A review on COMMUNITY PHARMACY PRACTICE IN NEPAL: CURRENTLY PROVIDED BY PHARMACIES

 

ABSTRACT

Objective: The aim of this review was to assess the current community pharmacy practice in Nepal.

Methods: Studies were identified through searches in Hinari, PubMed and Google scholars between the years 2010 to 2019.

Result: The study conducted at Pokhara reveals that about half of the community pharmacies were run by the non-pharmacist personnel. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. Similarly, study conducted at Bara and Parsa of Nepal showed that more than half of the antibiotic were dispensed without prescription. Research in Kathmandu valley showed that among the variabilities of services that a Community Pharmacy would convey Blood Pressure Measurement was seen as the most common one.

Conclusion: Overall, this review article concluded that there is noble initiation for providing quality of pharmaceutical services at the Nepalese Community Pharmacy despite of having strong policy. If the regulatory body become strong and handover the all the right to the pharmacist rather than orientation holder, this would ultimately lead to rational use of medication at the community level and patients get benefited.

Keywords: Nepal, Clinical pharmacy, Community Pharmacy, Health care, Pharmaceutical care, Pharmacy practice

INTRODUCTION

Community pharmacies are being recognized rapidly in many parts of the world as a source of professional medical advice.(1) It is a unique combination of service and business, where pharmaceuticals are sold (business), and information is provided about the use of medicines and the prevention and treatment of diseases (services). Community pharmacies are in most cases the first point of contact used by millions of people seeking health care every day. These community pharmacists could play a significant role in the self-management of minor illness by using over-the-counter (OTC) medicines, and hence improve the overall health of their communities(2).

In Nepal, “Community Pharmacy” is a professional term and often referred to as a medical shop or store (Aushadhi pashal) or a retail pharmacy and here the professional role of pharmacists is not well established. Moreover, people consider community pharmacists as chemists or medicine traders(3). Consumers' behavior in purchasing medicine from medical stores is similar to buying food items or general commodities from a grocery store. In developing countries like Nepal, the majority of people reside in rural areas where healthcare facilities are scarce. Thus, community pharmacies have become the most favored place for those seeking healthcare for general ailments(4), Furthermore, consultation is easier and cheaper. However, the problem is non-professionals, i.e., non-pharmacists, who operate community pharmacies, especially in rural areas. (5).

OBJECTIVE

-          To describe the current status of Nepalese community pharmacies and community pharmacist practice.

-          To discuss future directions for community pharmacy service development in Nepal that may lead to an enhanced primary care role in the context of the recent healthcare reforms.

METHODOLOGY

Studies were identified through searches in Hinari, PubMed and Google scholars using a combination of search terms, namely: ‘Nepal, Nepalese, community pharmacy, retail pharmacy, pharmacist, clinical pharmacy, pharmaceutical care, primary healthcare’. Articles were limited to those in English published between 2010 and 2019, and pertaining to Nepal. Additional articles were identified through the cross-referencing of articles and books.  Articles which reveals the ideas about the current practice of community pharmacy, were selected and reviewed.

RESULT AND DISCUSSION

A study conducted at Pokhara of western Nepal concerning pharmacy practice identified that close to a half the studied premises were operated by legally recognized pharmaceutical personnel, whereas the rest was run by people who didn't have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste  (6).

This shows that Community pharmacies in Pokhara offer a wide range of services but the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered, while lack of strong policy making agency may be another reasons.

The study conducted at two district of Nepal i.e. Bara and Parsa, among 161 community pharmacies, 25% were not registered and most of them were located in rural areas. It was typical (66.5%) to dispense antibiotics without prescription and most (91.4%) of the staffs involved in dispensing were non-pharmacists. Additionally, the study revealed common practices of replacing one brand of antibiotic with other brands (66%), dispensing incomplete courses of antibiotics (73%), and not giving any advice regarding antibiotic use (39%) or completion of a full course of therapy (80%).(5), which demonstrate the various components related to the irrational dispensing of antibiotics in the community.

Community Pharmacy Practice at three district of Katmandu Valley was conducted where the overall compliance with Good Pharmacy Practice indicators for Kathmandu, Bhaktapur and Lalitpur districts were found to be 12.81 (55.69%), 11.13 (48.39%) and 12.99 (56.48%). Among the variabilities of services that a Community Pharmacy would convey Blood Pressure Measurement was seen as the most common one. And the others services that pharmacies have provided were declining in the order of wound dressing, tetanus injection, Glucose detection and finally Rabies for all three districts. The 90% of Pharmacies of Lalitpur provide Blood pressure measurement service, while 80% of Kathmandu and 78% of Bhaktapur. Lalitpur district was superior on additional pharmacy service as depicted in the graph except for wound dressing service which was lead by Bhaktapur district with 83%(7). Overall, it shows that all districts glumly failed to comply with the standards set by GPP. Pharmacies seemed to profit oriented rather than providing quality of health services.

The survey conducted at community pharmacy of Kathmandu valley revealed the availability of the essential medicines was not 100%. High competition and high price variation were seen in medication like metformin 500 mg (254.6%) and atorvastatin 10 mg (327.6%). The study showed that maximum (54.7%) brands were manufactured in Nepal. (8)This overall suggest that pharmacies were not concern about the rational use of medication by providing essential medicine at affordable price.

CONCLUSION

Overall, this review article concluded that there is noble initiation for providing quality of pharmaceutical services at the Nepalese Community Pharmacy despite of strong policy and lack of competency among the pharmacist. If the regulatory body become strong and handover the all the right to the pharmacist rather than orientation holder, this would ultimately lead to rational use of medication at the community level and patients get benefited. This may uplift the respect to the pharmacy profession more than the word “medicine dispenser”.

REFERENCES

1.         Fang Y, Yang S, Zhou S, Jiang M, Liu J. Community pharmacy practice in China: past, present and future. International Journal of Clinical Pharmacy. 2013;35(4):520-8.

2.         Saini R, Rai A. Text Book of Community Pharmacy. New Delhi (India): New Age International. 2012.

3.         Bhuvan K, Alrasheedy AA, Ibrahim MIM. Do community pharmacists in Nepal have a role in adverse drug reaction reporting systems? The Australasian medical journal. 2013;6(2):100.

4.         Miller R, Goodman C. Performance of retail pharmacies in low-and middle-income Asian settings: a systematic review. Health policy and planning. 2016;31(7):940-53.

5.         Ansari M. Evaluation of community pharmacies regarding dispensing practices of antibiotics in two districts of central Nepal. PloS one. 2017;12(9):e0183907.

6.         Gyawali S, Rathore DS, Adhikari K, Shankar PR, KC VK, Basnet S. Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal. BMC health services research. 2014;14(1):190.

7.         Shrestha R, Ghale A. Study of good pharmacy practice in community pharmacy of three districts of Kathmandu valley, Nepal. International Journal. 2018;4(10):240.

8.         Shrestha R, Ghale A, Chapagain BR, Gyawali M, Acharya T. Survey on the availability, price and affordability of selected essential medicines for non-communicable diseases in community pharmacies of Kathmandu valley. SAGE open medicine. 2017;5:2050312117738691.