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Current status of pharmacies and qualications of
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Krishnaveni Marupudi
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Master's eses and Doctoral Dissertations
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Current Status of Pharmacies and Qualifications of Pharmacists in
Community Pharmacies of India
by
Krishnaveni Marupudi
Thesis
Submitted to the Department of Clinical Research Administration
Eastern Michigan University
in partial fulfillment of the requirements
for the degree of
MASTER OF SCIENCE
in
Clinical Research Administration
Thesis Committee:
Irwin Martin, Ph.D, Chair
Stephen Sonstein, Ph.D.
May 13, 2016
Ypsilanti, Michigan
i
Acknowledgments
I would like to acknowledge Raghavendra Rao Prasad Myneni, Associate Director of the Guntur
Medical Stores Association, for his immense cooperation during the survey distribution process.
ii
Abstract
India is a developing nation and has progressive health care facilities. An important part of its
health care system is the community pharmacy, where registered pharmacists provide
pharmaceutical services to the public. Community pharmacy is the first place the public looks for
drug-related information and medication counseling. The main objective of this study was to
investigate the current status of pharmacies and the impact of the Pharm D program (professional
pharmacy doctoral program) on the qualifications of pharmacists in India. This research
specifically addressed the fate of community pharmacies after the implementation of this
program. This research was conducted in the form of a cross-sectional survey in the Guntur
district, Andhra Pradesh state, India. The sample included representative pharmacies in the
district covering urban and rural areas. Earlier, the majority of pharmacies had non-pharmacists
dispensing or counseling patients. Though Pharm D graduates were found to be dispensing
medications in pharmacies, there was only minimal progress. It is recommended that the
Government of India should make the Pharm D mandatory for a dispensing pharmacist to
improve patient care.
iii
Table of Contents
Acknowledgments......................................................................................................................... ii
Abstract………………………………………………………………………………………….iii
Chapter 1: Introduction…………………………………………………………………………..1
Pharmacy Practice in India........................................................................................................3
Pharm D Degree and Its Impact in Pharmacy...........................................................................4
Additional Activities in the Pharm D Degree............................................................................5
Background to Research............................................................................................................6
Dispensing Practices in India....................................................................................................7
Purpose of the Research............................................................................................................8
Research Question....................................................................................................................8
Chapter 2: Research Design and Methodology ............................................................................ 9
Chapter 3: Results ....................................................................................................................... 10
Chapter 4: Discussion ................................................................................................................. 17
Chapter 5: Conclusion................................................................................................................. 20
References ................................................................................................................................... 21
Appendix A: Letter from the Association. .................................................................................. 25
Appendix B: Sample Survey Form ............................................................................................. 26
iv
Appendix C: Approval Letter from the EMU Human Subject Review Committee ................... 28
Appendix D: Comments from the Survey .................................................................................. 29
List of Tables
Table Page
1. Requirements for Registration as a Pharmacist India and USA ....................................... 2
2. Survey Questionnaire Analysis ....................................................................................... 10
3. Cross Tabulation Results by Location of Pharmacy ....................................................... 12
4. Cross Tabulation Results by Type of Pharmacy ............................................................. 13
5. Cross Tabulation Results by the Person Completing the Survey ................................... 14
6. Cross Tabulation Results of Pharm D Degree Impact on Hiring New Employees ........ 15
1
Introduction
Pharmacy is the science or practice of preparing and dispensing medical drugs. Notably,
pharmacy as a profession is rather a modern invention. Earlier traditional healers would
diagnose, treat, and dispense medications, but later apothecaries were established in the 12
th
century, which solely dispensed various types of medicines. The first pharmacy colleges to
provide formal pharmacy training appeared only in the eighteenth Century in Paris and they
paved the way for specialized pharmacy education (Desale, 2013).
In India, pharmacy education in its current form was initiated in 1932 at Banaras Hindu
University. The Pharmacy Act was passed in 1948 and the Pharmacy Council of India (PCI) was
established in 1949. With the strong recommendations of various Drugs Enquiry Committees to
control the practice of pharmacy, the Government of India introduced various training programs
for registration as a pharmacist and to procure a license (Singh & Chopra, 2008). Several degree
courses were therefore introduced which included a Diploma in Pharmacy (D. Pharm), Bachelor
of Pharmacy (B. Pharm), Master of Pharmacy (M. Pharm), Doctor of Pharmacy (Pharm D), and
a Doctor of Philosophy in pharmacy (Ph.D.); (Desale, 2013). After completing a pharmacy
degree, an individual could procure a license to establish a pharmacy outlet to practice pharmacy.
Community pharmacy is a type of pharmacy practice or health care system which
emphasizes providing medical services in a particular community. Community pharmacists are
responsible for dispensing and counseling according to patients medicine-related needs and
providing basic access to health care. The prime source of medicines for both hospitalized and
ambulatory patients is either the retail or community pharmacies. Unlike the earlier days, the
medicines that are available in community pharmacy are manufactured by the pharmaceutical
industry and are available through distributors or agents (Mossialos et al., 2015). Community
2
pharmacies are often the first and the only available source of inexpensive health care in India
(Kamat & Nichter, 1998; Goel, Ross-Degnan, Berman & Soumerai, 1996).
The eligibility requirements to practice as a clinical pharmacist vary by different
countries. Table 1 provides a brief description of the requirements for registration as a
pharmacist in India and the US.
Table 1
Requirements for Registration as a Pharmacist in India and USA
Country
Academic
Qualification
Duration of Course +
Internship/Residency
Regulatory
Authority
Additional
Requirements
to Practice
Pharmacy
India
Diploma in Pharmacy
Bachelor of Pharmacy
Pharm D
2 Years 3 months
4 Years 3 months
6 Year
Pharmacy
Council of
India
N/A
USA
Pharm D 4+ 2 Year
National
Association of
Boards of
Pharmacy or
State Boards of
Pharmacy
NAPLEX
(North
American
Pharmacist
Licensure
Examination )
+ MPJE
(Multistate
Pharmacy
Jurisprudence
Examination)
Source: Revikumar and Veena (2014).
However, in India, the community pharmacist is restricted to only supplying medicines.
Patient-oriented services are not in complete effect and only a few community pharmacists offer
them. The rising need for a community pharmacy system demanded a dedicated community
pharmacy professional, which led to the introduction of Doctor of Pharmacy (Pharm D) course,
which is a professional doctoral degree in pharmacy (Desale, 2013). Though the course was
started in the University of Southern California in 1950 as a six-year program, it has spread
3
across the world (Sonnedecker, 1976). The duration of the program varies from country to
country. The Pharm D program aims to train individuals to improve the quality of medication use
and enhance the safety of drug administration. Ward rounds, clinical postings, and residency are
the core components of the Pharm D program. These all help the students to become accustom to
the hospital environment and give an introduction to evidence-based therapy. The Pharm D
students have the opportunity of maintaining close relationships with health care providers such
as physicians and nutritionists and apply this knowledge in maintaining patient health
(Revikumar & Veena, 2014).
Pharmacy Practice in India
India has over a million registered clinical pharmacists of which currently 55% are in
community pharmacies, 20% in the hospital sector, 10% in industrial drug development, 2% in
academics, and the remaining in retail pharmacies (Ahmad & Patel, 2013). In 1937, the four-year
Bachelor of Pharmacy course was introduced in India that provided only industry-oriented
training, and clinical pharmacy practice was not discussed in detail. Most of the curriculum
concentrated on organic, inorganic, medicinal, and analytical chemistry. The rest of the
curriculum concentrated on drug manufacturing, development, and mechanism of action (Basak
& Sathyanarayana, 2010). A two-year diploma (D. Pharm) in the pharmaceutical sciences with
three months of practical training is the minimum requirement for awarding a license in
pharmacy. The current course curriculum for the D. Pharm at present was developed in 1991.
Health care policies, patient counseling methodologies, patient care, and engagement are not
covered in the curriculum (Basak & Sathyanarayana, 2010). Currently in India, these diploma-
trained pharmacists constitute the majority of the pharmacist workforce. Both of these programs
have a curriculum designed so that it is industry-oriented with an overemphasis on basic general
4
sciences and less coursework related to patient care and safe dispensing procedures. The majority
of the graduates of these programs choose to seek positions in the pharmaceutical industry or
drug regulatory agencies rather than practicing as a community pharmacist. These deficiencies of
the above-mentioned degrees are significantly improved with the introduction of Pharm D
(Basak & Sathyanarayana, 2010).
The Pharmacy Council of India (PCI) is the regulatory body responsible for managing
pharmacy profession and education. The PCI is constantly working hard to improve the
standards of the pharmacy curriculum in order to produce highly competitive and talented
professionals (Desale, 2013).
Pharm D Degree and Its Impact in Pharmacy
The government of India along with the Pharmacy Council of India introduced the
Doctor of Pharmacy (Pharm D) in 2008 (Garipelly, Garg, & Maleti, 2012). Currently, there are
approximately 47 institutions offering Pharm D degrees in India and more colleges are yet to be
approved (Basak & Sathyanarayana, 2010). This degree was mainly aimed at providing better
clinical services in the Indian health care system. This six-year program has extensive classroom-
based training for the first five years followed by an internship or residency for the last year. The
main objective behind the establishment of the degree was to raise the standards of pharmacy
practice in India in terms of drug safety, patient care, and also to make the pharmacy degree
acceptable in various countries across the world. It also aimed to provide improved patient care
in cooperation with prescribers and other health care professionals based on their knowledge of
therapeutics and evidence-based data. The issues that are relevant to the legal, ethical, social,
economic, professional, pharmaceutical, and clinical sciences that may have an impact on the
therapeutic outcomes are also taken into consideration while framing the contents of Pharm D
5
degree. Instead of establishing new policies which are, in fact, quite similar to the curriculum
already in place, the focus should be placed on evaluating the existent curriculum as well as on
the creation of an adequate number of jobs for the graduates from hundreds of pharmacy schools
all over India (Garipelly, Garg, & Mateti, 2012).
Additional Activities in the Pharm D Degree
Similar to the Bachelors of Pharmacy, the Pharm D degree includes the basics of drug
manufacturing, pharmacology, and medicinal chemistry, but in addition, the Pharm D graduates
also have an excellent opportunity to work alongside doctors, interact directly with patients, and
have an additional clinical exposure similar to the curriculum that is being followed in the United
States. In addition, it still has the chemistry-focused subjects covered. This also includes more
interaction with patients as well as improved inter-professional collaboration between health care
departments. Almost all aspects of patient care are covered in the curriculum. Pharmacists with
Pharm D qualifications are specially trained in the expanded curriculum, which has included all
the aspects which were not covered in previous degree courses (Mateti, Rajesh, Laddha, Sharma,
& Anantha, 2011).
Pharm D professionals review the medical history of patients to help design further
treatment plans. They participate in ward rounds with physicians and attend hospital meetings.
They provide patient medication counseling in which they assist patients by answering drug-
related queries and providing clinical information. They work together with physicians to
identify and minimize the risk of adverse drug reactions. Pharm D graduates also perform
community service in hospitals and work towards the enforcement of local pharmacy guidelines
(Deshpande, Farooq, John, & Rao, 2012).
6
In a study conducted by Srikanth, Ahmad, Reddy, Balkrishnan, and Nagappa (2013)
among students enrolled in the Pharm D program in different Indian pharmacy institutes, 96% of
the students were of the belief that more clinical skills could be acquired with a Pharm D when
compared to conventional degrees such as B. Pharm or M. Pharm. In another survey study
conducted by Ahmad and Patel (2013), nearly 65% of the students believed that if medications
were prescribed by Pharm D graduates along with physicians, the process of prescribing could be
made safer and beneficial for patients.
Background to Research
In developing countries such as India, community pharmacies play a very important role
in patient safety and wellbeing (Sabde et al., 2011). Moreover, in rural areas, community
pharmacies are the first and only reliable sources of medicines in the absence of primary health
care centers. Many drugs may be purchased without a doctor's prescription even for some of the
major diseases at community pharmacies (WHO, 1997). Thus, pharmacists play a crucial role in
patient care, especially to the poor and rural populations. Many of these patients try to avoid
doctor visits and instead consult a pharmacist for medications as a way of obtaining inexpensive
and affordable health care (Kamat & Nichter, 1998).
In India, many important barriers exist in providing pharmaceutical care for patients. One
of the major issues is related to the deficiencies in the pharmacist's education, training, and
qualifications. The other contributing factors that affect the quality of community pharmacies are
the weakness in the regulatory framework and the lack of proper recognition of the post of
clinical pharmacists by the other health care professionals in the society (Basak & Mil, 2009).
7
There is very little information describing the current status of pharmacies and the impact
of the Pharm D program on the qualifications of the pharmacist in community pharmacies of
India. Since the pharmacist’s education and qualifications are very important in several aspects
of improving health care for the benefit of the community, this research focuses on the impact of
the Pharm D degree on the practice of pharmacy.
Dispensing Practices in India
A study conducted in 2010 on "evaluating medicines dispensing patterns in Tamil Nadu,
Southern India" reported that in the majority of the drug stores, medications were dispensed by
less-qualified or even non-qualified personnel compared to other developed countries (Basak &
Sathyanarayana, 2010). Another study conducted in Kerala, India, which surveyed 53
pharmacies, found that only 10% who were involved in dispensing drugs were B. Pharm
graduates (Kiron et al., 2012). Sabde et al. (2011) surveyed 475 pharmacies in Central India and
reported that only ~12% of staff had professionally qualified pharmacist licenses. Kamat and
Nichter (1996) conducted a study in Mumbai, India to evaluate qualifications of dispensing
personnel and found that only 41% were B. Pharm graduates out of 75 pharmacies surveyed.
Thus, community pharmacists were present only in relatively few pharmacies and more than half
of pharmacies function without pharmacists. Rural parts are of critical importance in developing
countries, especially India where 72.2% of the population resides and there is frequent shortage
of primary care physicians and pharmaceutical care services. There is a need for expansion of
pharmacy practice, especially in rural areas where the community pharmacy system is usually
weak.
8
Purpose of the Research
The research investigated the current status of pharmacies and the impact of the Pharm D
program on the qualifications of pharmacists in India. The research focused on the impact of the
Pharm D program on the qualifications of the pharmacist by comparing community pharmacies
in rural and urban areas of Southern India.
Research Questions
a) What is the qualification of the person dispensing prescriptions in different types of
community pharmacies after implementation of the Pharm D program?
b) What proportion of dispensing pharmacists in community pharmacies hold the Pharm
D in rural areas versus urban areas?
9
Research Design and Methodology
Target Population
The target population for this study included pharmacy owners and managers who were
working in community pharmacies.
Sample Population
The sample population for this study included 493 pharmacies.
Method of Data Collection
The research survey was conducted in an online format. This online survey was shared
with Guntur Medical Stores Association, a local pharmacy organization that represents all the
community pharmacies in the district (Appendix A).The survey was distributed by the
association to the potential participants through email, which was sent to 493 pharmacies in the
district covering both rural, suburban, and urban areas. The questionnaire included ten questions
(Appendix B). Information collected included qualifications of the person dispensing
prescriptions or counseling patients before and after 2013, opinion and impact on business after
the introduction of the Pharm D program, and location of the pharmacy. The survey
questionnaire was designed using Google forms survey software. IRB approval was obtained
from the Eastern Michigan University Human Subjects Review Committee (UHSRC). The
approval letter can be found in Appendix C. After completing the ten survey questions, the
responses were recorded when the participants completed and submitted the questionnaire.
Changes in the qualifications of the person dispensing drugs before and after the introduction of
the Pharm D program were explored. Associations between qualitative responses were evaluated
and analyzed using Fisher's exact test and the chi-square test of independence.
10
Results
Analysis and Presentation of Data
The survey was sent to 493 pharmacies of which 388 (78.7%) participated and responded
to the survey. Summaries of the responses are presented in Table 2.
Table 2
Survey Questionnaire Analysis
Q1 1) Prior to 2013 who dispensed prescriptions in your
pharmacy?
Total
responses
% response
a Non-pharmacist 165 42.5%
b Pharmacist with a Bachelors in Pharmacy 213 54.9%
c Pharmacist with a Masters in Pharmacy 10 2.6%
d Pharmacist with a Pharm D degree 0 0.0%
TOTAL
388
Q2 2) Prior to 2013, who primarily answered the patient's
questions or counseled patients?
a Non-pharmacist 166 42.8%
b Pharmacist with a Bachelors in Pharmacy 212 54.6%
c Pharmacist with a Masters in Pharmacy 10 2.6%
d Pharmacist with a Pharm D degree 0 0.0%
TOTAL
388
Q3 3) Currently, who dispenses prescriptions at your
pharmacy?
a Non-pharmacist 163 42.0%
b Pharmacist with a Bachelors in Pharmacy 189 48.7%
c Pharmacist with a Masters in Pharmacy 10 2.6%
d Pharmacist with a Pharm D degree 26 6.7%
TOTAL
388
Q4 4) Currently, who answers patients' questions or
counsels patients in your pharmacy?
a Non-pharmacist 163 42.1%
b Pharmacist with a Bachelors in Pharmacy 188 48.6%
c Pharmacist with a Masters in Pharmacy 10 2.6%
d Pharmacist with a Pharm D degree 26 6.7%
TOTAL
387
11
Table 2 (continued)
The tenth question was open ended to provide respondents an opportunity to include
comments about the recent introduction of the Pharm D. The respondents who commented
giving significant reasons about their opinion of the Pharm D degree were included in Appendix
D only. Others just had no specific reasons supporting their opinion in the comments.
Q5 5) In your opinion, the introduction of the Pharm D
program requirements is
a Good idea 343 88.6%
d Bad idea 21 5.4%
c I have no opinion on the matter 23 5.9%
TOTAL
387
Q6 6) How has the Pharm D program impacted your
employees?
a I have been required to hire new employees 31 8.1%
b I have had to dismiss one or more employees 2 0.5%
c I have not had to change any personnel because of the
program requirements
349 91.4%
TOTAL
382
Q7 7) Location of pharmacy
a Urban 341 87.9%
b Suburban 16 4.1%
c Rural 31 8.0%
TOTAL
388
Q8
8) Type of pharmacy
a Independent pharmacy 153 39.4%
b Wholesale 12 3.1%
c Attached to health care facility 21 5.4%
d Retail chain 202 52.1%
TOTAL
388
Q9
9) Who is completing the survey
a Owner or store manager 280 72.2%
b Staff pharmacist 106 27.3%
c Other pharmacy employees 2 0.5%
TOTAL
388
12
Before 2013, there were no Pharm D graduates present in community pharmacies.
However, with the introduction of Pharm D after 2013, 26 (6.7%) of the responding pharmacies
had Pharm D graduates dispensing medications and counseling. Cross-tabulations were done for
the dispensing pharmacists with Pharm D degree and non-Pharm D degree pharmacists by
location of the pharmacy and the results are presented in Table 3.
Table 3
Cross Tabulation Results by Location of Pharmacy
Using the Fisher's exact test (Agresti, 1992), a comparison was made between the
proportion of pharmacists with a Pharm D degree and non-Pharm D pharmacists in suburban and
rural areas versus urban areas. In urban areas, only 0.6%of the pharmacies dispensed drugs by
Pharm D graduates, while for suburban and rural areas 51.1% of the pharmacies dispensed drugs
by Pharm D pharmacists. The one-tailed p value is 0.000 indicating that there is a statistically
significantly higher proportion of dispensing Pharm Ds in suburban and rural areas than urban
areas. Thus, a difference exists between the educational level of pharmacist and location.
Currently, who dispenses
prescriptions at your
pharmacy?
Total
Pharmacist
with non-
Pharm D
degree
Pharmacist
with Pharm D
degree
Urban Count
339 2 341
% within Location of pharmacy
99.4% 0.6% 100.0%
Suburban
+ Rural
Count
23 24 47
% within Location of pharmacy
48.9% 51.1% 100.0%
Total Count
362 26 388
% within Location of
pharmacy
93.3% 6.7% 100.0%
13
Cross tabulations were done for the pharmacists with Pharm D degree and non-Pharm D
degree pharmacists with respect to type of the pharmacy and the results are presented in Table 4.
Table 4
Cross Tabulation Results by Type of Pharmacy
The percentage of non-Pharm D pharmacists dispensing prescriptions decreased from
100% for independent pharmacies and wholesale/attached to health care facility to 87.1% for
retail chain pharmacies. All of the Pharm D graduates were present only in retail chain
pharmacies and none of them in either health care attached, independent, or wholesale
pharmacies. The chi-square test of independence was used to find out the educational level of
Pharm D and non-Pharm D pharmacists vary by type of pharmacy. A chi-square value of 25.66
was obtained with two degrees of freedom with a p value of 0.000. Thus, we can conclude that
Currently, who dispenses
prescriptions at your
pharmacy?
Total
Pharmacist
with non-
Pharm D
degree
Pharmacist
with Pharm D
degree
Type of
Pharmacy
Independent
Pharmacy
Count
153 0 153
% within Type of
Pharmacy
100.0% 0.0% 100.0%
Wholesale +
Attached to Health
care Facility
Count
33 0 33
% within Type of
Pharmacy
100.0% 0.0% 100.0%
Retail Chain Count
176 26 202
% within Type of
Pharmacy
87.1% 12.9% 100.0%
Total Count
362 26 388
% within Type of
Pharmacy
93.3% 6.7% 100.0%
14
there is a statistically significant relationship between educational level of pharmacist and type of
pharmacy.
Cross tabulations were done for the person completing the survey and their opinion about
the introduction of Pharm D program. The results are presented in Table 5.
Table 5
Cross Tabulation Results by the Person Completing the Survey
In your opinion, the
introduction of the Pharm D
program requirements is
Total
Good
idea
Bad
idea
I have no
opinion
on the
matter
Who is
completing the
survey
Owner or
store manager
Count
243 15 22 280
% within
Who is
completing
the survey
86.8% 5.4% 7.9% 100.0%
Staff
pharmacist or
other
pharmacy
employee
Count
100 6 1 107
% within
Who is
completing
the survey
93.5% 5.6% 0.9% 100.0%
Total Count
343 21 23 387
% within
Who is
completing
the survey
88.6% 5.4% 5.9% 100.0%
The table shows that 86.8% of owners or store managers versus 93.5% of staff
pharmacists or other pharmacy employees think that it is a good idea to introduce the Pharm D
degree. For the test of independence, a chi-square value of 6.64 was obtained with two degrees
of freedom and a p value is 0.036. This indicates that the opinion about the introduction of the
15
Pharm D degree does significantly differ between owners or store managers and staff
pharmacists or other pharmacy employees.
Cross tabulations were done for the person completing the survey with respect to the
Pharm D degree's impact on hiring new employees and the results are presented in Table 6.
Table 6
Cross Tabulation Results of Pharm D Degree Impact on Hiring New Employees
How has the Pharm D program
impacted your employees?
Total
I have
been
required
to hire
new
employees
I have had
to dismiss
one or
more
employees
I have not
had to
change any
personnel
because of
the program
requirement
Who is
completing
the survey
Owner or
store
manager
Count
30 2 242 274
% within
Who is
completing
the survey
10.9% 0.7% 88.3% 100.0%
Staff
pharmacist/
Other
pharmacy
employee
Count
1 0 107 108
% within
Who is
completing
the survey
0.9% 0.0% 99.1% 100.0%
Total Count
31 2 349 382
% within
Who is
completing
the survey
8.1% 0.5% 91.4% 100.0%
16
The table shows that 88.3% of owners or store managers compared with 99.1% of staff
pharmacists stated that there was no need to change any personnel after the introduction of
Pharm D degree. For the test of independence, a chi-square value of 11.36 was obtained with two
degrees of freedom and a p value is 0.003. Thus, the opinion concerning the impact of the Pharm
D program on hiring new employees differs significantly according to the person completing the
survey.
All the other possible cross tabulations were also tested for significance, but none of them
were significant. The last question asked respondents to include comments about the introduction
of the Pharm D program; 195 of the respondents gave comments to the question. Out of 195
comments, the respondents were either of the opinions that it was a good idea to introduce Pharm
D or that it was a bad idea. The significant reasons for believing it is an unnecessary degree
according to some respondents included fees too costly, a lengthy six-year degree program, and
also not improved curriculum. One interesting comment was that the degree was just introduced
to give Pharm D graduates foreign eligibility but not useful in India. Those who responded that it
was a good idea commented that the degree would make an impact in rural areas but only offered
in few colleges. Others just had no specific reasons supporting their opinion about the degree but
only commented that it was either good or bad (Appendix D).
17
Discussion
The qualification of the pharmacist plays a very major role in terms of patient safety and
wellbeing as they are medication experts; patient safety is at risk if the position of pharmacist is
occupied by non-qualified personnel. When the qualification of the person dispensing
prescriptions before and after Pharm D program was examined, it was found that the non-
pharmacists remained consistent but B. Pharm pharmacists decreased in number. Of Pharm D
graduates, 26 (6.7%) were first found dispensing medications after 2013 among the surveyed
pharmacies. Therefore, it is understood that even though the pharmacy owners started hiring
Pharm D graduates in place of B. Pharm pharmacists, non-pharmacists were not removed from
the stores and instead, their number remained unchanged. The factors taken into consideration by
the pharmacy managers to keep the non-pharmacist numbers constant were not evaluated by this
survey. Possibly, economic costs of the non-pharmacist were exploited by the pharmacy owners.
However, the M. Pharm pharmacists who were dispensing prescriptions remained constant even
after the Pharm D program, and all of them were in urban areas. Thus, those particular
pharmacies continued dispensing with higher qualified M. Pharm pharmacists and were
apparently unaffected by the Pharm D program.
The majority of the Pharm D graduates found dispensing prescriptions in the pharmacies
were present in rural areas (77.4%). This finding suggests that Pharm D graduates were more
inclined to work in rural areas as there might be more opportunities for career growth in rural
areas where there is always a significant shortage of primary care physicians. According to
Ahmad, Patel, Khan, & Chang (2014), Pharm D graduates can serve as valuable assets in non-
urban areas through safer prescribing and dispensing practices in the absence of primary care
providers. But this study was conducted in only one district of the Andhra Pradesh state, and the
18
location of Pharm D graduates employment in other places is unknown and the results cannot be
easily extrapolated to the rest of India. The majority of the 88.3% of owners or store managers
along with 99.1% of staff pharmacists stated that there was no need to change any personnel
after the introduction of Pharm D degree. This implies that most of them were of the opinion that
their hiring practices remains unaffected even after Pharm D degree implementation.
All of the Pharm D graduates worked in retail pharmacies rather than independent or
health care attached pharmacies. The survey showed that 12.2% of the retail pharmacies
responded that they have been required to hire new employees. This implies that retail
pharmacies may be more inclined to hire Pharm D graduates, although the reason for this hiring
is unclear. There were mixed opinions in the comments section about the introduction of the
Pharm D degree. Some of them were viewing the degree as a bad idea and not necessary,
whereas the rest of them were of the opinion that it was a good program. From this, we can
understand that there are mixed reviews and not everyone had a good opinion about the Pharm D
degree.
Even though 86.8% of the pharmacy managers agreed that the Pharm D program is a
good idea, whether they believe that the higher education requirement makes a better pharmacist
is yet to be determined. Whether the expectations of the Pharm D program will impact the
pharmacy owners’ hiring practices in the future will need to be examined. If the Pharm D
program was to be made a requirement in pharmacies by the Government of India, the
perceptions of the owners or store managers about this requirement should also be evaluated.
Whether this mandate is expected should also be investigated. The employment rates for Pharm
D graduates after degree completion should also be surveyed to evaluate the impact of the
program. It is uncertain whether the Pharm D hiring numbers will increase in the coming years
19
as this is the only beginning of the program implementation. The Government of India
implemented the new Pharm D program but did not make a regulation that only Pharm D
qualified graduates should dispense medications. Without such a mandate, the impact of the
Pharm D degree and its presumed positive benefit for patients may take a significant period of
time.
20
Conclusion
The qualifications of the person dispensing prescriptions after Pharm D degree
implementation was tested, and it was found that there is only a minimum progress after two
years. Even though Pharm D graduates were dispensing prescriptions in community pharmacies,
in the region surveyed they were limited in number, but they showed a strong presence in rural
areas. Furthermore, Pharm Ds are most quickly being added to rural chain store pharmacies.
21
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Appe
n
dix A: Le
t
t
ter from t
h
h
e Associati
o
o
n
25
26
Appendix B: Sample Survey Form
1) Prior to 2013 who dispensed prescriptions in your pharmacy? [Check all that apply]
a) Non-pharmacist
b) Pharmacist with a Masters in Pharmacy
c) Pharmacist with a Pharm D degree
d) Pharmacist with Bachelors in Pharmacy
2) Prior to 2013, who primarily answered patient's questions or counseled patients? [Check all
that apply]
a) Non-pharmacist
b) Pharmacist with Bachelors in Pharmacy
c) Pharmacist with a Masters in Pharmacy
d) Pharmacist with a Pharm D degree
3) Currently, who dispenses prescriptions in your pharmacy? [Check all that apply]
a) Non pharmacist
b) Pharmacist with Bachelors in Pharmacy
c) Pharmacist with a Masters in Pharmacy
d) Pharmacist with a Pharm D degree
4) Currently, who answers patients' questions or counsels patients in your pharmacy? [Check all
that apply]
a) Non pharmacist
b) Pharmacist with Bachelors in Pharmacy
c) Pharmacist with a Masters in Pharmacy
d) Pharmacist with a Pharm D degree
5) In your opinion, the introduction of the Pharm D program requirements is a
a) Good idea
b) Bad idea
c) I have no opinion on the matter
27
6) How has the Pharm D program impacted your employees?
a) I have been required to hire new employees
b) I have had to dismiss one or more employees
c) I have not had to change any personnel because of the program requirement
7) Location of pharmacy
a) Urban
b) Suburban
c) Rural
8) Type of pharmacy
a) Independent pharmacy
b) Wholesale
c) Attached to healthcare facility
d) Retail chain
9) Who is completing the survey?
a) Owner or store manager
b) Staff pharmacist
c) Other pharmacy employee
10) Please add below any comments on the recent Pharm D requirements and its impact on your
business?
28
Appendix C: Approval Letter from the EMU Human Subject Review Committee
29
Appendix D: Comments from the Survey
Pharm D degree not necessary. Higher costs for hiring Pharm D graduates.
Good idea that government introduced this degree.
Pharm D program bad idea. Already same work done by other persons.
P should be made mandatory.
Can change dispensing methods.
Not a good degree program. Should pay more for Pharm D pharmacists.
Good program but lot of time to see more Pharm D in market.
Not a very good program.
B. Pharmacy should be replaced by Pharm D overall.
The government should not have introduced the degree.
Very good program.
Should be made as 4 year program instead of total 6 years. Lengthy 6 year program.
Good for impact in rural areas.
Program curriculum should be improved more.
Fees too costly for Pharm D
More colleges should start this degree.
Bad idea because Non pharmacists lose jobs if degree made a rule for dispensing.
Very good program but only few colleges.
Bad idea and not worth program, fees are high.
Low standards, not improved curriculum.
Gives many Pharm D graduates eligible for foreign eligibility of registered pharmacist
not useful in India.
