Wednesday, May 4, 2011

MY VISION FOR THE CLINICAL PHARMACY PROFESSION

A pharmacy professional

A profession [1] is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Webb S, 1997).

Pharmacists are professionals who have the abilities and skills which are necessary to achieve outcomes related to:
• Providing pharmaceutical care to patients
• Developing and managing medication distribution and control systems
• Managing the pharmacy
• Promoting public health
• Providing drug information and education

While these outcomes seem easy to achieve, there is still a huge gap between what is expected of pharmacists [2] and what pharmacists actually achieve.

Clinical Pharmacist Training

The clinical component of pharmacist’s work need to improve the most and training for this role must meet the following objectives:
• to develop students' communication skills for effective interaction with patients and with practitioners of other health professions,
• to help students develop a patient awareness in the practice of pharmacy
• to enable students to integrate the knowledge acquired in course work prior to clinical exposure, and to apply it to the solution of real problem
• to develop students' awareness of their responsibility for monitoring the drugs taken by patients and,
• to help students become more aware of the general methods of diagnosis and patient care specifically related to drug therapy


Lifelong learning and professional growth

A good training in clinical pharmacy and the subsequent qualification as a practitioner is just but the beginning of a long journey towards developing competent professionals who will make an impact to the society. My desire is that pharmacists themselves will find it in their interest to develop, implement and sustain an internal mechanism where pharmacists’ knowledge, skills and attitudes are evaluated and improved.


Specialization

My vision for clinical pharmacy and pharmacy profession as a whole is that one day pharmacists will realize that it is not possible for an individual to accumulate enough knowledge in a lifetime to be an authority on all aspects of clinical pharmacy or general pharmacy. Some pharmacists have already realized this and are trying their best to fill the gap in the health care provision. The areas of specializations must however be relevant to the current needs, and must be continually reviewed to go with the times.


Certification

From patient to provider, the value of a certified practitioner registers throughout the health care continuum. This provides a legal basis and right to provide care in any clinical environment. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement.


How do we get there?

• The current clinical pharmacy training undergraduates are receiving in the University of Nairobi is much better than a decade ago; this is obvious when one engages a student on a clinical approach discussion. This needs to be sustained and even improved further.

• The undergraduate students in pharmacy should spend an extra year in training to be in line with internationally accepted standards for pharmacy training for students who have spent four years in high school or less than twelve years of pre-university education. This will give the pharmacists in training more time to accumulate knowledge, skills and attitude required to practice top level pharmacy.

• The internship should be done in areas where there is at least one preceptor per intern. The preceptor must have at least three years of experience in pharmacy practice post-registration and must be available at all times for consultation during the entire period of internship. The preceptor must demonstrate to have the knowledge, skills and attitudes required to train a highly motivated intern to have a successful professional life after registration before recertification.

• The pharmacist should be registered only if they pass pre-registration assessment that focuses on competencies expected of an entry level pharmacist. After that, annual practicing licence can be issued to a registered pharmacist without the need to sit for an exam, so long as there is evidence of continuous professional development (CPD) and the required CPD threshold has been achieved or exceeded.

• Only registered pharmacists should be allowed to practice pharmacy. Peer-led professional audits can be done on a regular basis to ensure that minimum standards required of a practice are maintained in all pharmacies.

• The current advanced training in clinical pharmacy needs to take at least 3 years with the pharmacist getting full residency status as their medical colleagues. The classes should be peripheral in term of time allocation, and real work environment practice to take the centre stage.

 The first half of the first year, can be fully academic, where an emphasis is placed on physiology, epidemiology, evidence-based healthcare and biostatistics. The second-half can the concentrate on pathophysiology, biopharmaceutics, pharmacokinetics, drug information and pharmacy management, toxicology, patient assessment, clinical chemistry and introduction to therapeutics and pharmaceutical care.
 The second year can be a year of problem-based learning where students need to build relationship with patients, other health care professionals and more importantly other pharmacists. The emphasis will be on the continuum of care, where there are multiple contacts between a student and an individual patient and student must have a plan for the patient who will be both in patient records and school of pharmacy records. The classes during this time will be mainly therapeutics, with numerous student presentations and faculty moderation. An adjunct class of advanced pharmacokinetics will be useful during this period. Some exposure to research methods can also be useful at this time
 The final year will concentrate on individual research work completion, more exposure to clinical areas of sub-specialization, and some level of participation in teaching more junior members so as to learn more. Communication and presentation skills, together with clinical audit [4] skills need to be enhanced at this stage. There should be evidence that the expected activities were actually carried out. Short-term exposure to other hospitals which are regional centres of excellence should be encouraged during this period.

• The newly qualified clinical pharmacists should practice for one year in the areas of their sub-specialty (residency) before they are awarded a board certification.

• The pharmacists to patient ratio should increase, and there should be presence of clinical pharmacists in all major specialties in major hospitals first, then to all other hospitals. The pharmacy specialist skills should not be spread thin, as there will be little or no overall impact. These specialists should be concentrated where they are needed most and should not be involved in primary care which registered pharmacists can provide with the help of lower cadre pharmaceutical professionals (technologists and technicians).

• The clinical pharmacists can harness their skills and knowledge by sharing information and experiences. They must have forums where they can communicate and influence the growth of the profession. Associations will leverage the growth of the profession by growing the capacity of the profession from within, and also by the lobbying forces outside the profession to further their interests.

• There must be a certification and recertification regulatory board [3] to certify pharmacists who meet the requirements to practice in their specialty areas, and prevent those who do not qualify from practicing.

• The clinical pharmacists should be able to motivate others to advance the practice of pharmacy. They should carry out clinical audits on a regular basis to demonstrate that the practice has improved. A clinical audit [4] is a cyclical process, involving the identification of a process to intervene, setting or adopting already available standards, comparing practice with the standards, implementing changes and monitoring the effect of those changes. Its purpose is to improve the quality of clinical care.

• There must be a standards body to force all healthcare providing institutions to meet certain minimum standards to be allowed to operate. Pharmacy practice can only excel if the pharmacists are well equipped to provide care.

REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya

1 comment:

Henry Robinson said...

glycomet 1000 mg is an oral enemy of diabetic medication containing metformin as a functioning ingredient. The medication utilized is for the treatment of type 2 diabetes mellitus.