View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Clinical Pharmacy Group: Social Pharmacy Division of Pharmacology and Pharmacotherapy Faculty of Pharmacy University of Helsinki Public Health and Patient Care Aspects in Pharmacy Education and Pharmacists’ Role in National Public Health Programs in India Siva Prasada Reddy Maddirala Venkata ACADEMIC DISSERTATION To be presented, with the permission of the Faculty of Pharmacy of the University of Helsinki, for public examination in Auditorium Athena, Siltavuorenpenger 3 A, on Friday 19 May 2017, at 12 noon. Helsinki 2017 Supervisors Professor Marja Airaksinen, PhD Clinical Pharmacy Group: Social Pharmacy Division of Pharmacology and Pharmacotherapy Faculty of Pharmacy, University of Helsinki Helsinki, Finland Proprietor Pharmacist Peter Kielgast, PhD Taastrup Pharmacy Taastrup Hovedgade 60 2630 Taastrup, Denmark Pre-examiners Professor B. Suresh Vice-Chancellor, Jagadguru Sri Shivarathreeshwara University and President, Pharmacy Council of India JSS Medical Institutions Campus Sri Shivarathreeshwara Nagara Mysuru – 570 015, Karnataka, India Dr. T. V. Narayana Director, Vikas Institute of Pharmaceutical Sciences Nidigatla village, Korukonda Mandal, Near Airport Rajahmundry, East Godavari Dist Andhra Pradesh – 533103, India Opponent Fernando Fernandez-Llimos, Ph.D., PharmD., M.B.A. Assistant Professor, Department of Social Pharmacy University of Lisbon, Portugal © Siva Prasada Reddy Maddirala Venkata 2017 ISBN 978-951-51-3169-0 (paperback) ISBN 978-951-51-3170-6 (PDF) Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis ISSN 2342-3161 (print) ISSN 2342-317x (online) University of Helsinki, Finland 2017 ABSTRACT Pharmacies are convenient for most people to get to and there is no need for an appointment to see pharmacist which makes them natural first port of call1 healthcare providers in the society. Worldwide, pharmacists are potentially a vital link in healthcare chain. Since public health services do not cater to all the population, pharmacies and private health providers can play a major role in the healthcare system. This also applies to India with a population of over 1.3 billion. Though there is a large presence, pharmacists both in public as well as in private sector remain largely an untapped resource in India.2,3,4 Aims and objectives The objective of this study was to assess public health and patient care aspects in pharmacy education and the role of pharmacists in national public health programs (NPHPs) in India. The research goal was to find out possibilities and ways of extending pharmacists involvement in national public health programs and how pharmacist education could partly facilitate this shift. The research was divided into four studies which were published as separate original publications. Two of the studies were programmatic studies (I, II) and two cross-sectional surveys (III, IV). The studies I-IV had the following specific objectives: to review pharmacy education system in India from public health and patient care perspective. to compare curriculum of different Indian pharmacy programs (DPharm, BPharm, and PharmD) to see overall differences with a focus on the amount of time devoted for pharmaceutical policies and public health, patient care and pharmacy practice aspects in the programs (I). to compare Indian pharmacy curriculum at all levels with pharmacy curriculum of USA, Finland and Denmark (II). 3 to explore acquaintance of final year pharmacy students with 11 major National Public Health Programs and their attitude on pharmacists’ involvement in public health and patient care (III). to characterize physician perceptions on the role of pharmacists in public health and patient care (IV). Comparison of curricula (I,II) The programmatic studies (I, II) were conducted between March 2012 and 2014. The curricula collected from the statutory agencies were used for the comparison to see the overall differences with a focus on the amount of time devoted for pharmaceutical policies and public health, patient care and pharmacy practice aspects in the programs. (I) Syllabi of courses leading to 1) registered pharmacist title in India (DPharm, BPharm and PharmD), 2) USA (PharmD, curriculum from University of Florida), 3) Finland (Master of Science in Pharmacy program from University of Helsinki), and 4) Denmark (Master of Science in Pharmacy program from University of Copenhagen) were used for comparison. (II) The results indicate that Indian DPharm and BPharm programs were industry focused, and only PharmD has focus on clinical pharmacy and patient oriented services (I). Indian and US PharmD programs contain most and Indian DPharm and BPharm least public health and patient care aspects (II). DPharm holders are mainstays of pharmacy practice in India but their degree least contains patient care and public health aspects. There is a gap in curriculum, particularly at DPharm level. (I) Pharmacy Students’ Perceived Knowledge and Attitude on their role in NPHPs (III) This study was conducted as a classroom survey among final year DPharm, BPharm and PharmD students in India to explore acquaintance with 11 major NPHPs and their attitude on pharmacists’ involvement in public health and patient care (III). A survey instrument was 4 prepared and distributed in a classroom survey to 326 students from 5 randomly selected pharmacy colleges from Southern part of India. (III) Students had positive attitudes on pharmacists’ involvement in NPHPs, although their attitudes varied in different student groups, PharmD and DPharm students being most positive towards involvement in NPHPs (III). The study also revealed the need for increasing contents supporting NPHPs to all pharmacy programs, particularly to BPharm program. Physician perceptions on the role of pharmacists in NPHPs (IV) A cross-sectional survey was designed to a convenience sample of physicians in Southern part of India. This small-scale pilot study was designed to develop a method for characterizing physicians’ perceptions on the role of pharmacists in public health and patient care in India. Six volunteers visited 800 physicians in Southern region in India and collected data in 2014. Survey instrument consisted of 28 structured questions based on NPHPs. The data were collated and extracted and descriptive statistical analysis was conducted by SAS (version 9.3). (IV) Among 129 responding physicians, 98% were comfortable with pharmacists’ roles in general, 96% comfortable to collaborate and 82% regarded pharmacists as part of health care team (IV). Physicians with shorter professional practice experience were more positive on pharmacists’ involvement in NPHPs than physicians having at least 11 years’ experience. Overall response of accepting pharmacists’ role and involvement in NPHPs was positive, Pulse Polio, HIV/AIDS, Tuberculosis and Tobacco control, and Leprosy eradication programs being the top NPHPs where physicians perceived pharmacists had a role to play. Conclusions and recommendations Upcoming PharmD graduates with 6 years education (training initiated in 2008) focused mainly towards clinical and patient care aspects should be able to change collaborative practice models and pharmacists’ involvement in patient care and NPHPs. It also would be useful to have an alternative curriculum line focusing on patient care and pharmacy practice aspects in 5 Indian DPharm and BPharm programs. Practicing pharmacists would benefit from easily accessible continuing education to cover their knowledge gaps in patient care and enhance their contributions to NPHPs. This study is first of its kind to evaluate pharmacy curriculum contents in India from patient care and public health perspective. It will be helpful to statutory authorities and curriculum reform committees in India and other countries where pharmacists’ role is continuing to evolve towards inclusion of public health and patient care. Further research with a scope of detailed national level analysis to identity pharmacists’ potential in NPHPs is needed. 6 ACKNOWLEDGEMENTS My dream with this study started long time ago while I was working for Forum of WHO-FIP´s South East Asian Pharmaceutical Associations. During my work, I was always keen to work on “Why pharmacists in India are not seen as important health care professionals to implement NPHPs?” and I wanted to continue working on this question. When I started discussing with my dearest supervisor Professor Marja Airaksinen about it, she was very much positive that this project would be helpful for the pharmacy profession in India and encouraged me to develop a research protocol. During the lsat years, this research work took me to different phases where I learnt pharmacy education systems in different parts of the world, communicated with students, volunteers and physicians in various cities in India and abroad. I owe my deepest gratitude to all the professors, students, physicians, and volunteers, who came forward to take their time. I am sure without their support it would not have been possible to complete this thesis. I’m utmost grateful to my main supervisor, Professor Marja Airaksinen. Thank you very much, Marja mam, for all your encouragement, support and guidance. I bow my head to you Marja mam for all your efforts to help me in completing the studies and all those countless hours that you spent on me after your long working days at the University to accommodate my work and guide