COMMUNITY PHARMACY
Syllabus:
Organization and structure of
retail and wholesale drug store – types of drug stores and design, legal
requirements for establishment, maintenance of drug store. Dispensing of
proprietary products, maintenance of records of retail and wholesale, patient
counseling, role of pharmacists in community health care and education.
SOME INROMATION
Patent or Proprietary Medicines
All remedies or prescriptions presented in a form ready
for internal administration or external use of human being or animals and which
is not include in the edition of Indian Pharmacopoeia or any other
pharmacopoeia authorized under the Drugs and Cosmetics Act 1940 and by Central
Government.
License
It is the document of permission
accorded under the rule to manufacture, sale or stock specified drugs. The
licensing authorities are appointed by the State Governments.
Schedule C & C1
It is a list of drugs given under
The Drugs Rules: that contains
C : Biological products
C1:
Other special products
Schedule X
It is the list of drugs whose
import, manufacture sale, labeling and packaging are governed by special
provisions.
SALES OF DRUGS
Sale includes the process
of passage of articles from the manufacturers to the consumers.
The entire process of sale of
materials from manufacturers to consumers can be illustrated as follows:
The different types of licenses
issuable for wholesale and retails are given below:
WHOLE SALE
 |
From fixed premises From
Motor Vehicles
 |
|||
 |
|||
License for
drugs License for Schedule License for License for
Other than
schedule Schedule X drugs drugs other than C & C1
C & C1
drugs C & C1 drugs (20G) C & C1 (21BB)
(20B) (21B)
(20BB)
RETAIL |
From
Shops Vendors
Only
specified drug
in
specified areas
Drug Stores Chemists
& Druggists Pharmacy
Pharmacists
Dispensing
chemist
Pharmaceutical
chemist
 |
Separate license Separate license Separate license
For drugs other for C & C1 drugs for Schedule X drugs
than C & C1 (21) (20F)
(20)
WHOLESALE OF DRUGS
General conditions
for wholesale
1.
Premise is of an area not less than 10 sq. metres, and
2.
In the charge of a competent person
Definition of
a competent person: (a) A registered pharmacist under the
Drugs and Cosmetics Act 1948
(b) A person who has
passed matriculation or its equivalent with 4 years experience or more in
dispensing as well as considered adequate by the licensing authority before
31.12.1969.
3.
The license should be displayed in a prominent place
open to the public.
4.
Drugs should be purchased only from a duly licensed
dealer or manufacturer.
5.
Sale can be made to a person holding requisite license
to sell or distribute the drugs. However, this shall not apply to the sale of
any drugs to:
(a)
an officer or authority purchasing on behalf of
Government, or
(b)
a hospital, medical, educational or research institution or a RMP (Registered
Medical Practitioner) for the purpose of supply to his patients; or
(c)
a manufacturer of beverages, confectionery and other non-medical
products, where such drugs are required for processing their products.
A. Conditions for
wholesale from fixed premises
(a) License for wholesale of drugs other than
Schedule C & C1 and X.
Form: 20B
Conditions: 1 to 5 of general conditions
(b) License for wholesale of Schedule X drugs:
Form: 20G
Conditions:
1 to 5 of general conditions
6. The licensee should forward to the licensing
authority copies of the invoices of sale made to the retail dealers.
7. Records should be maintained as
per schedule X drugs.
(c) License
for wholesale of schedule C & C1 drugs only
Form: 21B
Conditions
1
to 5 of general conditions
6.
The licensee should observe precautions prescribed for stocking or sale of
drugs.
7.
Records should be maintained as per schedule C & C1 drugs.
B. Conditions whole sale from motor vehicle
(a) Drugs
other than Schedule C & C1.
Form: 20BB
Conditions:
1
to 5 of general conditions
6. The licensee should inform the licensing
authority in writing in the event of change fo ownership of the vehicle
specified in the license within 7 days of such change.
(b)
Schedule C & C1 drugs
Form: 21BB
Conditions:
1
to 5 of general conditions.
6.
The licensee should observe precautions prescribed for stocking or sale of
drugs.
7.
Records should be maintained as per schedule C & C1 drugs.
8. The licensee should
inform the licensing authority in writing in the event of change for ownership
of the vehicle specified in the license within 7 days of such change.
Maintenance of Records
A. For schedule C
& C1 drugs
(i)
Date of purchases and sales.
(ii)
Name and address of the firms from whom drug was
purchaseed and to whom sold.
(iii)
Names and quantities of the drugs and their batch
number.
(iv)
Names of the manufacturer of the drug.
B. For schedule X drugs
(i)
Date of transactions.
(ii)
Quantities received, name and address of the supplier
and the number of the relevant license held by the supplier.
(iii)
Name of the drug, quantity supplied, batch number.
(iv)
Manufacturer’s name.
(v)
Name and address of the patient / purchasers.
(vi)
Reference number of the prescription against which
supplies were made.
(vii)
Bill numbers and dates of purchase and supply.
(viii)
Signature of the person under whose supervision the
drugs have been supplied.
RETAIL SALE OF DRUGS
For retail sale two types of licenses are issued:
(1) General and (2) Restricted
The shops for retail sale have to be specified as below:
1. Chemist
and Druggists establishments
which function under the supervision of a ‘Registered Pharmacist’ but wherein
drugs are not compounded.
2. Pharmacies
are establishments that function under the supervision of a ‘Registered
Pharmacist’ and which engage in compounding of drugs also.
3. Drug
Stores do not have a registered pharmacist and which can sell only
drugs specified as household remedies.
Chemists & Druggists and Pharmacies are required to
obtain separate licenses for sale of:
(a) Schedule
C and C1 drugs
(b) Schedule
X drugs
(c) Drugs
other than specified in Schedule C & C1 and Schedule X.
General licenses
General license are granted to persons who have premises for
the business and who engage the services of a ‘Qualified Person’ to supervise
the sale of drugs and do the compounding and dispensing.
Type of establishments:
(i) “Chemists and Druggists” and (ii) “Pharmacies”.
Conditions for grant of General License
(a)
Every licensee must have adequate premises with
adequate facilities for proper storage of drugs.
(b)
A competent person should supervise and control the
sale and distribution of drugs as well as head the premises.
(c)
If the qualified staff is changed, the licensee must
report it within a month from the date of change.
(d)
As per schedule N (list of minimum equipment to be
possessed by a pharmacy) requirements of equipment for a pharmacy should be
fulfilled.
(e)
If a person is licensed to sell Schedule C & C1
drugs wishes to sell any additional categories of drugs which are not listed in
his license, he must obtain the permission of the licensing authority to do.
(f)
All registers and records required to be maintained
should be preserved for period of at least 2 years from the date of last entry
made under the Act.
(g)
The licensee must allow an authorized Inspector to
inspect the premises, the registers and records.
(h) No
Schedule C and C1 drugs should be sold or exhibited for sale until due
precautions have been taken for their storage at the premises of the licensee.
The important procedures required to be followed for
various operations in the above kinds of establishments are given below:
A. Dispensing and
compounding of drugs:
All drugs those are compounded at
the premises against the prescription of Registered Medical Practitioner should
be compounded either by a Registered Pharmacist himself or under his direct and
personal supervision.
All supplies of drugs should be recorded in the Prescription
Register according to the following format:
Prescription register
(a) Serial
no. of the entry
(b) Date
of supply
(c) Name
and address of the prescriber
(d) Name
of the patient or name and address of the owner of animal , if drug is for
veterinary use
(e) Name
of drugs and their quantities
(f) In
the case of Schedule C and H and X drugs, the name of the manufacturer, batch
number and the date of expiry, if any
(g) Signature
of the Registered Pharmacist by or under whose supervision the medicine was
made up and supplied.
·
Drugs supplied against prescriptions under the
Employees’ State Insurance Scheme if all the particulars are given on the
prescription, and
·
Any drug other than those specified in Schedule
C and H if it is supplied in unopened original container.
·
The supply of any drug should be made against
cash/credit memo which shall contain:
(a) Name,
address and sale license number of dealer
(b) Serial
number of the cash/credit memo
(c) The
name and quantity of the drug supplied
Purchase register
Records of
purchase of a drug intended for sale in retail shall be maintained by the licensee
and shall show the following details:
(a) Date
of purchase
(b) The
name and address of the person from whom purchased and the license number of
that person
(c) The
name of the drugs, the quantity and the batch number
(d) The
name of manufacturer of the drug
(e) Purchase
bills including cash or credit memos shall be serially numbered by licensee
Supply of Schedule C drugs
A prescription register or cash book or credit memo should
have the following heading:
(a) Serial
No. of Entry
(b) Date
of supply
(c) Name
and address of the purchaser
(d) Name
and quantity of the drug supplied
(e) Name
of drug manufacturer
(f) Batch
no. as indicated on its label.
(g) The
date of expiry as recorded on its label
(h) Signature
of the qualified person under whose supervision the sale was carried out.
None of the schedule C drugs should be sold after the date
of expiry.
Supply of schedule H and X drugs
·
These drugs should be ratailed only on
prescription of a Registered Medical Practitioner.
·
The supply of these drugs to RMP, hospitals,
dispensaries and nursing homes shall be made against duly signed and written
order, which should be preserved by the licensee for a period of 2 years.
·
The prescriptions of these drugs must not be
dispensed more than once unless the prescriber has stated it clearly.
·
The supply of Schedule X drugs should be
recorded at the time of supply in a bound and serially numbered register
maintained for this purpose and separate pages should be allotted for each
drug. The following particulars should be there in the register:
1. Date
of supply, opening and closing stocks of drug on that day and relevant bill
numbers.
2. Name
of the drug, its manufacturer’s name and batch number.
3. Name
and address of the purchaser.
4. Sate
of prescription and name as well as address of the RMP
5. Signature
of person under whose supervision supply is carried out.
6. Signature
of purchaser with his address on the cash or credit memo.
Storage
of Schedule C and X drugs
A drawer or cupboard reserved for the
storage of Schedule X drugs or they should be stored in a part of the premises which is inaccessible to the
customer.
Storage
of veterinary drugs
A separate cupboard or drawer kept in
a part of the premises and solely reserved for storage of drugs meant for
veterinary use should be used. The customer should not have access to this part
of the premises.
Disposal of expired drugs
Expired drugs are to be destroyed at
the premises of the licensee within three months from the expiry date so that
expired drugs are not stocked by the licensee beyond three months from the date
of expiry.
Restricted License
Restricted licenses can be given to:
1. Dealers
or persons who do not engage the services of a qualified person and those drugs
whose sale do not require the supervision of a qualified person.
2. To
a vendor who purchases drugs from a licensed dealer for distribution in
sparsely populated areas where other channels of distribution of drugs are not
available.
Type of establishment:
Drug Stores
Conditions for grant of general licenses
(a) The
licensee can deal only with drugs, which can be sold without supervision of
qualified person.
(b) The
drugs should be bought only from dealers specified in the license if the
licensee have no fixed place of business or premises.
(c) The
drugs should not be sold if not stored under prescribed conditions.
(d) The
drug should be sold in original containers.
(e) The
license should be prominently displayed in the premises.
PATIENT COUNSELING
The
pharmacist’s role in pharmaceutical care involves identifying, resolving and
preventing drug-related problems that may arise from under-treatment,
over-treatment or inappropriate treatment.
Patient
counseling is the activities, which are carried out in the interview session
with the pharmacist and the patient or his/her representative. During this
session the pharmacists should perform the following activities:
(1) Interviews
the patient or his/her representative to obtain information for entry into
patient record, patient profile and family record.
(2) Instruct
and further clarifies the patients’ understanding of medication dosage, dosage
frequency and method of administration.
(3) Advises
patient of potential drug-related or health-related conditions that may develop
from the use of medication for which the patient should seek other medical care
(e.g. iron tonic constipation, black stool).
(4) Consults
with patient to identify symptoms properly in order to advise patient for
self-medication.
(5) Refers
patient to other health-care providers.
(6) Instructs
patients in the use of medical or surgical appliances (e.g. inhalers, colostomy
bags, trusses).
(7) Advises
patients on personal health matters (e.g. smoking, drug abuse).
The communication process
Communication is the sharing of information, ideas
thoughts and feelings between sender and receiver(s) . The goal of
communication is understanding.
The
instruments of communication are:
Spoken
works, facial expression, body posture, and other behavioral responses.
Step-I Sender wishes to send a message that has a certain
meaning. He may choose some words to best convey the intended meaning to the
receiver. The process sending the message is called encoding.
Step-II Once the information is encoded, the sender loses
control opf the message. Now the receiver decodes the message to understand the
meaning; but the receiver decodes the message based on his/her view of reality,
current feelings and perceptions of the sender. Thus the receiver may get a
different meaning than intended by the sender.
In
a successful communication the meaning that was thought by the sender
(meaning-1) and the meaning what is understood by the receiver (meaning-2) will
be equal. Now the sender should get the feedback about what the receiver has
understood.
Step-III Questions should be asked by the sender to the
receiver about what the latter has understood.
This
sequence of encoding and decoding continues as long as the communication goes
on.
Special
skill is required on the part of the pharmacist to effectively gather the
information from the patient and instruct the patient. Pharmacist may apply one
or more of the instruments of communication.
Information Gathering and Giving
Pharmacists incorporates information gathered from
(i)
medication-history interviews
(ii) and
counseling-information-giving sessions.
For instance, the pharmacist may learn through a
medication-history interview that the patient isnot following a prescribed
therapeutic regimen.
Cause: The patient
may lack an understanding of the illness, therapy and medication effects, or
the patient may lack the motivation to carry out the regimen.
Counseling session:
Once the causes are understood, the pharmacist is prepared better to tailor an
information giving session that addresses the patients specific needs. In this
session the pharmcist may provide
(i) instruction, motivation and monitoring.
(ii)
Pharmacist should discuss the effect of prescribed medication and any unwanted
medication regimens, special instruction about how and when to take the
medication and any unwanted effects and potential drug interaction.
Understanding illness experience
A patient may remain in mentally stressed condition due to
the following reasons:
(a) Patient
may face separation from family.
(b) Loss
of important social roles.
(c) Permanent
bodily changes or disabilities.
(d) Feeling
of helplessness and an uncertain future.
(e) Hospitalization
can be a terrifying experience and fear of unknown can be overwhelming,
sophisticated instruments, electronic monitors, i.v. solution, laboratory
tests, diagnostic machinery, unfamiliar surroundings, strange clothing, a dying
patinet in the next room, cries of pain, and a seriously ill room mate.
(f) Fear
of pain before a diagnostic or surgical
procedure.
(g) Fear
of death.
The way in which a patient reacts is determined by:
(a) age
(b) cultural
background
(c) emotional
development
(d) educational
background
(e) religious
beliefs and
(f) previous
illness experiences.
Role of Pharmacists
(a) A
skillful pharmacist is aware of the stress conditions a patient is undergoing
and he/she can cope with the possible reactions better.
(b) A
skillful pharmacist can explain the illness in simple terms to the patient.
(c) By
speaking some thing unrelated to the illness or treatment the stress due to
unfamiliar environment can be relieved.
(d) Simply
explaining the procedure may relieve the patient from the fear of pain e.g.
surgery, injection etc.
(e) In
case of fear of disabilities the pharmacist can show the bright side of it, how
he/she can cope with his/her disability.
(f) Researchers
in the area of death and dying patients have identified five patterns of
behaviors as the patient proceeds towards death.
(i) denial and isolation
(ii) anger
(iii) bargaining
(iv) depression
(v) acceptance
By recognizing
these stages pharmacist can comfort and support a dying patient. In this case
the best comfort may be offered to the patient is just being available to
listen. This encourages a patient to express feelings and provides a great
source of comfort.
(g)
Patients who are hostile or uncooperative require
patience and understanding. Pharmacist should motivate the patient by
explaining how the medication will relieve the symptoms rather than the
generalities on the importance of taking medication.
(h)
In case of depressed and withdrawn patients, short,
frequent conversation sends a information that someone is genuinely interested
in them. This will encourage the patient to talk and discuss the true feelings.
(i)
The most effective communication method with patients
depends on the degree of empathy demonstrated in the course of conversations.
Empathy is the sharing, perception and identification of a patient’s belief and
state of mind without actually sharing those beliefs or having the same
experiences.
Preparing for the interview
The
pharmacist should spend a few moments mentally preparing for the interchange
about to occur. The interviewer should be familiar with the type of questions
to ask and issues to pursue. Pharmacist must prepare himself / herself to deal
with the reactions of illness.
The interviewer should know as much as possible about the
patient before entering the room. A patient’s social and occupational history
will come to immense use while talking.
Opening the interview
1.
Introduction of
the Pharmacist and the patient: Pharmacists begin with verbal of nonverbal
skills. The pharmacist may call the patient by their proper name. Pharmacist
should clearly identify the purpose the
purpose of the interview.
2.
A social history may be taken. This includes daily
routine, family life, hobbies etc.
e.g. “Hello! My name is A. Samanta. I am the pharmacist in this
hospital. I’d like to spend some time talking to you about your medication.
Attending to non-verbal cues
During medication history session, pharmacists will act as
observers, self-critics, questioners, listeners and recorders. When they will
be busy with the above mentioned activities they may often forget about the
non-verbal cues they are sending to the patients.
e.g. Blank stares, inattentiveness, nervous speech patterns and
interruptions are distracting and detrimental to the effective communication.
e.g. When there is a barrier
like a tall counter between the patient and the pharmacist send a non-verbal
cue that the pharmacist is unapproachable.
The broad categories of non-verbal cues that send
information are eye contact, mannerisms and vocal qualities.
Eye contact
The movements of the other person’s eye send more clues than
any other facial movements. Eye contact helps assess the meaning that is behind
the patient’s words and conveys the meaning that “ I’m listening you”.
The interviewer should offer frequent and attentive eye
contact, and not blank stares. Thus, eye contact establishes patient trust and
rapport.
Mannerisms
Gestures,
vocal qualities, body movements clothing and hygiene may send non-verbal clues
about the interviewer to the patient. The interviewer should make the patient
feel comfortable by enhancing physical and psychological privacy.
In a sitting
posture the interviewer should be slightly inclined to the patient. If the
patient is lying down then the interviewer should sit beside him/her. This
posture of leaning towards the patient is a sign of attentiveness to the
patient’s needs.
Some other examples
of non-verbal communications are an inclined head, a head nod and hand gestures
that suggest understanding or the desire for more information.
During
recording medication history excessive writing of notes is disadvantageous. So
the listening power should be enhanced, if possible the note is taken later.
Vocal qualities
Pitch, range, tone, clarity and tempo are vocal qualities.
Pitch refers to the
frequency level of the voice. Speakers tend to vary pitch according to their
expressive habits. Some people speak in monotone (i.e. unvaried pitch); others
use dramatic and exaggerated pitch changes. Both are not accepted well by the
listeners. So the pharmacists should use natural voice with neither a wide nor
a narrow pitch.
Voice clarity: The voice of the interviewer must be
clear, audible. The interviewer should assess the patient’s hearing ability and
should change the speech pattern, if necessary.
Tempo is the speed of vocal production. Inappropriate
silence and delays may irritate patient. Fast tempo and frequent pauses often
are associated with emotions such as fear and anger. Slow tempo may be an
expression of sadness, depression, lack of confidence, etc. A slow tempo with
frequent pauses and utterances like “ uh”, “er” and ”um’’ can indicate uncertainity.
Asking questions apropriately
To be a good interviewer pharmacist must
select the type of question to be
asked,
think over the manner in which
questions will be asked,
avoid the repetition of questions
not use unnecessary use of
technical terms (i.e. jargon) and
select appropriate words to
formulate the questions.
Open and closed questions
The open question is broad and allows the patient
sufficient room to express information. It cannot be answered in one phrase or
with “yes” or “no”. Open questions generally begins with “When”, “Where”,
“How”, “What”, “tell me about”. Open questions starting with “Why” should be
rarely used because they may imply criticism.
e.g. Don’t use “Why did’nt you come in sooner for a refill?”
Use “How
do you know it is time for a refill?
The closed question is narrow and usually limits the
patient to direct and specific answer. Often closed questions begin with “is”,
“does”, “can”, “will”, “are” etc. The answers are often in “Yes” or “No”.
A balance of open and closed questions produces an effective
communication.
e.g.
Interviewer (Open question) “What
problems are you having taking your medication?”
Patient: “My
tablets are hard to swallow.”
Interviewer (Closed question) “You said
that your tablets are difficult ot swallow; are they always
difficult to swallow?”
Interviewer (Closed question) “Have you
missed any dose?”
Interviewer (Closed question) “Do you
have problems swallowing at other times?”
Direct
and indirect question:
Direct questions are to the point and may be open or closed.
Direct questions are to the point and may be open or closed.
Indirect questions may not sound like
a question at all. They disguise request for information This questions are used in edlicate subjects.
e.g.
Open direct: “Tell me about your leg cramps.”
Closed direct: “Are you concerned about
your leg cramps?”
Open indirect: “I’m wondering what you think
about your leg cramps.”
Open direct: “What can you tell me
about the penicillin you’re taking?”
Closed direct: “Did you finish the
penicillin”?”
Closed indirect: “Did you have any
penicillin left?”
Loaded and Leading Questions
Loaded and leading questions are forms of closed questions
that contain their own answers or imply judgement or both.
e.g. “You have never
had gonorrhoea, have you?”
This types of questions cut short the interview length and
especially requires when discussing sensitive subjects. However, this types of
questions are not fruitful for information gathering.
e.g.
Leading question: “Does the medicine
make you drowsy?”
Alternative question: “How does the medicine
make you feel?”
Double or multiple questions
Double or multiple questions present the patient s with two
or more inquiries at the same time.
e.g. “Are you using
medications like Aspirin, vitamin, antacids, cough and cold remedies?”
Multiple questions trap patients in a barrage of question and answers that leave the patient
confused or irritated.
Sot he above question may be asked in an alternative way:
“I am going to read a list of medicines you can buy in
the pharmacy or supermarket without a prescription. Stop me along the way and
tell me if you are taking any of them. If the name puzzles you, stop me, and
I’ll explain them further”
Closing the interview
The conclusion of an interview should
contain
a request for additional
information, which the patient thinks might be helpful,
a request for the patient’s opinion
about the reasons for the problem,
a summary of the data along with
the opportunity for the patient to make corrections if necessary,
an offer to answer any questions
now or in future,
a statement of when and where help
is available and leave-taking.
Information completeness and compliance issues
After an interview it is successful only when the
interviewer gather the following information:
What
medication(s) is (are) being taken?
What
is the medication being used for?
Is
the medication actually being taken?
How
is the medication taken?
How
often is the medication taken?
When
and with what is the medication taken?
How
regularly is the medication taken?
For
how long is the medication to be taken?
Is the medication working?
Is the medication working?
Are
there any bothersome effects from the medication?
Does
it ever happen that you forget to take the medication?
What
happens if you don’t take the medication?
The interviewers are expected to gather information about
medications taken previously, allergies, and problems with adverse effects and
possible recreational drug use.
ROLE OF PHARMACISTS IN COMMUNITY HEALTHCARE AND EDUCATION
Community Pharmacy
Community Pharmacies are retail drug stores where a
pharmacist is appointed. In addition to dispensing pharmaceuticals the
pharmacists in community pharmacies answer questions about prescriptions,
over-the-counter drug (OTC) drugs and provides health education to the
patients.
Role of pharmacists
in community pharmacy
Presently pharmaceutical care become technology-oriented
and at the same time become complex. So it is very difficult for a single
health care professional to cater to all the needs of a patient effectively.
Previously pharmaceutical care was drug-oriented, but now it is becoming more
patient-oriented. Community pharmacists are remaining in close contact with the
patients in a community. Pharamcists’ role in a community pharmacy may be as
follows:
Dispensing
prescriptions
Whenever a prescription arrives at
a pharmacist, he/she proceeds along a strategy called as the “ABCs” of
pharmaceutical care:
A: Assessment B: Bottling C: Counseling s
: Surveillance
Assessment:
The pharmacist meets the patient
prior to the preparation of the prescription to ascertain the appropriateness
of the prescribed therapy, allergies, current therapies, patient preference for
dosage forms (e.g. long acting, short acting) and patient
attitudes/reservations regarding the treatment.
Bottling
In this step medications are
prepared and packed, either by the pharmacist or by some trained hands but
under the supervision of the pharmacist for accuracy.
Counseling
The pharmacist again meets the
patient for traditional patient counseling. In this session the topics covered
are “how”, “when” and “why” – like how to use the medication, when to take it,
what diluent to use (water or milk), precautionary side effects, storage etc.
Surveillance
The at-risk
patients should be monitored for 24 to 48 hours over the telephone, if
possible, or by personal visit. Whenever the patient will come for the first
refill mandatory counseling is required to identify any adverse reaction,
non-complaint patient inquiries, chronic disease monitoring (e.g. blood sugar,
blood pressure etc.). To ensure continuity of treatment all this information
should be forwarded to the patient’s physician.
Pharmacoepidemiology
This
branch of epidemiology is concerned with the safety or risk assessment of a new
drug, which is newly marketed. It generates information about pharmaceutical outcomes
and monitors associated risks and adverse drug reactions. Community pharmacist
has the first hand exposure to this adverse reactions of patients and the
necessary knowledge to transmit the information to the drug authority in the
specified format.
Communicable disease
After the invention of
antibiotics some of the serious communicable diseases have been practically
eradicated, some like malaria, tuberculosis, plague, syphilis, gonorrhoea, AIDS
etc. are still common in different parts of our country. The pharmacists can
educate the community about how these dreaded diseases spread, what types of
precaution they should take, just after the infection what should they do etc.
The pharmacists can reduce the fear in the community by imparting information
regarding those diseases and how to tackle them.
Chronic disease control
In chronic diseases like
cardiovascular diseases (hypertension), diabetes, high cholesterol etc. the
pharmacists can recommend some change of habit of the patients to reduce the
effect of these diseases.
Moderate exercise can prevent
cardiovascular diseases, diet control along with exercise controls blood sugar
are few recommendations. Reduced smoking, taking low fat containing foods may
be other recommendations.
Health Education
In community pharmacy pamphlets,
leaflets, bulletins, booklets may be made freely available to the patients.
These literature may cover every important major disease, drug classes, drugs
of abuse, drug and food interactions, sexually transmitted diseases, immunizations,
family planning, fluoridation of water, poison treatment, disaster
preparedness, environmental protection and work place safety.
Maternal and Child healthcare
The basic idea behind the
maternal and child health care is adequate care of the mother and her child
though the time they are at highest risk of disease and death i.e. during the
pregnancy and the first year of life. The early diagnosis of the pregnancy with
the informed supervision of its progress through the delivery and immediate postpartum
period constitutes the maternal and childcare. Thus the pharmacist can guide
the mother about the hygiene, management of her pregnancy, and her infant. This
is more beneficial for the women those who lacks education.
After birth the pharmacists must
encourage breast-feeding by explaining the mother about its advantages.
The pharmacist must encourage and
guide the mother for planned immunization schedules against polio, diphtheria,
tetanus, pertussis, mumps and typhoid etc.
Nutrition
The pharmacist can help to correct improper food habits in
children, advise about special iron and calcium supplemented food in pregnant
mothers, suggesting special diets in diabetes patients, and advise people with
food allergies.
Environmental health
The pharmacist should alert their
patients about the environmental conditions prevailing in their community. This
is true of air and water, noise pollution that require concerted community
action.
The pharmacists should be aware
of the local occupations and their hazards and alert to their first symptoms of
any disease. For example workers exposed to dust are prone to respiratory
disease (asbestosis). The pharmacists should educate them how to get-rid-of the
problem (e.g. using masks and periodical medical check up).
Alcoholism and drug abuse
The diseases of alcoholism and drug abuse also come under
the purview of pharmacist. They can help in rehabilitation programs. They can
monitor a society whether any of his/her patients is becoming drug addicted or
not by seeing the changes within the patient.
Finally community pharmacist is the most nearest informed
person in a community about health related matters to whom the patient can get
answer to his/her queries regarding health realted matters.
Concept of HEALTH
Definition of Health by World Health Organization:
“
Health is a state of complete physical, mental and social well being and not
merely an absence of disease or infirmity.”
This statement has been further amplified to include the
ability to lead a “Socially and economically productive life.”
Dimensions of Health
Health
has several dimensions e.g. physical, mental, social, spiritual, emotional and
vocational etc.
Physical
Health
It means the perfect functioning
of the body. Biologically, health is a state in which every cell and every
organ of the body is functioning properly and perfectly at optimum level.
Signs of physical health:
Good complexion, clean skin, bright eyes, lustrous hairs,
not too fat, clean breath, good appetite, sound sleep, regular activity of bowel
and bladder, smooth and easy coordinated movements. All the organs including
the organs of special senses are normal in size and functioning. The pulse
rate, blood pressure and body weight etc. are all in normal limits.
Mental Health
It has been defined
as “a state of balance between the individual and the surrounding world”.
Psychological factors can induce many types of illness e.g. hypertension,
coronary artery disease, peptic ulcer etc. Similarly mental illness like
depression and schizophrenia can be produced due to decreased or increased
activity of the neurotransmitters.
The
characteristics of mentally healthy persons are:
(a)
Self-contentment:
He/She is free from internal conflicts and is not at war with himself.
(b)
Adjustment:
He/She gets well along with others. He accepts criticism and is not easily
upset.
(c)
Self-control:
He/She has got good self-control. His/Her behaviour is rational and there is
absence of emotional outbursts e.g. anger, fear, worries etc.
(d)
Self-respect:
He/She has a strong sense of self-esteem and he/she searches for his identity.
Social Health
It means harmony
and integration within the individual and with other members of the society.
The
characteristics of social health include possession of social skills, proper
social functioning and ability to see oneself as a member of society.
Spiritual
Health
It refers to the
spirit (or soul) of individual. The modern medicine approaches human health
care mechanistically, but ignores the feelings and ambitions of the patient.
But research have shown that spiritual link between mind and body is important
in human cure. Spiritual health cannot be explained fully. It is intangible
something that links physiology and psychology. [e.g. placebo, faith on the
healer etc.]
Determinants of Health
 |
The factors those affect the various aspects of health are considered as determinants of health. The factors may lie in the individual or in the environment.
Heredity (or
Genetic)
The physical and
mental features of every human being are ascertained by his/her genes at he
time of conception. The genetic make-up cannot be changed after the conception.
A number of
diseases are known to be of genetic origin:
e.g. mental
retardation, haemophilia, errors of metabolism (e.g. Phenylketourea, colour
blindness, night-blindness, muscular dystrophy etc.)
Genetic disorders
can lead to unusual adverse drug reactions e.g. solanine poisoning on
consumption of green potatoes, haemolysis by primaquine in persons deficient of
glucose-6-phosphate dehydrogenase.
Life styles
Life styles means
“the way people lives”. It includes cultural and behavioral patterns and
life-long personal habits e.g. smoking, alcoholism. Life styles are learnt from
parents, friends, school and mass media.
Some life style
factors may improve health e.g. adequate nutrition, enough sleep, sufficient
physical activity, etc. Many current day health problems e.g. coronary heart
disease, obesity, lung cancer, drug addiction are associated with life style
changes.
Socio-economic
conditions
(a)Economic conditions:
The economic
status ascertains the purchasing power, standard of living, quality of life and
the pattern of disease in the community.
Least
developed country
|
Developing
country
|
Developed
country
|
|
1. Life
expectancy at birth (yrs)
2. Mortality
in age group 1–4 years (per 1000)
3. GNP
per capita (US$)
4. Per
capita public expenditure on health (US$)
|
45
30
170
1.7
|
60
20
520
4
|
72
1
6230
320
|
(b) Education:
Education (especially female
education) has an influence on health status. e.g. The low infant mortality rate
in Kerala is due to its highest female literacy.
(c) Employment
Proper employment generates income
and raises economic status. Unemployment usually shows a higher incidence of
ill health and death. In many, loss of work may cause psychological and social
disturbances.
(d) Political
Political decisions concerning
resource allocation, choice of technology, manpower policy, and availability of
health services to different segments of society can certainly affect the
health status of the society. The percentage of GNP spent on Health is a
quantitative indicator of political commitment. WHO has set the target of at
least 5% expenditure of country’s GNP on health care. (In case of India it is
3% of GNP).
(e) Environment
Disease is related to changes in
environment e.g. climate, water, air, etc. Environment is classified as
internal and external. Internal environment pertains to each tissue, organ and
system of body and their harmonious functioning within the system.
External environment is divided
into physical (e.g. air, water, soil, climate etc.), biological (e.g.
microorganisms, rodents, insects etc.) and psychological components (e.g.
culture, religion etc.). all of them can affect the health of man and his
susceptibility to illness.
(f) Health services
The purpose of health service is
to improve the health status of population.
Primary health services like
immunization of children, provision of safe water, care of mother and child,
supply of essential drugs, can prevent a variety of diseases.
(g) Other factors
Other factors which influence
health of population include:
(i) Health related systems of food
and agriculture, industry, social welfare and rural development..
(ii) Adoption of
policies that would assist in raising standards of living provision for i.e.
more employment opportunities, increased wages, prepaid medical programs, and
family support system.
Indicators of health
Health indicators are required to measure the health status
of a community and also to compare the health status of one country to other.
Assessing the health status of a community helps to
(a) Identify
the health care needs of society.
(b) Utility,
need and success of availability of health services.
(c) Framing
and implementing better health policies to improve health status.
The important health indicators are as follows:
1. Mortality
indicator
(a) Crude Death Rate:
(b) Expectation of Life:
(c) Infant Mortality Rate:
(d) Child Mortality Rate:
(e) Maternal Mortality Rate:
(f) Disease specific mortality rate
2. Morbidity indicators
(i) Incidence and
prevalence of diseases in %
(ii) Notification
rate
(iii) Attendance
rates at health centres.
(iv) Duration of
stay in hospitals
(v) Absence from
work or school
3. Disability rates
(i) Number of days
of restricted activities
(ii) Bed disability
days
(iii) Work loss days
4. Nutritional status indicators
(i) Measurements of
weight and height, mid arm circumference of preschool children.
(ii) Heights of
children at school entry.
(iii) Prevalence of
low birth weight (less than 2.5 kg).
5. Healthcare services indicators
(i) Doctor :
Population ratio
(ii) Doctor : Murse
ratio
(iii) Population :
Hospital Bed ratio
(iv) Population
covered by a health center.
(v) Population of
infants who are fully imunized againsts diseases.
(vi) Proportion of
women who receive antenatal care.
(vii) Percentage of
population using various methods of family planning etc.
6. Indicators for social and mental health: Incidence
of suicides, homicides, drug abuse, smoking, obesity
7. Environment indicators: Pollution of air, water, noise, toxic
substances in food, sanitation facilities etc.
8. Socioeconomic indicators
(i) Per capita GNP
(ii) Dependency
ratio
(iii) Family size
(iv) Housing, the
number of persons per room.
(v) Rate of
population increase.
9.
Health policy indicator: Fund allocation for health care, sanitation, supply of
drinking water, housing,
Health education
Health education
is a process that informs, motivates and helps people to adopt and maintain
healthy practices and life styles, advocates environmental changes as needed to
facilitate this goal and conducts professional training and research to the
same end.
The three main objectives of Health
Education are:
(i) Informing the
people.
(ii) Motivating the
people
(iii) Guidance of
the people