Clinical pharmacy - Definition, Development and Scope

Definition, Development and Scope of clinical pharmacy


       Functions of clinical pharmacy

       Need for clinical pharmacy in India


After completion of this lecture, student will be able to:

       Discuss the functions of clinical pharmacy

       Discuss the need for clinical pharmacy in India

       Explain the qualification of personnel

Introduction to clinical pharmacy

       Clinical pharmacy may be defined as the science and practice of rationale use of medications, where the pharmacists are more oriented towards the patient care rationalizing medication therapy promoting health , wellness of people

       It is the modern and extended field of pharmacy

       “The discipline that embodies the application and development (by pharmacist) of scientific principles of pharmacology, toxicology, therapeutics, and clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied sciences for the care of patients”


       Until the mid 1960’s ; Traditional role

       The development of clinical pharmacy started in USA

       More clinically oriented curriculum  were designed with the award of  PharmD degree

       These developments influenced the practice of pharmacy in U.K

       Initially prescription and drug administration records were introduced followed by an increasing pharmacy practice in hospital wards

       Master degree programs in clinical pharmacy were introduced for first time in 1976

       The progress of clinical pharmacy development remained at low profile in the first decade after its birth in U.K

        However, Nuffield report in 1986 geared up the momentum for progression of clinical pharmacy

       Until today, the clinical pharmacy practice in Nepal is in embryonic stage

Origin of clinical pharmacy

       Clinical Pharmacy has its origin in the US in early 1960s

       Definition- Services provided by pharmacists in an attempt to promote rational drug use- safe, appropriate, cost effective

       Goal – To provide pharmaceutical care ( enhancing the care of individual patient)

Development of clinical pharmacy

          Pharmacy act (1948) - to control the standards of pharmacy profession

          D.Pharm (1953) – min qualification needed to practice pharmacy in India

          1990 – Period of awakening, need for pharmacist to contribute to improved medication use in community

          1991-   Educational regulations to include hospital, clinical, community pharmacy & health education in D.Pharm curriculum

          1996-97- First M.Pharm Pharmacy Practice program at J.S.S Mysore & Ooty

Need for Clinical Pharmacy in India

       Clinical Pharmacy Practice is concerned with the promotion of safe, effective & economical dug therapy

       Pharmacy Practice’ a broader term- includes C.P &  activities performed by pharmacist in hospital & community settings

       It includes- Dispensing, drug distribution. Drug information, health promotion, patient counseling,  pharmacovigilance, medication review

       Need of the hour in India

Need for Clinical Pharmacy in India

Pharmaceutical Industry

          Lack of fully fledged medical information departments by most pharmaceutical companies in India

          Presence of only technical info about  drugs  in package inserts

          Clinical pharmacist aims at providing unbiased drug information to doctors & patient counseling


          A busy practitioner may spend  only around 5-10 min/ patient

          OPD in general hospitals are always overcrowded

          Lack of time may lead to DRP’s ( drug related problems )

          Risk of drug duplications

          Infectious diseases often treated empirically

          Definitive therapy after culture & sensitivity data not often practiced

          Wide spread antibiotic resistance

          Clinical pharmacist can help by providing information to deliver safer & more effective drug therapy


          Drug policies mainly aimed at pharmaceutical industry rather than patients

          Price control, manufacture licensing have taken precedence over safe medication use

          ADR reporting systems not fully established

          Much can be done by government to establish PP in India


          Inability to read & write English used on medicine labels

          C.P’s can assist med. Compliance, provide counseling in local language, help resolve non- compliance

          PIL’s & advisory labels can be provided in local language

          Can advise on choosing most cost effective medicines in consultation with doctors

          Help minimize irrational & unnecessary drug use


       Lack of services offered by pharmacists in medical stores such as patient counseling because of poor knowledge, lack of training, lack of confidence and no financial benefits

       Hospital pharmacist manage drug inventory, dispensing, record keeping

       Clinical pharmacist with appropriate training can help improve medication use by providing services such as drug therapy monitoring, patient counseling, DI services, ward round participation,  ADR reporting & monitoring

Scope of clinical pharmacy in India

       Excellent relationship with the medical profession is needed to ensure progress of clinical pharmacy

       Rewarding career path with opportunities to contribute to improved medication use

        Employment in hospitals, teaching, drug information, pharmacovigilance, clinical research, medical information

Health Care System

Composed of physician (including other medical and dental staffs), pharmacist, nurse and other paramedics

Physician; diagnosis, prescription, monitoring, medical care

Pharmacist; prescription*, dispensing, counseling, monitoring, pharmaceutical care

Nurse; administering, monitoring, nursing care

Other paramedics; their own work

Load to physician & nurse; high due to the system of "physicians are all in all in hospital for the treatment of patient, with the help of nurse."

Concept of normal public/patient; same

Perceptions of Pharmacists

How do others see us?

“They just count a few tablets”

“They just weigh and measure things”

“A bunch of shop-keepers”

“Not really health care practitioners – they’re businessmen”

“Tell me how and when to use the Medicine”


“Do you need a degree to be a pharmacist?”

For practising Clinical Pharmacy

       Competence of health care practitioners

                -BPharm to Mpharm to PharmD*

              -PharmD+ Pre-registration + registration

                -Residency programs

                -Continuing Professional Development

       Informed general public – increased expectation             


       Pharmacy Practice’ a broader term- includes C.P &  activities performed by pharmacist in hospital & community settings

       Services provided by pharmacists in an attempt to promote rational drug use- safe, appropriate, cost effective

       Clinical pharmacist with appropriate training can help improve medication use by providing various services

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