Pharmacy Practice in Chronic Disease Management

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Pharmacy Practice in Chronic Disease Management

Anantha Naik Nagappa and Uday Venkat Mateti

Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka-576 104

What are Chronic Diseases and briefly discuss the burden of Chronic Diseases?

Chronic Diseases are those which remain for long period with sustained suffering and death. Here the patient continuously loses health and quality of life. The cure for the Chronic Diseases is elusive and it the major cause for the disability. For example: Asthma, Cancer, Diabetes and Heart Diseases. Globally Chronic Diseases are causing premature death and imposing a significant economic burden on individuals and society.

What are the types of Chronic Disease?

The Chronic Diseases are communicable and non-communicable diseases based on whether they are transmitted or not. For example: Human immunodeficiency virus is communicable Chronic Disease where as diabetes is not non-communicable disease.

Give the classification of Chronic Diseases

Chronic Diseases can be classified on the basis of complex causality multiple risk factors (Diabetes Type -II, Hypertension), long latency periods a prolonged course of illness functional impairment or disability (human immunodeficiency virus).

What is the difference between the screening and diagnosis of Chronic Diseases?

The Chronic Diseases are communicable and non-communicable carrying huge public health burden and the early detection offers opportunities for lessened burden of suffering and economic inputs. Detecting the diseases in a population is called screening and diagnosis is a confirmation of disease to begin treatment in an individual patient.

Identify the challenges in Chronic Disease Management?

The Chronic Disease development can be manipulated in a patient. If the patient and his/her relatives fully understands the details of disease, medications used for and importance of life style modifications. Ignorance about these aspects along with myths and misunderstanding leading to wrong practices is a major challenge. Availability of the infrastructure facilities required for management of disease is another challenge.

What is the importance of patient education in Chronic Disease Management?

The Chronic Disease Management is difficult to achieve due to accessibility and not due to non-availability of therapy. The patient education can be useful in improving accessibility, in the model of knowledge, attitude and practice. The aim of the Chronic Disease Management is to ensure each patient becomes competent of self-management his/her of condition.

What is the role of public health in Chronic Disease Management?

The Chronic Disease Management is important as many of the chronic diseases affect large number of population in society. The public health education can be an effective tool lessens the burden of disease. The public health measures regarding hygiene and sanitation can control the epidemics of communicable diseases. For non-communicable diseases public health messages regarding importance of diet and physical activity can play a significant role in control of diabetes, hypertension and obesity.

Highlight the preventive care in Chronic Disease Management?

The complications and causality of communicable diseases are usually high causing loss of human life and wealth. The preventive measures are proved highly effective in terms of lessening the burden of illness and savings of money. In the scenario of increased patient burden has put health care systems under lot of pressure due to mismatch of demand and supply. The Chronic Disease Management acts as a brake and brings down the patients reporting to treatment for critical health care. Hence the sustained practice of Chronic Disease Management is very important for balancing the healthcare facilities and the patient load.

What is the role of pharmacist in Chronic Disease Management?

Pharmacist being well versed with basic and applied pharmaceutical sciences is in the right place to provide patient education and counseling as part of community pharmacy services. The patients after receiving the prescriptions have to visit the pharmacy to fill them. While they prescriptions are dispensed the pharmacists interacts with the patients and makes a care plan focusing on drug, disease and life style modifications which will help the patients to manage their condition

What are tools used to measure the burden of illness?

The burden of illness is a parameter used in epidemiology, pharmacoeconomics and pharmacovigilance to estimate the impact of the disease on the society and public. The burden of illness can be calculated by estimating the prevalence, prevalence rate, incidence and incidence rate of the population.

What is the importance of non-pharmacological therapy in Chronic Disease Management?

The non-pharmacological treatment forms the basis of corrective and counter measures for the progression of the disease for example: Restriction of common salt is advised for the management of hypertension which has a profound effect in keeping the hypertension under control. The non-pharmacological therapies are being non-medication based is easy to adopt and practice. However in reality are neglected and under-utilized as the patients and healthcare providers are relying on pharmacological interventions.

What is the role of alternative medicine in Chronic Disease Management?

The patients with Chronic Diseases are likely to use medicines lifelong. All the medicines carry a burden of harmful side effects. It is a conveyance faith of the public that non-allopathic drugs do not harm much like allopathic medicines. Hence many patients are found to self-Medicare themselves in a hope and expectations that the alternative medicines can help them in getting rid of the disease. In that manner the people with Chronic Diseases are indulged in using alternative medicines along with allopathic medicines. However some patients consider consulting alternative medicine expert to treat them. The major drawback of alternative medicines lacking evidence of safety and efficacy.

What are the complications of drug treatment in Chronic Disease Management?

In Chronic Disease Management as patients is under continuous observation of health care professionals. Therese is a little chance the failure to identify signals of complications of established drug regimens. The complications due to long term treatment are inevitable. However early detection helping to take the appropriate dose adjustment or change over to safer medicines can act as guard against complications of drug treatment of Chronic Diseases.

Collaborative care practice in Chronic Disease Management

The patient condition will be changing from serious to ambulatory / treated at home in Chronic Diseases. The continuity of care is fundamental for ensuring the patient with good quality of life. The doctors and nurses are limited to hospital settings and practically not accessible to patients in ambulatory/ treated at home. As a result of it the condition of the patient worsens due to non-availability or supervision by healthcare professionals in ambulatory/ treated at home patients. To address this need the wellness centers and patient counseling centers are established by clinical pharmacists or other healthcare professionals. The collaboration among the doctors' nurses and pharmacists in a team is most cost effective approach for Chronic Disease Management.

Describe the role of Hygiene as an intervention in Chronic Disease Management?

The hygiene is the fundamental requirement for health. The infectious diseases bank on poor hygiene and causing diseases like anemia due worm infestations. The diseases like Tuberculosis, Human immunodeficiency virus and Hepatitis can be prevented by practice of public hygiene. The patients with Diabetes are susceptible to infections due to poor hygiene.

What is the role of health economics in Chronic Disease Management?

The goal of Chronic Disease Management is to make the treatment cost effective and affordable to the patients. If the patients are treated without the support of Chronic Disease Management the treatment become un-planned giving the opportunity for the disease to become serious condition requiring frequent hospitalizations leading to increased expenditure for the treatment. A well documented Chronic Disease Management approach gives the data for health economic evaluations like cost effective analysis. The health economic evaluations are necessary for documenting the value of Chronic Disease Management practice.


1. Sidney Katz, Amasa B. Ford, Thomas D. Downs and Mary Adams. Chronic-Disease Classification in Evaluation of Medical Care Programs. Medical Care 1969:7(2); 139-143.

2. Centers for Disease Control and Prevention: Chronic Diseases and Health Promotion. Available from:

3. World Health Organization- Global Burden of Disease. Available from:

4. Authoritative information and statistics to promote better health and wellbeing: Chronic diseases. Available from:

5. World Health Organization: Global Status Report on Noncommunicable Diseases 2010. Geneva: WHO Press; 2011.

6. World Health Organization: Noncommunicable Diseases Country Profiles 2011. Geneva: WHO Press; 2011.

7. Adrianna Murphy, Ajay Mahal, Erica Richardson and Andrew E Moran. The economic burden of chronic disease care faced by households in Ukraine: a cross-sectional matching study of angina patients. International Journal for Equity in Health 2013, 12:38.

About the Author

Anantha Naik Nagappa's picture

I am professor, intrested in developing the community pharmacy services in India, We have an association called ASSOCIATION OF COMMUNITY PHARMACISITS OF iNDIA. CHECK AT for further detials


Ph. Bhagavan P S RPh's picture

Sir, with due regards, please clarify my doubts on pharmacy practice:

What is the official definition of pharmacy practice?

Who or which agency like IMC / IMA / Health & Welfare department have recognized practice in pharmacy?

Where can the pharmacist practice?

Hospital? - where even doctors cannot practice in hospital. Doctors can practice only in their own clinic.

Private outlets like Chemist or pharmacy? - where the license labels the pharmacist as 'Qualified person' but not qualified pharmacist! and the license is strictly a trading license!

Private Pharmacy practitioner without drugs stock, only to counsel? - Will this be supported by doctors and will this not be an additional cost to the patient?- is it viable?

A practitioner is one who takes care of his client all through and is an independent professional to deliver the service as per his professional discretion.

A doctor is a practitioner as he takes care of the patient till he fully recovers.

A lawyer (Advocate) is a practitioner as he takes care of his client till a logical legal remedy is made available.

A chartered Accountant is a practitioner as he takes c are of all accounting issues of his client all through.

A Dietician is a practitioner as he delivers professional advice and takes care of his client as long as it is necessary.

What does or can a pharmacist do to call himself a practitioner?

Even the State Pharmacy Council that issues Registration certificate do not accord the title "Registered Pharmacy Practitioner" like its counter part Medical / Dental council or Physiotherapy council.

What is the locus-standi for the pharmacist to deal with the patient under any of the Indian law or health-care system?

Can a pharmacist deliver his professional service independently as per his professional discretion?

Bottom line

I think the whole gamut called Pharmacy-practice should be 'Re-visited'.


Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India
Anantha Naik Nagappa's picture

Dear Sir

The official definition is yet to come from pharmacy council of India however, the pharmacy practice has evolved 50 years ago. There are landmark developments in Pharmacy Practice which which emphasized a need of the pharmacist as a bridge between doctor, nurse and patient. It further affixes accountability and professional bondage between pharmacists and patients.

The closely related definition of pharmacy practice is Pharmaceutical care which is "Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life".

The Pharmacy Council of India is yet to come out with guidelines of pharmacy practice however, as a preamble the Pharm D regulations under the regulations of Pharmacy Act suggests the domain of service of pharmacy practice.

The pharmacy practice services are required wherever the drugs and therapeutic agents are used. In the hospitals, clinical pharmacists are engaged whereas ambulatory care and community settings are taken care by community pharmacists. The handling and custody of the drugs are slowly transforming by robots hence the pharmacist may not be required to be physically serve the prescriptions. Hence, the pharmacist has to develop in art and skill to work with the patients so that the patients become smart enough to self-manage the condition. The technical aspects of drug information services and patient counselling are going to be the future prospects for pharmacists.

The pharmacist uses and applies his knowledge to prevent the injuries that may happen during treatment and also applies his knowledge to achieve the best outcomes for the patients.

The documentation of the pharmacist's services makes the pharmacist to provide genuine information to all the stakeholders, hence the accountability aspect has to be strictly adhered to counter the casual attitude of the students. So, the pharmacist can deliver services within the framework of the law of the country. The pharmacy practice is described as a science and art.

Prof Anantha Naik Nagappa

My Page :

Albert Ana-Maria's picture

Very good article !

Hitesh Patel's picture

What is very common interaction you come across in practice when chronic disease patient using allopathic medications and natural medications ?

Anantha Naik Nagappa's picture

The monitoring of the condition is based on clinical measurements for example Diabetes monitoring depends heavily on blood glucose levels and glycosylated hemoglobin levels which is not enough for the management of the disease. The alternative medicines being prepared out of natural products are considered safe than synthetic allopathic medicines. It is always advisable not to administer orally at the same time and can be spaced 15-30 mins by administered. this would prevent or avoid drug-drug interactions arising due allopathic medicine with alternative medicines

Prof Anantha Naik Nagappa

My Page :

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