Dear Ramesh,

I'm an italian PhD pharmacist and I am currently attending the School of Hospital Pharmacy in Padua. Even if my Country may be considered as a developed nation, there is still a reluctance to promote the pharmacist role towards a clinical orientation, instead of the more classic stereotype of a professionist suited to manifacturing and supplying medicines.

Here in Italy there are several projects investing to patient-oriented health care, but the widespread experience is mainly related to drug management, from storage to formulation and pharmacovigilance. With change in the Health demands, I think that pharmacists should have a further role to play in patient care, closely supporting the activity of physicians and nurses in drug therapies, side effects monitoring and improving pharmacological schedules; in this sense, I think that the dialogue, the cooperation and a common Health planning shared with physicians are key factors to structure a more efficient clinical pharmacy service.

Here you can find two articles that I have found, hoping that they can help you...If you need to discuss about them, I am at your disposal!

Best regards,

Riccardo

Dear Riccardo,

Thank you for your views and contribution. 

Sincerely,

Ramesh

I am recently working on similar research. Pharmacy practice is in a rudimentary stage in most of the developing countries. People without academic qualifications are allowed to run Pharmacies. This has been the biggest problem here in developing country like Nepal. Government is trying much to stop these acts. However, these should be eliminated from the root level.

Most important thing is public awareness and there's a greater need to promote education regarding Pharmacy professionals as the source of information on drugs to the public. This can help to gain trust towards the profession.Besides this, Pharmacists should also be trained more and they should be educated about their role regarding patient care. They should change their pharmacy practice to patient oriented care and focus more on counseling and giving accurate drug information to the patients.

Dear Trishna,

Exactly, Majority of community pharmacies are run by the Non-pharmacist and most of them failed to fulfill the basic regulatory requirement and provide pharmaceutical care. Furthermore, the regulatory bodies are resource limited so monitoring and supervision are week. At the same time, Pharmacist and pharmacy technician are suffered from poor knowledge and skill required for patients oriented service and they are limited on dispensing of medication to patients.  As a results,  both other health care professionals and  patients have negative perception towards pharmacist/pharmacy assistant or pharmacy technician  as a drug seller instead of  health care provider. In this scenario,  improving the hospital and clinical pharmacy practice is really challenging and required a big jump. 

Sincerely,

Ramesh

I believe changing curriculum focusing more towards patient care like in developed countries is the first step. Further, the internship period should be increased and it also should be strengthened so that pharmacist be more practical in clinical settings and have chance to learn more in the practical world rather depending only on theoretical knowledge.

Dear Trishna,

I appreciate you suggestion. However, prolonging the duration of internship (as seen in Pharm D) will not improve the knowledge and skills under weak supervision and guidance as all most all pharmacies lack expert in the filed of Hospital pharmacy and clinical pharmacy practice.  Government initiate the hospital pharmacy within the premises of hospitals, however, they were in very primitive stage and were not free from political influence.      

Sincerely,

Ramesh

Yes you are right the main problem is there. This has always made the profession in the shade. Everybody is facing same problem in Nepal. Few Colleges have made internships available in each department of hospitals beside just limiting oneself to pharmacy but this is not going well because nobody is there to supervise them..

This can be improved if Government can focus more on strengthening the curriculum of Pharmacy like I said before. At least there will be initiation of a new system. If not now, when will be the first step then? It's the most important matter to think.

Dear Ramesh,

The best way to show the importance of hospital and clinical pharmacy is in my opinion to show its economic impact because there is a worldwide tendency to rationalize health expenditure.

The pharmacist can contribute greatly in reducing the cost of managing patients by reducing the length of stays and iatrogen rehospitalisations .... this is how we can convince managers to invest and develop these activities.

Good luck

Dear Hocine, 

Your suggestion are really appreciable and practicable. Strengthen of  hospital and clinical pharmacy improve the quality of care provided  to the patients and minimize the burden of drug related expenditure to the patients. At the same time patients will be better educated about disease and drugs which eventually  led to better therapeutic outcomes and reduces the tendency of re-hospitalization.   

Sincerely,

Ramesh

Dear Rasmesh,

I absolutely agree with you. There is work to do and we must take up this challenge.

Sincerly,

Hocine

Dear Hocine,

We also need to generate evidence for future pharmacy practice through innovative research to highlight the role of  pharmacist/pharmacy technician and need to strengthen our knowledge and skills through continuous pharmacy education/in-service education.  

Sincerely,

Ramesh

Dear J.W. Foppe,

Thank you for your contribution. However, Doctors deny to formulate and implement the hospital formulary.

Sincerely,

Ramesh

I totally agree with J/W. Foppe.  Start in a small unit department/unit first by your trained clinical pharmacist. Have early discussions with the respective heads of department on the benefits of such a service. Monitor closely and record statistics on workload and  achievements. Have weekly discussions with the clinical pharmacist, and get the approval/endorsement form the hospital director.

Many hospitals that I know in my country had gone through that process.

Good luck!

Dear Abdol Malek,

Thank you for your contribution. we try to use this aspect for the improvement of hospital and clinical pharmacy. However, we lack expert to do so.

Sincerely,

Ramesh

Greetings RameshJi,

Thank you for posting a very interesting situation faced by health services / pharmacy service leaders & managers in both developing & developed nations. The commonality of belief is  'The type of service that best meets the pharmacotherapy needs of individuals & populations in our country is one in which pharmacists effectively input into drug choice & use decisions, making a unique contribution to patient care.' & also 'Our country will get optimal value from pharmacists & medicines (both healthcare resources) if they provide 'evidence based' pharmaceutical care, rather than engage primarily in technical roles like drug inventory management.' We can expand on these statements by saying that there is potential to improve effectiveness, safety and cost-effectiveness.  Probably, the country cannot be worse off! :-) Evidence from the literature can be adduced to support these claims

The question is 'What are effective strategies  to achieve this?' Both top down & 'bottom up' effort is needed: Top down advocacy meaning convincing policy makers, & bottom up demonstration of impact in patient care units - stated by many colleagues here - where the contribution of a clinical or patient-care focused pharmacist can readily be demonstrated.  We also need to convince the educators & trainers!

Regards, David

Dear David,

Thank you for your valuable contribution. 

Sincerely,

Ramesh

Hi Ramesh!!!

I am mexican and in my country we have the same problem since many years ago. As many collegues as told you, the best way is begin in a small unit from, and for us, estudents in the last years of university are a good rsource: if you traine them appropiating, they can be a lot of work with you. Obviously, as disadvantage they will be just a few months in the proyect, but here we have obtained so many important data working with students, and then showing these data we have win some recognize of our job and we are trying to demonstrate the importance of the clinical pharmacist. And yes: unfortunatly as pharmacist our journey is long and we must walk in a short steps, step by step.

I hope at least encourage you :)

Best regards!

Dear Prisma,

Thank You for your valuable contribution.

Sincerely,

Ramesh

Hi Ramesh!

When I was working with a local government hospital in the Philippines, we started our Clinical Pharmacy by engaging key doctors who will approve of the idea of having one. We stressed on medication error prevention (there are a lot of researches available online can help justify this) and patient safety. We also talked to the nursing management and told them on the advantages of having a clinical pharmacist (how having one would make their job easier). This is almost the same strategy we did when we were establishing clinical pharmacy in a private - tertiary hospital in the same country. Do you have unit dose distribution in your hospital?

On how to encourage your pharmacists in the shift from product oriented to patient oriented - This is actually hard to do especially for those older Pharmacists who are already satisfied with what they are currently doing. This is easier to do with the younger ones (based on experience). You can make them realize that soon there will be no more room left for just dispensing pharmacists. There are a lot of dispensing machines that can actually take their place. So the need for this shift is important to make the other healthcare professionals and the patients realize the value of the pharmacy profession.

Being resource limited, you can actually start with patient counselling and drug information service. With that service, communication skills and product information are needed which will not be too expensive. The package inserts and MIMS are tools you can use..etc

Dear Rauth,

I appreciate your valuable suggestion. we are doing some of the above mentioned activities in our hospital and results are promising. We don't have unit dose drug distribution system but we have individual prescription system. Would you able to help us to improve the concept of hospital and clinical pharmacy in our hospital?

Sincerely,

Ramesh Sharma Poudel

Hi. Yes I can make suggestions based on how we did ours.