CLINICAL PHARMACY
MILIN THOMAS
SEMESTER 1
MPHARM PHARMACY PRACTICE
COPS,KOZHIKODE
CLINICAL PHARMACY
DEFINITION
EVOLUTION
SCOPE
CLINICAL PHARMACY
DEFINITION
Clinical pharmacy is the branch of pharmacy which deals
with the various aspects of patient care, dispensing of
drugs and advising patient on the safe and rational use of
drugs.
“Profession of clinical pharmacy will advance only
through the primary goals of quality care” –Paul F Parker
The updated definition of ESCP (European Society Of Clinical Pharmacy)clarifies that
clinical pharmacy :
1. Represents both a professional practice and field of research
2. Optimise the utilisation of medicines in order to achieve person-centered and public
health goals
3. As a practice encompasses cognitive, managerial and interpersonal activities targeting all
stages of the medicines use process, and as a field of research generates knowledge that
informs clinical decision-making, health care organization or policy
4. As a practice is restricted to pharmacists
5. Can be practiced regardless of setting
6. Encompasses pharmaceutical care but is not restricted to it.
• Clinical pharmacy allowed
pharmacists to shift from a
product oriented role towards
direct engagement with patients
and the problems they encounter
with medicines.
CLINICAL PHARMACY
AIM OF CLINICAL PHARMACY
• Optimize patient outcomes to achieve the best possible quality use
of medicines.
• To assist the physician in doing a better job of prescribing and
monitoring drug therapy for the patient.
• To assist medical and paramedical staff and documenting
medication incidents correctly.
QUALITIES OF CLINICAL PHARMACIST
COMMUNICATION
CLINICAL SKILLS
SKILLS
PROFESSIONAL MONITORING
EMPATHY
RELATIONSHIP DRUG THERAPY
EVOLUTION OF CLINICAL PHARMACY
• First degree in pharmacy: Banaras Hindu University- Prof. Mahadeva Lal Schroff
• Pharmacy Act -1948 and pharmacy council of India(statutory body to control the
standards of pharmacy profession) -1949
• First Education regulation-1953 : D pharm became the minimum qualification for
practice of pharmacy in India. (ER -1972, 1981 and 1991)
• pharmacy education was oriented towards the pharmaceutical industry-
Production, formulation, quality control and marketing. More than 100,000
formulations are currently marketed.
• In 1980s and 1990s -consequences of drug misuse, such as poor health outcomes
from drug treatment, antibiotic resistance, adverse drug reactions and economic loss to
patients-acknowledged not just by pharmacy profession, but also by the medical
profession ,patients and government.
• 1990s-period of awakening-urgent need of pharmacists to contribute to improving
medication use in the community.
• As a result, in 1991 Education regulations were amended to include the subjects of
hospital &clinical pharmacy, community pharmacy and health education, drug store
&business management in D pharm curriculum.
• Hampered by lack of teaching personnel in pathophysiology, applied therapeutics,
clinical pharmacokinetics & practice skills: patient counselling, drug information
&drug therapy review.
• MASTERS IN PHARMACY PRACTICE:
JSS College of Pharmacy, Ooty & Mysore -1997
Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore-1998
KLE College of pharmacy, Belgaum-1999
Manipal College of pharmaceutical sciences-2001
Al-Ameen College of Pharmacy, Bangalore
Annamalai University, Tamilnadu
Trivandrum Medical College, TVM
NIPER, Mohali
• As of 2011,23 institutions are offering postgraduate programmes in pharmacy
practice.
• In 2008-commencement of doctor of pharmacy programme in many institutions
and Pharm D post baccalaureate in some colleges.
EMERGENCE OF CLINICAL PHARMACY PRACTICE
IN UK &USA
• Poor medicine control system in 1960s
• UK: Approach was to adopt unit dose dispensing and pursue decentralization of
pharmacy services.
• USA: Unification of the prescription and the administration record-this document
needed to remain on the hospital ward and required the pharmacist to visit the ward
to order medicines.
• Initially termed as ‘ward pharmacy’ and later transition to “clinical pharmacy”
NEED FOR CLINICAL PHARMACY IN INDIA
Pharmaceutical industry
*Promotional materials by pharmaceutical industries–biased
and does not provide doctors with independent advice with
regard to indications of treatment &safety issues.
*Also package inserts with technical information not useful
for patients.
*Clinical pharmacy: provides unbiased ,independent drug
information to medical practitioners and can counsel
patients.
Prescribers
*High patient load(5-10 minutes/patient)-difficulty in clear diagnosis.
*Many medical practitioners do not receive adequate
pharmacotherapeutic training and often rely on drug information from
pharmaceutical companies, also prescribe the brand names with the
risk of duplication of therapeutic equivalents.
*Empirical therapy instead of definitive therapy for infectious
diseases.
*Bacterial resistance-broad spectrum antibiotics for simple infections.
*Clinical pharmacists can help by providing doctors with advice and
information to achieve safer and more effective drug therapy
Pharmacists
*Poor knowledge base, lack of training, lack of confidence,
no-financial benefits
*In India hospital pharmacists manage drug inventory, drug
dispensing and record keeping.
*With appropriate education and training, graduate
pharmacist can help improve medication use, drug therapy
monitoring, patient counselling, drug information services,
ward round participation, ADR reporting and monitoring.
Patients
• Clinical pharmacist can assist medication adherence
through patient counselling in local language.
• Patient informatory labels(PILS) and advisory labels in
local languages can help.
• PILS can be developed by clinical pharmacists in
consultation with other healthcare providers.
• Clinical pharmacists can advise patients and their
doctors ,the most cost effective medications for a
particular condition.
GOVERNMENT
*Government drug policies are aimed at pharmaceutical industry
rather than patients.
*Technical and commercial matters such as price control and
licensing of manufacturers have taken precedence over initiatives
to ensure medication safety.
*Advertising and promotional claims by industries not well
regulated.
*A functional national ADR reporting system lacks continuity and
remains to be established.
*ADR monitoring and reporting is an important role for clinical
pharmacist-improve medication safety, especially among paediatric
and geriatric patients.
*Much to be done by government to develop pharmacy practice.
SCOPE FOR CLINICAL PHARMACY PRACTICE IN INDIA
• Clinical pharmacy services are of great importance in hospitals because a clinical
pharmacist can serve as a guide to physician for safe &rational use of drugs.
• A clinical pharmacist can help to achieve economy in the hospital by
planning safe drug policies
suggesting means of reduction in waste
preventing misuse or pilferage of drugs
Preparation of budget by forecasting future drug needs of hospital, based upon their
drug utilization pattern
• Scope of clinical pharmacy is of utmost appreciation in following areas:
Drug information
Drug utilisation
Drug distribution
Drug selection
Drug evaluation
Pharmacy education and teaching
1. Preparation of patient medication history
• Interaction with patient
• Document hypersensitivities, food habits, drug dependence or intoxications with
chemicals, side effects of some drugs, incorrect drug administration etc
• This will help in saving physicians efforts and results in faster and accurate drug
therapy.
2. Rational Prescription
• Help physician in selecting the right drug
• Also identify the combinations that are irrational.
3. Bioequivalence and generic equivalence of pharmaceutical
formulations
• Number of factors influence bioavailability of drugs from dosage forms.
• Selection of proper drug therapy based on bioequivalence studies on different
dosage forms of same drug moiety.
4. Drug monitoring
• Monitor drug therapy for safety and efficacy
• Therapeutic drug monitoring is very essential for those drugs with narrow
therapeutic index or those which are administered chronically.
• Determine various pharmacokinetic parameters based on plasma concentration of
drugs and enzymes.
5. Adverse drug reactions and drug interactions
• Clinical pharmacists can help in the detection, prevention and reporting of adverse drug
reactions.
• Compile and process data using computers and make it available to the staff.
• Suggest physician for alternate drug therapy.
6. Drug information
• Clinical pharmacists has the knowledge and expertise to provide detailed information on
medicines to members of health profession and the public.
• Effective selection ,utilization and retrieval of drug literature.
• Abstract information from periodic bulletins or news letters and provides the same to
physicians.
7. Discharge counselling and patient compliance
• Compliance can be improved by educating and counselling patients at time of
discharge from hospital or during dispensing.
• Make patient aware of medication purpose ,administration schedule and side effects.
8. Clinical research and development programmes
• Clinical pharmacist can participate in research for development of various
formulations particularly in biological availability of active ingredients.
• He can help in conducting clinical trials based on sound principles of biostatistical
method of evaluation.
• Develop programmes for training pharmacists,nurses and interns.
9. Medical audit
• Medical audit is a logical and necessary
procedure within organized network
• The clinical pharmacist is either the initiator or a
very active member of a functioning committee.
• clinical audit involves reviewing the delivery of
healthcare to ensure that best practice is being
carried out.
10.Management of drug policies
• Participation in formulating health &drug
policies.
11. Drug-diagnostic test interference
• Results of numerous routinely performed and highly specialized BLTs in serum and other
biological material can be influenced by one or more drugs that are prescribed to patients.
12. Intavenous admixtures
• Ensure that compounded medications are of suitable quality, safety and efficacy.
OBSTACLES TO OVERCOME
D pharm pharmacists must be trained to provide theses services
Public must be educated to expect a professional service from the pharmacist
whenever a prescription is filled.
If this happens in a proper manner patients prefer these pharmacies that offers
professional support.
FUTURE CHALLENGES
1.Patient focused teaching
2.Continuous monitoring and development:
Quality of pharmaceutical education
Accreditation of institution and services
Employment opportunities in hospitals
3.Large population and shortage of clinical pharmacists
4. Networking between existing pharmacy practice centres
Kelkar committee-recommended that a professional or dispensing fee to be paid to the
practicing pharmacists: for this to happen pharmacists need to demonstrate their ability and
commitment in providing professional services.
REFERENCES
1. A Textbook of Clinical Pharmacy Practice-Essential concepts and skills-Parthasarathi.G, Karin Nyfort,
Hansen and Mila P Nahata, second edition –chapter 1
2. Clinical Pharmacy and Therapeutics-Roger Walker and cate Whittlesea, Fifth edition ,section -
1,pageno:2
3. A Textbook of Hospital & Clinical Pharmacy Theory & Practical, Dr.Prathibha Nand ,Dr.Roop K Khar
,part 2,chapter 1,page no:241-245
4. https://link.springer.com/article/10.1007/s11096-022-01422-7
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