Clinical Pharmacy Education, Practice and Research

Clinical Pharmacy, Drug Information, Pharmacovigilance, Pharmacoeconomics and Clinical Research

Dixon Thomas, Dixon Thomas

• Publisher: Elsevier
• Year: 2018
• ISBN:
  9780128142776
• Topic: Business
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry
• Index: Business

Clinical Pharmacy Education, Practiceand Research offers readers a solid foundation in clinical pharmacy and related sciences through contributions by 83 leading experts in the field from 25 countries. This book stresses educational approaches that empower pharmacists with patient care and research competencies. The learning objectives and writing style of the book focus on clarifying the concepts comprehensively for a pharmacist, from regular patient counseling to pharmacogenomics practice. It covers all interesting topics a pharmacist should know. This book serves as a basis to standardize and coordinate learning to practice, explaining basics and using self-learning strategies through online resources or other advanced texts. With an educational approach, it guides pharmacy students and pharmacists to learn quickly and apply. Clinical Pharmacy Education, Practiceand Research provides an essential foundation for pharmacy students and pharmacists globally.

• Covers the core information needed for pharmacy practice courses
• Includes multiple case studies and practical situations with 70% focused on practical clinical pharmacology knowledge
• Designed for educational settings, but also useful as a refresher for advanced students and researchers

Chapter 1

Introduction to Clinical Practice, Research, and Pharmacy Education

Dixon Thomas¹, Jennifer Marriott², Rao Vadlamudi³, Benny Efendie⁴, and Lucinda L. Maine^{5 1}Gulf Medical University, Ajman, United Arab Emirates ²Monash University, Faculty of Pharmacy and Pharmaceutical Science, VIC, Australia ³The Indian Pharmaceutical Association, Mumbai, India ⁴Monash University Malaysia, Bandar Sunway, Malaysia ⁵American Association of Colleges of Pharmacy, Alexandria, VA, USA

Abstract

Pharmacists provide patient care in their practice that optimizes therapy outcomes, as well as promoting health, wellness, and disease prevention. The concept of clinical pharmacy is important for pharmacists as they deal with patients. Community pharmacists usually serve ambulatory patients, and institutional pharmacists care for both ambulatory and inpatients. Pharmacists provide extended clinical services such as assessment of health status, drug information, independent or supplementary prescribing, and administration of certain vaccines. Pharmacists extend their cognitive services to other healthcare professionals in terms of providing drug information or pharmacotherapy services. To address these expanding practice responsibilities, pharmacy education must keep up with and achieve advanced educational outcomes. The internship or Advanced Pharmacy Experience at the end of the pharmacy program leads to independent, practice-ready graduates. Although pharmacists follow the evidence to improve practice and generate practice-based evidence, pharmaceutical scientists focus on innovating better drugs.

Keywords

Clinical pharmacy; Clinical practice; Pharmacy education; Pharmacy services; Research

Learning Objectives:

Objective 1.1 Describe salient features of clinical practice of pharmacists.

Objective 1.2 Address relevant concepts in pharmacy education leading to clinical practice.

Objective 1.3 Outline how research in pharmacy is improving patient outcomes.

Objective 1.1. Describe Salient Features of Clinical Practice of Pharmacists

According to the Oxford Dictionary of English, the term “clinical” is used in various medical fields to mean that it relates to the treatment of actual patients. Pharmacists, regardless of where they are working, are clinical staff and healthcare professionals. In 2005, the American College of Clinical Pharmacy (ACCP) defined clinical pharmacy as

a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.¹

The practice of clinical pharmacy embraces the philosophy of pharmaceutical care²; it blends a caring orientation with specialized therapeutic knowledge, experience, and judgment to ensure optimal patient outcomes. All direct patient care activities such as patient counseling, medication reconciliation, medication therapy assessment, and any other patient care service are clinical services at the bedside or otherwise (Figs. 1.1 and 1.2). Practice-based research must contribute to the generation of new knowledge that improves practice and the quality of life of patients.²

Significant developments in the pharmacy profession have occurred since the introduction of the concept “pharmaceutical care” in the early 1990s.² Pharmacists provide a wide range of clinical services³ irrespective of the setting in which they work.⁴ Advising a patient to take an irritant drug with plenty of water will improve quality of life if the patient is adherent to the advice. The clinical expertise of a pharmacist helps to judge if the patient would use medicines appropriately. Tailoring advice or other supporting services to improve adherence of patients to therapy and actions to be taken to prevent adverse outcomes are clinical services. In some countries, pharmacists have also been granted independent or supplementary prescribing rights. Administration of certain vaccines is another such clinical service provided by pharmacists in many jurisdictions. Pharmacists have a long history of managing minor ailments with nonprescription products or just with lifestyle advice. All these activities involve clinical skills.

Pharmacy education has evolved to address the necessary clinical pharmacy competencies. Bachelors of pharmacy programs in many countries have less clinical education, though its importance is increasing. To develop expertise in clinical pharmacy means obtaining a specialized master's program. Although bachelors make pharmacists, masters in clinical pharmacy make clinical pharmacists. In the United States, Doctor of Pharmacy (PharmD) is the only program that makes pharmacists. Pharmacists are considered to have clinical expertise in community pharmacy, hospital pharmacy, or other clinical pharmacy settings. Being a clinical pharmacist in a specialized area may require additional certification or residency.⁵

Figure 1.1 Clinical service at the bedside.
From Bob Nichols (photographer) https://commons.wikimedia.org/wiki/File:20130306-OC-RBN-3902_(8575102773).webp.

Figure 1.2 Patient counseling at the pharmacy.
From Rhoda Baer (photographer) https://commons.wikimedia.org/wiki/File:Woman_consults_with_pharmacist.webp.

Community-based pharmacy practitioners are highly accessible healthcare professionals. Ambulatory patients and other consumers benefit from pharmacists' clinical care and supply of healthcare products. Timely access to quality drugs is important for the patient. Providing the right drug at the right time is part of a pharmacist's duty of care. Institutional pharmacists usually deliver more complex clinical services in addition to their nonclinical roles. Pharmacists have always responded clinically to people's health needs, improving their access to quality drugs and providing advice about drugs. Pharmacists with full-time clinical responsibilities provide their services mostly at the bedside.⁶

Pharmacists are well educated to interact with patients concerning their diseases and medication. Pharmacists possess in-depth knowledge of medications that integrates with a foundational understanding of the biomedical, pharmaceutical, sociobehavioral, and clinical sciences. To achieve the desired therapeutic goals, the pharmacist applies evidence-based therapeutic guidelines, evolving sciences, emerging technologies, and relevant legal, ethical, social, cultural, economic, and professional principles.

Accordingly, clinical pharmacists assume responsibility and accountability for managing medication therapy in direct patient care settings, whether practicing independently or in consultation/collaboration with other healthcare professionals. With increased patient care activities, it is likely that more pharmacists are involved in medication management and assume some level of prescribing or advising authority, as has already occurred in some countries.⁷ The incidence of errors in pharmacist-written discharge medication orders in a study from the United Kingdom was found to be low.⁸

The clinical practice of pharmacists is evidence based. Pharmacists generate, disseminate, and apply new knowledge that contributes to improved health and quality of life. Pharmacists also supply evidence-based therapeutic advice to other healthcare professionals.¹

To discuss as a model, the American Association of Colleges of Pharmacy (AACP) consistently tries to standardize the educational outcomes of pharmacy programs in association with other pharmacy organizations. Three important documents that explain the educational outcomes of pharmacy undergraduate programs in the United States are as follows:

1. • Center for the Advancement of Pharmacy Education 2013 Educational Outcomes (CAPE 2013)⁹
2. • Pharmacists' Patient Care Process (PPCP)¹⁰
3. • Entrustable Professional Activities (EPAs)¹¹

AACP identified EPAs for pharmacy graduates. Core EPAs for New Pharmacy Graduates are discrete, essential activities and tasks that all new pharmacy graduates must be able to perform without direct supervision on entering practice or postgraduate training and operationalize the CAPE Educational Outcomes.¹¹ The 15 CAPE Educational Outcomes are relevant and consistent with emerging scientific and clinical developments and practitioner roles.⁹ Continued development of practice-specific EPAs are necessary to extend the definition of what a pha...