Clinical pharmacy – Definition, Development and Scope

Definition,
Development and Scope of clinical pharmacy

Content

       Functions
of clinical pharmacy

       Need
for clinical pharmacy in India

Objective

After completion of this lecture, student will be able
to:

       Discuss
the functions of clinical pharmacy

       Discuss
the need for clinical pharmacy in India

       Explain
the qualification of personnel

Introduction to clinical pharmacy

       Clinical
pharmacy may be defined as the science and practice of rationale use of
medications,
where the pharmacists are more oriented towards the
patient care rationalizing medication therapy promoting health , wellness of
people

       It
is the modern and extended field of pharmacy

       “The
discipline that embodies the application and development (by pharmacist) of
scientific principles of pharmacology, toxicology, therapeutics, and clinical
pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied sciences
for the care of patients”

History

       Until
the mid 1960’s ; Traditional role

       The
development of clinical pharmacy started in USA

       More
clinically oriented curriculum  were
designed with the award of  PharmD degree

       These
developments influenced the practice of pharmacy in U.K

       Initially
prescription and drug administration records were introduced followed by an
increasing pharmacy practice in hospital wards

       Master
degree programs in clinical pharmacy were introduced for first time in 1976

       The
progress of clinical pharmacy development remained at low profile in the first
decade after its birth in U.K

        However, Nuffield report in 1986 geared up the
momentum for progression of clinical pharmacy

       Until
today, the clinical pharmacy practice in Nepal is in embryonic stage

Origin of clinical pharmacy

       Clinical
Pharmacy
has its origin in the US in early 1960s

       Definition-
Services provided by pharmacists in an attempt to promote rational drug
use- safe, appropriate, cost effective

       Goal
To provide pharmaceutical care ( enhancing the care of individual
patient)

Development of clinical pharmacy

         
Pharmacy act (1948) – to control the
standards of pharmacy profession

         
D.Pharm (1953) – min qualification needed
to practice pharmacy in India

         
1990 – Period of awakening, need for
pharmacist to contribute to improved medication use in community

         
1991  
Educational regulations to include hospital, clinical, community
pharmacy & health education in D.Pharm curriculum

         
1996-97– First M.Pharm Pharmacy Practice
program at J.S.S Mysore & Ooty

Need for Clinical Pharmacy in India

       Clinical
Pharmacy Practice is concerned with the promotion of safe, effective &
economical dug therapy

       Pharmacy
Practice’ a broader term
– includes C.P &  activities performed by pharmacist in
hospital & community settings

       It
includes- Dispensing, drug distribution. Drug information, health promotion,
patient counseling,  pharmacovigilance,
medication review

       Need
of the hour in India

Need for Clinical Pharmacy in India

Pharmaceutical Industry

         
Lack of fully fledged medical information
departments by most pharmaceutical companies in India

         
Presence of only technical info about  drugs 
in package inserts

         
Clinical pharmacist aims at providing unbiased
drug information
to doctors & patient counseling

Prescribers

         
A busy practitioner may spend  only around 5-10 min/ patient

         
OPD in general hospitals are always overcrowded

         
Lack of time may lead to DRP’s ( drug related
problems )

         
Risk of drug duplications

         
Infectious diseases often treated empirically

         
Definitive therapy after culture &
sensitivity data not often practiced

         
Wide spread antibiotic resistance

         
Clinical pharmacist can help by providing
information to deliver safer & more effective drug therapy

Government

         
Drug policies mainly aimed at pharmaceutical
industry rather than patients

         
Price control, manufacture licensing have taken
precedence over safe medication use

         
ADR reporting systems not fully established

         
Much can be done by government to establish PP
in India

Patients

         
Inability to read & write English used on
medicine labels

         
C.P’s can assist med. Compliance, provide
counseling in local language, help resolve non- compliance

         
PIL’s & advisory labels can be provided in
local language

         
Can advise on choosing most cost effective
medicines in consultation with doctors

         
Help minimize irrational & unnecessary drug
use

Pharmacists

       Lack
of services offered by pharmacists in medical stores such as patient counseling
because of poor knowledge, lack of training, lack of confidence and no
financial benefits

       Hospital
pharmacist manage drug inventory, dispensing, record keeping

       Clinical
pharmacist with appropriate training can help improve medication use by
providing services such as drug therapy monitoring, patient counseling, DI
services, ward round participation,  ADR
reporting & monitoring

Scope of clinical pharmacy in India

       Excellent
relationship with the medical profession is needed to ensure progress of
clinical pharmacy

       Rewarding
career path with opportunities to contribute to improved medication use

        Employment in hospitals, teaching, drug
information, pharmacovigilance, clinical research, medical information

Health Care
System

Composed of physician (including other medical and dental
staffs), pharmacist, nurse and other paramedics

Physician; diagnosis, prescription, monitoring,
medical care

Pharmacist; prescription*, dispensing, counseling,
monitoring, pharmaceutical care

Nurse; administering, monitoring, nursing care

Other paramedics; their own work

Load to physician & nurse; high due to the system
of “physicians are all in all in hospital for the treatment of
patient, with the help of nurse.”

Concept of normal public/patient; same

Perceptions of Pharmacists

How do others see us?

“They just count a few tablets”

“They just weigh and measure things”

“A bunch of shop-keepers”

“Not really health care practitioners – they’re businessmen”

“Tell me how and when to use the Medicine”

“Counter-prescribing”

“Do you need a degree to be a pharmacist?”

For practising Clinical
Pharmacy

       Competence of health care
practitioners

                -BPharm to Mpharm to PharmD*

              -PharmD+ Pre-registration + registration

                -Residency programs

                -Continuing Professional
Development

       Informed general public – increased
expectation             

Summary

       Pharmacy
Practice’ a broader term- includes C.P & 
activities performed by pharmacist in hospital & community settings

       Services
provided by pharmacists in an attempt to promote rational drug use- safe,
appropriate, cost effective

       Clinical
pharmacist with appropriate training can help improve medication use by
providing various services

 

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