Download Report of an all India Quantitative study of Consumer perceptions

FEATURE
Report of an all India Quantitative study of Consumer
perceptions, availability, role, services provided,
medicines and expectations of pharmacists in India
PART II: PROFESSIONAL ASPECTS OF PHARMACEUTICAL SERVICE BY
PHARMACIST
D B Anantha Narayana1*, Kusum Devi2,, Asha A N2, Nimisha Jain2,Uday Bhosale 2, T Naveen Babu 2And
co-investigators Roop K Khar3,Moitreyee Mandal 4, Manjiree Gharat5
1* Managing Trustee, Delhi Pharmaceutical Trust, New Delhi.
2 Dept. of Pharm.Marketing and Management, Al-Ameen College of Pharmacy, Bangalore.
3 Dept. of Pharmaceutical Sciences, Jamia Hamdard, New Delhi.
4 Dept. of Pharmacy, J.C.Ghosh Polytechnic, Kolkata.
5 K.M.Kundnani Pharmacy Polytechnic, Ulhasnagar, Maharashtra.
The authors have already reported findings of an all India quantitative survey of perception and views of
3086 respondents across the country (Bangalore, Kolkata, Delhi and Mumbai) 1 .Part I of the report covered
professional and general aspects of Consumer perceptions on availability, role, services provided, medicines
and expectations of pharmacists in India. Readers may refer to the above paper to get details of objectives of
the survey, methodology, data acquisition and analysis, IT tool used for the analysis and other aspects.
We now report findings of the survey related to professional services rendered by the Pharmacists as on today,
consumer views of what they consider as common ailments, when they prefer to go to a chemist rather than
a doctor and their future expectations regarding additional services to be provided by a pharmacist.
Keywords: pharmacist, retail outlets and availability, first all India survey, quantitative survey
Asking for and Handling
Prescriptions
Disease Conditions where
Prescription is insisted on
On enquiring about this specific aspect,
38% respondents opine that a pharmacist
does ask for the prescription and 10%
are of the opinion that the pharmacist
dispenses medicines without a prescription.
However, a major 52% are of the opinion
that the pharmacist sometimes asks for the
prescription before dispensing. The above
finding is based on the overall survey. Only
a maximum of 13% respondents felt that
a chemist always asks for the prescription
which is fairly encouraging and indicative
of presence of professional ethics during
dispensing.
A maximum of 45% people opined that
chemist always insisted on prescription for
sleep problems, 30% for chest problems
and 25% for stress problems. Similar trends
were observed in Mumbai, Bangalore
and Kolkata. However, in Delhi, a slight
difference in response was obtained with
36% & 40% of population opining that
the chemist insisted on prescription for
sleep problems and chest/throat problems
respectively.
To determine the access to information
regarding the patient counseling aspects
a question was posed to the respondents.
In total, 52% people have problem in
accessing such information and 48% people
did not have any problem in procuring the
necessary information.
In Mumbai, Kolkata, Delhi and
Bangalore 44%, 49%, 61% and 55% people
respectively feel that they have problem in
accessing information and 56%, 51% 39%
Figure 1: Frequency of asking for prescription by chemist
In Mumbai, it was encouraging to
note that 50% of the respondents opine
that chemists always ask for prescription.
Additionally 42% said that sometimes they
were required to produce prescription.
Only 8% opined that chemist did not ask
for prescription. In the three cities, viz.,
Bangalore, Kolkata and Delhi, there was a
significant difference in opinion in between
the urban and rural respondents with
Mumbai being an exception.
These findings could be attributed to the
fact that prescriptions are not being asked
when dispensing medicines for chronic
problems or for minor problems such as
headache, body pain, cold cough etc.
*E-mail: [email protected]
Pharma Times - Vol. 43 - No. 08 - August 2011
Patient Counseling
32
Figure 2: Disease conditions for which prescriptions are insisted
upon by the chemist
after purchase. However, 74% of urban
population and 85% of rural population feel
that it is the duty of pharmacist to give such
information.
Surprisingly, in Delhi 49% population
showed willingness to pay, with 16% people
ready to pay five rupees and 22% ready
to pay one rupee to the pharmacist for
providing professional services. In Kolkata,
Mumbai and Bangalore the percentage of
people willing to pay an amount between
one to five rupees for the much required
information on medicines was 12 %, 12%
and 18% respectively.
Extent of Brand Substitution
and 45% respectively feel that they did not
have problems in accessing information on
medicines.
It is quite alarming that 61% people in
the capital city have problem in accessing
the much needed information on medicines.
It is not comfortable to know that on an
average 50% of the medicine buyers are
finding it difficult to get information related
to proper usages of medicines.
As around 50% of population is not facing
problem in getting information on medicines,
we posed one more question to find out if
the chemist is the information provider for
the patients or not. We asked them if their
chemist is giving them information on use
of medicines or not.
It was heartening to know that all over
India, 69% people opined that chemist is
giving them information on use of medicines.
A more number of rural population as
compared to urban population is in favor
of pharmacist as the information provider.
A similar response was obtained in
Bangalore.
Usefulness of Information given by
Chemist
Further, to check the usefulness of
information given, we asked consumers
whether the information given by the
chemist in the past helped them to get better
with the medicines or not.
All over India, 67% of the population
feels that information given by the chemist in
the past did help. The percentage of people
feeling the same in the following cities was
75% in Mumbai, 67% in Bangalore, 64%
in Kolkata and 62% in Delhi. Interestingly,
more number of female population benefited
by the information as compared to male
population.
Willingness to pay money for getting
Professional Information
Survey revealed that 78% of the
respondents feel that it is the duty of the
chemist to provide the information on the use
of medicines but 22% showed willingness
to pay an amount between 1-5 rupees for
getting additional information on medicines
Figure 3: Patient counseling provided by the chemist
To find out the extent of substitution by
the chemist, a question asking the same
was posed to the respondents. 58% of the
population feels that the chemists substitute
the brand prescribed after informing the
consumer while 15% feel that substitution
of the brands prescribed is done without
informing. 20% feel that chemist never
substitutes the brands prescribed. The
percentage of people feeling the same
in individual cities, viz., Bangalore, Delhi,
Kolkata and Mumbai was 14%, 15%, 12%
and 39% respectively. While 66% of the
population in Bangalore and Delhi feels
that the chemist substitute the medicine
brands prescribed after informing them, 16
% and 14% population in the same cities
feel chemist substitutes without informing
them.
In Kolkata and Mumbai, 55% and 46
% of the population respectively feels that
the chemist substitute the medicine brand
prescribed after informing them and 21%
and 10% feels chemist substitutes without
informing.
Deliberate substitution with costlier
brands of the same therapeutic moiety or
with brands which give higher profit margins
should be seriously viewed upon and
needs corrective measures. Substitution
of medicines could probably be associated
with non-availability of prescribed brands in
the retail outlet which requires the respective
Pharma companies to adopt efficient
distribution channels. Another reason for
non-availability could be that chemist is
deliberately stocking only expensive or the
brands which offer high returns. Although
the percentage is low but 11% people
feel that the chemist deliberately gives
expensive brands. 7% people feel that the
chemist substitutes cheaper brands on
request by the consumer.
Overall more percentage of rural
population feels that chemists substitute
brands to dispense expensive brands.
Similar trends are observed in Bangalore,
Delhi and Mumbai.
Pharma Times - Vol. 43 - No. 08 - August 2011
33
Figure 4: Level of brand substitution by chemist.
Instances of Prescriptions being
Referred back to the Doctor
To find out aspects related to the above
issues, we asked respondents under what
conditions does the chemist ask/insist that
they go back to the doctor, even though they
have a prescription. 18% opined that they
were sent back if prescription was more than
3 months old, which points to the high level
of ethics being practised by pharmacist.
45% people said that the pharmacist asks/
insists them to go back to doctor when there
is some doubt in the prescription.
The concern of the pharmacist for the
health of medicine buyers is evident by the
fact that 17% of consumers were sent back
to doctors due to health issues.
Also, 20% of people said that they were
never asked to refer back to the doctor.
The same opinion was reflected by 30% of
retired population. This is further reflected by
49% retired people in Bangalore. In Mumbai,
51% were sent back particularly when there
was a doubt in the prescription.
Issue of Bill on Purchase
On a total basis, 36% of the respondents
opined that chemist does not give a bill when
the amount involved is too small, with 34%
mentioning that it happens when they don’t
ask for one. An encouraging finding is that
only a considerably lower percentage of
respondents (16%) said that chemist does
not give bill when he is too busy. An almost
similar trend was observed in Mumbai and
Kolkata with responses in Bangalore and
Delhi differing marginally.
These findings indicate that the
regulatory mechanism should become
tougher so that the chemist will issue the
bill for every sale irrespective of amount
or consumer requirements. Also consumer
awareness should be increased and they
should insist on bill for every purchase.
Requirement of Additional Services
In order to determine if the public
would want any additional services from
the chemist they were enquired about the
same. The quarter (25%) on a totality said
that they wanted facilities for BP check from
chemist with almost a similar percentage
(22%) mentioning first aid followed by 20%
who said body weight measurement.
The number of respondents opting for
body temperature measurement was lower
(16%) followed by an even lower percent
(11%) for blood sugar determination. The
age wise trend was similar to the total
trend in Mumbai, Bangalore and Delhi with
Kolkata being a little different. Here 31% of
the respondents opted for BP check which
is higher than that obtained in total and in
other cities.
Trust on Pharmacist for Prescribing
In continuation with the previous queries,
respondents were asked if they trust the
chemist to give them medicine when they
approach him without going to the doctor.
The response was encouraging on an
overall basis and individual city wise with
69% of the total respondents opining in the
affirmative and 31% saying the contrary.
This indicates that the number of people
having a trust in the pharmacists’ knowledge
about medicines is more than double the
number of people who do not. This is a
positive finding as pharmacist is that person
in the drug distribution chain who would be
in direct contact with public and patient.
In fact, it has been observed in actual
practice that patients sometimes ask a
chemist to give them medicines for their
problems without consulting a doctor. In
relation to this, a question was posed to the
respondents to find out for what conditions
would they prefer to visit a chemist and not
consult a doctor. The survey revealed that
53%, 65%, 45% of the total respondents
preferred to go to chemist for conditions
like fever, cold/cough, and pain/ache
respectively. The number of patients willing
to go to a chemist for the treatment of
stomach pain was comparatively lower at
33%. Small differences in percentage were
observed in the responses obtained from
the four cities in comparison to the total
percentage.
Conditions for which the consumers
preferred to consult a chemist
without visiting doctor.
Condition
Fever
City
Mumbai (%)
Bangalore (%)
Kolkata (%)
Delhi
(%)
TOTAL
42
62
69
37
53
Cold/ Pain/ Stomach
cough ache
pain
68
78
65
47
65
44
53
41
40
45
30
31
45
29
33
NOTE: The total numbers of responses add
up to more than 100% as the question was
a multiple choice one.
In continuation to the above query,
the respondents were asked if they would
want the chemist to be allowed legally to
give medicines for nine common medical
problems varying from aches/pains to
loose motions. The total responses showed
that 49%, 49%, 57%, 39% and 47% of
the respondents wanted the chemist to
be allowed legally to give medicines for
aches/pains, fever, cold/cough, minor
burns, minor cuts/wounds respectively.
However, the percentage of patients
wanting the chemist to dispense medication
in treatment of sudden and severe pain,
allergy, nausea/vomiting and loose motions
was comparatively lower at 30%, 23%, 27%
and 27% respectively.
Consumer’s opinion on legally allowing the chemist to dispense medications
for common medical problems.
Condition
City
Aches/ Sudden/ Fever Cold/ AllerPains severe
Cough gy
Pain
Minor
burns
Minor Nausea/ Loose
cuts & vomiting motions
wounds
Mumbai (%)
50
21
38
59
20
39
34
26
28
Bangalore (%)
56
25
57
68
17
30
37
23
29
Kolkata (%)
49
32
67
54
29
35
43
33
28
Delhi
36
40
33
47
25
50
51
24
21
49
30
49
57
23
39
47
27
27
(%)
TOTAL
NOTE: The total numbers of responses add up to more than 100% as the question was
a multiple choice one.
Pharma Times - Vol. 43 - No. 08 - August 2011
34
The responses to both the questions
reveal that a significant percentage of
patients would want the chemist to dispense
medication for conditions like cold/cough,
fever, pain/aches and minor cuts and
wounds. Allowing the chemist legally to
dispense medicines for above conditions for
a short duration like a maximum of two days
can be considered. But importance should
be given to the type of pain killers that can
be dispensed taking into consideration that
drugs like Ibuprofen, Diclofenac sodium,
Aspirin, are contraindicated in certain
groups of patients. So, training of chemist in
this regard is an absolute necessity before
any decision is taken.
Further, one more open-ended question
was posed to the respondents to list the
problems for which they would trust a chemist
to give them medicines. The respondents
gave a list of following problems:
Problem
Quoting Frequency
pharmacists and get medicines for few
days. They put themselves on these
medicines, which more than 50 % have
found to be useful and meets the need
to treat such common ailments. They
recognize that such a practice is good
and must be encouraged and legally
allowed.
• They also recognize that many
pharmacists’ refer to doctors and stay
away from giving/dispensing medicines
for many diseases where pharmacists’
consider it is not good to give medicines,
say like sleep problems, severe chest
infections etc.
Recommendations:
Based on the survey findings, the authors
have the following recommendations:
• The Professional associations in
Pharmacy need to continue and also
enhance continuing education proProblem
Quoting Frequency
Fever
980
Allergy
30
Cold
877
Minor burns
29
Pain
736
Loose motion
16
Cough
592
Throat pain
08
Head ache
274
First aid
08
Stomach pain
108
Chest pain
05
Body pain
59
Constipation
02
Vomiting/ nausea
39
Acne
02
Cold/cough
39
Joint pain
02
Wounds and cuts
39
Stress
01
Results and Authors’ Views:
In studies like these, it is not possible to
draw specific conclusions and authors want
to deliberately stay away for doing so, as
there can be many perspectives.
However, the study findings taking both
part 1 and part 2 of the Reports in totality,
the following can be summarized:
• There is a definite trend in the consumers feeling the importance of the
Pharmacists, recognition of their role
in health care, trust factor has gone up
from what it was a decade ago.
• Consumers are getting useful information from the pharmacists about disease
and medicines although they want more
from all the pharmacists and are not
willing to pay for such information and
counseling provided.
• Consumers have more demands
in various services provided by the
pharmacists.
• Consumers have on their own drawn
up what they consider as common
ailments that are not serious, and visit
grammes for current pharmacists in
retail outlets. This work needs to be enlarged to cover all pharmacists across
the nation.
• Programmes to build Skills and Competencies, as well as desired domain
knowledge need to be drawn up and
put in place.
• A habit for reading
and hunger for
information needs
to be created
amongst pharmacists. Pharma
Industry which focuses on Doctors
alone needs to
be made to think
of the obligation
to educate pharmacists too, as
well as building
better and “not
trade only” relations with chemists.
• Health care delivery models need to be
reviewed at National levels to involve
pharmacists fully and major reforms
in the same need to be thought of.
Preparation of a list of common & minor
diseases, medicines for treating such
diseases need to be prepared.
• Drugs and Cosmetics Act and Rules
need to be reformed to review Schedule
H drug list, outing in pace a clear OTC
drug policy, and also publish/notify a
“Pharmacist dispensing list of drugs”
and “Pharmacists’ to refer to Doctor”
list of diseases/medicines. Such a move
will be expected to have a number of
benefits including improving access
to medicines, reducing health care
costs, etc. Such a move will face stiff
opposition from many quarters which will
be interested in “Protecting Turf wars”
or “Territory marking” tendencies, which
need to be objectively discussed in
multi-functional/professionals meetings
openly.
Authors would be happy to receive inputs
on the study, and hope professionals and
regulators will take note of the findings.
REFERENCES
1.
D B Anantha Narayana, Kusum
Devi, Asha A N, Nimisha Jain, Uday
Bhosale, T Naveen Babu. Report of all
India quantitative study of consumer
perceptions, availability, role services
provided, medicines and expectations
of pharmacists in India Part I: Report of
the study on professional and general
aspects. Pharma Times, Vol.43, No. 04,
April 2011, 12-17.
2.
D B Anantha Narayana, Brijesh Regal,
Kusum Devi, Asha A N, Nimisha Jain
et al. Perceptions of consumers about
Pharmacists- Report of the results of a
market research conducted amongst
consume in Bangalore and Delhi. Pharma
Times-Vol 41, No. 9, September 2009,
15-18.
Indian Pharmaceutical
Association
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