Author: Divya Suthar*1 

Abstract:

Clinical pharmacy concerned with science and the rational medication use and it is widely recognised as an essential profession in the multidisciplinary environment of patient care. Clinical pharmacists are the one who works directly with the physicians and patients. The purpose of this study is to emphasis clinical pharmacist’s importance in several regions.

The study also concerned with clinical review where the pharmacist check the drug therapy to ensure that the patient is getting appropriate dose, dosage, dosage form, duration of therapy for their medical state. The clinical pharmacy services are one of the beneficial ways to improve the patient health care.

Since the start of the Coronavirus (COVID-19) pharmacists are playing a key role adopting innovative strategies to minimize the adverse impact of the pandemic. It is concluded that the characteristics of interactions between physicians and clinical pharmacists has impact on physician-pharmacist collaboration and improve patient care.

Introduction:

• Clinical Pharmacy

Clinical pharmacy is a branch of pharmacy that involve the provision of patient care with the use of medications to optimize the health outcomes of patients. The growth of clinical pharmacy has been expanded to medical clinics and hospitals, where the clinical pharmacist works as a part of multidisciplinary team and other health care professionals. The major role of it is to optimise the use of medications for the best patient outcomes¹.

• Clinical Pharmacist

As clinical pharmacist working directly with the physicians and patients so they are well- positioned to fill the gap between patients and physicians since they have in-depth understanding of medicines and also have regular interactions with prescribers. They together can offer a high-quality patient care. The clinical pharmacist in health care team can attend the ward round. Due the availability of clinical pharmacist on the ward was a game-changing aspect of pharmacy advancements. Clinical pharmacist aids in identification, prevention and reduction of medication interactions and adverse drug reactions (ADR)^2,3.

They provide their expertise in medication evaluation, drug related issue diagnosis, treatment suggestions and medical compliance promotion. Clinical pharmacists have more focused on medical and medication information, scrutinize the medication mistakes such as prescription, dispensing and administration errors, detect drug interaction, track adverse drug reactions (ADR) and give patient counselling among other things. They also give specification on how to utilise inhalers, insulin pens, eye drops, nasal sprays and other medical equipment ^2,3.

Role of clinical pharmacist during COVID-19:

As we know that health care professional pharmacist has played active role during COVID-19 pandemic by acting with the community to continuing care for patients with chronic diseases and providing the pharmaceutical care to the patients. They provided the definitive and reliable information for preventing, detecting, treating and managing coronavirus infections.

During flu season the US pharmacists and physicians collaborate to make flu patients receive prompt treatment⁵. Canadian pharmacists were actively involved in battling the severe acute respiratory syndrome crisis⁶. Pharmacists have ensured the supply of non- routinely stocked medicines in hospitals during the COVID-19 pandemic and provided information for these drugs⁷.

In vitro drugs which have antiviral effects such as lopinavir/ritonavir, chloroquine and hydroxychloroquine or immune-modulating agents such as tocilizumab or interferons has been considered to have great promise. It is the pharmacist role to provide accurate data about the safe dug delivery, drug-drug interactions and its adverse effects. Pharmacist are a trusted and accessible resource for the public during this COVID-19 pandemic⁸.

Telehealth and other novel pharmaceutical services were established for the patients in hospitals as well as many household quarantined patients with chronic condition, requires expert consulting in this pandemic.

Figure 1: Clinical Pharmacist

Clinical pharmacy services provided during COVID-19:

Clinical pharmacy services work with medical and nursing staff to create and sustain a clinical practise with a patient care service, collaborating to improve the pharmacotherapeutic elements of patient care². Their function as an academic institute’s faculty member.

1) Professional service guidance to pharmacist and pharmacies

Pharmacist in community, hospital and in others health care settings helps in guiding the prevention of spread of COVID-19 and supporting the efficient management of infection by health care system. It gives the advice on preventive measures, equipment stock and appropriate laboratory testing.

2) Establish emergency drug formularies based on treatment guidelines

As currently there is no such specific vaccines and any effective antiviral therapy for treating the COVID-19. Therefore some antiviral drugs and injection were used to control the infection. Pharmacist applied evidenced based medication use evaluation approaches to collect and give the proper drug information to clinicians for better understanding and prescribing these drugs. In addition to keep all the front-line pharmacists updated is highly crucial and challenging.

3) Monitor and resolve drug shortages

During COVID-19 all countries suffered from the drug shortages. Both prescribed and over the counter (OTC) medication shortages occur and there is also the short supply due to production disruptions for various reasons. Therefore the pharmacist and pharmacies conducted the active surveillance and addresses the shortages issue promptly under the American Society of Health-system Pharmacists [ASHP] guidelines.

4) Provide event-driven pharmaceutical care activities

Pharmacist conduct literature evaluations and ensure the appropriate use of off- label drugs and it is also mandatory to assist in evaluating the efficacy and safety of drugs and to monitor adverse drug reactions⁹.

5) Establish remote pharmacy services to reduce human-to-human infections

By online drug consultation drug delivery services have effectively reduce over crowding and spreading of viruses through person to person transmission during coronavirus epidemic. Example, the Pharmacy Department of Xiangya Hospital, Central south University, created an online remote pharmacy servicenvia WeChat®.

6) Educate the public with a focus on infection prevention and disease management

Health personnel and hospital workers are highly exposed to the virus and therefore at higher risk for infection. In addition, medical students should be mentored and supported in order to mentally and emotionally deal with additional stress related to the pandemic. For instance, During the Severe Acute Respiratory Syndrome (SARS) outbreak in Singapore, university lectures utilized simulation strategies in clinical education in order to prevent and reduce the risk of infection in students¹⁰.

7) Participate in clinical trials and drug evaluation

The monitoring of patients is most significant challenge that the performing trials sites are currently facing. The clinical trial’s integrity is halted due to the spread of COVID-19 infection.

Figure 2: Pharmacist Roles During COVID-19

Clinical Review:                                                                                                                       

Clinical review is one of the integral components of medication review and should preferably be performed on a daily basis. It is the review of the patient’s progress for the purpose of assessing the therapeutic outcome. Therapeutic goal for the specific disease should be clearly identified before the review.

The primary aims of the clinical review are to:

• Assess the response to drug treatment
• Evaluate the safety of the treatment regimen.
• Assess the progress of the disease and the need for any change in therapy
• Assess the need for monitoring
• Assess the convenience of therapy to improve compliance

The procedure follow for the clinical review is:

• Collection of patient specific data should be undertaken routinely
• The data collected should be clinically relevant and documented in the pharmacy patient profile.
• Results of biochemical, haematological, microbiological, radiological and other investigations should be reviewed
• Information elicited from the patient should also be considered

Information obtained must be interpreted and evaluated with reference to Clinical features, Pathological condition, Indication for investigation, Patient medication history, Planned outcomes of therapy.

Clinical Research and Drug Development:

This two have much to do with the clinical trials. Pharmacist playing a central role in the research process which can influence the success of clinical trials. In clinical trials, clinical pharmacist can even serve as lead investigators and patient instructors and they also help patients participation in clinical trial research. If the drugs perform well in trials and is nominated to go into full scale commercial production then this will be another area where many pharmacists can employ^11,12,13,14.

Figure 3: Clinical Trial

Pharmacovigilance:                                                                                                                

According to World Health Organization Pharmacovigilance defined as “the science and activities concerned with the detection, assessment, understanding and prevention of adverse effects or other medication-related problems.”² It is essential to establish the pharmacovigilance system to support public health policy¹⁵. To assessing the safety of drug and its appropriate use pharmacovigilance is necessary¹⁶. Spontaneous reporting is used to generate signals on new or rare adverse drug reactions (ADRs)¹⁷.

Conclusion:

Pharmacists are at the forefront of patient care and can have a significant impact on patient management. Pharmacist are up to speed on the latest developments in medicine and may contribute successfully to clinical research projects and other current research initiatives.

Pharmacist must be proactive and take a leadership role in assuming pharmacy related responsibilities. All pharmacists regardless of their speciality are directly or indirectly must ensure that ‘the appropriate medicine is given to the right patient at the right time in the right amount via the right channel in the right way.’ A scoping review of published studies suggests that future research with a more detailed description and an evaluation of the impact of pharmacist intervention is needed to guide future actions in COVID and other pandemic.

References:

• Clinical Pharmacy https://news-medical.net/health/Clinical-Pharmacy.aspx
• Role of clinical pharmacist in healthcare: An overview https://researchgate.net/publication/356961436w
• Clinical pharmacist: The major support to indian healthcare system in near future https://ncbi.nlm.nih.gov/pmc/articles/PMC4517317/
• Role of clinical pharmacist during COVID-19 pandemic: A scoping review https://news-medical.net/health/Clinical-Pharmacy.aspx
• Fighting against COVID-19: Innovative strategies for clinical pharmacists https://ncbi.nlm.nih.gov/pmc/articles/PMC7194937/
• Severe acute respiratory syndrome: A pharmacist’s role https://ncbi.nlm.nih.gov/pmc/articles/PMC7167812/
• What is the role of pharmacists in treating COVID-19 patients? The experiences and expectations of front line medical staff https://frontiersin.org/articles/10.3389/fpubh.2021.778863/full#:~:text=From%20the%20perspectives%20of%20medical,and%20interactions%20during%20the%2 0COVID

• Role of clinical pharmacist during Covid-19 pandemic https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.1231
• https://ncbi.nlm.nih.gov/pmc/articles/PMC7101875/#CR6
• The role of educating health-care personnel in prevention, diagnosis or treatment of COVID-19: A narrative mini review https://ncbi.nlm.nih.gov/pmc/articles/PMC8826867/
• Impact of COVID-19 on clinical trials and clinical research: A systematic review https://ncbi.nlm.nih.gov/pmc/articles/PMC7538012/
• The pharmacists’ role in clinical research https://elsevier.es/es-revista- farmacia-hospitalaria-121-articulo-the-pharmacists-role-in-clinical- S1130634311000626
• Pharmacy services during COVID-19 pandemic: experience from a tertiary care teaching hospital in Pakistan https://joppp.biomedcentral.com/articles/10.1186/s40545-020-00277-5
• Pharmacists in research and development https://abpi.org.uk/careers/working-in-the-industry/research-and- development/pharmacy/pharmacists-in-research-and-development/
• A review of pharmacovigilance https://ncbi.nlm.nih.gov/pmc/articles/PMC4668980/
• A review of pharmacovigilance https://jpadr.com/index.php/jpadr/article/view/54
• Under-reporting of adverse drug reactions. Estimate based on a spontaneous reporting scheme and a sentinel system https://pubmed.ncbi.nlm.nih.gov/9776440/