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clinical pharmacist role in rational drug therapy NEU

a presentation for Prof. Dr. Rumaysa

ak daud

on 27 January 2014

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Transcript of clinical pharmacist role in rational drug therapy NEU

Thank you for your attention!
you have a role in this world
so stand up :)

(cc) image by nuonsolarteam on Flickr
Other 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.
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
medical team
being negative &low self esteme
Done BY:
Abdikarim Mohamed Abdi
Pharm.D , MSc

Supervised BY:
Prof. Dr Rümeysa Demirdamar
• Rational drug use
• The role of clinical pharmacist
• Effects of pharmaceutical care applications
- Diabetes Mellitus
- Cardiovascular Diseases
- Psychiatry
• Studies regarding rational drug use in Asthma, COPD and 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
the management of major CVD risk factors i
n outpatients.

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 i
ntensified 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]
CHD & Hyperlipidemia
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.

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. 4]
Psychiatric diseases :

Implementing clinical pharmacists' consult recommendations in psychiatric clinics was
associated with significantly greater improvement in overall severity of illness and global improvement
. 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 studies
Studies regarding rational drug use in Respiratory 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
The Role Of Clinical Pharmacist In Implementing Rational Drug Use.
medication errors and patient safety are worldwide major concern and common topics of discussion for decision makers i.e. president of the United States, federal and state legislators, the insurance industry, pharmaceutical companies, health care professionals, and patients.
American College of Clinical Pharmacy Board of Regents approved that
clinical pharmacy
is the branch of pharmaceutical concerning science and the practice of
rationale drug use.

"Pharmaceutical care" the clinical pharmacist major role.

much of the benefits of this practice is recently well documented and assessed by clinicians
Pediatric diseases:
Coordinated efforts of pharmacists' interventions during the discharge process have a positive impact on pediatric health.

Also studies have clearly shown The positive effect of presence of a person reviewing and registering the drug records on the overall drug error rate in pediatric patients
While as many
as 60% of patients do not have their asthma under good control,
and many assume this is normal! [36,37] approximately
70% of patients may be using their inhalers incorrectly
. In many cases, poor or incorrect technique is the root cause of patients not having success with their medication therapy.[38]

In one study carried in British Columbia,
two groups
were compared with
interventional group receiving pharmaceutical care plus usual care
while control group received only usual care, patients in the enhanced care group had
75% fewer emergency room visits
over those in the usual care group.

Mainly on improving inhalation technique of asthma and COPD patients which is poor.

While rare studies claim that there was no significant difference between study groups and two trails reported decreases in quality of life.
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