Introduction to Clinical Pharmacy
The term clinical pharmacy was first used in 1953. The concept of clinical pharmacology started in the 1960s with two incidences.
First, in 1962 “The Thalidomide Tragedy“, it was found that consumption of the popular sedative thalidomide resulted in the birth of babies with sealed limbs.
Second, in 1968 phenytoin toxicity was reported in Australia which was because of a change in formulation i.e. switching over from calcium sulfate to lactose as an inert excipient in the tablets.
To investigate the bioavailability, pharmacokinetics, and toxicity of different formulations. Obviously, this job was mainly given to pharmacology and clinical pharmacists developed as a subject in medical institutions
In the context of pharmacy practice, clinical pharmacists are practitioners who provide comprehensive medicines management and related care for patients in all healthcare settings.
They are pharmacists with specialized advanced education and training who possess the clinical competencies necessary to practice in team-based, direct patient care environments.
Definition of Clinical Pharmacy
Clinical Pharmacy can be defined as the branch of pharmaceutical sciences dealing with the utilization of a pharmacist’s knowledge, skills, and judgments related to biomedical and pharmaceutical sciences, to prove the safety, the cost, and the precision of drug usage in patient care.
The entire focus of clinical pharmacy practice is to promote the rational use of drugs that results in health, well-being, and disease prevention and, ultimately, improve the patient’s quality of life.
Qualities of Clinical Pharmacist
- Good communication skills (Freely and effectively)
- Good clinical skills ex etiology of disease, signs, symptoms, lab tests, etc.
- Good professional relationship (Physicians, nurses, paramedical staff)
- Good empathy (Responsibility towards medical care)
- Monitoring drug therapy (Ongoing treatment process)
Role And Responsibility of Clinical Pharmacist
- Clinical Pharmacy is the area of practice in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.
- Clinical pharmacists rely on their professional relationships with patients to give their advice to best meet individual patient needs and desires.
Role of Clinical Pharmacist:
- Therapeutic Drug Monitoring (TDM)
- Rational drug use
- Medication outcomes and comparative effectiveness
- Pharmacoepidemiology
- Medication Therapy Management
- Medication outcomes
- Hematology and Oncology Pharmacists
- Pharmacogenomics & Pharmacoeconomics
- Pharmacokinetics and pharmacodynamics
- Transitions-of-care Services
1. Therapeutic Drug Monitoring (TDM):
The ultimate aim of TDM is to determine doses of drugs that suit the characteristics of individual patients by applying knowledge of clinical pharmacokinetic principles.
2. Rational drug use:
The pharmacist’s role in improving rational drug therapy when he is a part of the patient care team is to guarantee the patient the proper use of the best drugs available.
The new drug distribution systems allow the pharmacist to perform new duties in the patient care area and the clinical pharmacist will be an important participant in drug information retrieval and dissemination in the hospital.
3. Medication outcomes and comparative effectiveness
There is a critical need for more comparative effectiveness studies of Pharmacy-based interventions, the use of team-based care within primary care offices, and strategies to improve medication adherence.
Example: Hypertension specialists who conduct such studies, must pay particular attention to the type of intervention, the outcome measure of interest, study design, data collection, and analysis. As this field continues to evolve, we can all hope that such progress yields better BP control in the population.
4. Pharmacoepidemiology:
Analyses of drug-related problems (DRP) in inpatient and outpatient settings directed toward the minimization of the impact of DRP in patients as well as the development of safe medication practices.
Pharmacoepidemiology covers different parameters:
- DRP management in various healthcare facilities
- DRP and intravenous drug administration
- Associations between the use of antiepileptic agents and bone quality
- Study of benefits and risks of self-medication by over-the-counter drugs
5. Medication Therapy Management:
The pharmacy student, community practice resident, or pharmacist should be able to:
- Explain how pharmacists are in a unique position to provide medication therapy management (MTM) services.
- Recognize the differences between MTM and pharmaceutical care.
- Explain how MTM services are implemented with the five core elements.
- Discuss how innovative patient care programs have assisted in the development of MTM.
- Recognize how the implementation of MTM services is evolving into the overall healthcare structure.
Core Elements of an MTM Service Model in Pharmacy Practice.
The MTM service model in pharmacy practice includes the following five core elements:
- Medication therapy review (MTR)
- Personal medication record (PMR)
- Medication-related action plan (MAP)
- Intervention and/or referral
- Documentation and follow-up
6. Medication outcomes
The type, frequency, and result of clinical outcomes used to assess the effect of clinical pharmacy interventions in inpatient care varied considerably among the included studies. The most frequently reported outcome measures included clinical measures/assessments by physicians and health care service use.
7. Hematology and Oncology Pharmacists
The knowledge and skills of an oncology pharmacist support a wide variety of functions in all aspects of patient care; from the bedside to implementing policies and from primary research to influencing other clinicians in the selection and management of anticancer therapies. The oncology pharmacist is often one of the few team members who fully understands the safety, efficacy, pharmacologic, and financial components of patient care in individuals with cancer.
8. Pharmacogenomics & Pharmacoeconomics
Pharmacogenomics refers to the use of the genetic information of patients or diseased tissues (e.g. cancer tissue of a patient) to aid prescribers in selecting the correct drug and dose for the patient. Genetic data can reveal a patient’s risk for adverse effects or toxicity from a particular drug or the likelihood that the drug will have any effect at all.
The field of pharmacogenetics provides us with diverse opportunities for pharmacists to help healthcare workers optimize the therapeutic outcomes of intended pharmacotherapy.
9. Pharmacokinetics and pharmacodynamics
In this part pharmacist is responsible for recording and using different parameters that are useful in patient care:
- Drug Clearance
- Drug Elimination
- Volume of Distribution
- The Half-Life
- Dosing Variations
- Oral Availability
- Pharmacodynamics
- Pharmacogenetics
- Saturable Drug Metabolism
- Protein Binding
- PH and Pharmacokinetics
- Dosing and Age
- Drugs in Pregnancy
- Drug Interactions
- Drug Transport
10. Transitions of Care Services
Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current healthcare system, as emphasized by The Joint Commission and other healthcare organizations.
Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.
Responsibilities (Conclusions)
- Develop clinical pharmacy programs according to policies and regulations
- Review records of patients to determine the appropriateness of medication therapy
- Evaluate the patient’s condition to ensure all issues are being treated
- Identify untreated health problems and refer patients to appropriate physicians
- Develop effective medication plans that minimize the risk of adverse side effects
- Consult on dosages, medication substances, etc.
- Advise on the correct administration of drugs
- Assess the results of pharmaceutical treatments
- Collaborate with healthcare professionals to ensure optimal patient care
- Keep accurate documentation of medication plans and patient progress
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