|
 
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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 17
| Issue : 4 | Page : 1031-1033 |
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Clinical pharmacists as potential contributors in reducing drug-related problems in daily practice: A glance at Indian setup
Jimmy Jose1, Kavitha Saravu2
1 School of Pharmacy, University of Nizwa, Nizwa, Oman
2 Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| Date of Submission | 18-Apr-2021 |
| Date of Acceptance | 05-Jun-2022 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Dr. Jimmy Jose
School of Pharmacy, University of Nizwa, Nizwa
Oman
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_167_21
How to cite this article:
Jose J, Saravu K. Clinical pharmacists as potential contributors in reducing drug-related problems in daily practice: A glance at Indian setup. J Datta Meghe Inst Med Sci Univ 2022;17:1031-3 |
How to cite this URL:
Jose J, Saravu K. Clinical pharmacists as potential contributors in reducing drug-related problems in daily practice: A glance at Indian setup. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Mar 28];17:1031-3. Available from: http://www.journaldmims.com/text.asp?2022/17/4/1031/369479 |
| Drug-Related Problems | |  |
A drug-related problem (DRP) is “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes.”[1] Based on problems (potential) associated with treatment effectiveness, treatment safety, and others such as patient dissatisfaction with therapy, despite optimal clinical and economic treatment outcomes, DRPs are classified into three primary domains.[1] Based on the causes, DRPs are classified into eight domains [Table 1].
DRPs are not uncommon worldwide and are a common contributor for admissions to the emergency department.[2],[3],[4] Various studies in India have attempted evaluating the frequency of DRPs among patients.[2],[5]
| Clinical Pharmacy – An Expanded Role of the Traditional Pharmacy Profession | | |
Pharmacy profession has evolved from its traditional drug-focused basis to an advanced patient-focused basis.[6] In the mid-1960s, a modified role of a pharmacist was developed in the form of clinical pharmacy activities in developed countries to accommodate this radical change.[7]
“Clinical pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.”[8] The pharmaceutical care philosophy is embedded in clinical pharmacy. Pharmaceutical care involves a close cooperation of pharmacists with patients and other professionals and in turn involves three major functions: identifying potential and actual DRPs, resolving actual DRPs, and preventing potential DRPs.[7]
The services offered by clinical pharmacists can contribute toward achieving improved patient outcomes, particularly by reducing DRPs, are multidimensional, and are as follows.[9]
Medication history interview
It is a critical component in drug therapy. Through medication expertise and appropriate communication skills, a clinical pharmacist can obtain necessary information on medication history to appropriately influence the future line of approach for a patient. The obtained information can be beneficial for cross-checking and can add to the information already gathered by a clinician or nursing staff.
Assisting in drug therapy selection
With advances in drug therapy, availability of multiple treatment options, presence of polypharmacy, and coexistence of multiple diseases in a patient, appropriate selection of an efficacious, safe, and cost-effective drug therapy often becomes a challenge in daily practice. Clinical pharmacists can critically evaluate the drug-related needs of a patient, thereby assisting clinicians in rational selection of drug therapy for the patient.
Medication order or prescription review
Multiple factors might contribute to inadvertent medication errors or nonoptimal prescribing in daily practice. Clinical pharmacists can dedicatedly review medication orders or prescriptions and thus significantly contribute to ensure the rational use of medications. They could review appropriateness in the selection of medications as well as dosage regimens, considering patient and disease details, and identify any untreated indication and use of medications without an indication. Moreover, the emphasis is on prevention, identification, and management of potential adverse drug reactions and drug interactions in the patients. These identified details can be communicated to the treating physician to make appropriate decisions based on the clinical judgment.
Drug and poison information services
Considering the vast amount of medication-related information available in various sources, healthcare professionals often experience difficulty in accessing and comprehending this information for a patient or in general. Clinical pharmacists with their medication expertise, information searching skills, and communication skills can provide unbiased and updated drug information in clinical practice.
Ward round participation
The participation of pharmacists as members of the medical team on a routine basis facilitates the provision of various clinical pharmacy services, mainly assisting in drug therapy selection, medication order review, and drug information retrieval.
Medication safety
Clinical pharmacists can be involved in prevention, monitoring, identification, assessment, management, and reporting activities (pharmacovigilance) associated with adverse drug reactions, thereby promoting safe drug use.
Patient medication counseling
Clinical pharmacists could spend dedicated time with patients in addressing their medication-related queries and educating them on the appropriate use of medications, medication administration techniques, as well as essential safety-related matters, thereby contributing to improve medication adherence.
Ancillary services
Clinical pharmacists can participate in various other activities, including coordinating therapeutic drug monitoring services. Clinical pharmacists, particularly those with an infectious disease training, could actively participate in an antimicrobial stewardship program that is used in practice settings of health systems to improve patient outcomes while minimizing the unintended consequences of antimicrobial use.[10],[11] They can initiate, coordinate, or contribute to research on medication-related aspects, thereby contributing to multidisciplinary research and the effective dissemination of study results in journals or conferences.
All aforementioned activities could be beneficial in identifying, solving, and preventing potential DRPs. Proactive responses of clinical pharmacists in daily clinical practice can ensure and advance rational drug therapy, thereby averting several medication therapy misadventures.[8]
| Pharmacist Involvement as a Member of the Multidisciplinary Healthcare Team | | |
A comprehensive systematic review with focused meta-analyses of 298 studies demonstrated the significant effects of pharmacist-provided direct patient care in the United States on therapeutic, safety, and humanistic outcomes across various healthcare settings and disease states.[12] Multiple studies have reported the role of pharmacists in dealing with DRPs in India.[13],[14]
| Specific Concerns on Drug Use in Indian Setup | | |
Numerous pharmaceutical formulations are available in India, including irrational drug combinations and nonessential medications. Many clinicians may largely rely on the promotional materials from pharmaceutical companies as the main source of drug information.[15] The patient load for prescribers is extremely high in usual practice.[15] The possibility of medication duplication owing to multiple prescribers or duplicate prescribing of therapeutic equivalents, individually or as part of combinations, is high.
| History and Current Status of Clinical Pharmacy Education and Practice in India | | |
Currently, the following pharmacy degree programs are offered in India: diploma in pharmacy, bachelors of pharmacy, masters of pharmacy (MPharm) in various specialties, doctor of pharmacy (PharmD), and doctor of philosophy. Among these programs, successfully completing an MPharm in pharmacy practice/clinical pharmacy as well as a PharmD ideally equips a pharmacist to function as a clinical pharmacist.
Pharmacy education in India has evolved substantially. In the 1990s, academic regulators in India identified specific needs for graduating pharmacists to involve in the advanced role of direct patient care and accordingly introduced a postgraduate program – MPharm in pharmacy practice.[15] The graduates are extensively trained to execute patient-oriented activities through bedside teaching with exposure to clinical cases during ward rounds, along with the medical team, and are directly and indirectly mentored by clinicians.[16] In addition, these students have to conduct a year-long postgraduate research project generally on clinical and drug-related aspects, thereby equipping them to contribute to clinical practice and research.
In 2008, the Pharmacy Council of India established a PharmD program comprising 5 years of full-time study and 1 year of internship or residency to continue strengthening clinical pharmacy education and practice. Besides didactic courses, the program includes clinical and hospital pharmacy posting of the students.[17]
Although clinical pharmacy services have proved and are proving their significance in numerous healthcare systems globally, currently, only very limited professional clinical pharmacy services are provided in India and a huge lack of awareness regarding these services exists.[18] Moreover, no regulatory guidelines exist for recruiting qualified clinical pharmacists in Indian hospitals, and the regulatory framework does not recognize the need for clinical pharmacists in hospital settings.[19]
| Future Challenges and Opportunities | | |
Considerable challenges exist for the establishment and wide acceptance of clinical pharmacy in general. Qualified clinical pharmacists who graduated over the past 20 years are underutilized in healthcare settings.
Extremely few private hospitals are currently offering a position as a clinical pharmacist.[20] The central government and all state governments should recognize the significance of clinical pharmacists and devise strategies accordingly to introduce a cadre of clinical pharmacists in the healthcare system, thereby taking critical steps to optimize medication use in the country.[7]
Awareness of clinical pharmacy and acceptance of clinical pharmacists as members of a cooperative healthcare team by healthcare professionals are essential for the survival and growth of clinical pharmacy in India.[8],[15],[16] Acceptance by the healthcare professionals is very essential, and the same should be earned by the clinical pharmacists. Clinicians should not perceive that pharmacists infringe into their territory and should understand that clinical pharmacists have a specific role in assisting them to attain the common goal of all healthcare professionals – patient welfare.[15],[21]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Porter G, Grills N. Medication misuse in India: A major public health issue in India. J Public Health (Oxf) 2016;38:e150-7.  |
| 3. | Alghamdy MS, Randhawa MA, Al-Wahhas MH, Al-Jumaan MA. Admissions for drug-related problems at the Emergency Department of a University Hospital in the Kingdom of Saudi Arabia. J Family Community Med 2015;22:44-8. |
| 4. | Perinpam L, Haag JD, Baudoin MR, Fowler CL, Sunga KL, Bellamkonda VR, et al. 177 drug-related problems in emergency department patients: A prospective evaluation of prevalence, categorization, and disposition. Ann Emerg Med 2014;64:S64. |
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| 8. | American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy 2008;28:816-7. |
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| 12. | Chisholm-burns MA, Lee JK, Spivey CA, Slack M, Herrier RN, Palmer J, et al. US pharmacists' effect as team members on patient care systematic review and meta-analyses. Med Care 2010;48:923-33. |
| 13. | Parthasarathi G, Ramesh M, Jakka Krishna K, Shivakumar M. Assessment of drug-related problems and clinical pharmacists' interventions in an Indian teaching hospital. J Pharm Pract Res 2003;33:272-4. |
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| 17. | Ministry of Health and Family Welfare (Pharmacy Council of India); 2008. May 10, Pharm. D. Regulations 2008. The Gazette of India, No. 19, Part III, Section 4; p. 1-97. Available from: http://www.pci.nic.in/pdf/PharmD-Revised-A.pdf. [Last accessed on 2019 Jun 4]. |
| 18. | Deshpande PR. Should the PharmD degree be the basic educational requirement in India for pharmacists? Am J Pharm Educ 2013;77:132. |
| 19. | Mangasuli S, Rajan S, Khan SA. A decade of pharmacy practice education in India. Am J Pharm Educ 2008;72:2006-8. |
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| 21. | Venkat MU, Naik AN. Doctor of pharmacy in India: Scope and professional challenges. J Pharm Res 2011;10:97-101. |
[Table 1]
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