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Report on pharmacist perception in India - part 2Document Transcript
FEATURE Report of an all India Quantitative study of Consumer perceptions, availability, role, services provided, medicines and expectations of pharmacists in India PART II: PROFESSIONAL ASPECTS OF PHARMACEUTICAL SERVICE BY PHARMACIST D B Anantha Narayana1*, Kusum Devi2,, Asha A N2, Nimisha Jain2,Uday Bhosale 2, T Naveen Babu 2And co-investigators Roop K Khar3,Moitreyee Mandal 4, Manjiree Gharat5 1* Managing Trustee, Delhi Pharmaceutical Trust, New Delhi. 2 Dept. of Pharm.Marketing and Management, Al-Ameen College of Pharmacy, Bangalore. 3 Dept. of Pharmaceutical Sciences, Jamia Hamdard, New Delhi. 4 Dept. of Pharmacy, J.C.Ghosh Polytechnic, Kolkata. 5 K.M.Kundnani Pharmacy Polytechnic, Ulhasnagar, Maharashtra. The authors have already reported ﬁndings of an all India quantitative survey of perception and views of 3086 respondents across the country (Bangalore, Kolkata, Delhi and Mumbai) 1 .Part I of the report covered professional and general aspects of Consumer perceptions on availability, role, services provided, medicines and expectations of pharmacists in India. Readers may refer to the above paper to get details of objectives of the survey, methodology, data acquisition and analysis, IT tool used for the analysis and other aspects. We now report ﬁndings of the survey related to professional services rendered by the Pharmacists as on today, consumer views of what they consider as common ailments, when they prefer to go to a chemist rather than a doctor and their future expectations regarding additional services to be provided by a pharmacist. Keywords: pharmacist, retail outlets and availability, ﬁrst all India survey, quantitative surveyAsking for and Handling Disease Conditions where Patient CounselingPrescriptions Prescription is insisted on To determine the access to information On enquiring about this speciﬁc aspect, A maximum of 45% people opined that regarding the patient counseling aspects38% respondents opine that a pharmacist chemist always insisted on prescription for a question was posed to the respondents.does ask for the prescription and 10% sleep problems, 30% for chest problems In total, 52% people have problem inare of the opinion that the pharmacist and 25% for stress problems. Similar trends accessing such information and 48% peopledispenses medicines without a prescription. were observed in Mumbai, Bangalore did not have any problem in procuring theHowever, a major 52% are of the opinion and Kolkata. However, in Delhi, a slight necessary information.that the pharmacist sometimes asks for the difference in response was obtained with In Mumbai, Kolkata, Delhi andprescription before dispensing. The above 36% & 40% of population opining that Bangalore 44%, 49%, 61% and 55% peopleﬁnding is based on the overall survey. Only the chemist insisted on prescription for respectively feel that they have problem ina maximum of 13% respondents felt that sleep problems and chest/throat problems accessing information and 56%, 51% 39%a chemist always asks for the prescription respectively.which is fairly encouraging and indicativeof presence of professional ethics during Figure 1: Frequency of asking for prescription by chemistdispensing. In Mumbai, it was encouraging tonote that 50% of the respondents opinethat chemists always ask for prescription.Additionally 42% said that sometimes theywere required to produce prescription.Only 8% opined that chemist did not askfor prescription. In the three cities, viz.,Bangalore, Kolkata and Delhi, there was asigniﬁcant difference in opinion in betweenthe urban and rural respondents withMumbai being an exception. These ﬁndings could be attributed to thefact that prescriptions are not being askedwhen dispensing medicines for chronicproblems or for minor problems such asheadache, body pain, cold cough etc.*E-mail: email@example.comPharma Times - Vol. 43 - No. 08 - August 2011 32
Figure 2: Disease conditions for which prescriptions are insisted after purchase. However, 74% of urban upon by the chemist population and 85% of rural population feel that it is the duty of pharmacist to give such information. Surprisingly, in Delhi 49% population showed willingness to pay, with 16% people ready to pay ﬁve rupees and 22% ready to pay one rupee to the pharmacist for providing professional services. In Kolkata, Mumbai and Bangalore the percentage of people willing to pay an amount between one to ﬁve rupees for the much required information on medicines was 12 %, 12% and 18% respectively. Extent of Brand Substitution To ﬁnd out the extent of substitution by the chemist, a question asking the same was posed to the respondents. 58% of the population feels that the chemists substituteand 45% respectively feel that they did not Usefulness of Information given by the brand prescribed after informing thehave problems in accessing information on Chemist consumer while 15% feel that substitutionmedicines. Further, to check the usefulness of of the brands prescribed is done without It is quite alarming that 61% people in information given, we asked consumers informing. 20% feel that chemist neverthe capital city have problem in accessing whether the information given by the substitutes the brands prescribed. Thethe much needed information on medicines. chemist in the past helped them to get better percentage of people feeling the sameIt is not comfortable to know that on an with the medicines or not. in individual cities, viz., Bangalore, Delhi,average 50% of the medicine buyers are Kolkata and Mumbai was 14%, 15%, 12% All over India, 67% of the populationﬁnding it difﬁcult to get information related and 39% respectively. While 66% of the feels that information given by the chemist into proper usages of medicines. population in Bangalore and Delhi feels the past did help. The percentage of people that the chemist substitute the medicine As around 50% of population is not facing feeling the same in the following cities was brands prescribed after informing them, 16problem in getting information on medicines, 75% in Mumbai, 67% in Bangalore, 64% % and 14% population in the same citieswe posed one more question to ﬁnd out if in Kolkata and 62% in Delhi. Interestingly, feel chemist substitutes without informingthe chemist is the information provider for more number of female population beneﬁted them.the patients or not. We asked them if their by the information as compared to malechemist is giving them information on use population. In Kolkata and Mumbai, 55% and 46of medicines or not. % of the population respectively feels that Willingness to pay money for getting the chemist substitute the medicine brand It was heartening to know that all over Professional Information prescribed after informing them and 21%India, 69% people opined that chemist is and 10% feels chemist substitutes without Survey revealed that 78% of thegiving them information on use of medicines. informing. respondents feel that it is the duty of theA more number of rural population as chemist to provide the information on the use Deliberate substitution with costliercompared to urban population is in favor of medicines but 22% showed willingness brands of the same therapeutic moiety orof pharmacist as the information provider. to pay an amount between 1-5 rupees for with brands which give higher proﬁt marginsA similar response was obtained in getting additional information on medicines should be seriously viewed upon andBangalore. needs corrective measures. Substitution Figure 3: Patient counseling provided by the chemist of medicines could probably be associated with non-availability of prescribed brands in the retail outlet which requires the respective Pharma companies to adopt efficient distribution channels. Another reason for non-availability could be that chemist is deliberately stocking only expensive or the brands which offer high returns. Although the percentage is low but 11% people feel that the chemist deliberately gives expensive brands. 7% people feel that the chemist substitutes cheaper brands on request by the consumer. Overall more percentage of rural population feels that chemists substitute brands to dispense expensive brands. Similar trends are observed in Bangalore, Delhi and Mumbai. Pharma Times - Vol. 43 - No. 08 - August 2011 33
Figure 4: Level of brand substitution by chemist. In fact, it has been observed in actual practice that patients sometimes ask a chemist to give them medicines for their problems without consulting a doctor. In relation to this, a question was posed to the respondents to ﬁnd out for what conditions would they prefer to visit a chemist and not consult a doctor. The survey revealed that 53%, 65%, 45% of the total respondents preferred to go to chemist for conditions like fever, cold/cough, and pain/ache respectively. The number of patients willing to go to a chemist for the treatment of stomach pain was comparatively lower at 33%. Small differences in percentage were observed in the responses obtained from the four cities in comparison to the totalInstances of Prescriptions being the chemist they were enquired about the percentage.Referred back to the Doctor same. The quarter (25%) on a totality said that they wanted facilities for BP check from Conditions for which the consumers To ﬁnd out aspects related to the above chemist with almost a similar percentage preferred to consult a chemistissues, we asked respondents under whatconditions does the chemist ask/insist that (22%) mentioning ﬁrst aid followed by 20% without visiting doctor.they go back to the doctor, even though they who said body weight measurement. Condition Fever Cold/ Pain/ Stomachhave a prescription. 18% opined that they The number of respondents opting for City cough ache painwere sent back if prescription was more than body temperature measurement was lower Mumbai (%) 42 68 44 303 months old, which points to the high level (16%) followed by an even lower percentof ethics being practised by pharmacist. Bangalore (%) 62 78 53 31 (11%) for blood sugar determination. The45% people said that the pharmacist asks/ Kolkata (%) 69 65 41 45 age wise trend was similar to the totalinsists them to go back to doctor when there trend in Mumbai, Bangalore and Delhi with Delhi (%) 37 47 40 29is some doubt in the prescription. Kolkata being a little different. Here 31% of TOTAL 53 65 45 33 The concern of the pharmacist for the the respondents opted for BP check which NOTE: The total numbers of responses addhealth of medicine buyers is evident by the is higher than that obtained in total and in up to more than 100% as the question wasfact that 17% of consumers were sent back other cities. a multiple choice one.to doctors due to health issues. In continuation to the above query, Trust on Pharmacist for Prescribing Also, 20% of people said that they were the respondents were asked if they would In continuation with the previous queries, want the chemist to be allowed legally tonever asked to refer back to the doctor. respondents were asked if they trust theThe same opinion was reﬂected by 30% of give medicines for nine common medical chemist to give them medicine when they problems varying from aches/pains toretired population. This is further reﬂected by approach him without going to the doctor.49% retired people in Bangalore. In Mumbai, loose motions. The total responses showed The response was encouraging on an that 49%, 49%, 57%, 39% and 47% of51% were sent back particularly when there overall basis and individual city wise withwas a doubt in the prescription. the respondents wanted the chemist to 69% of the total respondents opining in the be allowed legally to give medicines for afﬁrmative and 31% saying the contrary. aches/pains, fever, cold/cough, minorIssue of Bill on Purchase This indicates that the number of people burns, minor cuts/wounds respectively. On a total basis, 36% of the respondents having a trust in the pharmacists’ knowledge However, the percentage of patientsopined that chemist does not give a bill when about medicines is more than double the wanting the chemist to dispense medicationthe amount involved is too small, with 34% number of people who do not. This is a in treatment of sudden and severe pain,mentioning that it happens when they don’t positive ﬁnding as pharmacist is that person allergy, nausea/vomiting and loose motionsask for one. An encouraging ﬁnding is that in the drug distribution chain who would be was comparatively lower at 30%, 23%, 27%only a considerably lower percentage of in direct contact with public and patient. and 27% respectively.respondents (16%) said that chemist doesnot give bill when he is too busy. An almost Consumer’s opinion on legally allowing the chemist to dispense medicationssimilar trend was observed in Mumbai and for common medical problems.Kolkata with responses in Bangalore andDelhi differing marginally. Condition Aches/ Sudden/ Fever Cold/ Aller- Minor Minor Nausea/ Loose Pains severe Cough gy burns cuts & vomiting motions These findings indicate that the City Pain woundsregulatory mechanism should becometougher so that the chemist will issue the Mumbai (%) 50 21 38 59 20 39 34 26 28bill for every sale irrespective of amount Bangalore (%) 56 25 57 68 17 30 37 23 29or consumer requirements. Also consumerawareness should be increased and they Kolkata (%) 49 32 67 54 29 35 43 33 28should insist on bill for every purchase. Delhi (%) 36 40 33 47 25 50 51 24 21Requirement of Additional Services TOTAL 49 30 49 57 23 39 47 27 27 In order to determine if the public NOTE: The total numbers of responses add up to more than 100% as the question waswould want any additional services from a multiple choice one.Pharma Times - Vol. 43 - No. 08 - August 2011 34
The responses to both the questions pharmacists and get medicines for few • Health care delivery models need to bereveal that a significant percentage of days. They put themselves on these reviewed at National levels to involvepatients would want the chemist to dispense medicines, which more than 50 % have pharmacists fully and major reformsmedication for conditions like cold/cough, found to be useful and meets the need in the same need to be thought of.fever, pain/aches and minor cuts and to treat such common ailments. They Preparation of a list of common & minorwounds. Allowing the chemist legally to recognize that such a practice is good diseases, medicines for treating suchdispense medicines for above conditions for and must be encouraged and legally diseases need to be prepared.a short duration like a maximum of two days allowed. • Drugs and Cosmetics Act and Rulescan be considered. But importance should • They also recognize that many need to be reformed to review Schedulebe given to the type of pain killers that can pharmacists’ refer to doctors and stay H drug list, outing in pace a clear OTCbe dispensed taking into consideration that away from giving/dispensing medicines drug policy, and also publish/notify adrugs like Ibuprofen, Diclofenac sodium, for many diseases where pharmacists’ “Pharmacist dispensing list of drugs”Aspirin, are contraindicated in certain consider it is not good to give medicines, and “Pharmacists’ to refer to Doctor”groups of patients. So, training of chemist in say like sleep problems, severe chest list of diseases/medicines. Such a movethis regard is an absolute necessity before infections etc. will be expected to have a number ofany decision is taken. benefits including improving access Recommendations: Further, one more open-ended question to medicines, reducing health carewas posed to the respondents to list the Based on the survey ﬁndings, the authors costs, etc. Such a move will face stiffproblems for which they would trust a chemist have the following recommendations: opposition from many quarters which willto give them medicines. The respondents • The Professional associations in be interested in “Protecting Turf wars”gave a list of following problems: Pharmacy need to continue and also or “Territory marking” tendencies, which need to be objectively discussed in enhance continuing education pro- multi-functional/professionals meetings Problem Quoting Frequency Problem Quoting Frequency openly. Fever 980 Allergy 30 Authors would be happy to receive inputs Cold 877 Minor burns 29 on the study, and hope professionals and regulators will take note of the ﬁndings. Pain 736 Loose motion 16 REFERENCES Cough 592 Throat pain 08 1. D B Anantha Narayana, Kusum Head ache 274 First aid 08 Devi, Asha A N, Nimisha Jain, Uday Bhosale, T Naveen Babu. Report of all Stomach pain 108 Chest pain 05 India quantitative study of consumer Body pain 59 Constipation 02 perceptions, availability, role services provided, medicines and expectations Vomiting/ nausea 39 Acne 02 of pharmacists in India Part I: Report of Cold/cough 39 Joint pain 02 the study on professional and general aspects. Pharma Times, Vol.43, No. 04, Wounds and cuts 39 Stress 01 April 2011, 12-17.Results and Authors’ Views: grammes for current pharmacists in 2. D B Anantha Narayana, Brijesh Regal, retail outlets. This work needs to be en- Kusum Devi, Asha A N, Nimisha Jain In studies like these, it is not possible to larged to cover all pharmacists across et al. Perceptions of consumers aboutdraw speciﬁc conclusions and authors want Pharmacists- Report of the results of ato deliberately stay away for doing so, as the nation. market research conducted amongstthere can be many perspectives. consume in Bangalore and Delhi. Pharma • Programmes to build Skills and Com- However, the study ﬁndings taking both petencies, as well as desired domain Times-Vol 41, No. 9, September 2009,part 1 and part 2 of the Reports in totality, knowledge need to be drawn up and 15-18.the following can be summarized: put in place. • There is a deﬁnite trend in the con- • A habit for reading sumers feeling the importance of the and hunger for Pharmacists, recognition of their role information needs Indian Pharmaceutical in health care, trust factor has gone up from what it was a decade ago. to be created amongst phar- Association macists. Pharma • Consumers are getting useful informa- Industry which fo- tion from the pharmacists about disease cuses on Doctors and medicines although they want more alone needs to from all the pharmacists and are not be made to think willing to pay for such information and of the obligation counseling provided. to educate phar- • Consumers have more demands macists too, as in various services provided by the well as building pharmacists. better and “not • Consumers have on their own drawn trade only” rela- up what they consider as common tions with chem- ailments that are not serious, and visit ists. Pharma Times - Vol. 43 - No. 08 - August 2011 35