To Ascertain the Present Scenario of Pharmacy Services In

Kolkata Compared To Developed Countries

ABSTRACT
Pharmacies are not same as an average grocery store or jewellery store, customers are not
buying medications for their luxurious needs. Pharmacies deal with products which are
capable of saving lives and at the same time these possess significant risk. If the people
handling these are not qualified, it may even lead to life and death risk to the patients. The
primary objective of this project is to identify the current scenario of retail pharmacy in
Kolkata and to compare with developed countries. For this project, 4 major zones of Kolkata
were chosen and a survey was conducted on the pharmacies of those areas. At the same time
to complement the primary objective, a survey of the customers visiting the pharmacies was
also conducted .The analysis showed that the services provided by the pharmacies in Kolkata
are not up to the mark. It highlighted the scarcity of pharmacists and the presence of under
qualified person operating the shop. Although it was found that some customers want to
know information related to their medication but few pharmacies are willing to or able to
share the information required, due to their lack of knowledge. The results showed
insufficiency in both the competence level and functioning of pharmacies as compared to the
standard. Remedial measures are required for upliftment of the present status.

INTRODUCTION

Clinical pharmacy is defined as the area of practice in which pharmacists provide

patient care that optimises medication therapy and promotes health, wellness
and disease prevention.(1) The practice of clinical pharmacy embraces the
concepts of both pharmaceutical care, first introduced by Helper and Strand,
(2)and medicines management, which encompasses the entire way in which
medicines are selected, procured, delivered, prescribed, administered and
reviewed to optimise the contribution that medicines make to producing
informed and desired outcomes of patient care.(3)
(1)American College of Clinical Pharmacy. The definition of clinical pharmacy.
Pharmacotherapy 2008; 28: 816817.
(2)Hepler C, Strand L. Opportunities and responsibilities in pharmaceutical care.
Am J Hosp Pharm 1990; 47: 533543.
(3)Audit Commission. A Spoonful of Sugar Medicines Management in NHS
Hospitals. London: Audit Commission, 2001.

Pharmacies are not same as an average grocery store or jewellery store,

customers are not buying medications for their luxurious needs. Pharmacy shops
deal with products which are capable of saving lives, if the person operating

these shops are under qualified as the data shows then how the person buying
the medication can be sure that the medication given to him by the shop is
authentic? Lives can be threatened if a wrong drug is administered. A pharmacist
is required to be present in the shop at all times, so that the customer gets
proper care and advice from him/her about the medication and usage.
Pharmacist are the second line of defence for the patients, if the doctor misses
some details like allergy history or drug-drug interaction then its the
pharmacists duty to correct this issue as they are the only one with this
capability and knowledge to do it. But as we can see from the data that the
present scenario is quite disturbing. The pharmacies do not have pharmacist
present at the premises in most cases.
FIP guidelines for good pharmacist Competencies:
Pharmaceutical Public Health Competencies
Competencies
Health promotion

Medicines information and advice

Behaviours
Assess the primary healthcare needs (taking into
account the cultural and social setting of the
patient)
Advise on health promotion, disease prevention
and control, and healthy lifestyle
Counsel population on the safe and rational use
of medicines and devices (including the
selection, use, contraindications, storage, and
side effects of non-prescription and prescription
medicines)
Identify sources, retrieve, evaluate, organise,
assess and disseminate relevant medicines
information according to the needs of patients
and clients and provide appropriate information

Pharmaceutical Care Competencies

Competencies
Assessment of medicines

Compounding medicines

Behaviours
Appropriately select medicines (e.g. according to
the patient, hospital, government policy, etc.)
Identify, prioritise and act upon medicinemedicine
interactions;
medicine-disease
interactions; medicine-patient interactions;
medicines-food interactions
Prepare
pharmaceutical
medicines
(e.g.
extemporaneous,
cytotoxic
medicines),
determine the requirements for preparation
(Calculations,
appropriate
formulation,
procedures, raw materials, equipment etc.)

Dispensing

Compound under the good manufacturing

practice for pharmaceutical (GMP) medicines
Accurately dispense medicines for prescribed
and/or minor ailments and monitor the dispense
(re-checking the medicines)
Accurately report defective or substandard
medicines to the appropriate authorities
Appropriately validate prescriptions, ensuring
that prescriptions are correctly interpreted and
legal
Dispense devices (e.g. Inhaler or a blood glucose
meter)
Document and act upon dispensing errors
Implement and maintain a dispensing error
reporting system and a near misses reporting
system
Label the medicines (with the required and
appropriate information)
Learn from and act upon previous near misses
and dispensing errors

Medicines

Advise patients on proper storage conditions of

the medicines and ensure that medicines are
stored appropriately (e.g. humidity,
Temperature, expiry date, etc.)
Appropriately select medicines formulation and
concentration for minor ailments (e.g. diarrhoea,
constipation, cough, hay fever, insect bites, etc.)
Ensure appropriate medicines, route, time, dose,
documentation, action, form and response for
individual patients
Package medicines to optimise safety (ensuring
appropriate re-packaging and labelling of the
medicines)

Monitor medicines therapy

Apply guidelines, medicines formulary system,

protocols and treatment pathways
Ensure therapeutic medicines monitoring, impact
and outcomes (including objective and
subjective measures)
Identify, prioritise and resolve medicines
management problems (including errors)

Patient consultation and diagnosis

Apply first aid and act upon arranging follow-up

care
Appropriately refer
Assess and diagnose based on objective and
subjective measures
Discuss and agree with the patients the
appropriate use of medicines, taking into account
patients preferences
Document any intervention (e.g. document
allergies, medicines and food, in patient
medicines history)
Obtain, reconcile, review, maintain and update
relevant patient medication and diseases history

Organisation and Management Competencies

Competencies
Budget and reimbursement

Behaviours
Acknowledge the organisational structure
Effectively set and apply budgets
Ensure appropriate claim for the reimbursement
Ensure financial transparency
Ensure proper reference sources for service
reimbursement

Human Resources management

Identity and manage human resources and

staffing issues
Participate, collaborate, advise in therapeutic
decision-making and use appropriate referral in a
multi-disciplinary team
Recognise and manage the potential of each
member of the staff and utilise systems for
performance management (e.g. carry out staff
appraisals)
Recognise the value of the pharmacy team and
of a multidisciplinary team
Support and facilitate staff training and
continuing professional development

Improvement of service

Identify and implement new services (according

to local needs)
Resolve, follow up and prevent medicines
related problems

Procurement

Access reliable information and ensure the most

cost-effective medicines in the right quantities
with the appropriate quality
Develop and implement contingency plan for
shortages
Efficiently link procurement to formulary, to

push/pull system (supply chain management)

and payment mechanisms
Ensure there is no conflict of interest
Select reliable supplies of high-quality products
(including appropriate selection process, cost
effectiveness, timely delivery)
Supervise procurement activities
Understand the tendering methods and
evaluation of tender bids
Supply chain and management

Demonstrate knowledge in store medicines to

minimise errors and maximise accuracy
Ensure accurate verification of rolling stocks
Ensure effective stock management and running
of service with the dispensary
Ensure logistics of delivery and storage
Implement a system for documentation and
record keeping
Take responsibility for quantification of
forecasting

Work place management

Address and manage day to day management

issues
Demonstrate the ability to take accurate and
timely decisions and make appropriate
judgments
Ensure
the
production
schedules
are
appropriately planned and managed
Ensure the work time is appropriately planned
and managed
Improve and manage the provision of
pharmaceutical services
Recognise and manage pharmacy resources (e.g.
financial, infrastructure)

Professional/Personal Competencies
Competencies
Communication skills

Behaviours
Communicate
clearly,
precisely
and
appropriately while being a mentor or tutor
Communicate effectively with health and social
care staff, support staff, patients, carer, family
relatives and clients/customers, using lay
terms and checking understanding
Demonstrate cultural awareness and sensitivity
Tailor communications to patient needs
Use appropriate communication skills to build,
report and engage with patients, health and
social care staff and voluntary services (e.g.

verbal and non-verbal)

Document CPD activities
Engage with students/interns/residents
Evaluate currency of knowledge and skills
Evaluate learning
Identify if expertise needed outside the scope of
knowledge
Identify learning needs
Recognise own limitations and act upon them
Reflect on performance

Continuing Professional Development (CPD)

Legal and regulatory practice

Apply and understand regulatory affairs and the

key aspects of pharmaceutical registration and
legislation
Apply knowledge in relation to the principals of
business economics and intellectual property
rights including the basics of patent
interpretation
Be aware of and identify the new medicines
coming to the market
Comply with legislation for drugs with the
potential for abuse
Demonstrate knowledge in marketing and sales
Engage with health and medicines policies
Understand the steps needed to bring a medicinal
product to the market including the safety,
quality, efficacy and pharmacoeconomic
assessments of the product

Professional and ethical practice

Demonstrate awareness of local/national codes

of ethics
Ensure confidentiality (with the patient and other
healthcare professionals)
Obtain patient consent (it can be implicit on
occasion)
Recognise own professional limitations
Take responsibility for own action and for
patient care

Quality Assurance
workplace

and

Research

in

the

Apply research findings and understand the

benefit risk (e.g. pre-clinical, clinical trials,
experimental clinical-pharmacological research
and risk management)
Audit quality of service (ensure that they meet
local and national standards and specifications)
Develop and implement Standing Operating
Procedures (SOPs)
Ensure appropriate quality control tests are
performed and managed appropriately
Ensures medicines are not counterfeit and
quality standards

Self-management

Identify and evaluate evidence-base to improve

the use of medicines and services
Implement, conduct and maintain a reporting
system of
pharmacovigilance (e.g. report
Adverse Drug Reactions)
Initiate and implement audit and research
activities
Apply assertiveness skills (inspire confidence)
Demonstrate
leadership
and
practice
management skills, initiative and efficiency
Document risk management (e.g. critical
incidents)
Ensure punctuality
Prioritise work and implement innovative ideas

FIP guidelines for good pharmacy practises:

Reception of the prescription and confirmation of the integrity of the
communication

Assessment of the prescription by the pharmacist

.
.
Assembly of the prescribed items
Advice to ensure that the patient or carer receives and understands sufficient
written and oral information to derive maximum benefit from the treatment
.
Following up the effect of prescribed treatments
.
Documentation of professional activities
Some definitions
Prescription monitoring
The core of pharmacists contribution to appropriate prescribing and medication
use is made whilst undertaking near-patient clinical pharmacy activities.
Checking and monitoring patients prescriptions on hospital wards is the starting
point for this process and on most hospital wards the prescription card and
clinical observation charts (temperature, pulse rate, blood pressure, and so on)
are typically kept at the end of the patients bed. This allows the clinical
pharmacist to interact with the patient whilst reviewing the contents of the
prescription.
Community Pharmacy - The area of pharmacy practice in which medicines and
other related products are sold or provided directly to the public from a retail (or

other commercial) outlet designed primarily for the purpose of providing

medicines. The sale or provision of the medicine may be either on the order or
prescription of a doctor (or other health care worker), or over the counter
(OTC).
Pharmacist - A person with a formal higher qualification such as a three-year
(minimum) university degree or diploma in pharmacy.
Qualified Pharmacy Technician/Dispensary Assistant - A person with formal
dispensing training (at a lower level than a pharmacist) involved in the
dispensing of medicines. (The training, or at least a part of it, would have taken
place at a recognised training institution and a certificate or licence would have
been issued.)
Unqualified Pharmacy Technician/Dispensary Assistant - A person who is
involved in the dispensing of medicine, but who has only received on the job or
in house training.
Community Health Care Worker - A person who is trained to provide simple,
low level health care commensurate with the level of training.
Clinical audit Clinical audit is pivotal in patient care: it brings together
professionals from all sectors of healthcare to consider clinical evidence, promote
education and research, develop and implement clinical guidelines, enhance
information management skills and contribute to better management of
resources all with the aim of improving the quality of care of patients.

Literature review

Current scenario of pharmacies in developed countries

United Kingdoms
The current community pharmacy services practised in United Kingdom are:
Prescription monitoring.
In UK pharmacy practise, prescriptions given to patients are revised for
medication dosing errors, correctness of administration route, drug interactions,
prescription ambiguities, inappropriate prescribing and many other potential
difficulties. Various questions related to medication histories, including allergies
and intolerances, efficacy of prescribed treatment, side-effects and adverse drug
reactions (ADRs) are asked to the patient. The medical and nursing staffs are
regularly present on the ward which allows the pharmacist to communicate
easily with other members of the health care team valuing the prescriptionmonitoring service that clinical pharmacists provide.

Medication errors and adverse drug reaction reporting

In spite of the important role that clinical pharmacy services play, patients
receiving drug therapy may still be at a risk of experiencing unintended harm or
injury due to medication errors or from ADRs. Around 10%of all hospital
admissions are due to adverse effects, and medication errors account for onequarter of all the incidents threatening patient safety. A small proportion of
patients are always at a risk of suffering from ADRs even when the prescribed
and administered treatment is correct and there are no visible errors. Clinical
pharmacists in UK play a major role to detect and manage the ADRs and, also,
directly report ADRs to the Committee on Safety of Medicines via the Yellow Card
scheme. Their involvement can help to increase the number of ADR reports
made, particularly those involving serious reaction.

Medication history-taking and medicines reconciliation

The National Institute for Health and Clinical Excellence (NICE) and the National
Patient Safety sanctions the crucial role of clinical pharmacists in undertaking
medicines reconciliation for patients on admission to hospital. It was recognised
that the increased risk of morbidity, mortality and economic burden to health
services are mainly caused by medication errors and noted that errors occurred
most commonly on transfer between care settings, mainly at the time of
admission, with unintentional variances of up to 70%.With the increasing use of
information technology, summary care records of patients can be accessed from
their general practitioner which offers a timely and accurate method for gaining
essential information. The patients are questioned by the pharmacists on their
concordance with prescribed treatment and the prescribed medicines are selfchecked by pharmacists to ensure stability for reuse in hospital and selfmedication. Pharmacists also help to identify whether or not an admission is due
to prescribing errors or ADRs. Pharmacy technicians are increasingly involved in
supporting these roles

Patient education and counselling, including achieving concordance

An agreement is reached after negotiation between a patient and healthcare
professional that respects the beliefs and wishes of the patient in determining
whether, when and how medicines are taken. This change in approach optimises
the benefits of treatment by helping patients and pharmacists collaborate in a
therapeutic partnership. Helping patients to understand their medicines and how
to take them is a major feature of clinical pharmacy. Healthcare professionals are
concerned about Patient adherence to medical regimen of treatment
recommended by the doctors. Adherence to treatment, particularly for long-term
chronic conditions, can be poor and tends to worsen as the number of medicines

and complexity of treatment regimens increase .Concordance is a new approach

to the prescribing and taking of medicines.

Integrated medicines management

Integrated medicines management is a structure of practise in UKs pharmacies
which helps to bring together several fundamentals of clinical pharmacy services
which have been proven to be effective in dealing with medicines management
problems, delivering additional input at key phases of a patients stay:
admission, inpatient monitoring and counselling and discharge.

Professional and clinical audit

Clinical pharmacists in UK can be involved in many different types of audit. These
may range from topics including audit of clinical services themselves (for
example, clinical pharmacy interventions) or may examine which treatments are
used and how they are applied within the framework of drug use evaluations.

Australia

The community Pharmacy system of Australia is among the best system of

community pharmacy in the world. It delivers medicines to the public in a
convenient, affordable and equitable manner.
The Australian Federal Government provides verified efficacious prescription
medications at subsidised rate through a network of over 5000, pharmacistowned community pharmacies through the Pharmaceutical Benefits Scheme
(PBS). The Community Pharmacists competently dispense these subsidised
medications to improve and save the lives of the Australian people. In the
absence of these committed community pharmacists who manage the medicine
supply and the PBS the cost of medicines would increase and it would
compromise the health of the people in the community.
In combination with Australias unique medicine scheduling system and the
efficient range of professional health services, the PBS forms the mainstay of
community pharmacy in this country.

The community pharmacists and their services are always available in most of
the cases; these services are offered to the people devoid of any monetary
charge and without the need to make an appointment. Irrespective of where they
live, all Australians have the same access to PBS medicines (within 24 hours) at
no financial disadvantage.
Pharmacists are responsible for all the advice and service provided in their
pharmacies. The pharmacist should always be present in his/her pharmacy and
abide by the rules of the Pharmacy Board to have their continuing registration
and approval to dispense medication under the PBS. If a pharmacist is found to
be neglecting and not following the rules then he/she might lose their
registration. A pharmacist who loses registration cannot continue to operate a
pharmacy or even work in one. This is together, a strong public protection and
prevention against any lessening of professional standards.
Pharmacists cultivate good associations with their patients, at times over
generations, as many people avail the benefits of being the client of a single
pharmacy. The stronger the pharmacist-patient relationship, the better the health
outcomes that can be expected.

USA
Current pharmacy practice in USA is substantially more varied in terms of scope
of practice and practice setting.
Traditional roles of the pharmacist to solely dispense medication product have
been greatly expanded. Nowadays in USA the community pharmacists assess
and counsel patients, provide health maintenance information, reduce drug
misadventures through clinical interventions , evaluate patients who access the
health system through community pharmacies, and perform point of care
testing ,administer immunizations (as one of many public health functions),
respond to disaster needs, assume regulatory roles in drug delivery to assure
safety.
Some pharmacists in advanced practice settings are involved with provision of
more extended direct patient care through comprehensive disease management,
CDTM, medication management, health promotion/disease prevention, care
coordination and followup patient care. Many of these services are similar in
scope and complexity to other primary care services delivered in health care
system of USA.
Pharmacist Roles
Currently, pharmacists deliver patient care services in a variety of practice
settings through CPA to manage disease whereby they:
Perform patient assessment (subjective and objective data including
Physical assessment);
Have prescriptive authority (initiate, adjust, or discontinue treatment) to
manage disease through medication use and deliver collaborative drug
Therapy or medication management;

Order, interpret, and monitor laboratory tests;

Formulate clinical assessments and develop therapeutic plans;
Provide care coordination and other health services for wellness and prevention
of disease;

Current scenario of pharmacy in India

India faces massive challenges in providing health care for its vast and growing
population. Despite many barriers, community pharmacy services are central to
the safe and effective medicines management in advancing health.
After the enforcement of provisions of the Pharmacy Act 1948, pharmacists
working in India must have a pharmacist registration certificate issued by the
state in which they wish to practice. To obtain a registration certificate, the
prospective pharmacist must acquire the minimum diploma (D. Pharm.) from a
pharmacy institute that is recognized by the Pharmacy Council of India4
(PCI).The community pharmacists who actually manage pharmacies today are
mostly D. Pharm. holders (diploma pharmacists).Once qualified, most of these
pharmacists receive little additional training and there is no exposure to up-todate information. Many of these people, who did not succeed in placement in
government hospitals, are currently working as community pharmacists in the
private community pharmacies.
On paper, every community pharmacy must have a diploma pharmacist or B.
Pharm pharmacist onsite. In practice, few pharmacists are onsite in community
pharmacies and the dispensing is undertaken by the owner of pharmacy, a
relative in case of the pharmacy being owned by a pharmacist, or other
supporting person (assistant or attendant) with knowledge of selling medicines.
A majority of pharmacy owners, who are not pharmacists, hire pharmacists on a
token basis and as a result, pharmacists are never available to dispense
medications

One study reported that pharmacists lack proper training to undertake patient
counselling.
The public perception of community pharmacy and the pharmacist is very weak.
The general population considers community pharmacists as drug traders and
obviously not better than the general store owners. Consumers and patients
consider a visit to the medical store to purchase drugs in much same way they
consider a visit to a grocery to buy food items. The educated people consider
the retail pharmacist as a person who has acquired a drug licence to supply the
medicines or a grocer who deals in medicines. They think anyone in our country
can open a stationary shop and a medical store (i.e. pharmacy) also. The
pharmacists are portrayed as poor compounders, who are assistants to doctors
in mainstream films and dramas.
Since the 1980s there has been phenomenal growth of private institutions
offering D. Pharm. course s. However, most of these self- financing institutions
that provide education in pharmacy are away from practice environment
resulting in diploma pharmacists lacking the skills needed for the community
practice setting.

More than a decade has passed since education in clinical pharmacy practice
was introduced in India. Yet, there has been negligible or no improvement in the
practice of the pharmacy profession in Indian hospitals. Despite the introduction
of this field of education, the presence of the clinical pharmacist is minimal to
non-existent in the health-care system. This has led to several drug-related
problems, including the deaths of patients.

Standards for good pharmacy practise

We have gone through the FIP guidelines and selected the ones which are most
relevant to our project

Standards are an important part in the measurement of quality of service to the

consumer.
Good pharmacy practice requires that the core of the pharmacy activity is the
supply of medication and other health care products of assured quality,
appropriate information and advice for the patient, and monitoring of the effects
of use.
Good pharmacy practice requires that an integral part of the pharmacist's
contribution is the promotion of rational and economic prescribing and of
appropriate use of medicines.
Good Pharmacy Practice requires that the objective of each element of pharmacy
service is relevant to the patient, is clearly defined and is effectively
communicated to all those involved.

Pharmacists should have input into decisions about the use of medicines. A
system should exist that enables pharmacists to report adverse events,
medication errors, defects in product quality or detection of counterfeit products.
This reporting may include information about drug use supplied by patients or
health professionals, either directly or through pharmacists.
The pharmacist should be aware of essential medical and pharmaceutical
information about each patient. Obtaining such information is made easier if the
patient chooses to use only one pharmacy or if the patient's medication profile is
available.
The pharmacist needs independent, comprehensive, objective and current
information about therapeutics and medicines in use.
Pharmacists in each practice setting should accept personal responsibility for
maintaining and assessing their own competence throughout their professional
working lives.

FIP guidelines state that all people should have:

Access to a community health care worker with appropriate

pharmaceutical training
Access to a person trained to a higher level than a community health care
worker
Access to a qualified pharmacy technician with appropriate training
Access to a qualified pharmacy technician working under the direct
supervision of a pharmacist
Direct access to a pharmacist *

* In developing countries it is accepted that at present, and for some time to

come in most cases, due to insufficient numbers of pharmacists, it is not possible
for people in all areas to have direct access to a pharmacist. The level of
pharmaceutical service that can be offered will, therefore, largely be determined
by location.
1. 2. However, the underlying principle that has to be adopted is that all people
should have access to an adequate pharmaceutical service.
1. 3. In many cases it is perceived that the level of responsibility placed on
health workers is disproportionate to the training that they have received. The
working group recommends that all community health care workers are given at
least a basic training appropriate to the level of pharmaceutical service they are
required to render. It is assumed that at the primary health care level, the
medicines will be relatively simple and few in number. The community health
care workers need to be given basic training in how these medicines must be

used to ensure that patients are given medicines which are appropriate for the
condition/problem being treated, along with accurate instructions.

To ensure that the right patient receives the appropriate medicine in the correct
dose and form

The right patient should get the right medicine

Possible interactions should be avoided. The quality and integrity of the
medicine should be maintained throughout the indicated shelf life
Correct and clear instructions should be given to the patient to ensure
correct and safe use of the medicine, for optimal benefit of the patient in
line with the objective of the treatment
The patient should be given, basic information regarding special
instructions for use, warnings if applicable, possible adverse/side effect
and action to take in the event of certain events occurring.

Records
To facilitate patient care and provide an audit trail:

A record of all medicines supplied should be kept detailing name of

patient, name & strength of medicine, dosage, quantity supplied, date of
dispensing
Individual patient medicine records should be maintained in a system,
manual or computerized, which allows for easy retrieval of patient
information

Health information, patient counselling & pharmaceutical care

To promote good health and prevent ill health, all personnel should be trained
and equipped in terms of literature and support material to give advice on
general health matters as well as more specific information and services relating
to medicines supplied by them.

Research methodology
Data Analysis
For pharmacist data, we approached 63 pharmacies in total and at each
pharmacy we asked the representative of the pharmacy to allow us to present
our questionnaire. Only 39 pharmacies allowed us to present our questionnaire
to them. Among other pharmacies some didnt allow us to present our

questionnaire claiming that the pharmacist is unavailable at the time of our

survey, some refused to interact with us and few even acted violently towards
us. (Make pie!)
For patient data, we stood outside the pharmacies and approached the
customers who were coming out of the pharmacies after purchasing the
medication. We asked them to fill out our questionnaire, most of them allowed us
but few of them refused to fill out the questionnaire. Some of the customers had
some personal opinions about the survey and also about the pharmacy services
given in Kolkata.
Key-point of Analysis:
1. Pharmacist not available in maximum pharmacies
2. In max cases the persons were underqualified
3. Max pharmacies did not ask for any medication history from
patients
4. The customers usually ask for information about the medication
they are purchasing, but it is not provided to them by the
pharmacy personnel.
5. Most of the pharmacies do not provide any information
6. No authentic counselling is offered
7. Pharmacies reported that ADR reporting is absent in most cases
8. Most pharmacists do not check appropriateness of prescription

Key point analysis of patients:

1. Most customers buy medicine against prescription
2. Very less medication details is provided by the pharmacy to the
customers
3. Negligible follow up services provided
4. Few pharmacy ask for medication history
5. Qualified pharmacist/competent person was not present in the
premises at the time of survey
6. Maximum time the usage guidelines is given by the Doctor or
shopkeeper of the pharmacy, who is not the pharmacist

During the analysis data received from the pharmacists and from the
patients have been analysed separately
The Pharmacist data analysis

Presence of Pharmacist in the premises

In our survey we approached 39 pharmacies, out of which, in 9 shops the person
who represented the pharmacy to us claimed to be the pharmacist of the shop,
which comes to 23% of the total. The personnel present in the rest 77% of
pharmacies said that they didnt have any pharmacists present at the time of
survey

pharmacist
yes

no

23%

77%

Out of the 9 pharmacies in which the person representing the pharmacy and
claimed to be the pharmacist of that shop, we found only 2 person had D.
pharm qualification, which is the basic qualification needed to obtain a license
in India. 2 other person were found to be associated with retail pharmacy for
over 30 years and therefore they may have licenses issued before the
revision of the Law which makes them Pharmacists too.
The rest of the 5 personnel didnt have the qualification required to be a
pharmacist, they were higher secondary pass and graduates.

VeriFICATION OF PHARMACIST CLAIM

rue pharmacist; 44%

Not Pharmacist; 56%

Qualification of the pharmacy representative

We have found that none of the pharmacies had any B.Pharm or M.Pharm
qualified personnel present in the premises of the pharmacy during our
survey. The number of D.pharm qualified personnel were 2 which comes to
5%.The graduates present were 9(23%) among which most of them were
from non-science background. The rest 28(72%) were below undergraduate
level, the least of which was class 8 standard.
Only 1 post graduate personnel was found who was a MBA

Prescription Frequency

It was found that 15 pharmacies (38%) claimed that the patients always
purchased medications against a prescription.10 pharmacies (26%) claimed that
patients frequently purchased against prescription.13 pharmacies (33%) claimed
that the patients moderately purchased medications against prescription.1
pharmacy (3%) claimed that the patients seldom purchased medications against
prescription.
It was observed during the survey that they do dispense prescription drugs
without prescriptions. Even when they claimed that they refuse to give out
medication without prescription.

prescription freqency
seldom; 3%
moderate; 33%

always; 38%

frequently; 26%

Medication history

It was found that the number of pharmacies asking about medication

history of patients was 3 which comes to 8%.The remaining 36
pharmacies(92%) did ask for any medication history of patients.

medication history
yes; 8%

no; 92%

Do customer ask for information?

In our survey of 39 pharmacies we found that 25 pharmacies(64%)

claimed that customers ask information about the medicines that they
are purchasing which generally involved mostly when to take and
how to take also the reason of usage. The remaining 14 pharmacies
(36%) claimed that patients did not have any queries regarding the
usage of medication they purchased.
However the queries of patients regarding medication were only met
with denial from the personnel claiming that it is not their duty.

whether customer ask for information

no; 36%

yes; 64%

Provide information spontaneously

We found that the personnel present in 33 (85%) pharmacies didnt

provide any information about the medication to the patients on their
own. Only personnel present in 6 (15%) pharmacies provide medication
information on their own.

spontaneously
yes; 15%

no; 85%

Acceptance of advice by the patients

In our survey of 39 pharmacies, 24 pharmacies claimed that the
patients have least acceptance of their advice. Which is 61% of the
total. 7 (18%) pharmacies claimed that patients are neutral towards
their advices. 4 pharmacies (10%) said that the patients have moderate
acceptance of the advices given. 3 (8%) pharmacies said patients have
low acceptance of their advice. Only 1 (3%) pharmacy said that the
patient have high acceptance of their advice.

acceptance level
highest; 3%

moderate; 10%
neutral; 18%

least; 62%

low; 8%

Counselling

We found that 35 pharmacies (90%) did not provide any counseling to

patients regarding the medications they are purchasing. Only 4
pharmacies (10%) provided counseling to the patients, which we
observed was not up to the mark of standard pharmacy practice.

counseling
yes; 10%

no; 90%

Level of ADR reporting

We found that 25 pharmacies claimed that they never received any

reports of ADR. Which is 64% of the total. 5 (13%) pharmacies claimed
that they rarely receive ADR reports. 3 (8%) pharmacies claimed that
they seldom receive ADR reports. 5 (13%) pharmacies said that they
moderately receive reports of ADR. Only 1 (3%) pharmacy said they
receive reports of ADR frequently.

ADR freqency
frequently; 3%
moderately; 13%
seldom; 8%

never; 64%

rare; 13%

Follow up services
In our survey of 39 pharmacies we found that follow up services is
provided by 7 pharmacies, which is 18%. The rest 32 (82%) pharmacies
offer no follow up services.

follow up
yes; 18%

no; 82%

Home delivery
In our survey of 39 pharmacies we found that 12 pharmacies are
offering home delivery services, which is 31%. The home delivery
services are mostly offered by retail chain pharmacies. Rest 27 (69%)
pharmacies do not offer home delivery services.

home delivery

yes; 31%

no; 69%

Awareness campaign

In our survey of 39 pharmacies we found that only 3 pharmacies

conduct awareness campaign, which is 8% of the total. The rest 36
(92%) pharmacies conduct no awareness campaign.

awareness
yes; 8%

no; 92%

Experience of pharmacy representative

In the sample group of the 39 surveyed pharmacies, the persons representing

the pharmacy to us were found to have sample average 15 years of experience.
16 personnel had 1- 1o years of experience
15 personnel had 11 20 years of experience
6 personnel had 21 30 years of experience
2 Personnel had 31 40 years of experience

Experience
16
14
12
10
8
6
4
2
0

1-10 years

11-20 years

21-30 years

31-40 years

Experience

Average customer served

Out of the 30 pharmacies which gave data about their customer load, it was
found that the pharmacies have an average load of 258 patients per shop.
Some pharmacies reported to have more around 1000 customers per day but it
should be noted that pharmacies which claimed to have over 500 patient load
were 24 hour open pharmacy.
Established retail pharmacy chain was found to have more patient load than the
other pharmacies present in the same area.

Parameters of appropriateness of prescription

Only 3 pharmacies dont check for the appropriateness of prescription
Name and date: 21
Expiration date: 8
Batch 3
MRP 3
Mostly the Pharmacy shop representative claims that they check the
prescription, but it is found that they only check names of the doctor, patient and
the medicine. Few pharmacy representative claim to check the batch and MRP
(Maximum Retail Price). Only 1 pharmacy checks the formulation. All pharmacies
neglect to check whether the medicine given to the patient is the correct
medicine for the person is appropriate for the child.

Patient data analysis

Purchased the medicine forOn the basis of our survey conducted we found that 47 patients bought
medicines for personal usage(43%).The rest 63 patients bought
medicines for their family members (mother, father, wife, husband)

Chart Title

Purchased medicine for; 43%

Personal use ; 57%

Medication details received

On the basis of our survey conducted we found that only 2 patients

were informed about the side effects/adverse effects of the drug they
are purchasing(0%).4 patients were informed about the special
precautions to be taken while administration.(3%).12 patients were
informed about the maximum daily dosage that can be administered.
(8%).46 patients were informed about how to administer the
drug(31%).37 patients were informed about when to take the drug
limited to before or after meals.(25%).

The remaining 46 patients were informed nothing about the drug they
are purchasing (even on inquiring)

1%

8%

31%

31%

25%

Get details about

Side effect/ Adverse effect

Drug/ Food interaction

Special Precaution

Maximum daily dose

How to take

When to take

Storage condition

Others

Nothing

Patients bring prescription

On the basis of our survey conducted on 110 people we found that 99
patients purchased medications against a prescription, which comes to
90%.The remaining 11 patients purchased medication without a
prescription. (10%)

Prescription

Yes; 10%

Follow up service offered or not

On the basis of our survey conducted we found that 108 patients
claimed that the pharmacies they purchase from does not give any sort
of follow up services.(98%).The remaining 2 patients claimed that the
pharmacies thy purchase from gives follow up services.(2%)

Follow up
Follow up; 2%

Yes; 98%

Regular patients or not

On the basis of our survey conducted we found that 54 patients were
regular customers of the pharmacies from which they were purchasing.
(49%).The reaming 56 patients were not regular customers of the
pharmacies form which they were purchasing. (51%).

Purchase regularly

Yes; 51%

Purches regularly; 49%

Medication History
On the basis of our survey conducted we found that 109 patients
claimed that they were not inquired about their allergy history or
concurrent medication or disease profile by the personnel present in
the pharmacy.(99%).1 patient claimed to be inquired about his
concurrent medication by the pharmacy personnel

mediction history

Allergy history; 1%

Disease profile; 99%

Identification of Pharmacists (*need

calc)
Presence of Pharmacists
On the basis of our survey conducted we found that only 5 patients
claimed that the pharmacy from which they are purchasing had a
pharmacist. (5%) The remaining 105 patients claimed that there were
no pharmacists present in the pharmacies from which they purchased
their medication

Chart Title
5%
Yes

No
95%

Medication usage advice

In our survey of 110 patients, we have found that 55 patients
reported that they have only received advice about the medication
from the doctor and no advice was given by the shopkeeper. Which is
50% of the total. 46 (42%) patients reported that they have been
advised by the shopkeeper or the shop attendant along with the
doctor who gave them the prescription.
5 patients reported that they had been advised by the pharmacist of
the shop, whom they had identified.
4 patients reported that they were not given any advice by anyone.
In all cases we found that the person purchasing the medicine knew
about the basic how to take and when to take usage guideline,
as it was provided by the prescribing doctor.

Adviced by
Pharmacist only; 5%
No advice; 4%

doctor only; 50%

Shopkeepr + Doctor; 42%

Conclusions
Pharmacist conclusion
During the survey we approached the persons operating the shop to allow us to
present our questionnaire to the pharmacist of the shop. The person we
approached then either referred us to another person saying he is the one who
will answer the questionnaire or he himself answered the questionnaire. During
the analysis we found that only 9 person who filled out the questionnaire claimed
to be the pharmacist. The other people didnt claim themselves to be the
pharmacist of the shop in the questionnaire.

From this it is clearly visible that we can say only 23% pharmacy has a
pharmacist present. The other 77% doesnt. When we verified the 23% pharmacy
personnel who claimed themselves to be pharmacist by their qualification
details, we found that only 4 people were eligible to be a pharmacist/competent
person of a pharmacy retail. Because according to the law at least a Diploma
holder in pharmacy course is eligible as a pharmacist except some special cases
such as people who have been granted license before the amendment was
made. (Competent)
Considering the same, from our findings we can say that only in 10% cases,
pharmacists were present to operate the shop at the time of survey. That means
in 90% cases no pharmacist/competent person was present during the time of
survey.
So, in effect only 10% of the pharmacies had the capability to serve the
customers who are buying something as serious as medicines, which has
potential life or death consequences
In the analysis of the pharmacy representative answering the questionnaire, we
didnt find any B. Pharm or M. pharm available to answer the questionnaire at
the time of survey. We found in our analysis that in 78% pharmacy shop the
people operating the pharmacy are even below graduate level and answered our
questionnaire putting himself as the representative of the pharmacy. 23%
pharmacies had representatives (the person answering the questionnaire) who
were graduates and only 5% pharmacy had representatives who were D. pharm,
which is the basic level of educational qualification required to be a registered
pharmacist.
Thus most of the personnel serving the customers and selling the medicines are
below graduate. Moreover we found pharmacies with personnel qualified as low
as eight standard dispensing the medication to the customer. It cannot be
expected from them to explain to the customers about drug food interaction, if
the customer asks for medication information. Even if we take into account the
experience of the personnel, complex and newer data like drug-drug interaction,
which can be life threatening, cannot be explained by them to the customer. By
allowing these personnel to sell medicine we are putting the lives of the patients
at risk and we are giving these personnel free lease to endanger peoples lives.
Most of the time customers come with prescription while buying the medication
as reported by the representatives of the pharmacies. 38% pharmacies reported
that customers always comes with prescription and 26% pharmacies reported
that customers they serve frequently comes with prescription. More than 60% of
the customers come with prescriptions most of the times. Only 3% reported that
the customers seldom comes with prescription. From this its visible that in most
cases the prescription is brought by the customers which is the only requirement
the customer needs to fulfil to be able to buy medication. Its clear from this that
the customers are aware about the necessity of prescription to purchase
medicines.
But when further asked whether the pharmacy personnel checks the prescription
for its correctness or appropriateness, its seen in the analysis that even when
claiming that they do check for the appropriateness of the prescription, they
mostly check names of the doctor, patient and the medicine. Few pharmacy

representative claim to check the batch and MRP. Only 1 pharmacy checks the
formulation. All pharmacies neglect to check whether the medicine given to the
patient is the correct medicine for the person or if the medication is appropriate
for the child.
The dosage or whether there is interaction between the drugs is not checked by
any of the pharmacists. Now if a wrong or higher dose of a Sedative drug is given
and the patient sinks due to this dosage then a life may be lost. If only the
pharmacists were qualified and checked the prescription before dispensing then
such cases can be avoided.
Only 8% pharmacies ask for the medication history of the patient and that too
they check only what the doctor has written under Rx if the same prescription is
being used multiple times (patient card). The rest 92% do not ask for any
medication history before dispensing medicine. During survey it was even
observed that the personnel operating the pharmacy said its not their duty to
ask for the record of patients medication history. In a country like India, we
agree its not possible to keep records like other developed countries, but the
basic process has to start somewhere down the line to make pharmacy
conditions better. Medication history record-keeping and keeping of photocopies
of prescription is very much required. Without proper medication history it is
difficult to determine the medicines which the patient is allergic to or the
concurrent medication the patient is taking.
When asked whether the customers ask for information about medication, then
we found 64% pharmacy personnel replied in the questionnaire that the
customers ask information about how to take and when to take also the reason
for the use of the medication. 36% claimed that the patients have no queries.
The patients ask for minimal information as they dont know about the medicines
much and there is a lack of awareness. The queries of patients are not answered
by the pharmacy personnel in most cases, in cases of confusion they refer to the
doctor. As we established earlier that very few pharmacies have proper
pharmacists, so to play it safe they dont advice the patient they just make the
customer visit the doctor repetitively. The person who is dispensing the medicine
in most cases are under qualified to handle confusion over molecule name, brand
change and dosage. Only a pharmacist can alter dose and change molecule
prescribed by the doctor.
15% pharmacies claimed that they provide medication information and usage on
their own spontaneously. 85% pharmacies provide no information to the patients
about the medication or its usage to the patients that means unless the
customer asks the personnel dispensing medicines do not feel the need to ask
whether the patient need advice or not. They just dispense drugs which can
potentially kill patients, such careless dispensing of medication can cause
accidental overdose if the patient or the person administering the drug is not
advised by the dispensing pharmacist or the doctor about the maximum dose or
other usage guidelines, among many other problems. The personnel are not
inclined to serve the patients. But their willingness is not the only factor. Their
own knowledge is the main factor, as we saw that most personnel dispensing
medicines are below undergraduate level and not qualified to be pharmacist,
they dont know the medication information and usage guidelines on their own.
Therefore they cant provide details.

69% pharmacies reported that the acceptance level of advice among patients
are least and low. But only 15% of the pharmacies claimed to actually give any
advice on their own. So these 69% pharmacies which reported that the
acceptance is least or low provided the information without even giving any
advice.
Only 10% pharmacies reported that they provide counselling to the patients, but
the rest offer no counselling services to the patients. Providing counselling helps
the patients understand his disease or disorder better and to understand the
medication he/she is taking. Without proper understanding of the medication and
usage guidelines of the medication its not safe to administer the medication. In
developed nations we saw that counselling is always offered, but in India very
few pharmacies are providing such services. In most cases this service is
primarily provided by retail chain pharmacies. A staggering 90% pharmacies just
dont counsel the patients, they just dispense and take the money without giving
the necessary services.

Patient CONCLUSION
From our survey of 110 patients from 5 different areas in Kolkata we have
concluded the following about the state of pharmacy services and mentality of
patients
I.

II.

III.

IV.

Patients are well aware of the fact that they should always purchase
medicines against a prescription hence they rarely fail to bring
prescription to the pharmacies. This shows that they are aware about their
duties and are willing to follow them, provided some help is offered from
the pharmacies too. They are serious about their health.
However they are not getting adequate help from the pharmacies in terms
of usage of their purchased medicines .we have seen that only a handful
of pharmacies provide some details as to when to take the medicine and
at what intervals, however this information is substandard. The remaining
details of side effect adverse effect drug food interaction special
precaution maximum daily dose is hardly provided. maximum patients are
just handed the medicines according to their prescription and sent back
without an explanation as to why should the patient take that medicine
The major reason for the lack of responsibility is the absence of a qualified
licensed pharmacist in pharmacies. The people running the pharmacies
are themselves under qualified the least being class 9. They are not
capable of supplying the necessary information to the patients and hence
avoid their questions, sometimes even turn them down rudely. When
asked about their particular behavior the claim that it is not their duty to
cater to the queries of patients as the doctors are available for that. This
shows that most of the people running the pharmacies have no basic idea
about the duties of the pharmacist or the services that should be provided
to the patients. Hence when the curious patients ask questions about their
state of medication they only get replies of ask your doctor.
Since the absence of pharmacist is a common phenomenon, the patients
are not aware that a pharmacist should be always present in pharmacies

V.

VI.

and hence have compromised. (* needs to be verified)When asked if they

were given any details from the pharmacy they say that it is the job of a
doctor to provide them details and not the Pharmacist. From this
statement we can identify the ignorance of patients about the rules of
pharmacies and its duties. Due to this ideals patients have started asking
less and less questions to the pharmacy personnels in fear of being
turned down. But the patients cannot be blamed as the person whose duty
is to attend to the shop is not present, the shop is operated by
shopkeepers who are incompetent. The patients feel asking for advice
from these persons are not good because they are not qualified, which is
true.
The absence of pharmacist leads to no medication history being asked
from patients before purchasing of medication. This may lead to the wrong
administration of a drug to the patient. Their allergy history or concurrent
medication details which provide valuable information as to what type of
drug to prescribe to patients is hardly ever asked for. Even the follow up
services provided are nil.
The state of pharmacies in Kolkata is far from an ideal one. Even the basic
services that should be provided to every purchasing customer is absent
in almost all of the pharmacies. The most basic step that can be taken to
improve the state of pharmacies is the recruitment of qualified
personnels/pharmacist who are able enough to know their duties and
provide services to patients. However this also requires a change of
mentality of patients from a doctor favored attitude to a balanced one.
Without the help of patients, pharmacists cannot gain control and rights.
Another major step that can be taken is setting up of awareness
campaigns to educate people about the duties of a pharmacist so that
they become well aware before purchasing.

Conclusions compare
From our project certain issues about the current community pharmacy scenario
of Kolkata has come to light. These neglected issues if taken care of can greatly
improve the conditions in Kolkata and help to eradicate patient deaths due to
wrong administration of medicine, lack of information, lack of healthcare
professionals and side effects from medicines. In India the average pharmacist to
patient ratio is one per every 1987 patients. The analysis from our survey clearly
supports this point in which only a single qualified pharmacist was found form
among 35 pharmacies surveyed. Medication prescription and drug monitoring is
done by doctors only which increase the patient load on them. (One every
1700).important services like patient counselling and cross checking of
medications cannot be further performed by doctors as it increase the stress on
them. We need qualified and competent pharmacists for these services which is
absent.
It was observed that most of the pharmacies were run by under qualified and
incompetent personnel having very less knowledge about the duties of a
pharmacist and negligible idea about patient care. It was seen that the average
number of customers purchasing medications against a prescription is high, but
Pharmacists do not check these prescriptions for appropriateness and

authenticity. The customers do not receive any medical counselling or

information on the side effects or adverse effects. In India the extrapolated figure
for death due to adverse drug reaction every year is 400,000 and yet theres is
no well-defined system for ADR reporting for patients. Not only does our health
infrastructure fails to keep up with the ever growing population of patients but
also the demand for the job of a pharmacist is falling steadily due to a very low
compensation and high working hours.it is no longer a service but has become a
profession.
In Kolkata the average literacy rate is 85% and yet most patients are unaware of
the duties and services they should be receiving from a pharmacist. This
ignorance doesnt limit to patients only as it was seen none of the pharmacy
personnel themselves were aware of the duties they should be providing to a
patient. Some patients do not get any relevant information even after they
enquire about it in the pharmacy. This shows that there is a need for awareness
in forms of campaign and other media on the topic of healthcare and pharmacy
services to enlighten both patients and pharmacists. More and more people
should be encouraged to join the healthcare service and take up the pharmacist
job.