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Mazhar M1, Ansari. A2, Rajput SK1*
1Department of Pharmacology, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh-201313.
2Department of Social Work, University Road, University of Delhi, Delhi-110007.

In lieu of the fact that without adequate supervision, the assurance of quality of any system is not possible; clinical pharmacy has emerged as one of the latest and unmapped discipline of pharmacy in the 21st century. The existence of clinical pharmacists in medical rounds could support physicians in optimizing pharmacotherapy. This novel profession in India extends its diversions to good manufacturing practices, procurement/preparation/distribution of medication, reporting ADRs/ ADEs and on the whole to a very promising aspect of patient healthcare service. The state of clinical pharmacy in India is in the transformational state showing serious positive promising changes in the past couple of years. Even hospitals have started distinguishing the importance of clinical pharmacy and have taken initiatives for making it possible although at a budding stage. The clinical pharmacy branch of pharmacy is surely attaining new heights in regard to patient care services which have certainly increased the services and satisfaction to the patients.


PharmaTutor (ISSN: 2347 - 7881)

Volume 3, Issue 2

Received On: 22/12/2014; Accepted On: 05/01/2015; Published On: 01/03/2015

How to cite this article: M Mazhar, A Ansari, SK Rajput; Clinical Pharmacy in India: Recent Advances and Perspective; PharmaTutor; 2015; 3(3); 31-36

Clinical pharmacy has emerged as one of the latest branches of pharmacy in 21st Century.[1] It is where pharmacists deal with various aspects of patient care, dispensing of drugs and advising patients on the safe and rational use of drugs. It can also be explained as a part of pharmacy in which the clinical pharmacist provides patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. To elaborate the story we can say that clinical pharmacy is to use drug control and the effective application of the knowledge. Professional skills and ethics assure the optimal safety in the distribution and use of medicine. The purpose of the Professional Education in Clinical Pharmacy and Public Health is to qualify each pharmaconomist (expert in pharmaceuticals) to practice clinical pharmacy at a higher and more professional level. [2,3] Hence, ensures the patient’s maximum well-being during the drug therapy.

Clinical pharmacy describes the new role of the 21st Century’s pharmacists. It doesn’t restrict the role of a pharmacist merely to good manufacture practices, easy procurement, proper preparation, distribution and control of drug products. In addition, it also comprises functions necessary to discharge a particular set of social responsibilities related to proper therapeutic use of drugs in the aspects like prescribing, dispensing and administrating drugs, documenting professional services, direct patient involvement, Reviewing drug use, Education, Consultation and Counseling. The aim of clinical pharmacy practice is to ensure the patient’s maximum well-being and to play a meaningful role in the safe and rational use of the drugs. These goals are to enable the physician do a better job of prescribing and monitor the drug therapy for patient. Further, to help the medical and para-medical staff to enable effective drug therapy. Clinical pharmacy practice also deals with proper maintenance of the documentation regarding the medication incidents effectively to maximize the patient’s compliance in drug use process.

Building up a Clinical Pharmacist
Internationally, particularly in the countries like the US, Canada, Australia etc clinical pharmacists have extensive education in the biomedical, pharmaceutical, socio-behavioural and clinical sciences.[4] Most clinical pharmacists have a Doctor of Pharmacy (Pharm.D.) degree and many have completed one or more years of post-graduate training (e.g. a general and/or specialty pharmacy residency). Many clinical pharmacists also choose to become Board Certified through the Board of Pharmacy Specialties (BPS) which was organized in 1976 as an independent certification agency of APhA (American Pharmacists Association). A pharmacist may become a Board Certified Pharmacotherapy Specialist (BCPS), a Board Certified Oncology Pharmacist (BCOP), Board Certified Nuclear Pharmacist (BCNP), Board Certified Nutrition Support Pharmacist (BCNSP), or a Board Certified Infectious Disease. [5] It is denoted as an "Added Qualification" or AQ. In order to obtain one of these specialties you must first be a Board Certified Pharmacotherapy Specialist and then submit a portfolio to the Board of Pharmacy Specialties for review to determine if they will grant you the added qualifications.

In India, M.Pharm (Clinical Pharmacy) is a two-year post graduate Psychiatric Pharmacist (BCPP) through the Board of Pharmacy Specialties (BPS). There are also sub specialties within the Pharmacotherapy specialty: Cardiology and degree course, after B.Pharm. In this course, the Graduates of Pharmacy are provided with the opportunity to acquire knowledge about all the tasks performed by a pharmacist in hospitals, nursing homes, clinics or any other such places. The course focuses on the study of the patterns of use and effects of drugs on patients and deal with the correct and appropriate use of medicinal products and devices. In order to seek admission into the course, one has to appear for GATE/GPAT Entrance examination or any other State or University entrance examination.

Qualities of clinical pharmacist
Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics.  Often collaborate with physicians and other healthcare professionals. Pharmacists should be well-versed with the common language used by the people in order to communicate with the patient and co-professionals easily and effectively. Pharmacists are also expected to have thorough knowledge of the etiology of the disease, its signs, symptoms, pathophysiology, diagnostic tests, pharmacokinetics, etc. Proper clinical training should be given to the clinical pharmacist to provide information regarding rational drug use, drug therapy and drug doses. [6]

Condition for a clinical pharmacy -A clinical pharmacy professional should appreciate the role of medical and para-medical staff. There should be enough bondage between the physician and the pharmacist to visit the patients together. All of the medical staff should develop an inter-professional relationship to enhance the quality of patient care. Further, there should be a deep sense of responsibility in the clinical pharmacist with respect to medical care. It helps in maintaining proper patient history and gaining confidence. As drug therapy is an ongoing process it needs to be checked by the clinical pharmacist timely. It may be changed according to the patient’s condition and requirement. 

Health care team and a clinical pharmacist
There are certain laid roles and responsibilities of a clinical pharmacist in a health care team that consists of several medical and para-medical professionals. These responsibilities should be executed by the clinical pharmacist with immense care. The clinical pharmacist should interact with the patients and maintain their complete and exhaustible medical history. The clinical pharmacist should also do proper documentation of the hypersensitivities or allergy to certain drugs, food habits, drug dependence or intoxications to certain chemical substances, side effects of some drugs, incorrect drug administration, etc about the patient.[7] The prescribed drugs may interact with certain OTC drugs; therefore, after receiving the prescription the clinical pharmacist should check the patient’s medical history for drug related interactions and patient’s habits. This helps in effective and accurate medical therapy.

In the selection of a proper drug product/generic formulation (depending on the bio-availability and equivalence of such products) the clinical pharmacist can help the physician. Clinical pharmacist can help in monitoring of drug therapy to ensure safety and efficacy. Monitoring of the drug therapy is very important particularly for those drugs that have narrow therapeutic index or administered chronically.[8] Various pharmacokinetic parameters can also be checked by the clinical pharmacist based on: plasma concentration of drug, enzymes and measurement of glucose quantity in blood, etc.

Patients with kidney impairment or hepatic disorders are more prone to adverse drug reactions. Clinical pharmacist can help in detection, prevention and reporting of adverse drug reactions. He may advice the physician for alternate drug therapy for the concerned patients. Clinical pharmacists may play a major role in designing health and drug policies, and assist as a source of information for the health care professionals and to the public. The drug management greatly relies on the clinical pharmacist to check the selection, requirement, procurement, distribution and use of the drugs. Also, Research and development in the field of biological availability of active ingredients requires active participation by the clinical pharmacists. The clinical pharmacist can help in executing clinical trials and based on standard principles and bio-statistical evaluation. A clinical pharmacist is an expert to provide detailed information to the health professionals and the general public. Effective selection, utilization and retrieval of drug literature by the clinical pharmacist can enable in the proper understanding of the facts by the medical team. He can also abstract information from periodic bulletins, newsletters or other pharmacy literature.

Scope of clinical pharmacy in India
In hospitals the services regarding clinical pharmacy are of considerable value because the concerned clinical pharmacist serves as a guide to the physician for safe and rational use of drugs.[9] He also assists to achieve economy in the hospital by planning safe drug policies, suggestive means of reduction of waste, by preventing misuse or pilferage of drugs. In addition to it the preparation of preventing forecasting future drug requirements of the hospital, based upon their drug utilization patterns. Therefore, scope of clinical pharmacy covers areas to foster innovation, improve public health and provide a knowledge exchange. Clinical pharmacist enables rational drug use by providing correct drug information including the proper utilization of the drugs utilized as drug therapy, along with all the precautions to be taken as indicated or asked by the pharmacist or the physician. [10] It discourages any irrational or reckless use of drugs and also, concerns with the procurement of the drugs into the market from the industry and their channelization to the patient for use. Clinical pharmacy also deals with ensuring safety and efficacy of the drugs after marketing. Safety can be evaluated by means of non-experimental research, whereas evaluation of efficacy in a variety of settings representing normal medical practice generally requires experiments, randomized and blinded. National or International markets are flooded with tens of drug combinations, low therapeutic value products or duplicate brand names[11]. Thus, under this study it is clarified how to choose the correct drug for administration or treatment.



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