Proper use of medicines: what developments and opportunities for pharmacists? 

Dr. Ritu Rana Prabhu Ponnusamy

19th April 2016

Issues/ gaps of proper use of medicine Key opportunities for pharmacists Rationale to engage pharmacists Evidence from study Challenges Acknowledgement

Structure

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Consumer /Patient

Poor Access

Lack of Availability

Poor Compliance to treatment

Poor Follow up

to test

Lack of Affordability

Barriers to proper use of medicines   

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Key opportunities for pharmacists 

Improving treatment compliance 

Providing follow up investigation / test 

Ref: A  Study on diabetes and hypertension in India 2014‐15, PSI 

Rationale Availability  The doctor‐population ratio in  India : 0.5/1000 * Pharmacists/ chemists –Population ratio : 0.68/1000 Presence in both urban and rural 

Accessibility   : Pharmacies are often the first point of access to health care advice and medicine for common ailments**

Credibility : Community  have bond and trust with local pharmacists*** 

Ref: *National Health Profile 2015, ** BMC Health Services Research201111:351, ***BMJ Global Health 2012

Are pharmacists prepared for new opportunities? 

What is their knowledge & dispensing behaviour?

Only 29% had proper knowledge of signs & symptoms, prevention, management and dispensing of DM& HTN

41 percent stocked OHA, insulin & anti hypertensive

~ 30 % were  advising either to follow up once in 6months ‐ 1 year or even no need to follow up

Key findings from a baseline study, 2014 

DM: Diabetes Mellitus , HTN: Hypertension  

Post the baseline study eachenrolled pharmacist (350 in all )was visited at least thrice in a yearby project person To provide detailed and correct 

information   To promote positive  behaviours  To understand need of the 

pharmacists 

Intervention 

Type of Information card  used 

Divider SlideKey Results

10

12.7

14.7

Round - I (2014) Round - II (2015)

Mean score (max score: 16)

Reduced myths about DM/ HTN 

MythsDiabetes cannot be prevented. Only overweight or obese people are prone to have Diabetes.Diabetes predominantly affects men. Diabetes only affects old and rich people. Diabetes is not a killer disease. Diabetes only affects rich and urban people.People with diabetes should eat only special Diabetic foods.Hypertension cannot be controlled.

11

19

25.6

Round I 2014 Round II 2015

Mean score (max score: 29)

Increased basic knowledge about DM/HTN

Basic knowledge: Signs, symptoms, management and ways of prevention of DM/HTN 

12

4.7

6.2

Round - I (2014) Round - II (2015)

Mean score (max score: 7)

Increased dispensing knowledge 

Dispensing Knowledge: What is dispensing? how to stock different medicines? what should be advised while dispensing ? 

13

40.6%

50.9%

Round - I (2014) Round - II (2015)

Increase in pharmacists stocking oral anti‐diabetic, insulin and ant‐hypertensive drugs

14

69.4%

89.6%

Round - I (2014) Round - II (2015)

*Follow up in 3‐6 months

Increase in pharmacists advising regular* follow‐up with physician 

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Pharmacists initiated tapping opportunities 37%  pharmacists monthly follow up 

their clients to improve  treatment  compliance 

7.4% do follow up blood sugar and blood pressure testing 

Consistent in providing medicine to their near by patients (~80%)( from II R of survey )

Increased clientele  

Enhanced trust of community (field anecdotes) 

• Quality issues of screening / testing facility at pharmacy 

• Equipped enough to  Refer the patient for appropriate medical advice 

To promote treatment adherence/ self care  

To respond to patients/ clients need

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Pharmacists responded well to intervention, demonstrated improvements:– Knowledge – Dispensing– Stocking…

Indication of tapping the opportunities – Monthly follow‐up for treatment compliance– Follow‐up investigation…– Providing credit

Pharmacists, a key stakeholder for reducing barriers to proper use of medicines for DM/HTN

Conclusion

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Project Team at PSI Research team at PSI Project partners ( PHFI& Project Hope) Eli Lilly & Company   All the participants of study  

Acknowledgements

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psi.org.in

Thank you