the roles and barriers to clinical pharmacy

clinical pharmacy

• health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, and disease prevention

• patient care + specialized therapeutic knowledge, experience, and judgement

duties of an inpatient clinical pharmacist

• determine if a patient’s prescribed medications are meeting the patient’s needs and goals of care based on their individual health problems

• consult with physicians and other providers in selecting medication therapy

• provide parenteral nutrition recommendations and monitoring, complete pharmacokinetic and renal dosing consults, and recommend IV to PO switches

• participate in clinical rounds to provide real-time recommendations for medication therapy changes

• address transitions of care barriers and provide patient education prior to discharge

• participate in antimicrobial stewardship to optimize local antibiotic usage

duties of an outpatient clinical pharmacist

• determine if a patient’s prescribed medications are meeting the patient’s needs and goals of care based on their individual health problems

• initiate, adjust, and/or discontinue medications for chronic disease states, establishing relationships with patients for long-term monitoring

• provide patient education on glucose monitoring, injection technique, inhaler device technique, etc.

• educate the patient on other ways to improve/maintain their health, like exercise, diet, or immunizations

• conduct pharmacogenomic testing to provide individualized therapy recommendations

• ensure patients have access to affordable medications

development of clinical pharmacy

• 1821: first college of pharmacy opens

• 1950: first PharmD degree awarded

• 1957: first pharmacist participates in an inpatient rounding service

• 1962: first hospital pharmacy residency program began training

• 1970: federal funding increased to expand clinical pharmacy faculty based on ACCP report

• 1973: first paper to describe improved patient outcomes through clinical pharmacy services was published

• 1980: ASHP publishes new residency accreditation standards

• 1990: expansion of community pharmacy residency programs

• 1992: AACP votes for PharmD as only pharmacy degree

• 2000: ACPE no longer accredits BS programs

residency training

• post-graduate year 1 (PGY1)

  • 1689 general pharmacy programs (acute care and ambulatory care)

  • 210 community-based pharmacy programs

  • 151 combined PGY1 and PGY2 programs

• post-graduate year 2 (PGY2)

  • 25 available sub-specialties

barriers for inpatient clinical pharmacy

• lack of financial resources and leadership support

• lack of provider status

• lack of awareness among the healthcare team about clinical pharmacy

• lack of sufficient time for clinical activities due to work overload

• lack of adequate compensation

• limited number of clinical pharmacists

barriers for outpatient clinical pharmacy

• lack of provider interest or time and leadership support

• lack of provider staus/need for collaborative practice agreements

• limited reimbursement for pharmacist-provided services

• physical space limitations

• convincing patients of the value of pharmacists within a healthcare team

• access to electronic health records in the commnity