Introduction to Clinical Pharmacy

Clinical Pharmacy
Pharmacy service that is focused on the patient rather than a product (the prescription).

Focus of Practice
Selling a product

Patient care

Clinical Pharmacy
Drug Information Hospital practice Clinic Practice Clinical research Clinical education Pharmaceutical Industry

Pharmaceutical Care
Identification, resolution, and prevention of drugrelated problems.
Untreated indications Improper drug selection Subtherapeutic dosage Failure to receive drugs Overdosage Adverse drug reactions Drug interactions Drug use without indication

Areas of Focus for Clinical Pharmacy Efforts

Patient counseling Disease management Medication safety Drug Policy Management Clinical research

Common Diseases for Clinical Pharmacy Services

Diabetes Hypertension Hyperlipidemia Infectious diseases Asthma Cancers

What Clinical Pharmacists Do

Provide direct patient care Support physicians and nurses Write drug policies / formularies Conduct research Review and evaluate drug use

Clinical Pharmacy Services

The patient who comes to your pharmacy Recommend the most appropriate non-prescription medication for the patients condition. Check to see if there are any interactions with other drugs. Assure there are no disease or allergy contraindications Provide recommendations for how to take the medication. Provide information about the drug or disease.

Clinical Pharmacy Services

The patient in the hospital Perform medication history. Check to see that the drug dosage is appropriate. Check patient allergies. Provide medication counseling before the patient leaves the hospital.

Clinical Pharmacy Services

The Hospital Evaluate published studies to determine which drugs should be used (Formulary) Answer drug information questions from physicians and nurses. Perform reviews of medication use (drug use evaluation) Write guidelines for drug use

Clinical Pharmacy Services

The Community Offer disease screening (diabetes, osteoporosis, hyperlipidemia, hypertension) Offer lectures to community groups. Provide immunizations. Patient counseling.

Medical College of Georgia

The Medical College of Georgia

Teaching hospital for the State of Georgia Medical, nursing, dental schools. Associated with University of Georgia College of Pharmacy. 500 hospital beds, many clinics, trauma center Separate pediatric hospital 23 pharmacists, 45 pharmacy technicians

Clinical Pharmacy in Augusta, Georgia, USA

Drug Information Center Renal transplantation service Oncology Pediatrics Intensive care unit Anticoagulation clinic Emergency room

Drug Information Center

Answer questions from physicians and nurses. Review clinical studies on new drugs. Recommend drugs to add to hospital formulary. Conduct drug safety reviews.

Drug Information Center

Drug Formulary
A selected list of drugs that are recommended for use in a health care system. Most hospitals, government systems, and insurance companies have formularies. Should be based on evidence that the selected drugs are more effective, safer, or less expensive.

Promote Medication Safety

Design prescribing, drug dispensing, and drug administration systems that reduce the chance of errors.

Clinical Pharmacist in Surgery

Rounds with surgery team Assist with antibiotic selection Write policies for antibiotic use Pharmacokinetic dosing Design parenteral nutrition regimens Pain assessment and analgesic recommendations Provide drug information Patient counseling

Renal Transplant Service

Assist in dosage adjustment for immunosuppressants (such as cyclosporine) Manage other chronic diseases (diabetes, hypertension, hyperlipidemia) Review drug regimens. Patient counseling and compliance monitoring.

Oncology
Assure safety of cancer drug treatments. Provide drug information to physicians and nurses. Provide information and counseling to patients. Assist with clinical studies.

Anticoagulation Clinic
See patients after referred by physician. Monitor coagulation tests (such as prothrombin time). Check for adverse effects (bleeding). Provide education to patients. Encourage compliance.

Pediatrics
Assist with determining the best dosage and route of administration. Create policies for drug use in children. Provide drug information to physicians.

Intensive Care Service

Trauma service and Medical Intensive Care Rounds with intensive care teams. Review drug regimens. Pharmacokinetic dosing.

New Clinical Pharmacy Areas in Georgia

Wellness Clinic (disease screening) Immunization programs Disease management Clinical drug study management Medication Access Program

Wellness Clinic
Disease screening (hypertension, diabetes, osteoporosis, hyperlipidemia)

Wellness Clinic
Medication counseling for patients Immunizations Smoking cessation

Clinical Pharmacy Research

Principle investigator or Co-investigator with physicians Pharmacokinetic studies Clinical efficacy trials Pharmaco-epidemiology Pharmaco-economics Post-marketing safety studies Quality of life / patient satisfaction studies

Trends in Pharmacy
Automation of prescription dispensing function Increasing drug costs Greater need for drug information and assessment New drugs based on biomedical discoveries Patient concern for drug safety

Other Important Trends

Aging of the population. Greater use of medications for chronic disease. Introduction of new, expensive medications Shortage of physicians Increasing authority of nurses, physician assistants, and psychologists.

Who Hires Clinical Pharmacists?

Hospitals Community Pharmacies Drug Companies Physician groups Federal government Insurance companies

Documented Benefit of Clinical Pharmacists

Decrease drug costs Decrease drug adverse effects Reduce mortality in hospitalized patients