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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