CLINICAL PHARMACY 142

HISTORY OF CLINICAL PHARMACY (PPT 1)

HISTORY OF CLINICAL PHARMACY

1960’s - poor medicines control system which resulted to the automation of the regular pharmacists’ functions; mass production of medicines.

HISTORY OF CLINICAL PHARMACY

In the USA, unit dose dispensing was initiated and they pursued decentralization of pharmacy services.

HISTORY OF CLINICAL PHARMACY

In the UK, the unification of the prescription and administration record paved the way for pharmacists to visit the wards and handle the ordering of medicines.

HISTORY OF CLINICAL PHARMACY

Clinical pharmacy has emerged due to the presence of of the pharmacists in the patient areas (clinical setting) and their interest in promoting safe medication use.

HISTORY OF CLINICAL PHARMACY

From ward pharmacist (UK), the term clinical pharmacy was adopted.

HISTORY OF CLINICAL PHARMACY

In the 1980’s, clinical pharmacy practice grew because of its outcome-cost-effective medicine use in the hospital.

HISTORY OF CLINICAL PHARMACY

The positive economic and clinical outcomes were recognized by institutions and governments and the clinical pharmacy practice was established. (Walker R. and Whittlesea C. (2012). Clinical Pharmacy and Therapeutics)

HISTORY OF CLINICAL PHARMACY

Impact of clinical pharmacy on patients and institutions were studied and high acceptance of the practice was shown by doctors and other Hospital pharmacists.

HISTORY OF CLINICAL PHARMACY

Clinical pharmacy was introduced into pharmacy education in the 1970’s.

HISTORY OF CLINICAL PHARMACY

Specializations stared in the 1980s and continued on to the present time.

HISTORY OF CLINICAL PHARMACY

Pharmaceutical care as the new philosophy of the practice was developed in the 1990 by Dr. Charles Hepler and Linda Strand.

HISTORY OF CLINICAL PHARMACY

Clinical pharmacy finds its application in the community setting as well in the 1990s.

HISTORY OF CLINICAL PHARMACY

Medication Therapy Management became a clinical pharmacy service provided to various institutions outside of the hospital and community pharmacy settings in early 2000s.

CLINICAL PHARMACY

The area of pharmacy concerned with the science and practice of rational medicine use; It is patient-oriented, evidence-based, and designed to promote health, wellness and disease prevention in order to improve quality of life of patients.

CLINICAL PHARMACIST

A pharmacist in any practice setting who provides a substantial amount of of direct patient-oriented care with emphasis on the science and practice of rational drug use.

CURRENT SPECIALIZATIONS

Adult Medicine

Ambulatory Care

Cardiology

Clinical Administration

Clinical Informatics

Critical Care

Drug Information

Emergency Medicine

Endocrinology/Diabetes

Geriatrics

Hematology/Oncology

Women’s Health

Immunology/Transplantation

Infectious Diseases

Managed Care

Medication Therapy Management

Nephrology

Nutrition Support

Outcomes and Economics

Pain and Palliative Care

Pediatrics

Psychiatry and Central Nervous System

Pharmacotherapy

MEDICATION THERAPY MANAGEMENT

Identity (who) - Pharmacist

Philosophy (Why?) - Pharmaceutical Care, Interprofessional Collaboration

Strategy (How?) Medication Therapy Management

Behaviors (What?) - Patient Counseling, Medication Therapy Review, Motivational Interviewing, Disease Management Assessment, Patient Education, Documentation, Follow-up

Contexts (where, when?) - Community Practice, Institutional Practice, Consulting Practice, “Anywhere the Patient is”

DISCUSSION NOTES - CLINICAL PHARAMACY OVERVIEW

Pharmacy evolved from just making and dispensing medicines to having a role in clinical settings.

CLINICAL PHARAMACY OVERVIEW

Clinical Pharmacy emerged as a new area of practice, especially from the 1980s onwards.

CLINICAL PHARAMACY OVERVIEW

Realization that it reduced healthcare costs by:

• Preventing wrong medications.

• Reducing hospital stays.

• Avoiding additional medications and complications.

• Preventing malpractice suits for doctors, nurses, and pharmacists.

CLINICAL PHARAMACY OVERVIEW

Avoids malpractice suits for doctors, nurses, and pharmacists.

HISTORY AND DEVELOPMENT OF CLINICAL PHARMACY IN THE PHILIPPINES

• Clinical Pharmacy introduced by US-trained professionals in the 1970s.

• Early adoption in institutions like Makati Medical Center and PGH.

• Clinical pharmacists started being consulted by doctors regarding medications.

• Though it started early, it hasn’t become mainstream.

• Still practiced but with limited integration into the system.

IMPACT OF CLINICAL PHARMACY - CLINICAL OUTCOMES

Studies show that having clinical pharmacists lessened the length of stay of patients, the expenses for the patients, and there are some studies showing that having clinical pharmacists even lowered the mortality.

IMPACT OF CLINICAL PHARMACY - ECONOMIC OUTCOMES

• lessened the expenses for the patients

• lowered the cost on the side of the institution

IMPACT OF CLINICAL PHARMACY - HUMANISTIC OUTCOMES

patient-centered care and satisfaction

IMPACT OF CLINICAL PHARMACY

• Clinical Pharmacy introduced in the BS Pharmacy curriculum in the 1970s.

• Over time, specializations developed: e.g., cardiovascular pharmacy. Increasing over time.

• Modern curriculum includes pharmacotherapy in 4th year (previously only 3–5 units).

• Clinical exposure and real-life case discussions enhance practical learning.

PHARMACISTS’ ROLE IN THE CLINICAL TEAM

• Doctors may lack detailed knowledge of medicine formulation and excipients.

• Pharmacists are critical for:

  • Modified release formulations.

  • Dosing for NGT (nasogastric tube) patients.

  • Preventing drug/food interactions.

  Pharmacists can intervene and correct prescribing errors effectively.

  
  
  

MEDICATION THERAPY MANAGEMENT

• MTM emerged as an extension of clinical pharmacy and pharmaceutical care.

• Focuses on rational medicine use.

• Ensures appropriate medicines are given and therapeutic outcomes achieved.

FROM CLINICAL PHARMACY TO PHARMACEUTICAL CARE TO MTM

Evolution of practice:

1. Clinical Pharmacy

2. Pharmaceutical Care

3. Medication Therapy Management (MTM)

   Includes:

• Patient counseling

• Medication therapy review

• Motivational interviewing (for adherence issues)

• Disease management

• Education and documentation

• Follow-up

PHARMACEUTICAL CARE PROCESS

1. Assessment 

• Review patient meds, interview patient, gather history.

2. Identification of Medication-related Problems

3. Care Plan Development 

• Create interventions/solutions.

4. Follow-up & Evaluation  

• Assess success of the care plan.