Clinical Pharmacy

Basma Y. Kentab MSc.

Define clinical pharmacy

Differentiate between pharmacy and clinical pharmacy.

Explain the qualification required for clinical pharmacists

List clinical pharmacists competencies

Outline

Clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medication use.

ACCP, Pharmacotherapy 2008;28(6):816–817

Definition of Clinical Pharmacy

Clinical pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.

The Detailed DefinitionImportant Aspects

ACCP, Pharmacotherapy 2008;28(6):816–817

The practice of clinical pharmacy embraces the philosophy of pharmaceutical care

“Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve or maintain a patient’s quality of life”.

This calls attention to the fact that the primary object of practice and research is ultimately the patient

The Detailed DefinitionImportant Aspects

Clinical pharmacy also has an obligation to contribute to the generation of new knowledge that advances health and quality of life.

This means that in addition to optimizing therapy and promoting patient health, clinical pharmacy must also be engaged in research.

The Detailed DefinitionImportant Aspects

The clinical pharmacist cares for patients in all health care settings

This emphasizes two points: ◦ that clinical pharmacists provide care to their patients

(i.e., they don’t just provide clinical services), and ◦ that this practice can occur in any practice setting

The term “clinical” does not necessarily imply an activity implemented in a hospital setting. 

The Detailed DefinitionImportant Aspects

Clinical pharmacists assume responsibility & accountability for managing medication therapy in direct patient care settings, whether practicing independently or in consultation or collaboration with other health care professionals.

Clinical pharmacist researchers generate, disseminate, and apply new knowledge that contributes to improved health and quality of life.

The Detailed DefinitionImportant Aspects

Clinical pharmacists are experts in the therapeutic use of medications.

They routinely provide medication therapy evaluations and recommendations to patients and health care professionals.

Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications

The Detailed DefinitionImportant Aspects

The discipline of pharmacy embraces the knowledge of synthesis, chemistry and preparation of drugs

Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use and drugs effects on the patients.

The focus of attention moves from the drug to the single patient or population receiving drugs.

How Does Clinical Pharmacy Differ from Pharmacy ?

to promote the correct and appropriate use of medicinal products and devices.

This is achieved by: maximising the clinical effect of medicines minimising the risk of treatment-induced adverse events minimising the expenditures for pharmacological

treatments.

Goal of Clinical Pharmacy

Pharm D Degree Master Degree in clinical pharmacy Residency with 2 years of training

How to Pursue a Profession in Clinical Pharmacy in Saudi Arabia

•Monitor patients in the health care setting

•Assess patient-specific medical problems

•Evaluate patient-specific drug therapy and therapeutic problems.

•Design a comprehensive drug therapy plan for patient specific problems

•Collaborate with patients, caregivers, and other healthcare professionals.

Clinical problem solving, judgment, &

decision making

Clinical Pharmacist Competencies

ACCP, Pharmacotherapy 2008;28(6):806–815

•Educate patients

•Educate other health care professionals

•Communicate effectively.

•Document interventions in the patient medical record.

Communication and education

Clinical Pharmacist Competencies

•Demonstrate the motivation and commitment to become a lifelong learner.

•Retrieve biomedical literature using appropriate search strategies.

•Interpret biomedical literature with regard to study design, methodology, statistical analysis, significance of reported data, and conclusions.

•Integrate data obtained from multiple sources to derive an overall conclusion or answer.

Medical information evaluation & management

Clinical Pharmacist Competencies

•Patient safety and drug therapy evaluation

•Critical pathways

Management of patient populations

Clinical Pharmacist Competencies

•Apply disease-oriented knowledge of the following areas (anatomy, physiology, epidemiology, etc….)

•Demonstrate competence in the pharmacotherapy of medical problems

•Apply the following principles (pharmacokinetics, pharmacodynamics, pharmacoeconomics…etc) in the setting of each disease state, patient population, and/or therapeutic category

Therapeutic knowledge areas

Clinical Pharmacist Competencies

Clinical pharmacy activities may influence the correct use of medicines at three different levels: ◦before, ◦during ◦and after the prescription is written.

Level of Action of Clinical Pharmacists

Clinical trials Formularies Drug information Drug-related policies

A) Before the Prescription Is Written

Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments.

The clinical pharmacist monitors, detects and preventsDrug related problems

The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring.

Community pharmacists can also make prescription decisions directly, when over the counter drugs are counselled.

B) Process of Writing the Prescription

Untreated indications. Improper drug selection. Subtherapeutic dosage. Failure to receive medication Medication overdosage. Adverse drug reactions. Drug interactions. Medication use without indication.

Drug Related Problems

Counselling Drug use evaluation Outcome research Pharmacoeconomic studies

C) After Writing the Prescription

Clinical Pharmacy Practice Areas

Ambulatory care Critical care Drug Information Geriatrics and long –term care Internal medicine and subspecialties Cardiology Endocrinology Gastroenterology Infectious disease Neurology

Nephrology Obstetrics and gynecology Pulmonary disease Psychiatry Rheumatology Nuclear pharmacy Nutrition Pediatrics Pharmacokinetics Surgery