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PHARMACIST ROLE IN CLINICAL ASSESSMENT

Author: NAYANA M

Pharm D Intern

Bapuji Pharmacy College

Keywords: clinical pharmacist, public health, ADR (adverse drug reaction), pharmacovigilance, OTC (over the counter), TDM (therapeutic drug monitoring)

Introduction:

Pharmacists are healthcare professionals who guide individuals with their medications. They also help patients perceive their medications, including how to take them, potential reactions, and responsiveness to their queries. They also make sure that the medications prescribed for patients contribute to the most effective potential health outcomes. Pharmacy as a profession evolved through metamorphosis, wherever within the past it had been lot of dispensing oriented currently it focuses on the safe and effective use of medicines to achieve increased optimal patient outcomes. Studies have found that pharmacists with broader roles and responsibilities have reduced overall expenses and enhanced the quality of healthcare outputs, especially chronic conditions, obtained by the healthcare system.

Pharmacists play a vital role as ideal professionals for public health at the frontline of health care. The knowledge, skills, and experience of a pharmacist enable them to support public health care by promoting healthy lifestyles, preventing long-term illness, and educating patients to better manage their medicines. Public health is a multifaceted field that involves epidemiology, biostatics, and the management of various health services. Other feature of public health includes environmental health, community health, behavioral health, health economics, public health protocol, mental health, work-related safety, health issues related to gender, and sexual and reproductive health ^[6,2]. Public health practices that are performed in today’s current world require multifaceted groups of healthcare professionals and workers. These broad organizations include physicians, nurses, clinical and hospital pharmacists, biostatisticians, public health supervisors, veterinarians, and maternal health experts. In today’s world, the services of a pharmacist involve higher patient orientation, and regulatory and public health functions. Various objectives of public health can be aided through an ideal set of skills of pharmacists and their experience in pharmacotherapy, pharmacovigilance, prevention services, access to health care services, patient counseling, and various other work performed by them^[6,4]. Active contribution of public health services involves -Identification and solution of community health problems by monitoring health status; diagnosing and findings to be made in case of any community-wide health threat; information, training, and promotion of the community about various health problems are provided by pharmacists about many diseases; develop plans and guidelines to promote individual and social health initiatives; organize civic partnerships related to health; ensuring safety and protecting health by enforcement of regulatory guidelines; cascading individuals to crave personal health care and assuring health care services when not available; affirming major and suitable health care workforce for the community; assessment of population-based health services for effectiveness, safety, accessibility, and quality, adding on to the existing knowledge through research and bringing out innovative effective solutions for health issues^[3,6].The wide health practice, knowledge, and expertise of a pharmacist makes them a suitable source for providing public health favors in most public-private environments, such as hospitals, pharmaceutical companies, hospitals, retail shops, and nursing homes. In our community, they are a proper source of education on sedentary living which impacts health outcomes. Pharmacists play an active role in screening various diseases e.g., diabetes, hypertension, liver fibrosis, cancer, etc immunization techniques, clinical investigations, patient counseling on smoking cessation, alcohol, drug abuse and prevention, health education, etc. They are a readily available sources of knowledge providing education on self-management of diseases (e.g. hypertension, diabetes, HIV, cardiovascular diseases), family planning, and drug-drug interaction ^[5].  Pharmacists are the best institution for teaching and training physicians, nurses, and other healthcare workers on the different dimensions of adverse events of drugs, prescriptions, and problems related to drug therapy. Pharmacists can provide knowledge by offering services within the government health schemes, and information about the drug through counseling, newsletters, seminars, teleconferencing, and short-term courses in nursing and medical colleges ^[8]. Pharmacists also assist in rehabilitation by guiding the use and choice of surgical devices and equipment to individuals and groups. The scholar is full of incidences in which the pharmacist is working/ assisting in high blood pressure and colorectal testing, control and contraception programs for sexually transmitted diseases, health awareness programs, and OTC drug choice advising and assisting patients^[7]. Pharmacists have approved social and environmental programs in rural regions such as control of chronic illness, water pollution, chemotherapy agents, sanitation and waste disposal. Another important part of interest is rural pharmacists which fills a gap in both pharmacy and public health. In view of the fact that rural health is often an area of higher importance towards geographical need, rural-health imbalance cannot be overlooked. The local pharmacist provides a necessary clinical source of knowledge in many rural regions with fewer capitalize available. This also applies in poor metropolitan places. In these public sub-sectors, pharmacists are especially precious assets since the pharmacist acts as a readily available information and screening resource for healthier life. By consulting local pharmacists, many community members may avoid overpriced visits to emergencies for that prevalence of acute illness or circumstances that may provide relief for provisional OTC drugs, especially those without insurance. Therefore, pharmacists can commit in solving and eliminating health differences. Pharmacists, like all healthcare professionals, should engage themselves in operations that can contribute to the elimination of health imbalances, through training in cultural skills, collecting information on drug use in specific communities and encouraging workforce diversity ^[9].Clinical pharmacy is a health science discipline in which clinical pharmacists provide patient care that enhances medication therapy and promotes health, and disease prevention. Clinical pharmacist aims to develop and promote the rational and appropriate use of medicines and pharmaceutical care, in the interest of the patient and the community ^[2].Pharmacists participate in the consultation of the clinical treatment plan and parenteral nutrition and played an active role in controlling the rationality of the medication plan and promoting the nutritional rehabilitation of patients ^[5].

Pharmacist role in different health-care setups:

• Prescription review: Ensures patients get the right drugs for their health condition and there are minimal or no adverse consequences. Prevention, detection, assessment and documentation of ADR’s. Pharmacist can prevent various medical errors by improving patient health literacy and maintaining vigilant control and balance ^[8].
• Health and safety: They check that prescription are correct by reviewing each patients medication history and prescriptions are up-to-date by making sure the patient last visit to doctor. Administration and encouragement of immunization. Distribution of contraceptive measures and education about family planning. Advancement of healthy lifestyles, reduce hospitalizations. As reported by the Centers for Disease Control and Prevention, smokers try to quit more effectively when their doctor and pharmacist help them to do so. The substance abuse involves the administration drug and alcohol. These are two main areas associated with the adult and adolescents which may self-medicate practicing Legal and illegal use of drugs and alcohol that can lead to severe health issues such as liver fibrosis. In addition, drug addicts can intentionally or unintentionally combine ^[10].
• Hospital pharmacist: Ward round participation, obtaining medication history of the patient. Respect and maintain patient’s privacy and confidentiality. Providing information about drugs and poison. Communication with prescribers; to discuss about alternative medicines or changes in dosage this helps to ensure that the prescribed drugs do not cause adverse reactions^[7].
• Counsel patients: The pharmacists may provide the information about current clinical conditions/ proceedings of the patient and educate them about the safe and appropriate use of medicines, thereby enhancing his therapeutic outcomes. Explains about medication adherence, life style modification if required, diet, side effects and possible interactions with prescribed medication, about risk factors, complications, prevention and cure for disease.
• Administrative tasks: They perform health and wellness screenings, also includes maintaining patient records and stocking medications, maintain pharmacy and medical records. They serve as scientific peers and resources within the healthcare community.
• Community pharmacy: Here they generally involve in dispensing of drugs, promotion of healthy lifestyles, support for self care, uses patient leaflets, smoking/alcohol cessation programs etc.  Also ensure quality, security and proper disposal of pharmaceuticals by mixing, packing and labeling procedures in compliance with health care policies and regulations.
• Clinical research: They take part in clinical trials and research processes to find out how these medications can affect the human body. Clinical review and therapeutic drug monitoring (TDM). Patient education in clinical trial and enhances patient participation in clinical trial research. Medico-legal issues records maintenance. Pharmaceutical industry plays a key role to play in the public health management. Essentially, primary function of the pharmaceutical companies is to formulate, develop and bringing lifesaving efficacious medicines to the market for promoting good health to the mankind ^[4].

Conclusion:

The pharmacist is the key health care professionals in helping individuals to achieve the best outcome from their medications. The role of pharmacist have expanded from compounding, dispensing of medicines to a lot of concerned into clinical aspect such as medication and therapy management, counseling, immunization programs, drug intervention and ADR reporting^[9].  They also may conduct health and wellness screenings, provide immunizations, administer the medications given to patients, and provide advice on healthy lifestyle ^[7]. Pharmaceutical services in developing countries face some specific challenges in contrast to those faced by pharmacists within the developed world. In most developing countries, lack of acceptable and good-quality medicines are the most common problem encountered. Irrational use of medication and weak regulatory enforcement of drug sales also are serious issues in developing countries ^[10]. Pharmacist play a advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, counseling and prescribing, therefore there is much need in increasing awareness relating to role of pharmacist in health-care setup^[8].

Reference:

1. Pharmacist with responsibilities and skills, by indeed editorial team; 2022 july 3.
2. American college of clinical pharmacy: pharmacotherapy 2008;28(6):816-817.
3. Understanding the pharmacy profession. David pharmacy.2017 November 24.
4. Deshpande R P,Vantipalli R.et al. Clinical pharmacists: The major support to Indian healthcare system in near future. Journal of pharmacy & bioallied sciences.2015 Jul-Sep;7(3):161-174.
5. Jia X, Zhang W.et al. What is the role of pharmacists in treating COVID-19 patients? The experiences and expectations of front line medical staff. Frontiers in public health.2021 December 20;9.
6. Sahoo PK.et al. Role of pharmacist in public health management. Pharmabiz.com.2020 July 30.
7. Khan N.et al. Pharmacists’ viewpoint towards their professional role in the healthcare system: a survey of hospital settings in Pakistan. BMC Health Services Research.2020 July 02;610(20).
8. Pearson GJ. Evolution in the practice of pharmacy- Not a revolution. Canadian medical association journal. 2007 May;176(9):1295-6.
9. Kokane VJ. et al. Role of pharmacist in the health care system. The journal of community health management. 2016 January-March;3(1):37-40.
10. Masurkar NK. Pharmacists can play a critical role in enhancing healthcare delivery in India. ETHealthWorld.2021 September 25.