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What is Clinical Pharmacy?
Below you will find a brief outline explaining the profession of Clinical Pharmacy and the important role of a Clinical Pharmacist. The profession is still relatively unknown in Europe and requires a complex and developed set of competencies. If you would like more detailed information, we invite you to
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Clinical Pharmacy - a Definition
Clinical Pharmacy is a commonly used term in pharmacy practice and in pharmacy literature.
It is a health specialty, which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices.
Clinical Pharmacy includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used.
The term “clinical” does not necessarily imply an activity implemented in a hospital setting. A community pharmacist may perform clinical activities as well as a hospital practitioner.
How does clinical pharmacy differ from pharmacy?
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the discipline of pharmacy embraces the knowledge on synthesis, chemistry and preparation of drugs
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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.
Clinical Pharmacy - Overall Goal
The overall goal of clinical pharmacy activities is to promote the correct and appropriate use of medicinal products and devices. These activities aim at:
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maximising the clinical effect of medicines, i.e., using the most effective treatment for each type of patient
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minimising the risk of treatment-induced adverse events, i.e., monitoring the therapy course and the patient’s compliance with therapy
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minimising the expenditures for pharmacological treatments born by the national health systems and by the patients, i.e., trying to provide the best treatment alternative for the greatest number of patients.
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Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use of medicines at three different levels: before, during and after the prescription is written.
1. Before the prescription
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Clinical trials
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Formularies
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Drug information
Clinical pharmacists have the potential to implement and influence drug-related policies, i.e., making decisions on which drugs deserve to be marketed, which drugs should be included in national and local formularies, which prescribing policies and treatment guidelines should be implemented.
Clinical pharmacists are also actively involved in clinical trials at different levels: participating in ethical committees; study monitoring; dispensation and preparation of investigational drugs.
2. During the prescription
Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments.
The clinical pharmacist monitors, detects and prevents harmful drug interaction, adverse reactions ad medication errors through evaluation of prescriptions’ profiles.
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.
3. After the prescription
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Counselling
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Preparation of personalised formulation
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Drug use evaluation
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Outcome research
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Pharmacoeconomic studies
After the prescription is written, clinical pharmacists play a key role in communicating and counselling patients.
Pharmacists can improve patients' awareness of their treatments, monitor treatment response, check and improve patients' compliance with their medications.
As members of a multidisciplinary team, clinical pharmacists also provide integrated care from 'hospital to community' and vice versa, assuring a continuity of information on risks and benefits of drug therapy.
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Activities of Clinical Pharmacists
The principle activities of a clinical pharmacist include:
Consulting
Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level.
Selection of drugs
Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers.
Drug information
Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.
Formulation and preparation
Formulation and preparation of medicinal products and devices according to acceptable standards to meet specific patients' needs.
Drug use studies and research
Drug use studies/ pharmacoepidemiology/ outcome research/ pharmacovigilance and vigilance in medicinal devices: collecting data on drug therapies, their costs and patient outcome through structured and scientific methods.
Pharmacokinetics/ therapeutic drug monitoring
Studying the kinetics of drugs and optimising the dosage.
Clinical Trials
Planning, evaluating and participating in clinical trials.
Pharmacoeconomy
Using the results of clinical trials and outcome studies to determine cost- effectiveness evaluations.
Dispensation & Administration
Dispensing and administration of medicinal products and devices: studying and developing systems for the dispensing and administration of medicinal products and devices that can guarantee a higher security in administration, a reduction of expenditure and a reduction in medication errors.
Teaching & Training
Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners.
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How to Pursue a Profession in Clinical Pharmacy
At present Schools of Pharmacy in Europe do not satisfy the minimal requirements for an appropriate education in clinical pharmacy. They are still largely focused an old model of pharmacy activity, e.g., based on chemistry and basic sciences knowledge.
A few universities have modified and broadened their curriculum including topics as epidemiology, pharmacoeconomics, clinical medicine, communication skills, the latter being particularly important for community pharmacists.
The majority of new graduates in pharmacy will therefore work either in the community or the hospital setting to learn the skills unique to a Clinical Pharmacist.
Membership in ESCP and participation in ESCP courses, conferences and symposia are provide important learning platforms for pharmacy graduates wishing to specialise in Clinical Pharmacy.
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