Research in Social and Administrative Pharmacy j (2015) j–j
Letter to the Editor
Potential for community pharmacies to promote rational drug use in Pakistan Iftikhar Ali, M.Phil., Tahir Mehmood Khan, Ph.D.* Monash University, Malaysia
Community pharmacies have different functions, the goal being to serve society’s need for both medicinal products and pharmaceutical services. Community pharmacies are considered as the most accessible and economical source of health care delivery.1 Keeping in view the importance of community pharmacies and their outreach to patients, many developing countries have optimized this area of health care services in a way to ensure the safe and effective use of drugs.2 However, community pharmacy is a blend of professional services within the context of a business enterprise.3 The way drugs are procured, stored and dispensed and the services provided by the community pharmacists dictate the quality and standard of their use, thus leading to the possibility of irrational use of medication.4 In Pakistan, the community pharmacy sector seemingly has been given short shrift by legislators and by health care authorities responsible for implementation of services. Community pharmacy in Pakistan is an outlet focused solely on the business aspects of selling medicine. Allopathic and homeopathic medicines are sold side by side, regardless of the type of license the pharmacy holds. To that end, there is mostly always a conflict of interest in promoting rational drug use. The prevalent conflict of interest has led to many drug use problems, namely selfmedication, inappropriate antibiotic prescription, and steroid use. Another important complication of inadequate community pharmacy laws is inappropriate prescribing of medication by unauthorized or untrained personnel.5 These untrained
dispensers or pharmacy assistants’ prescriptions are favored by patients due to the ease of acquiring a “cure,” so to speak. Patients, possibly due to their lack of education and counseling, prefer a “quick-fix” rather than waiting to be seen by a physician and paying the extra expenses.4 Global research experience reveals evidence of the possibility of improving community pharmacy practice through a combination of interventions to promote safe and effective drug use.6 In Pakistan, there is a dire need to address the current use of community pharmacies as a first-line treatment source for most of the population. The stepping stone to change this current practice is to involve the community pharmacist in promoting rational drug use. A certain set of approaches needs to be implemented to achieve better pharmaceutical care services while not adding cost strains on the health care system. According to recent statistics, there are 8102 pharmacists who are categorized as ‘A’ category; 31,000 pharmacy technicians categorized in ‘B’ and ‘C’ categories in the country.5–8 There are over 63,000 private pharmacies in operation. In theory, if all the pharmacists and technicians are employed by private pharmacies, there still remains vacant positions and roles. According to the Pharmacy Council of Pakistan (PCP), 70% of pharmacists are employed in the pharmaceutical industry, while only 10% work at community pharmacies. When compared to other health care professionals, the role of pharmacists is blurred.9 Pharmacy, although in its infancy, still lacks a proper prerogative and niche in Pakistan society.7
* Corresponding author. School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway 45700, Selangor, Malaysia. E-mail address:
[email protected] (T.M. Khan). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.09.003
Letter to the Editor / Research in Social and Administrative Pharmacy j (2015) 1–2
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Community pharmacies due to their easy accessibility and close proximity to the masses present as a gateway to the health care system that offers professional pharmaceutical patientcentered services. The community pharmacist occupies an ideal role of being a buffer between the patient and prescriber. There is an imminent need to utilize this particular segment. Adopting appropriate and necessary interventions from other developing countries will improve the health care system and avoid complications. The opportunity exists to make these possibilities a reality; however, optimization of roles through legislative, market, and other influences is paramount.
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Acknowledgments None. Conflict of interests: None. References 1. A literature review: pharmaceutical care as an evolving role at community pharmacies in Pakistan. 2. Adepu R, Nagavi BG. General practitioners’ perceptions about the extended roles of the community
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pharmacists in the state of Karnataka. Indian J Pharm Sci 2006;68:36–40. Qadwai W, Krishanani MK, Hashmi S, Afridi M, Ali RA. Private drug seller’s education in improving prescribing practices. J Coll Physicians Surg Pak 2006;16:743–746. (Online)Role of Dispensers in Promoting Rational Drug Use. World Health Organization; 2000. (Cited 2009 July 8). Available from URL: http://dcc2. bumc.bu.edu/prdu/Acrobat_Files/TG_Acrobat_Files/ 12_disptg.pdf. Rabbani F, Cheema FH, Talati N, et al. Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi. J Pak Med Assoc 2001; 51:149–154. Westerlund T, Bjork HT. Pharmaceutical care in community pharmacies: practice and research in Sweden. Ann Pharmacother 2006;40:1162–1169. Babar Z. Medicalizing Pakistan (Online). CHOWK; 2007. (Cited 2009 November 20). Available from URL: http://www.chowk.com/articles/11520. Pharmacy Council Pakistan. Status of the Pharmacist in Pakistan; 2004. Hussain A, Ibrahim M, Baber Z. Using the potentials of community pharmacies to promote rational drug use in Pakistan: an opportunity exists or lost? J Pak Med Assoc 2012;62:1217–1222.
