Clinical Pharmacy: Still an Evading Trend

An article I wrote for the Philippine Ask Your Pharmacist website about Clinical Pharmacy Practice in the Philippines written on the 20th of January 2013. 

Everyday, thousands of lives are afflicted with different kinds of diseases. Acute or chronic they may be, these would have great impacts in the lives of the patient and his or her family.

Physicians’ knowledge of medicines and pathophysiology is what makes them indispensable in the medical community. However, physicians must also work hand-in-hand with other healthcare professionals in order to obtain the best medical regimen that a patient needs. Here, the Clinical Pharmacist enters the picture.

What is a Clinical Pharmacist or what is Clinical Pharmacy? According to the American College 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 practice of clinical pharmacy embraces the philosophy of pharmaceutical care; it blends a caring orientation with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes.1

In short, a Clinical Pharmacist is concerned with the science and practice of rational medication use.1 This means that he/she is actively involved in making sure that the medicines are given to the right patient, at the right time, at the right dosage form and strength and at the right administration site, all throughout the patient’s medication regimen and provide information in an objective manner. This means that a clinical pharmacist is not solely focusing on the medications, but is now interacting with the patients and their family. In a hospital setting, the clinical pharmacist is involved in determining the past medication history of a newly admitted patient as well as the patient’s allergies. During the whole course of the patient’s stay in the hospital, the clinical pharmacist checks the patient’s medications to see whether there are possible drug interactions and makes sure that high-alert medications such as antibiotics are monitored. Clinical pharmacists also monitor for any adverse events and report them on a timely basis. Clinical pharmacists are proactive in that they communicate their findings and suggestions to the physicians, nurses, physical therapists, nutritionists, and the like. When a patient is to be discharged, the clinical pharmacist counsels the patients on his/her take home medicines. They inform them of the proper dosing strength and schedule.

This practice is not limited to the hospital setting alone and can be applicable to any practice setting, be it at a community pharmacy setting, manufacturing setting, hospice care or nursing home. The simple dissemination of new knowledge of a drug to other health care professionals and patients is an act of clinical pharmacy practice.

In a community pharmacy setting, clinical pharmacy practice is being done by doing the extra service of adding essential information that the patient needs to know about the drug – like food and drinks that are prohibited while taking the medicine, the proper dosing schedule of the medicine to avoid side effects (e.g., upset stomach, headache, dizziness, drowsiness, etc.), drug interactions among medicines taken, or numbers to call for any adverse events or emergency situations – information that may have been missed out by the physician upon prescribing. Nowadays, community pharmacies are already incorporating in their computer systems essential information about medicines that alert them so that they may be able to inform the patient upon buying the product. Aside from this, pharmacies are already applying the US practice of maintaining a patient database in order for them to track the patient’s medication regimen and make better medical judgments about it. Practices applicable to the hospital setting alone can now be applicable to the community pharmacy such as drug interaction check, timely adverse event reporting, and monitoring of alert medications such as antibiotics, anticoagulants, insulin, etc.

Here in the Philippines, the practice of Clinical Pharmacy in the hospital setting is steadily growing. However, there is still quite a bit of a challenge when it comes to applying it to the community setting, but a few are already doing it. The challenge here is for pharmacists to be accepted as an essential being in the planning, organizing, implementing and monitoring of a patient’s medication regimen, hence averting any therapy misadventures.

Reference:

1. American College of Clinical Pharmacy. The Definition of Clinical Pharmacy. Pharmacotherapy 2008;28(6):816–817.