Author: D. Kalai Selvi

Introduction:

Pharmacists play a crucial role in educating them and encouraging the care for the patient by counseling them as well as communicating with the prescriber. Clinical pharmacists are the ones who fill the gap between the patient and the medical practitioner. The need for clinical pharmacists becomes more important. A clinical pharmacist is defined as a discipline that focuses on improving the rationality and efficacy of drugs and minimizing drug-related problems in patients. The demand has now led to an increase in the importance of clinical pharmacists because the way they used to provide the services is more crucial. Because the demand for dispensing and counseling in the clinical is increasing day by day. The clinical pharmacist plays an important role in educating the patient and encouraging care for the patient by counseling them and communicating with the prescribed. This is the reason why clinical pharmacist produces service to the healthcare profession for the development of clinical pharmacy. Therefore, the great work between clinical pharmacists and physicians can build a strong pillar to provide healthy and quality service to the patient. Due to all these reasons, the availability of a clinical pharmacist in and around the healthcare service is meant to develop the pharmacy field.

The activities of clinical pharmacy:

Therapeutic drug monitoring:

TDM is the chemical parameter that will directly deals with prescribed procedures. TDM is to analyze the dose-response relationship, rationale, and effectiveness by gathering knowledge of pharmaceutics, pharmacodynamics, and pharmacokinetics. TDM starts the assessment of the safety of a medicine in the clinical setting. Therefore TDM is the parameter that can be used to suggest clinical to provide safe and effective drug therapy to individual patients. Where the monitoring can be used to confirm the plasma drug concentration which is used to determine the therapeutic range.

Toxicology:

In this toxicology, medical equipment should be multi-professional. Majorly antidotes are used and medical practitioners search for rapid information in the field of medicinal chemistry and toxicology. Thus, in this field, clinical pharmacists are involved. The clinical pharmacist has to work with toxicological skills to learn about reason and management of therapy errors, critical thinking, problem-solving risk management, management ability, behavior–specific skill are the user requirement for the management of toxicity caused by given drug therapy.

Medication review and counseling:

Lots of studies reported the role of clinical pharmacists is very much important for better service for the patient. The clinical pharmacist can correlate the diagnosis, medication history, and prescription of a particular patient. Therefore, we can say that clinical pharmacists play a crucial role in healthcare pharmacies to minimize Drug Related Problems (DRPs) in given geriatric patients. The DRPs were correlated with the medication, and demographic, responsible for to increase in DRPs, and an increase in age groups of patients has the chance of DRPs will also be increased. The reason behind drug-drug interaction is the relationship between the number of drugs prescribed at a single time and DRPs observed in geriatric patients .it also may alter the response of the drug to minimize drug interaction pharmacokinetic properties of each drug is deeply studied. Otherwise, alternate therapy should be prescribed to decrease episodes of interaction with the patient, by replacing drugs with their substitutes.

Clinical pharmacy at the emergency department:

In this department, the knowledge of pharmaceuticals, pharmacokinetics, pharmacovigilance, and Therapeutic Drug Monitoring (TDM) is completely studied. Modern development has decided on pharmacokinetics parameters by measuring the concentration of drugs in the blood. Whereas TDM is a method that practitioners to provide safe, effective, and successful care to patients. ADR is like a threatening process where it creates a negative impact on life and expense on the healthcare system.

Protocols:

In this, where the pharmacist are being appointed for monitoring and inspect the patients in the critical care unit to analyze the inaccuracy and to eliminate the risk of adverse effects because of polypharmacy etc. Another study reported that where the clinical pharmacist may play an important

role in reducing the wrong prescription and reducing possible adverse drug effects which improves the lives of elderly patients. These pharmacists are very essential for the healthcare team in the intensive care unit.

Pharmacist practice models and clinical activities:

                        In this, interacting with a pharmacist in the inpatient may help to improve post-discharge medication adherence, reduce adverse drug reactions and medication errors, etc. several recent studies, reviews and meta-analyses have demonstrated the effect of  Clinical Pharmacy Services (CPS) in cardiovascular patients. This shows that the clinical pharmacist has helped to improve cardiovascular disease (CVD) risk factor management. Clinical pharmacists have shown a particular effect in patients with heart failure .for inpatient service in a single-center trial of 180 patients with heart failure, measured the effect of pharmacist participation in heart failure sounds. The composite of all-cause mortality and heart failure events was significantly lower after 6 months in the team with pharmacist participation (4 events vs. 16 events [all-cause mortality of heart failure];p=0.005) pharmacist care for inpatients and outpatients with heart failure has resulted in decreased hospitalizations. The heart failure society of America recently coauthored a joint opinion paper with the American College of Cardiology (ACCP) Cardiology Practice and Research Network that outlined and supported roles for pharmacists in multidisciplinary heart failure teams.

Advocacy and public health:

The public health of clinical pharmacists has been evolving as clinical practice opportunities have expanded. Starting with the department of health and human service’s “Healthy people:” initiatives, and continuing with the current ” Million hearts ” initiative to prevent one million heart attacks and strokes by 2017, pharmacists have been sought out for their potential contributions to be national campaigns pharmacist have a unique role in the community – based public health initiatives due to the sheer number of neighborhood pharmacies, which provide easy access to care for patients, although evidence–based drugs therapies and government education campaigns have been successful in reducing cardiovascular deaths in the past several decades much work remains to be done. The million heart campaign estimated that baseline aspirin use for high-risk patients still only 47 %, blood pressure is controlled in only 46%, cholesterol is only in 33%,  and smoking association is only in 23% at baseline, all of which are fair from their clinical targets of 70%. Pharmacist participation in the campaign through chain pharmacy corporations has largely targeted enhanced cardiovascular risk screening, as well as educational efforts. The pharmacist also participates significantly in the registry are payor – directed efforts to systematically improve quality through improved medication use and optimization, such as the joint commission core measure. For example, hospitals employing clinical pharmacists credentialed in cardiology performed better in cardiovascular medication-related core measures. Pharmacists, both clinical and general practitioners, play a valuable role in public disease prevention of health promotion through education, preventive health screening, and quality assurance.

Conclusion:

Clinical pharmacists play a major role in the emergency department to growth and development. They are acknowledged patient care privilege by combining with the health system or physicians. Healthcare workers are responsible for proper patient care for reducing medication errors. Most medication errors are detected and reported by the clinical pharmacist. Clinical pharmacists, through their unique training and practice focused on medication use, are positioned to serve an important role for patients on the cardiovascular care team. Clinical pharmacists currently engaged with medical practices also make substantial contributions to practices through the optimization of drug use and avoidance of preventable adverse drug events. Thus, clinical pharmacists are an asset for healthcare workers and patients.

References:

1. https://www.researchgate.net/publication/346354277_A_REVIEW_ON_CLINICAL_PHARMACY_SERVICIES
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7. https://www.jacc.org/doi/full/10.1016/j.jacc.2015.09.025