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Clinical pharmacy services

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While the MTM is a clear and comprehensive process of providing medication therapy evaluation and solution, There are several other types of services that serves the common goal of improving medication therapy. Pharmacists have been involved in many innovative clinical services over time. This indicates that pharmacists are persistently making efforts in creating new clinical roles. Other forms of clinical pharmacy services besides MTM are also widely in action. For instance, medication reconciliation. Which is developed in response to the understanding that medication errors occur too frequently when patients are transferred from one setting to another, such as hospitalization or ambulatory visits at more than one clinics or health facilities.
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In these circumstances, medications are often added or deleted without careful considerations whether they are needed or not. And, Medication reconciliation is the process of pharmacists assessing patients’ medication profile during clinical setting transition. And, to ensure non-disrupted, and updated medication therapy. Nowadays medication reconciliation is considered an important quality service for pharmacists to provide. Another form of CPS is Education, whether on patients, students, or other health care professionals, pharmacists provided education can help reduce medication errors by raising awareness and promoting general knowledge of medications. In some states in the US., Pharmacists have even taken on the responsibility of providing immunization.
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Determining a patients’ need for an immunization and Setting up a tracking and reminder program to ensure patient gets proper immunization protection at the appropriate timing. Primary health care is defined as a patients’ first of contact with the health care system. As such, pharmacists are an integral part of primary health care. In the United states, Nearly every state has a collaborative practice agreement that allows pharmacists and physicians to define the pharmacist’s role in medication and care management. And As health care reimbursement continues to evolve, pharmacists will see more opportunities to expand their roles. Clinical pharmacists can provide valuable population based care through development and enforcement of guidelines in managed care settings.
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Guidelines or regulations regarding certain medications, such as antibiotics or narcotics are necessary in preventing errors or potential abuse of medications. Through engaging in these policy making, pharmacists can expend their beneficial services to a population rather than individual patients. Clinical and medication distribution are services that are distinct but complementary activities in ensuring safety of medication use. Medication distribution focus on delivering the correct physical drug product to the patient, while clinical pharmacy services aims to reduce medication related problems and therefore maximize the benefits of medication therapy.
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This includes making sure that the medication is appropriate for the patient, in aspects of appropriate medication choice, dosage and prevention of drug-drug interaction, As well as ensuring the instructions for safe and effective use of the medication are well understood by the patients or their care giver. Now that we have talk a lot about what clinical pharmacy is, and how pharmacists nowadays can provide services beyond medication dispensing. But, whether these services really have positive impact on patients, there have been numerous studies conducted and published, examining the impact of these services.
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In a study published in 2004, which analyzed different types of clinical pharmacy services in hospital-based setting in the US, and their correlation with major health outcomes such as mortality rates, lowering of drug costs, shorter length of hospitalized stay, lower medication error rates, and lower total costs of patient care The study Aimed to identify the services that had the most significant impact, and lowest costs, and should be provided consistently to patients in a hospital setting. The results showed that among all the clinical pharmacy services they analyzed, there are five types of the services that offers the best documented likelihood of improving health care for patients.
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The five core services are: providing drug information, adverse drug reaction management, drug protocol management, medical rounds participation, and admission drug histories. These services demonstrated most significant favorable impact on the Health outcomes, and researcher strongly recommended hospitals in the US. to consistently provide. Another study reported in 2007 showed evidence that seven of the clinical pharmacy services were significantly associated with reduced hospital mortality rate. Pharmacist provided Services on drug use evaluation, in-service education, ADR management, drug protocol management, and Pharmacist participation on CPR team, on medical rounds, and evaluation of drug history upon admission. These services all showed significant impact on reducing mortality rates.
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In the meanwhile, the staffing of pharmacy administrators and clinical pharmacy also have significant correlation with reduced hospital mortality rates. In recent years, studies regarding clinical pharmacists’ impact on health outcome of patients with specific diseases such as diabetes, coronary heart disease, chronic kidney disease, or transplant recipients have been published, also showing the positive impact CPS and raising acknowledgement of clinical pharmacists’ work. One the other hand, while providing clinical pharmacy services is seemingly very costly, due to the need for additional man-power, More and more studies and reports are showing that clinical pharmacy services have positive impacts not only on health outcomes but also on economic perspectives.
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With clinical pharmacist intervention, reduced potential medication errors, minimized un-necessary medication treatment, and prevention of potential harm due to inappropriate medication therapy, the total cost of patient treatment is actually reduced. A review study published in 2008 provided evidence that for every 1 dollar invested in clinical pharmacy service, generates 4.81 dollar in reduced over-all costs or other economic benefits. Showing that CPS provides a positive return on investment. With More and more studies and reports support positive impacts of clinical pharmacy services, and showed that in general, CPS were cost-effective. In todays world, with prolonged average life expectancy, and heavy economic burden of medical costs, this has become an incentive for implementing Clinical pharmacy services.

There are several other clinical pharmacy services (CPS) besides the MTM. Ms Chen will explain the medical and economic impacts of clinical pharmacy services.

Key concepts:

There are many types of clinical pharmacy services. Pharmacists also carry out:

  • Medication reconciliation, assessing patients’ medication profile during clinical setting transitions, to ensure non-disrupted, and updated medication therapy.

  • Education, on patients, students, or other health care professionals. This aims to reduce medication errors by raising awareness and promoting general knowledge of medications.

  • Occasionally, pharmacists determine the type of immunization a patient needs and set tracking and reminder programs to ensure the patient receives timely immunization.

Pharmacists also participate in policymaking, contributing to the development and enforcement of guidelines in managed care settings. This expands their impact beyond individual patients, to affect the whole population.

Literature review:

In 2004, a study analyzed the correlation between CPS and positive health outcomes. Amongst the wide spectrum of CPSs, providing drug information, adverse drug reaction management, drug protocol management, medical rounds participation, and admission drug histories, had the most significant impact on the positive health outcomes.

A study in 2007 also revealed CPS can reduce hospital mortality rate. On the surface, providing clinical pharmacy services is very costly, due to the need for additional manpower. However, a study published in 2008 provided evidence that for every $1 invested in clinical pharmacy service, generates $4.81 in reduced over-all costs or other economic benefits. Showing that CPS provides a positive return on investment.

Share and learn:

  • Why do you think it is important to assess the impacts of CPS? Try to take the perspective of different stakeholders (government, patient, hospital etc.).

  • Do you know of other CPS not mentioned in this step?

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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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