a licensed
pharmacist.
·
And passing a national exam (NAPLEX - North
American Pharmacist Licensure Exam) and a pharmacy law exam (MPJE - Multistate
Pharmacy Jurisprudence Exam).
The
designation Pharm.D is erroneously likened to a PhD Degree. A Pharm. D
professional would be able to prefix ―”Dr.” to his name.
Major domains where Pharm.D graduates in US are employed
Pharm.D
graduates in the US are employed in wide domains. A majority are employed in
the community pharmacy or hospital pharmacy, Apart from these two arenas, there
are other roles requiring special talents and interest.
1.Community
Pharmacy and Consultant Pharmacists
Pharmacists
talk to people when they are healthy and when they are sick; when they are
concerned with an emergency; when they have specific needs, when they are
seeking advice or information.
Pharmacists
serve patients and the community by providing information and advice on health, providing medications and
associated services, referring patients to other sources of help, such as the
physician. As a result, patients have come to depend on the pharmacist as a
health care and information resource of the highest calibre.
Pharmacists, in and out of the community pharmacy, are specialists in the
science and clinical use of medications.
They are the knowledgeable about drugs and its activity.
2.
Hospitals and Other Institutional Settings
As members
of the health care team, institutional pharmacists have an opportunity for
direct involvement with patient care.
The knowledge and clinical skills make this individual an authoritative source
of drug information for physicians, nurses, and patients. Pharmacists in hospitals are responsible for
systems which control drug distribution and are designed to assure that each
patient receives the appropriate medication, in the correct form and dosage, at
the correct time. Maintain records on each patient, using them not
only to fill medication orders but also to screen for drug allergies and adverse drug effects. Hospital
pharmacy practice having highly
specialized areas, including nuclear pharmacy, drug and poison information, and
intravenous therapy. There is also demand for management expertise, including
finance and budgeting, personnel administration, systems development, and
planning.
3.
Managed Care Pharmacy /managed care
organizations (MCOs).
Managed care is a system designed to
optimize patient care and outcomes and foster quality through greater
coordination of medical services. MCOs incorporate pharmaceutical care which
strives to improve access to primary and preventive care, ensure the most
appropriate and effective use of medical services in the most cost-effective
manner.
Areas in which managed care
pharmacists can play a role include:
a)
Practice
Guidelines and Protocol Development
o
Managed care pharmacists often work directly with physicians and other
care givers to determine which medical treatments, including which drug
therapies, are most effective in enhancing patient outcomes.
o
That can involve regularly reviewing
medical literature to determine which medications are the safest and most
effective for treating certain diseases.
b)
Drug utilization review/drug use evaluation
o
Managed care pharmacists review drug utilization to determine which
patients and prescribers are using particular medications.
o
This allows the pharmacist to
determine whether some drugs are inappropriately prescribed or used.
c)
Care management programs
o
Often called "disease
management programs," these
programs involve having pharmacists, physicians, case managers and other care
givers work together to effectively manage and coordinate the overall care of
patients who are at high risk of serious complications because of certain
disease states
Other
responsibilities in the managed care environment can include:
§
contracting with local pharmacies-to
develop networks to serve plan members
§
contracting with pharmaceutical
manufacturers -to receive rebates
§
claims processing -to assure
accurate claims payment
4.The
Pharmaceutical Industry
o
Another option is represented by the
pharmaceutical industry which produces chemicals, drugs, and other health
products.
o
Pharmacists do such things as
marketing, research and product development, quality control, sales, and
administration.
5.
Academic Pharmacy
They are involved with teaching,
research, public service, and patient care. Others serve as consultants for
local, state, national,& international organizations. Becoming a member of the faculty at a college
of pharmacy usually requires a postgraduate degree and/or training, in the US.
Pharmacy practice faculty has
significant responsibility for patient care, in addition to their work in
teaching and research.
6.Other
Fields in Pharmacy
o
Pharmacists use their basic
educational backgrounds in a host of federal, state, and professional
positions.
o
At the federal level, pharmacists
hold staff and supervisory posts in the
·
United States Public Health Service,
·
the Department of Veterans Affairs,
·
the Food and Drug Administration,
and in all branches of the armed services.
o
At the state level there are
agencies charged with regulating the practice of pharmacy to preserve and
protect the public health.
o
There are
pharmacists in advertising, packaging, technical writing, magazine editing, and
science reporting.
o
There are pharmacists with legal
training serving as patent lawyers
or as experts
What
could be the potential arenas where Pharm.D graduates can have a job prospect
in the present scenario in India?
The so mentioned areas
of specializations, where clinical pharmacists can serve, can be made a reality
in India, also. Pharm.D being a clinically-oriented professional degree emphasizes on
the components
of pharmacy like Hospital & Clinical Pharmacy, Community Pharmacy and
Clinical Research.
Graduates can find jobs related to the clinical side; with gradual amendments
being made in the health care industry, a Pharm.D graduate could play an active
role in heading the Hospital Pharmacy Setting and in industries related to
clinical trials.
Phenomenal
rise in the world-class speciality hospitals in India
With more and more
foreigners choosing Indian Super Speciality hospitals, because of their
comparatively affordable treatment with a quality matching those of
international standards and with the medical tourism becoming a buzz word in
the economy, many hospitals in the country are facing competition, forcing them
to upgrade their standard of healthcare. When it comes to healthcare, the
safety considerations are of prime importance, the foreign patients usually opt
for hospitals that have JCI accreditation, which certifies the hospitals for
their standard of treatment outside the USA. Hence hospitals are now vying for
JCI accreditation to have an edge over the others. One of the JCI requirements
for medication use process is the “prospective audit of the medication orders
for appropriateness” by trained professionals prior to drug administration.
Clinical pharmacists are the ideal professionals for the job. So, JCI
accredited hospitals of India will be a potential job opportunity for the
Pharm.D professional.
Multinational
Clinical Research and trials
Thanks to
globalization, a large
number of international Pharmaceutical companies like: Eli Lilly, Aventis, Novartis, AstraZeneca,
Pfizer, Johnson & Johnson, Merck, Bristol-Meyers-Squibb and GlaxoSmithKline
are opting for clinical trials and many
of the multinational pharmaceutical have set up their clinical research
operations in India.
The industry is heading towards a business worth 1.4 billion by way of clinical
trials and it is highly profitable as these trials cost 44
percent less as compared to US-based trials. It is expected that 50,000 job
opportunities will be created for clinical research operations, where Pharm. D
professionals can have a bright job prospect.
Hurdles await to be looked over in India
o
In India, the role of the
clinical/hospital pharmacists is ill defined and the job opportunities in the
private hospitals are negligible.
o
Majority of the Indian population depends on
the publicly funded hospitals for treatment. Inclusion of another expert in the
healthcare team will substantially increase the cost of treatment, which may
not be affordable by most of the State governments.
o
To
practice in the USA, a pharmacy professional has to clear Foreign Pharmacy
Graduate Equivalency Examination (FPGEE) and North American Pharmacist
Licensure Examination (NAPLEX) which is conducted by National Association of
Boards of Pharmacy (NABP) to assess individual‘s competency and knowledge for
the job. However there is no such test in India to assess the Pharm. D
professionals.
o
To
properly train a Pharm. D professional, an institute should have elaborate
infrastructure like 300 bed hospital and expensive faculty, making the course
more expensive
o
With
years of sustained effort, the B. Pharm and M. Pharm Degree holders of India,
have managed a foothold in the pharmaceutical industries, mainly in
manufacturing, quality control and marketing. A Pharm. D professional being on
the clinical side won‘t be suitable for those roles
CONCLUSION
T o sum up, it is evident that skilled pharmacy
professionals can bring up the pharmacy care services in India too and serve as
partners in the global healthcare growth. The diversity of pharmacy is one of
its chief strengths. And, in diversity lies your opportunity. A country’s
development lies in the hands of their healthy citizens and a strong healthcare
system is the foundation for a healthy society.
Our ex-prime
minister Mrs. Indira Gandhi said, "Life is not mere living but living in
health". Though there would be unavoidable obstacles in the path, it
appears that steps like introduction of Pharm.D in our pharmacy education, is
likely to bring that dream closer.
Junise Vazhayil, (Associate professor)
Mary.R.Mathew –(IInd year Pharm.D)Al
shifa College of Pharmacy
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