Importance Of Clinical Pharmacists Research Articles

The Importance of Clinical Pharmacists in Improving Blood Glucose and Lipid Levels in Patients with Diabetes and Myocardial Infarction.

The aim of this study was to evaluate whether intervention by clinical pharmacists can improve blood glucose and lipid levels in diabetic patients with complex medical conditions. The retrospective database included 138 patients with diabetes who had presented with acute myocardial infarction (AMI) between January 2019 and October 2021. Blood glucose and lipid levels were measured within 12 weeks and 78 weeks of follow-up. Propensity score matching (PSM) was used to balance the confounding effects of patients' characteristics. A total of 138 eligible patients were assigned to either the intervention group (n = 47) or the usual care group (n = 91). After the intervention, there were significant improvements in blood glucose (glycosylated hemoglobin-HbA1C % from 9.0 to 8.3; fasting blood glucose-FBG mmol/L from 11.3 to 7.1; postprandial blood glucose-PBG mmol/L from 17.0 to 12.1; p < 0.001) and lipid levels (total cholesterol-TC from 4.9 to 3.5, low-density lipoprotein cholesterol-LDL-C from 3.0 to 1.8, p < 0.001, mmol/L) in both follow-up periods. The blood glucose effects were most pronounced in the PBG control rate (76.9% vs 54.0%) before PSM, while HbA1C% and PBG control rate after PSM were significantly higher in the intervention group (HbA1C% rate: 65.6% vs 38.5%; PBG rate: 79.2% vs 45.8%; p < 0.05, intervention vs non-intervention). Subgroup analysis further confirmed the improvement of blood glucose and lipid mainly in patients with higher baseline FBG (≧10mmol/L) and moderate follow-up duration (4-12 weeks). The intervention of clinical pharmacists in multidisciplinary team can significantly improve blood glucose and lipid levels in complex type 2 diabetic patients, especially those with high baseline FBG and moderate follow-up durations.

Clinical Pharmacy Education and Practice in Nepal: A Glimpse into Present Challenges and Potential Solutions.

This commentary article highlights the challenges in providing clinical pharmacy education in Nepal and suggests a few ways forward. Contrary to other health care professions, clinical pharmacy practice is a new healthcare discipline in the country which is currently undergoing transition. The existing pharmacy curriculum and training in the country can provide competencies needed for pharmacists in industrial settings. Considering the importance of clinical pharmacists in patient care, the Government of Nepal has implemented a policy recommending the recruitment of clinical pharmacists in hospitals. However, the education and training for pharmacists provided in the country are not sufficient enough for optimum patient care and for delivering clinical pharmacy services. International collaborations in terms of faculty and student exchanges, preceptor training, and accreditation by international organizations such as Accreditation Council for Pharmacy Education (ACPE), establishment of need-based curriculum, incorporating clinical pharmacy department under the organizational structure of hospitals, etc., may be the right approaches to improve the current status of clinical pharmacy education in the country.

A importância do cuidado farmacêutico em mulheres no período gestacional

A atenção farmacêutica é um serviço relevante na promoção do uso racional de medicamentos e sucesso farmacoterapêutico, devido ao conhecimento e acessibilidade existente por parte do farmacêutico. Logo, denota-se grande importância da prestação desse serviço às gestantes, em razão dos possíveis riscos materno-fetais associados ao medicamento. Bem como a doenças pré-existentes e condições durante este período que requerem a medicalização, como hipertensão arterial e diabetes mellitus gestacional, que apresentam grande relevância na saúde pública brasileira, em virtude da incidência que exibem e das complicações que podem provocar, consistindo em cenários oportunos para o acompanhamento farmacêutico visando auxiliar a adesão ao tratamento e promoção de saúde. Nesse contexto, objetivou-se compreender a importância do farmacêutico clínico na orientação farmacológica durante a gestação. Foi realizada uma pesquisa nas bases de dados Scielo, PubMed, Google Scholar e ScienceDirect, usando os descritores: categorias de risco; hipertensão; diabetes mellitus; automedicação; gravidez; náuseas; vômitos; eclampsia e assistência farmacêutica, todos selecionados dos DeCS nos idiomas: Português e Inglês. Evidenciou-se nesse estudo, a importância da atenção farmacêutica na gravidez, relacionado à orientação segura e adequada de terapias medicamentosas, reduzindo a automedicação, como também no processo de adesão terapêutica, através do acompanhamento contínuo e regular, destacando a importância da realização correta do tratamento e sugerindo intervenções terapêuticas necessárias, contribuindo assim para a melhora da qualidade de vida materno-fetal. Portanto, essa pesquisa assume relevância ímpar, uma vez que explanou a atenção farmacêutica para gestantes, colaborando para o desenvolvimento de ações e campanhas visando mostrar e conscientizar a importância do farmacêutico clínico durante a gestação.

The IMPACT OF CLINICAL PHARMACY SERVICES IN GENERAL SURGERY

Objective: The objectives of this study include performing pharmaceutical care-related research and documenting regarding drug-related problems in the surgery department. Further, these types of studies may bring consciousness to both physicians and patients regarding drug use in surgery.&#x0D; Methods: A Prospective interventional study was conducted in a general surgery hospital. The prescriptions were analyzed for the use of inappropriateness of drugs using the classification for drug-related problems.&#x0D; Results: Out of 100 cases, 62 patients were observed with drug-related problems. The number of antibiotics prescribed was 0, 1, 2, 3, 4, 5, 6 in 8, 11, 12, 32, 18, 18, 1 cases respectively. A significant increase in the outcome of antibiotic rationality and cases adhered to guidelines was seen in November compared to October and somewhat decreased in December due to some limitations. The overall study states that prescribing has a more important cause of Drug-related problems compared to dispensing and the use of the drug.&#x0D; Conclusion: Drug-related problems have to be acknowledged as a very important contributing treatment factor for the best health care outcome. Our study shows the importance of clinical pharmacists in every hospital for identifying and resolving drug-related problems and medication errors.

Assessment and Evaluation of Drug-Drug Interactions in an Intensive Care unit of a Tertiary Care Hospital and Clinical Pharmacist's Intervention Strategies

Aims: To identify and assess the prevalence of Drug-Drug Interactions (DDIs) in the prescriptions filled at Intensive Care Unit(ICU). To suggest necessary clinical pharmacist interventions and assess the importance of clinical pharmacist in ICUs. Methodology: Prospective interventional study conducted in a tertiary care hospital setting, South India for a period of six months (October 2017- March 2018) after the approval from Independent Review Board (PD007/IRB/NRML/17-18) A total of 120 prescriptions were screened during the study period for the possible DDIs by using Lexicomp software and Drugs.com drug interaction checkers. Identified DDIs were categorized based on their severity in to three types (major, moderate, minor DDIs) and based on their mechanism in to two types (Pharmacokinetic(PK), and Pharmacodynamic (PD) DDIs). Necessary clinical pharmacist interventions were proposed and discussed with the doctors during ward rounds. The acceptance of proposed interventions; outcomes of the study were documented. Different factors like age of the patients, number of medications, length of hospital stay and number of co morbidities were assumed to be the predictors contributing to DDIs .Statistical Analysis was done by using SPSS software 20.0 and Pearson’s test was used to assess the significant correlation between the predictors of DDIs. Results: Out of a total of 120 prescriptions screened, a total of 97 possible DDIs were observed in 65 prescriptions. The incidence of at least one DDI per prescription was 32.5%, two DDIs per prescription were 14.17% and more than two DDIs per prescription were 7.50%.The most prevalent type of DDIs was found to be moderate drug interactions accounting for 51.55% followed by major (32.99%) and minor (15.46%)DDIs. The high risk category of drugs involved in the DDIs was found to be Antibiotics (28.26%). Pharmacodynamic interactions (71.13%) with synergistic action (29.89%) were found to be most prevalent. Number of medications, length of stay and number of diagnosis were found to be significantly related to the risk of DDIs (P value 0.04, 0.05, 0.04 respectively).The level of acceptance of proposed interventions was 50%. The outcomes of the proposed interventions showed that a total of 28 possible potential DDIs had been prevented. Conclusion: Most of the drug interactions were predicable and preventable. The level of acceptance of interventions and the positive outcomes of this study supports the need for a clinical pharmacist in Indian hospital setting to optimize the patient care and improve the patient safety.

Decision aids in complex polypharmacy : Medication data bases and counselling by clinical pharmacists

The number of older people with polypharmacy (more than six drugs taken simultaneously) is increasing. The greatest proportion consists of guideline drugs, analgesics and psychopharmaceuticals because in many cases of geriatric multimorbidity several underlying main diseases are present which must be treated according to the guidelines. Polypharmacy is a complex and difficult situation for all treating physicians because substantial side effects and intoxication can be induced but it can also be very difficult to recognize which drug was at fault and how a reduction can be safely made. This article describes the exemplary case of a77-year-old patient with drug-induced delirium and demonstrates the procedure followed. The question of rapid assistance by the utilization of medication data bases is described and the importance of clinical pharmacists is demonstrated. In the future working with medication data bases will possibly become increasingly more important for physicians and hopefully simpler. The case presented here also shows that the effective and justified reduction of drugs can show a very good effect and is possible.

Acceptance and importance of clinical pharmacists’ LIMM-based recommendations

The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists. The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher. This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.

Clinical pharmacy services in an Iranian teaching hospital: a descriptive study

To understand the types of services provided by Iranian clinical pharmacists in nephrology and infectious disease wards, the acceptance rate of clinical pharmacy services in these wards by physicians and the clinical significance of these services in the main teaching hospital in Iran. Nephrology and infectious disease departments of a university hospital in Iran. During a 12-month prospective data gathering phase, details of all clinical pharmacy services in the nephrology and infectious disease wards of a large university hospital were recorded in the pharmacotherapy monitoring forms. Significance impact of clinical pharmacists' services was assessed according to the guidelines of The Society of Hospital Pharmacists of Australia. Number and type of services provided. During 1 year, clinical pharmacists contributed to 1,386 services for 1,105 patients who were admitted in these two wards; of these services, about 95% were accepted by the physicians and about half of them were of moderate-to-life saving clinical significance. Also at least 32% of services were considered to reduce the cost of drug therapy. These results support the importance of clinical pharmacists' participation in health care team rounds to improve the overall quality of medication therapy, enhance patient care and outcome and reduce drug costs to patients and society.