Clinical Pharmacy Methodology, Education and Practical Application: comparison of three countries (Czech Republic, Great Britain, USA)

symposium organized by Czech Professional Society of Clinical Pharmacy

Clinical Pharmacy Practice in the United States: The Role of Education, Training and Credentialing in the Development and Expansion of Clinical Pharmacy Services

Marketa Marvanova, PharmD, PhD, BCGP, BCPP, FASCP

• Dean and Professor, Skaggs School of Pharmacy, University of Montana, Montana, Missoula MT 59812

Clinical pharmacy (CP) in the United States is among the most developed and progressive in the world where the clinical pharmacist works directly with physicians, other healthcare professionals and patients providing direct patient care and comprehensive medication management in hospitals (e.g. emergency, critical care, internal medicine, neurology, psychiatry), clinics, nursing homes/long-term care facilities, and manage care organization among others. The clinical pharmacists practice as essential members of the interprofessional healthcare team to optimize the use of medications and promote health, wellness and disease prevention while improving patient outcomes, decreasing healthcare costs and increasing access to care. Clinical pharmacists need depth knowledge of pharmacology/medications, pathophysiology, disease presentation and diagnosis, patient physical assessment and laboratory monitoring, evidence-based therapeutic guidelines and disease management, wellness and prevention, pharmacokinetics and therapeutic/drug monitoring, electronic health records and clinical documentation, as well as effective written and verbal communication skills. To provide the foundation for development and expansion of CP services across the healthcare system, there is need for advanced terminal pharmacy degree, postgraduate residency training and specialty clinical certifications, and legal frameworks enabling such practices. Development and expansion also require and can generate public acceptance and demand for CP roles in collaborative and interprofessional practices within the healthcare institutions and system.

The status of CP practice in the U.S. along with highlights from several progressive states will be discussed along with the role of education, advanced clinical training and credentialing in enabling and developing a highly-trained CP workforce to provide advanced patient care and comprehensive mediation management.

The work of a clinical pharmacist in the UK

Mgr. Karolína Russ

• Department of Clinical Pharmacy, Ostrava Municipal Hospital, Czech Republic

Pharmacist in the UK are the third largest healthcare profession, with clinical pharmacy being one of many pathways they can follow. Clinical pharmacy in the UK is not necessarily always bound only to the hospital environment, but can be practised in other healthcare settings, both national as well as private. Clinical pharmacist need to gain appropriate education, have excellent communication skills, empathy and be able to work within a multidisciplinary team. Throughout their career, they are expected to obtain competencies (from general to consultant level competency framework), undergo extensive training in various areas as well as postgraduate education. They are expected to follow professional alongside regulatory standarts developed by the pharmacy profession. Personal working experience of the speaker in the hospital environment with various challenging duties is presented, whilst new, exciting professional pathways (eg. independent prescribing) for clinical pharmacists are being introduced in the UK. The role of clinical pharmacists in the UK is constantly evolving , with the possibility to specialise later in their career and opportunity to progress into management or teaching within their working enivornment and work closely with the wider multidisciplinary team.

Clinical pharmacy methodology, organization, education and practice in the Czech Republic

Jan Miroslav Hartinger, PharmDr., Ph.D.

• Institute of Pharmacology, 1^st Faculty of medicine, Charles University and General University Hospital, Prague

Jana Gregorová, PharmDr. PhD.

• Department of Clinical Pharmacy, Hospital Na Bulovce, Prague

Clinical pharmacy in the Czech Republic is quickly developing and becoming an independent pharmaceutical specialization which aims to bring the knowledge of pharmacology and pharmaceutical sciences into the clinical practice. Clinical Pharmacy Practice Methodology formulated by Czech Professional Society of Clinical Pharmacy will be presented. In the Czech Republic proactive automatic medical records screening by clinical pharmacist is proposed. Based on prespecified risk factors patients’ medication therapy is classified as low, medium or high risk. Subsequently a plan to eliminate existing or possible drug related problems is made and discussed with the attending physician. Repeated controls by clinical pharmacist are carried out as needed (in case of new diagnosis, changes in overall state etc.). Recommendations are recorded in patient’s medical documentation. For outpatient and inpatient setting also direct counselling according to the physicians’ request is provided. The inpatient procedures (medication checks, recommendations, repeated controls etc.) are covered from health insurance and new ambulatory procedure (comprehensive medication review) for outpatient praxis is approved. Complex education program has been established to support high demands that are placed on clinical pharmacists. Results from a pilot study carried out in one clinical pharmacy ward after new methodology has been implemented will be presented.