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Copy of clinical pharmacist role in rational drug therapy

a presentation for Dr. basima journal clup

Katarina Kaca

on 12 May 2013

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Transcript of Copy of clinical pharmacist role in rational drug therapy

Conclusion Thank you for your attention! you have a role in this world
so stand up :) Subject 2 Spark (cc) image by nuonsolarteam on Flickr Group Group french study japan american Member Member study concluded that Pharmacist interventions, interacted directly with the physicians at ward level, could play an important role in optimizing antibiotic use, thus lead to the reduction in patients’ length of hospital stay and health care cost
(cc) photo by theaucitron on Flickr (cc) photo by theaucitron on Flickr copy paste branches if you need more.... (cc) photo by medhead on Flickr regulations medical team goverment being negative &low self esteme DONE By:
Othman Salah al-zoubi
Abdikarim Mohamed Abdi

supervised by:
Dr. Basima Al-momani Outline
• Rational drug use
• The role of clinical pharmacist
• Effects of pharmaceutical care applications
- Diabetes Mellitus
- Cardiovascular Diseases
- Asthma and COPD
- Psychiatry
• Studies regarding rational drug use in infectious diseases
• Conclusion
Diabetes Mellitus
Many studies done on effect of pharmacist interventions on glycemic control in diabetes have shown an overall improvement in A1C for patients in a diverse group of settings and across multiple study designs. Studies with smaller numbers of participants and those performed in the United States generally showed greater improvements in intervention group measures of A1C. A greater effect was also noted when pharmacists were afforded prescriptive authority. Other studies suggested that pharmacist interventions can reduce long-term costs by improving glycemic control and thus diminishing future diabetes complications.[
Cardiovascular diseases:
Several studies have shown that Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in outpatients.[9]
Pharmacist intervention can significantly improve medication adherence and blood pressure control in patients treated with antihypertensive agents they can modify factors affecting adherence, improve adherence and reduce BP levels in patients treated with antihypertensive agents. This suggests that one effective method of improving BP control is for pharmacists to recognize inadequate hypertension knowledge and medication adherence and develop strategies that enlist the patient as a participant in the management of his/her health also this reinforces the pharmacists’ role in improving the health care system, leading to superior hypertensive patient outcomes.[10]
other findings related to ischemic heart disease indicate that an intensified education and care of patients after ischemic stroke by dedicated pharmacists based on a concept of pharmaceutical care may maintain the Health-related quality of life of patients.[11]
Regarding hyperlipidemia early studies claim that Attempts to lower total cholesterol levels are likely to be more successful when combined with programs that include teamwork between physicians and pharmacists.[12] New studies suggest positive impact of clinical pharmacist, Total cholesterol and other parameters were sensitive to pharmacist interventions, The implementation of clinical pharmacy services in a primary care setting has resulted in better patient lipid profile outcomes.[13]
Other studies of Pharmacist care in the treatment of patients with HF suggest that pharmacist interventions greatly reduce the risk of all-cause and HF hospitalizations.
Interventions that include some element of pharmacist care reduced the rates of both all-cause hospitalization and HF hospitalization by almost one-third. Because HF is one of the leading causes of hospitalization, these studies recommend the addition of a pharmacist to the HF team. Other studies have confirmed that a substantial proportion of HF exacerbations can be attributed to medication misadventures, highlighting the potential importance of pharmacists on the HF team.[14]
Asthma & COPD:
Studies on effect of pharmaceutical care on asthma and COPD patients show that pharmaceutical care program increased patients' PEFRs(peak expiratory flow rates) compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care based mainly on improving inhalation technique of asthma and COPD patients which is poor, this increased patient satisfaction but also increased the amount of breathing-related medical care sought. While rare studies claim that there was no significant difference between study groups and two trails reported decreases in quality of life.
Psychiatric diseases :
Implementing clinical pharmacists' consult recommendations in psychiatric clinics was associated with significantly greater improvement in overall severity of illness and global improvement [17]. Psycho pharmacists provide important drug-related information to patients and consultation regarding potential neuroleptic-induced adverse effects. In addition, psychopharmacists serve as consultants to other clinicians concerning the risks associated with the use of neuroleptics and participate in neuroleptic-discontinuation clinics. Morbidity associated with neuroleptic-induced tardive dyskinesia has exposed healthcare providers to legal repercussions; therefore, pharmacy intervention may aid in the reduction of legal liability

1- Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital
2- Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study
3- Other brief abstracts
Studies regarding rational drug use in infectious diseases:- Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital |CHINA Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study | Departments of Pharmacy and Medicine, Stobhill Hospital, Glasgow,UK (20)
A prospective observational intervenional clinical study To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital.
Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention(group 1) and 4 weeks post intervention (group 2).Six months later, data were collected for a further 4 weeks following a second intervention(group 3).
Interventions consisted of pharmacy led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching.
study suggests that simple, locally developed guidelines may facilitate more appropriate use of IV antibiotics with earlier switching to oral therapy. This may reduce hospital stay and antibiotic expenditure. Every prescriber has a responsibility to prescribe antibiotics appropriately, although others in the clinical team play an important part in the administration of antibiotics and the review of therapeutic decisions.
As such, the clinical pharmacist potentially has an important role in promoting and maintaining appropriateprescribing of IV antimicrobials in hospitals.Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.
Other brief studies:
Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications having wide scope in drug Information & utilization, evaluation and Selection Medication Therapy management and finally disease State Management, this made clinical pharmacists to have a wide efficient practice in many specialties in implementing rational drug use and optimizing the use of medications promoting to health, wellness & disease prevention.
Why ??
as the number of medications continues to grow, drug regimens becomes more complex

. Worldwide 50% of medicines and more are inappropriately prescribed, dispensed or sold

50% of patients take them incorrectly
Rational drug use :
“patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.”
Adequate follow up
Reasons for irrational-ism
Lack of information.
inadequate training & education of medical graduates.
Poor communication between health professional & patient.
Lack of diagnostic facilities/Uncertainty of diagnosis.
Demand from the patient.
Defective drug supply system & ineffective drug regulation.
Promotional activities of pharmaceutical industries.
Leading to :

1. Ineffective & unsafe treatment
2. Exacerbation or prolongation of illness.
3. Distress & harm to patient
4. Increase the cost of treatment
To implement rational.. Measure irrational
The types of irrational use of medicines.
The amount of irrational use.
The reasons why medicines are used irrationally
second International Conference on Improving the Use of Medicines (ICIUM)
Thailand 2004 :
Countries should implement national programs in order to improve the use of medications and these programs should:
All levels of health care private or puplic
Local evidence based
Separate prescribing and dispensing
Generic prescribing
Drug quality assurance programs
measure drug prices
Scale up & monitor successful interventions eg:
Prescription of 3-day antibiotic therapy for pneumonia which is just as effective as 5 days;
Use of multi-faceted coordinated interventions which are more effective than single ones;
Implementation of structured quality- improvement processes possibly through Drug and Therapeutic Committees.
Interventions should address community
medicines use by:

improving patient adherence
encouraging school programmes
regulating pharmaceutical promotion
Evaluating medicines use in chronic diseases (more cost-effective)
Clinical pharmacists
as an expert in the therapeutic use of medications

qualified to assume the role of drug therapy expert and ensure rational drug therapy.
Tasks: Medication Therapy Management (MTM)
prescribing drugs

administering them,



preventing errors & SE

Reviewing route & dosage forms

providing consultations
Full transcript