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How much clinical is clinical pharmacy?
By Dixon Thomas.
Pharmacy profession strives to progress providing more clinical services in institutional and community settings. The clinical pharmacy has been used as a job sector in addition to hospital pharmacy and community pharmacy. One clear distinction of clinical pharmacy is not having dispensing roles. Hospital and community pharmacy practice involve significant amounts of pharmacy operations. Expansion of clinical services to ambulatory practice tends to refer pharmacists to be clinical staff irrespective of the practice settings. No consensus exists on how much of clinical service is labeled as clinical pharmacy.
Pharmacists are and should be considered clinical staff, similar to doctors, nurses, physiotherapists, and other health professionals, who provide direct patient care. “Clinical” usually refers to human patients and all those who seek healthcare. Clinical pharmacy is more of a concept than a setting because clinical services could happen in hospitals, community pharmacies, or even in a patient’s home. The majority of the time spent by pharmacists involves interactions with patients and other health professionals, the arrangement of practice sites, dispensing, documentation, and continuous professional development. Pharmacists often spend a significant amount of time preparing their pharmacy operations, layout, and services. However, pharmacy preparation time and dispensing time are decreasing with the help of pharmacy technicians and automation. Pharmacy operations involve ensuring quality medicines with proper instructions to patients that could be considered as clinical.
From a patient’s viewpoint, pharmacists are primarily involved with supplying medications, providing instructions on how to take medications properly, and answering general questions. Pharmacists also educate their patients about relevant diseases and healthcare needs. In hospital pharmacies, decreased interaction with inpatients sometimes results in pharmacists being seen as nonclinical staff. Though a hospital pharmacist does not always directly interact with inpatients, checking the appropriateness of a drug, validating the dose, and assuring its correct administration to prevent drug-related problems are considered to be direct patient care activities. Subsequently, a pharmacist performs as a patient advocate within the healthcare team to contribute to the overall clinical decision-making process. Clinical pharmacists with advanced training can provide additional healthcare services at the bedside, but this does not mean that dispensing pharmacists are nonclinical. Dispensing pharmacists, while applying the expected competence in preventing drug-related problems (e.g., wrong dose, wrong route of administration, drug interactions), are contributing to direct patient care.
Clinical pharmacy practice in community settings is ambulatory in nature. The professional services may be less complex than those involved in acute care medicine, depending on the location of their practice, but their importance to the overall health and well-being of the patient is just as important. Being the primary point of consultation and sometimes the only healthcare professional involved in direct patient care for a visit, community pharmacists need to apply their clinical skills. The clinical skills enable a pharmacist to collect patient information, perform physical assessment, interpret laboratory data, suggest appropriate intervention for a defined problem, and educate patients. Chronic care management is an essential component of this practice.
To conclude, it is not clear how much patient interaction should be considered as clinical pharmacy. Bedside clinical pharmacy services are generally regarded as higher cognitive services. Primary healthcare roles of community pharmacists have significance in covering a larger population. In some cases, pharmacists could be the only healthcare professional to take care of primary healthcare needs of the public, Specialization and super-specialization in clinical practice yield higher recognition and remuneration for institutional pharmacy services. Specialization is happening in ambulatory care settings too, but not as much as in bedside care.
About the book
- Covers the core information needed for pharmacy practice courses
- Includes multiple case studies and practical situations with 70% focused on practical clinical pharmacology knowledge
- Designed for educational settings, but also useful as a refresher for advanced students and researchers
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