Pharma Sep 08 1-15

Creating Value for All Healthcare Stakeholders Vol:5

Issue: 10

September 1-15

2008

Price Rs 20/-I believe .. patient

I believe .. patient power can heal a sick healthcare system The Indian healthcare system has become sick. In the private sector, doctors are no longer held in high regard; the doctor-patient relationship has deteriorated; and patients believe that the medical profession has become commercialized. The dismal state of the government’s healthcare services for the poor and the middleclass has also been extensively documented. The knee-jerk reflex has been to train more doctors ; set up more hospitals; and force corporate hospitals and doctors to provide subsidised medical care. This is simply a form of “band-aid medicine”. The only effective solution will be to rely on the one resource which is almost inexhaustible-the people themselves. The principle is simple educate them so they can manage their own health problems. The reason that India is shining today is that we are in a demographic ”sweet spot.” India’s major strength is its middleclass, with its millions of educated young adults, and protecting their health should be a high priority. Unfortunately, healthcare remains a neglected area, because of which millions of working years (and billions of rupees) are wasted on preventable illnesses. Medical absenteeism exacts a huge toll, but because it is hidden from public view, we have not addressed this problem effectively. This is a daunting task, and the challenges are enormous. However, the biggest mistake we make is to assume that people are incapable of tackling their own medical problems; and that we need to look to doctors for solutions. We need to change our focus. Instead of trying to provide sophisticated healthcare services (blindly imported from the West), which need expensive technology, fancy machines and highly trained specialists, we need to tap the people themselves. People are smart and motivated, and are capable of remaining healthy, if we give them the right tools and teach them how to use them. Doctors are illness experts - and not healthcare experts. Healthcare needs to learn from the revolution which has occurred in microfinancing. When given money and the freedom to use it as they see fit, even very poor people have come up with remarkably innovative ideas which could never have been planned, designed or anticipated by the traditional experts bankers! Information Therapy - the right information at the right time for the right person - can be powerful medicine ! Ideally, every clinic, hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem. The key is to develop patientfriendly materials which people will want to watch and can learn from. Most of us are visual learners, so this should be in graphic format. Modern technology has made creating and sharing visuals easy, so each community can build its own customised health

PhaRMeD TRADE NEWS

3-3-62/A New Gokhale Nagar, Ramanthapur, Hyderabad - 500 013 Tel Fax : 040-27030681, Mobile : 98495-51183 E-Mail : [email protected] www.pharmedtradenews.com

video libraries with ease ! A simple example would be to find an articulate doctor with excellent communication skills, and to record a doctor-patient consultation with her about the top ten common clinical problems. A library of such videos could then be published online as “open source content” ; and patients and doctors could download and dub these in local languages. This version can again be uploaded to the web and shared with other patients from all over the country. Web 2.0 technology empowers patients to form support groups and communities where expert patients can help others. As the technology improves, it will soon be possible to deliver this graphic educational content on the third screen which is quickly becoming universal - the cellphone. Patients will find these videos much easier to relate to, since the videos are in their own language; deal with their immediate personal concerns; use local characters they can identify with; and provide local solutions which they are familiar with. Information Therapy enhances patient autonomy by putting patients first; promotes patient-centered healthcare; respects the fact that the patient is the expert on himself; emphasizes personal responsibility for health; reduces the risks of medical errors; improves patient compliance with therapy; reduces the risk of litigation, because the patient has realistic expectations of the treatment; empowers patients to make their own decisions; and allows the intelligent use of integrative medicine, (such as yoga, homeopathy and ayurveda), so people can explore what works best for them. It creates expert patients and allows patients and doctors to form a healthy partnership, by improving doctorpatient communication. Finally, it saves money on medical care, both by promoting self-care (thus encouraging patients to do as much for themselves as they can, and not become dependent on doctors) ; and helping them with veto power, so they can refuse medical care they don’t need, thus preventing overtesting and unnecessary surgery. Is educating people about their health and medical issues too expensive? In fact, it’s too expensive not to do it ! Human capital is India’s most precious resource and we cannot afford to squander it. Information Therapy is free ; has no side effects; and provides a terrific return on investment. We should insist that doctors dispense information therapy every time they do a consultation; advise a lab test; or prescribe medicines. In fact, both the government and insurance companies can make prescribing information compulsory. Information Therapy can be Powerful Medicine - let’s make the most of it ! Dr Aniruddha Malpani, MD, Medical Director HELP [email protected]

Editor & Publisher

V. Bhava Narayana Associate Editors

EDITORIAL BOARD Prof.B.Suresh, President Pharmacy council of India

Dr. Aniruddha Malpani, M.D Dr. Mahesh Sharma,

Dr. Jawahar Bapna, Rtd Director, IIHMR

Prof. G.P.Mohanta

S.W. Deshpande, DG, AIDCOC

M.D (Ayurveda)

Dr. P.Hanumantha Rao, ASCI, Hyd

This Publication is Only for the use of Medical & Pharmacy Professionals Printed, Published and Owned by V. Bhavanarayana, and printed at Kala Jyothi Process Pvt. Ltd., 1-1-60/5, R.T.C. 'X' Roads, Musheerabad Hyderabad - 20. Published at 3-3-62/A New Gokhale Nagar, Ramanthapur, Hyderabad - 500 013, R.R. Dist. Editor : V. Bhavanarayana * RNI No.: APBIL/2004/12036 Postal LIC NO : HSE 806/2004-06. C Pharmed Trade News, 2004 * Person responsible under PRB act for selection of news Pharmed Trade News does not neccesarily subscribe to the views expressed in the publication. All views expressed to the magazine are those of the contributors Pharmed Trade News not responsible or accountble for any loss incurred, directly or indirectly as a result of the information provided.

PhaR MeD News KIMS Healthcare services provider Kerela Institute of Medical Sciences is looking to acquire two hospitals in South India and has earmarked a budget of Rs 300 crore for the purpose. The company is primarily interested in acquiring hospital with a capacity of 100-150 beds in Bangalore and surrounding areas in South India. KIMS is the first venture of KIMS Healthcare Management which was started by a group of doctors and entrepreneurs and it currently it runs 450-bed multi-specialty hospital in Thiruvananthapuram, Kerala. FORTIS Fortis Healthworld has acquired CRS Health, a Delhi-based pharma and wellness retail chain. It is also planning to rebrand itself and the pharma chains it acquires in future as Religare Wellness. CRS is the drug retailing arm of the diversified Delhi-based SAK Industries. Though the size of the deal is not big, it is Malvinder Singh and Shivinder Singh’s first acquisition since they sold their pharma company Ranbaxy to Daiichi Sankyo. Fortis will pay around Rs 15 crore to acquire 90% stake in CRS Health. Ravi Rajan & Company was the advisor to the deal. CRS has 30 stores which will help Fortis expand in the South. The promoters of CRS Health will hold 10% stake. Fortis has around 40 stores and plans to expand its presence to over 100 cities in 18-24 months. PIRAMAL GROUP Aiming to provide affordable medicines in rural areas and to combat chronic diseases in the country, pharma major Piramal Group in collaboration with ASSOCHAM and various NGOs has launched a project here on Saturday. The programme ‘help-your-body’, inaugurated by former President APJ Abdul Kalam, will emphasise on imparting knowledge on healthy food for healthy body and target each and every individual. ”Genetic causes, obesity, stress, inappropriate dietary habits and lack of exercise play a major role in causing chronic ailments,” Swati Piramal, Piramal Group’s Director said. According to a WHO report, 38.8 crore people will die in the next ten years due to chronic diseases and a significant proportion would be from India. ”India is expected to be the chronic disease capital with over 70 mn diabetics, 213 mn hypertensive patients and 60 mn with arthritis by 2025. We feel the government, the private sector, the medical fraternity, NGOs should come together against the onslaught of chronic diseases,” Piramal said. Kalam suggested that the group should integrate various systems of medicine such as allopathy, ayurveda, homoeopathy, unani, siddha and yoga available in the country to fight chronic ailments at an affordable cost.

PhaRMeD TRADE NEWS

TELE-MEDICINE India’s second largest car manufacturer Hyundai Motor India Ltd has initiated a satellite-linked mobile health clinic with telemedicine facility covering 20 villages near its Irrugattukottai plant near Chennai, a company statement said Wednesday. The company has also entered into an agreement with Sri Ramachandra University to operate the mobile clinic manned by a team consisting of a medical officer, pharmacist, nurse and an attendant. Hyundai Motor has availed the services of the university which in turn engaged Indian Space Research Organisation (ISRO) to have the telemedicine connectivity via antenna, fixed on the mobile van, to enable interactive treatment involving both doctor and patient with the main centre at Sri Ramachandra Medical College. The project cost, estimated to be around Rs.1 million, is borne by Hyundai Motor as part of its corporate social responsibility (CSR) activity, the statement said. Electrical stimulation may ease vaginal pain Transcutaneous electrical nerve stimulation or TENS is a safe and effective treatment for a type of vaginal pain called vestibulodynia.Vestibulodynia is the burning pain that occurs in the vulva, one of the most sensitive parts of the body, located at the opening of the vagina. Intercourse, tampon insertion, and wearing tight clothing may cause the pain. Although many women experience vestibulodynia, the cause is not fully understood. TENS has been used to treat a number of chronic pains and involves nerve stimulation through the skin with mild levels of electricity. To test whether or not TENS can cure vestibulodynia, Italian researchers randomly assigned 40 women with vestibulodynia to undergo real or sham TENS treatments delivered with a vaginal probe twice weekly for a total of 20 sessions. Pain levels were assessed before and immediately after treatment and at 3 months. The researchers used standard pain scales and questionnaires and found that the TENS group experienced significant improvements in pain, whereas the sham group did not. Pain during intercourse and sexual function also improved with TENS.The above findings show that TENS is a simple, effective and safe short-term treatment for the management of vestibulodynia. However, it is probably not a one-time cure for vestibulodynia and the effect of TENS may decline with time. BJOG: An International Journal of Obstetrics & GynaecologyAugust 2008 ILLOGICAL FDCs Partial, cumulative list of dubious fixed-dose combinations (FDCs) being marketed in India but not approved in any developed country. Most of these combinations are not approved by the Drugs Controller General, India and hence illegal. ALPRAZOLAM ALPRAZOLAM ALPRAZOLAM ALPRAZOLAM IMIPRAMINE RISPERIDONE NORFLOXACIN

SEPTEMBER, 1-15, 2008

+ SERTRALINE + IMIPRAMINE + FLUOEXETINE + MELATONIN + DIAZEPAM + TRIHEXYPHENIDYL + TINIDAZOLE

Page 2

NORFLOXACIN + TINIDAZOLE + DICYCLOMINE NORFLOXACIN + TINIDAZOLE + LOPERAMIDE NORFLOXACIN + METRONIDAZOLE NORFLOXACIN + ORNIDAZOLE CIPROFLOXACIN + TINIDAZOLE CIPROFLOXACIN + METRONIDAZOLE OFLOXACIN + TINIDAZOLE OFLOXACIN + METRONIDAZOLE OFLOXACIN + ORNIDAZOLE FLUCONAZOLE + TINIDAZOLE DOXYCYCLINE + TINIDAZOLE TETRACYCLINE + METRONIDAZOLE MEFENAMIC ACID + DROTAVERINE NIMESULIDE + PARACETAMOL NIMESULIDE + DICLOFENAC NIMESULIDE + DICYCLOMINE NIMESULIDE + CHLORZOXAZONE NIMESULIDE + METHOCARBAMOL NIMESULIDE + CAMYLOFIN NIMESULIDE + SERRATIOPEPTIDASE NIMESULIDE + TIZANIDINE NIMESULIDE + PARACETAMOL + CHLORZOXAZONE NIMESULIDE + TIZANIDINE + PARACETAMOL ROFECOXIB + TIZANIDINE IBUPROFEN + TIZANIDINE DICLOFENAC + TIZANIDINE DICLOFENAC + FAMOTIDINE DICLOFENAC + PARACETAMOL + TIZANIDINE DICLOFENAC + SERRATIOPEPTIDASE DICLOFENAC + PARACETAMOL + SERRATIOPEPTIDASE IBUPROFEN + PARACETAMOL + MAGNESIUM TRISILICATE RANITIDINE + DICYCLOMINE SUCRALFATE + OXETHAZINE CISAPRIDE + SIMETHICONE CISAPRIDE + OMEPRAZOLE MOSAPRIDE + METHYLPOLYSILOXANE MAGALDRATE + SIMETHICONE + OXETHAZINE + DICYCLOMINE DIAZEPAM + DRIED ALUM. HYDROX. GEL + ALUM. GLYCINATE + OXYPHENONIUM DIAZEPAM + DRIED ALUM. HYDROX. GEL + MAG. TRISILICATE + DIMETHYLPOLYSILOXANE DIAZEPAM + MAGALDRATE + OXYPHENONIUM DIAZEPAM + PROPANTHELINE + DIHYDROXY. ALUM. AMOXYCILLIN + SERRATIOPEPTIDASE PIPENZOLATE + PHENOBARBITONE AMOXYCILLIN + PROBENECID + TINIDAZOLE CEFUROXIME + SERRATIOPEPTIDASE ROXITHROMYCIN + AMBROXOL CIPROFLOXACIN + AMBROXOL CEFOPERAZONE + SULBACTUM RAMIPRIL + LOSARTAN AMLODIPINE + LISINOPRIL AMLODIPINE + ENALAPRIL AMLODIPINE + RAMIPRIL AMLODIPINE + LOSARTAN ATENOLOL + ALPRAZOLAM PROPRANOLOL + ALPRAZOLAM PROPRANOLOL + DIAZEPAM CINNARIZINE + DOMPERIDONE DOMPERIDONE + RANITIDINE DOMPERIDONE + OMEPRAZOLE DOMPERIDONE + FAMOTIDINE MEBENDAZOLE + PYRANTEL MEBENDAZOLE + LEVAMISOLE SIMVASTATIN + NICOTINIC ACID CETIRIZINE + PARACETAMOL + PHENYLPROPANOLAMINE

Source: MIMS - India

PhaRMeD TRADE NEWS

MNC REDUCE MED REPS Multinational pharmaceutical companies are trimming their medical representatives or sales force in India. While some have introduced voluntary retirement schemes to their sales force, others have stopped recruitments. Most companies have started offering ‘executive’ designations to their sales force so that they do not form part of employee unions. Federation of Medical Representatives Association of India (FMRAI) general secretary DP Duvey confirmed the development. He said: “About 10 MNCs are cutting 100-200 people each in India.” In addition, he added, they are not recruiting fresh field agents but people in different designations that does not come under the purview of employee unions. A source from Sanofi-Aventis also admitted that the company was changing the designations of people so that they do not have the union’s protection. Mr Duvey said the list of the companies reducing field workforce includes Merck, Sanofi, Novartis, Pfizer, GlaxoSmithKline (GSK) and Wyeth. Incidentally, they are cutting down almost 1,000 sales staff globally. Spokespersons for Sanofi-Aventis and GSK denied the reduction in field staff in India or abroad. Email queries sent to Merck, Wyeth and Pfizer nearly two weeks ago did not elicit response. Atul Walavalkar, a medical representative with Johnson & Johnson (India), said: “The job description has not been changed but the designation has been. Companies are doing this to try and reduce the bargaining power that the medical representatives have. They are sugar-coating the issue.” Instead of the usual medical representative designation, companies are assigning new designations like professional service representative and medical service representative, he added. Another medical representative with Wyeth, who did not wish to be quoted, told ET that the company started a voluntary retirement scheme in 2004 to encourage people to leave the company. It has also not recruited any new talent for the past four years and has preferred to go in for franchisees for marketing purposes. Pfizer has managed to keep the unions out completely by assigning designations such as “professional service officer”, said a Pfizer employee. According to Ajay Piramal, chairman of Piramal Healthcare, “MNCs look at numbers on a global level. Their productivity in India is low because the price is low here. Also, they don’t have a large product basket so the medical representatives are working with a lot less.” Ironically, Indian pharma companies are going the opposite way and hiring as many people as possible. “The Indian market is growing at 14 per cent per annum and Indian companies are not looking at cutting back on their sales force. At Sun Pharma, we are looking at gradually expanding the number of medical representatives we have,” the company spokesperson said. Mahendra Bangar, Wockhardt’s HR vice-president, said: “We have ambitious plans for expanding out sales force and want to retain out market position and rank. Many Indian companies are looking at expanding in rural areas and rural markets and we are looking at that as well.” Elder Pharma, which makes 80 per cent of its turnover from the Indian market, is also expanding its field force. “Disease profiles are growing in India. We have a field force of 1,800 all over India, but are looking at expanding in rural areas. MNCs, on the other hand, are using franchising models and asking Indian pharma companies, who have a strong field force, to market their products.” Swati Piramal, vice-chairperson of Piramal Life Sciences, said: “We are hiring strongly and in one of our major divisions

SEPTEMBER, 1-15, 2008

Page 3

(Tru Care) we are doubling sales force from 600 to 1200. We are customer-driven and align our products to what customers need in both urban and rural areas.” The sales force, she adds, is the pillar of the company and play a vital part in growing sales. Sales force cuts are the easiest to make but if marketingrelated costs and decisions are judiciously made then costs can be controlled, said Mr Bangar.

Source: The Economic Times BULK DRUGS PRICES The government would take measures to revive bulk drug units that have either closed down or suspended manufacturing due to short supply of raw material from China. Bulk drugs are active pharmaceutical ingredients (APIs) used in the manufacturing and processing of a medicines or formulations. Due to shortage of raw material and their rising prices, close to 50 bulk drug manufacturing units have closed while others have cut down manufacturing of loss-making drugs. According to industry sources, China is the largest supplier of raw material for bulk drugs to India and controls over 70% of the Rs 15,000-crore annual market for imported bulk drugs. ”China has also been dumping a large number of cheaper APIs into the Indian market for almost last 10 years. Despite the government imposing anti-dumping duty on several APIs and intermediates, the import of cheaper drugs has continued,” an industry expert said. As the Chinese government had shut many manufacturing units to cut pollution during the ongoing Olympics, prices of such drugs have gone up. In order to help the industry manage the situation, the government has started inspecting bulk drug clusters such as Hyderabad, Ahmedabad and Vadodara. However, industry observers feel prices of certain bulk drugs are declining. “Traders who were hoarding these items are

now offloading them since prices would fall once Chinese supplies resume,” SME Pharma Industry Confederation’s general secretary Jagdeep Singh said. Industry sources said the price of ofloxacin has come down to Rs 2,700 per kg in the past few weeks as compared to Rs 3,200 per kg earlier. Similarly, price of a broad spectrum antibiotic tetracycline (used to treat bacterial infections) has fallen from Rs 1,300 per kg to Rs 950 per kg. The price of oxytetracycline, which used to cost Rs 700 per kg till some time ago, has declined to Rs 570 per kg. However, prices continue to be high in the case of items such as paracetamol, said Mr Singh. The price of paracetemol has risen from Rs 165 per kg to Rs 325 per kg. PPI Cost-Effective as Co-Therapy with Aspirin for Cardiovascular Prophylaxsis — In patients taking aspirin for cardiovascular prophylaxis, over-the-counter proton pump inhibitors significantly reduce bleeding and are cost-effective in average-risk patients, investigators here concluded. Action Points ◆

Explain to patients that co-treatment with a proton pump inhibitor may reduce the risk of gastrointestinal bleeding associated with long-term aspirin therapy.

◆

Note that the findings were based on a statistical model, not a randomized, controlled clinical trial.

Statistical modeling suggested only a third of the risk of upper gastrointestinal bleeding and associated deaths in averagerisk patients who began concomitant PPI therapy at age 65, Sameer Saini, M.D., of the University of Michigan, and colleagues reported in the August issue of Archives of Internal Medicine.

Running a successful Medical practice can be hard work ! Do you find that there is too much work, too much hassle, ◆

Long energy-exhausting hours and crushing workloads leaving little or no free time for yourself or your family ?

◆

Demanding dissatisfied patients ?

◆

Inadequate payment for all your hard work ?

◆

You need help ! Successful Medical Practice – Winning Strategies for Doctors, is the first book on the art of practice management, written for Indian doctors. The purpose of this book is to help you find a truly satisfying way of practicing medicine which will:

◆

Give you control of your time;

◆

Allow you to do work which you felt was worthwhile, for patients that you enjoy seeing; and

◆

Pay you well for your effort, so that you enjoy going to work every day.

The secret is to learn how to manage yourself. This book will teach you time management, knowledge management, and relationship management skills, so that you can become a more productive, happier and more successful doctor. This 300 page book is packed with information, gleaned from many years of practice. You can apply this immediately to your own practice, and start flourishing !

Available only from : PTN Communications 3-3-62a, New Gokhale Nagar, Ramanthapur. HYDERABAD. Price Rs 250 only.Pl draw your DD/Cheque/ Mo in favour of PTN Communications.

PhaRMeD TRADE NEWS

SEPTEMBER, 1-15, 2008

Page 4

Added Value of Pharmacists in the Public Health Dr. Nirmal K. Gurbani Public Health Training Institute, Jaipur

Pharmacists Availability: India ▲

Nearly 500,000 trained pharmacists Almost 75% engaged in CP and HP

▲

Elsewhere Pharmacists - considered as experts in

▲

medicine management and health care ▲

▲

Large pool of HRH remained unutilized as service

▲

Self care (Diabetes, HT, OA, etc.)

▲

Managing supply of medicines and other items

▲

Rational Use of Medicines (influencing prescribing & medicine use)

Access to Primary Health Care ▲

provider by the government, society or allied health

professional to diagnose or/& treat his/ her complaints,

professionals

including prevention (Health Education)

Working in isolation rather than as a member of the health

▲

care team

Changing Paradigm of Pharmacy Practice ▲

Traditional role of pharmacists to manufacture and supply medicines has undergone a sea change

▲

Forced the evolution of the pharmacist’s role into a more

Pharmacist is usually first contact with majority of Population in times of sickness and quest for health

Untapped Manpower in NHP An ANM/HW with bare 10+18m training ▲

Community pharmacy practice evolved in the post Second World War period

▲

PHC : first contact that a patient has with a health care

A crucial partner of Healthcare team (NHP) - direct contact, communication, IEC

▲

Managing SC with about 5000 population

▲

Advising, educating & prescribing 20-30 products to the

patient centred approach

community

Pharmacy in a New Age (PIANA)

Pharmacists have better educational background in

The New Horizon has identified 4 major Area

Health Education, National Programmes and RCH, but

1.

Managing Prescribed Medicines

are not exploited under NHP

2.

Managing Chronic Conditions

3.

Managing Common Ailments in giving patients (reassurance and advise with or without use of Non-Rx

Current Public Health Concerns in India Some of the public health challenges we face today are ▲

Med) 4. Public Health - promoting & supporting Healthy Lifestyles (helping people to protect their own health)

Major Breakthrough WMA and the FIP joint statement on working relationship between physicians and pharmacists aims to demonstrate that each have ▲

complimentary and supportive roles and

▲

responsibilities

WHO Recognition Pharmacist WHO and FIP have also jointly identified seven-core expectations from the pharmacists as: •

Communicator

•

Care Giver & Quality Drug Supplier

•

Trainer & Supervisor

•

Care Giver & Quality Drug Supplier

•

Trainer & Supervisor

•

Collaborator

•

Health Promoter

•

Leader & Manager

•

Life-long learner

Communicable, Non-Communicable, Vector-born Diseases (NVBDCP), All NPs

▲

Malnutrition (Vit A & D Def., Anaemia)

▲

RCH

▲

Sedentary Lifestyle/Improper diet

▲

Sexual Behavior/STD’s, HIV-AIDS

▲

Substance Abuse: Alcohol,Tobacco,Drugs

▲

Family Violence

Evidence base for Pharmacist in Public Health A practical guide for Community Pharmacists- Jointly prepared by Pharmaceutical Services Negotiating Committee, National Pharmaceutical Association, Royal Pharmaceutical Society of Great Britain; www: PharmacyHealthLinl ▲

Smoking cessation

▲

Coronary heart disease

▲

Skin cancer prevention

▲

Drug misuse

▲

Sexual health (including emergency hormonal contraception)

▲

Immunisation

▲

Head lice management

▲

Oral health

Good Pharmacy Practices

▲

Mental health

Activities to be addressed:

▲

Obesity

▲

Accidental injury prevention

▲

Promotion of good health (prophylaxis & care)

PhaRMeD TRADE NEWS

SEPTEMBER, 1-15, 2008

Page 5

▲

Folic acid and pregnancy

Pharmacists : Patient Information

▲

Asthma Diabetes Nutrition and physical activity Multi-topic health promotion campaigns

Use of Patient Information Leaflets (PILs) in Mumbai (2004-

▲ ▲ ▲

2006) ¨

in collaboration with Delhi Pharmaceutical Trust

Desired Qualities of Public Health Professionals

▲

Excellent Communication Skills Trustworthy People Oriented Easily Accessible Experts in providing health care information

▲

Good rapport with other healthcare providers

▲ ▲ ▲ ▲

¨ ¨ ¨

Pharmacists Qualifies All Desired Qualities

▲ ▲

Smoking Cessation – IPA NPW : Pharmacists for Tobacco ▲

Free Society ▲

Youth Counseling – Drug Abuse, STD’s

▲

HIV-AIDS : SEARPharm Forum Guiding Principles for

▲

Fight Against HIV-AIDS ▲

Elder Outreach – Nursing Home Activities

▲

Active Lifestyle/Diet Modification Activities

LACK

OF

PATIENT’S

KNOWLEDGE

&

NON

▲ ▲

ADHERANCE TO TREATMENT REASONS ▲

Inappropriate attitudes and poor communication skills

▲

of providers ▲

Patient’s fear of asking questions, esp doctors

▲

Inadequate consulting time

▲

Lack of access to printed information about drugs (leaflets

▲

Inability to pay for prescribed medicines

▲

Complexity and duration of treatment particularly in chronic diseases

IMPACT OF PROVIDING DRUG INFORMATION TO THE PATIENTS ON PATIENTS KNOWLEDGE Delhi Study (DSPRUD)

Sum of primary indicators score Supplementary Indicators Next appointment Adverse effects Precautions

▲

Knowledge of the patient (Mean + SD) Control group (n=114) Study group (n=118) Pre

Primary Indicators Purpose Dose Frequency Duration of treatment

Post

Pre

Post ▲

1.07 (1.53) 3.49 (1.97) 3.54 (1.94) 3.14 (2.66)

*1.45 (1.69) *3.78 (1.75) *3.75 (1.75) 3.21 (2.60)

1.32 (1.70) 2.88 (2.02) 2.95 (2.09) 2.21 (12.42)

**3.42 (2.04) **4.22 (1.97) **4.27 (2.00) **3.83 (2.22)

11.25 (5.86)

*12.21 (5.44)

9.36 (6.39)

**15.66 (7.33)

3.40 (2.75) 0.04 (0.39) 0.09 (0.45)

3.42 (2.80) 0.01 (0.09) 0.11 (0.36)

3.14 (2.10) 0.05 (0.41) 0.08 (0.46)

**4.15 (2.18) **2.47 (1.87) **2.89 (2.07)

▲

Sum of supplementary indicators score

3.52 (2.78)

3.52 (2.76)

3.27 (2.67)

**9.52 (5.21)

▲

Missed doses (Mean +SD) Regular Occasional Not missed

1.6 (0.7) 12 19 83

PhaRMeD TRADE NEWS

TB Patients buy medicines from pharmacists Importance of Compliance - not been fully emphasised by prescribers, leading to MDR and XDR Pharmacists as valuable resource was hardly tapped under the TB Control Programme A TB Fact Card project was launched by IPA in 2005 in Mumbai as collaborative project with CPA, IPSF, Maharashtra State Chemist & Druggists Association & Mumbai District TB Control Society Students of 6 Pharmacy Colleges, 5000 patients

Compliance established Another major breakthrough - participation of some Pharmacists as DOTS providers-an excellent example of PPP

Collaboration between community pharmacists and local TB units of the RNTCP could provide a continuum of care for patients navigating their way from diagnosis to treatment Strategies that involve greater public and private sector collaboration could lead to significant improvements in TB control.

Pharmacists in Malnutrition ▲

1.9 (.4) 3 7 108

through 50 retail pharmacists PILs were for Atenolol, Cefadroxil, Atorvastatin, Diclofenac and Glibenclanmide In the present study respondent’s medication taking behaviour (compliance) was improved in 91% cases compared to the 36% prior to the intervention

Spanish Study : Provision of directly observed treatment short course (DOTS) through community pharmacies in Spain resulted in improved treatment completion and cure rates when compared to self-administered treatment (Reference: Juan G, Lloret T, Perez C, et al. Directly observed treatment for tuberculosis in pharmacies compared with self-administered therapy in Spain. Int J Tuberc Lung Dis 2006;10:215–221)

or labels)

Parameters

Distributed to 3500 patients in Mumbai and Thane area

Pharmacists Fight against TB

Some Areas Suited to Pharmacist Volunteerism in Public Health T▲

Leaflets : KM Kundnani Pharmacy Polytechnic

▲

In Satara (Maharashtra) – PPP; Pharmacists, their association, IMA, Government & other associations/ individuals Each year Health camp for children but no follow up Pharmacists played important role in finding cases of malnourished children with the help of Aanganvadi workers 84 children in age 6 months to 6 year Malnutrition category 3 & 4 identified and enrolled in the programme

SEPTEMBER, 1-15, 2008

Page 6

▲

In a year, on each first day of the month -medical and

▲

of HE literature in their outlets

HE posters ▲

Implement and Regulate GPP Guidelines with same

▲

IPA / IMA/ PCI / MCI

Pharmacists Action Needed Commitment

of

Pharmacists,

Pharmaceutical

▲

▲

isolation for a week in NPWs

Collaboration - PCI, IPA, IPGA, APTI, IHPA, AICDO, IPO, etc and Social Clubs & Org. Lion, Rotary, etc.

▲

▲

Focus from product to patient

▲

PCI initiating a NEED BASED Curriculum Designing for

▲

Pharmacist is circumcenter of a triangle with physicians, patients and nurses at the corners

Government’s Role Considering prevailing unmet need of trained HRS in achieving the targets under NHPs - Redefine National

▲

He has direct contact with patients and Community

▲

Patient finds much more in comfort with Pharmacist than a physicians

Health Policy and augment the workforce by including Pharmacist as HRH ▲

Draw appropriate training manuals for empowerment

▲

Pharmacist is under utilized in PH and NHPs

▲

Steps should be taken by the Government and the

of pharmacists in all NHPs like Training Manuals for doctors, nurses, HWs, Aanganwadis, etc ▲

▲

pharmacist together to play a significant role in NHPs ▲

Treat CP outlets as distribution & display point for HE literature for public and HE posters

▲

Awareness of Community pharmacy and Role of a

check up by IMA doctors and pharmacists distributed free medicines Many other individuals & associations

fervor as GMPs under Schedule M

▲

Pharmacy Associations need to work in collaboration and Partnerships, A & N

Implement and Regulate GPP Guidelines with same

Roles of Pharma Organizations

Advocacy and Networking

CONCLUSIONS

appropriate empowerment

▲

PCI:Open up - encorage DHOs as faculty in HE & doctors in medically oriented subjects

Transforming trading mentality to professional services mindset

Working together for various national and international days, events and compaigns, instead of only working in

Associations & Organizations on consensus ▲

Collaboration and Partnerships with other health professionals; eg WMA / FIP

fervor as GMPs under Schedule M

▲

Encourage Ph for display of HE posters and distribution

(grocers, food merchants) joined ▲

Now most of the children have shown significant progress & weight gain of 5 to 7 kgs.

Pharmacist

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Hospital Directory dabad Eye Care Hospital Polytecnic Road - 380015 Ahmedabad 079-26446133, 26430503 Bansali Trust Hospital & Diagnosis Opposite Dinabhai Tower, Sahyog Building, MirzapurAhmedabad 25350722 Chatrabhuj Lajpatrai Hospital Shahibaug RoadAhmedabad 22866311 Chest Disease (ESI) Hospital Kamdar Rajya Vima Yojna, Gujarat StateAhmedabad Dr. Arvind Shah General Hospital Near Chhotalal Chawl, Odhav Main RoadAhmedabad 2 871054, 2871382 ESIS General Hospital BapunagarAhmedabad 2745770, 2743935 Gujarat Cancer & Research Institute Civil Hospital Compound, AsarwaAhmedabad (079) 22681451, 22681433(079) 2268 5490 Gulab Bai General Hospital Opposite Kalupur Police Station, Dhana Suthar ni Pole NakaAhmedabad 339055, 384468 Gulabdevi S Chowdhary Kidney Hospital Shahibaug RoadAhmedabad 2866313 Infectious Disease Hospital Near Calico Mill, Pirana Road, BehrampuraAhmedabad 25323646 Leprosy Hospital NarolAhmedabad 25712309 M.P. Shah Cancer Hospital Gujarat Cancer & Research Institute, New Civil Hospital Campus, Asarwa Ahmedabad (079) 2268 1451, 2268 1433(079) 2268 5490 Nagri Eye Hospital Near Gujarat College, Ellis BridgeAhmedabad 26466724 / 26460176 Navdeep Clinic Opposite Aakashwani, Ashram Road Ahmedabad 6584009 P.P. General Hospital

Ramnagar, SabarmatiAhmedabad Paraplegia Hospital Civil Hospital CampusAhmedabad 079 22680471079 [email protected] Sharadaben General Hospital SaraspurAhmedabad 361072 Thakersay Charitable Trust Hospital Near Umiya Vijay Bus stand, Near Satellite RoadAhmedabad 6744244 Victoria Jubilee Hospital Kalpur Railway Station, Railwaypura Ahmedabad 2141080 No.71, 11th Main, Malleswaram, Opposite Malleswaram Railway StationBangalore Bangalore Hospital 202 RV Road,Bangalore south Bangalore 91-80-26632753/3494 Bangalore Institute of Oncology Cancer Detection Centre, 44-45/2ND CRS RM Roy ExtensionBangalore 40206400 Bangalore Kidney Foundation 6, 11th Cross, 15th Main, PadmanabhanagarBangalore(80) 26392700 Bhagawan Mahaveer Jain Heart Centre General Miller Road, Vasantha NagarBangalore 22207640 / 22207649 Bhagawan Mahaveer Jain Hospital Millers Road, Vasantha NagarBangalore 2207641-49, 2260944, 2261153 Bowring & Lady Curzon Lady Curzon Road, Shivaji nagarBangalore 25591325, 25591362 Cauvery Medical Center 3-B, HBS Apartments No.1, Edward RoadBangalore CDR Medical Center 531, 11 Main, 4 V Block, JayanagarBangalore 26655055 Church of South India Hospital 2, Hazarat Kambal Posh RoadBangalore 2861103, 2861104 City Corporation Hospital 5 Kempegowda CLE 9, VijaynagarBangalore 23300977

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