|Year : 2014 | Volume
| Issue : 1 | Page : 1-2
Being a clinical pharmacist: Expectations and outcomes
Parloop A Bhatt
Department of Pharmacology, Lallubhai Motilal College of Pharmacy, Ahmedabad, Gujarat, India
|Date of Web Publication||16-Jan-2014|
Parloop A Bhatt
Department of Pharmacology, Lallubhai Motilal College of Pharmacy, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatt PA. Being a clinical pharmacist: Expectations and outcomes. Indian J Pharmacol 2014;46:1-2
The health Millennium Development Goals and advances toward universal health coverage could not be achieved. This could be attributed to many reasons such as critical shortages and maldistribution of healthcare personnel; retention and performance gaps of human health resources thereby hindering the delivery of health interventions. Recently, Health Ministry of India gave a go ahead to start a new 3 and 1/2 years Bachelor of Science (BSc) in community health program to create a new cadre of health professionals to improve rural healthcare infrastructure. With it the government envisioned to be able to create a resource of healthcare providers in rural India. However, according to the doctors and pharmacist, this rural health is taken care by them. Instead a better effective alternative is to upgraded/put to use the pharmacist's knowledge even at primary level. The focus of attention then moves from the drug to the patient/population receiving drugs.
As per rule 6515 of the Drugs and Cosmetics Rules 1945, registered pharmacists are legally required during the dispensing and selling of medicines and registration falls under the clause 'i' and section 2 of the Pharmacy Act , 1948. The role of contemporary pharmacy practice has evolved. The pharmacist who primarily dispensed medicines, now has a more exhaustive and team-based clinical role of supervising medication and counseling patients. Patient/population/disease-centered management of medication, holistic health improvement, and services to prevent diseases are additional roles of a pharmacist. The services may be performed by pharmacists practicing in hospitals, community pharmacies, nursing homes, home-based care services, clinics, and any other setting where medicines are prescribed and used.
Placing the prescription as the mandated regulatory document for patient treatment, clinical pharmacy activities may influence the correct use of medicines at three different levels: before, during, and after the prescription is written.
| » Before the Prescription|| |
Involvement in conduct of clinical trials; preparation of formularies and a source of drug information serve the ground. Clinical pharmacists can make decisions on drugs to be marketed, to be included in national/local formularies, which prescribing policies and treatment guidelines to be implemented. Clinical pharmacists are actively involved in clinical trials at different levels including preparation and dispensing of investigational drugs; monitoring of clinical studies and being a part of ethics committees and other regulatory forums.
| » During the Prescription|| |
In India, the scope of clinical pharmacist is wide, extending from counseling and influencing the mindset of prescribers by pathological, pharmacological and pharmacoeconomic information. The clinical pharmacist is a pharmacovigilator who aids in monitoring, detecting, preventing and notifying drug interactions, adverse drug reactions, and medication errors by evaluating the prescriptions. Decisions about over the counter drug prescription can be independently taken by community pharmacists.
| » After the Prescription|| |
Counseling, preparation of personalized formulation, drug use evaluation, outcome research, and pharmacoeconomic studies stand as the hallmarks. Pharmacists can improve patients' awareness, monitor treatment response, check and improve patients' medication compliance besides provide integrated care from 'hospital to community' and vice versa.
The overall goal of a clinical pharmacist is to promote appropriate use of medicines and devices so as to ensure maximum clinical safety and efficacy of medicines. The goal is to balance efficacy versus risk of drug therapy for each patient. This also includes monitoring the therapy course and the patient's compliance with therapy, minimizing the treatment expenditures borne by the national health systems and patients.
Although laid, much health-related activities need to be explored by clinical pharmacist in developing countries like India. A few areas, which may be well taken up, include the following:
Although India is now the world's largest exporter of generic medicines, free access to good quality generic medicines is lacking. This unmet need is particularly high in preventing and treating the growing burden of diseases like heart diseases, stroke, and noncommunicable diseases. The clinical pharmacist plays a pivotal role in the disbursement of cost effective medical treatment through generic campaign. A free drug scheme called Jan Aushadhi, which guarantees free or subsidized medicines to the poor and needy, has recently been implemented in India .  Besides promoting health education and healthy behaviors, clinical pharmacist can facilitate access to the existing formal health system.
Life expectancy and population in India has doubled since independence.  Despite few successes, high residual rates of infection and increased prevalence of disabling chronic diseases leave more individuals to stay home longer, requiring home health services. These can be provided by clinical pharmacist with rehabilitation and quality of life improvement programs.
India's specialist physicians residing in semi urban areas are closer to 25%, and a mere 3% reside in rural areas,  leaving 700 million deprived of healthcare facilities. Telemedicine is a fast-emerging trend in India, supported by information and communications technology and plummeting telecom costs. Clinical pharmacist aided telemedicine services would resolve many problems of rural areas.
Disease surveillance is important to public health management. Sentinel surveillance as well as active and passive surveillance, besides analysis and interpretation of this database, could answer early and better response to disease outbreaks addressed by the clinical pharmacist.
Prevention programs addressing risk factors (obesity/malnutrition, alcoholism, smoking/tobacco, and lack of exercise) can lead to change in lifestyles to reduce early onset of disease. Awareness and generation of activities like extended use of low cost statins and adherence to antihypertensive treatment could deliver immediate and long-term health gains.
In April 2013, a structured overview of the key electronic medical records (EMRs) standards with respect to Indian conditions was recommended by an EMRs Standards Committee.  The role of the clinical pharmacist indicates its implementation in the health/hospital information system. Health-related applications (apps) establishing nutritive values, drug adherence, monitoring of diagnostic parameters, and implanted devices remotely can be developed.
In 2013, guidelines were established by the Technology Assessment Board for government hospitals on patient treatment and the selection of medicines. Clinical pharmacist cannot only aid in developing these guidelines but also in its implementation, serving evidence-based treatment more so for tropical/nutritional pathologies. An area of concern is establishing guidelines for antimicrobial prophylaxis in various surgeries by drug utilization studies.
Only 4% of medical science data is published as compared with 38% in chemistry and 15% in engineering.  The knowledge, skill, and expertise of the clinical pharmacist can publish case studies and outcomes as scientific publications to establish a lineage of medical writers in synergism to evidence generation.
In conclusion, a clinical pharmacist can integrate an ideal healthcare system, which constitutes basic criteria's of competence, empathy, and accountability, pursuit of quality, medical care, and cost-effective use of the results of relevant research with special attention to vulnerable groups such as children, women, disabled, and the aged.
| » References|| |
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|2.||The Drugs and Cosmetics Act 1940 and Rules there under 1945, Ministry of Health and Family Welfare, Government of India. Available from: http://www.cdsco.nic.in/html/Drugs and Cosmetic Act [Last accessed on 2013 Dec 19]. |
|3.||Health and health care in India-national opportunities-global impact. Available from: http://www.ucl.ac.uk/pharmacy/documents/news_docs/healthcareinindiajuly2013 [Last accessed on 2013 Dec 20]. |
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|7.||Bibliometric study of India's Scientific Publication outputs during 2001-10; Department of Science and Technology, Government of India, July; 2012. |
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