“Clinical Pharmacy” in the Community Setting

A quick Google search of the phrase “Clinical Pharmacy” led me to Wikipedia’s definition which states “Clinical Pharmacy is the branch of pharmacy where pharmacists and pharmaconomists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention.”  I work at D-REX Pharmacy in Jonesville, NC where my title is “Director of Clinical Pharmacy Services” and my lab coat reads “Clinical Pharmacist.”  So what does that mean and am I really any different than any of my pharmacist colleagues?  Although I am the newest addition to our staff and the only pharmacist here with doctorate-level training, I would argue we are all clinical pharmacists.

It actually used to bug me when teachers and faculty at pharmacy school would try to persuade us to do a residency by insisting it was the “only way you would find a job in clinical pharmacy.” As my pastor would say, there is a good Greek word for that…bologna!  If we are performing our jobs correctly, I believe most any pharmacist practices “clinical pharmacy” whether they work in a small independent pharmacy or the largest teaching hospital in the country.  I won’t argue that there are some clinical aspects of pharmacy that are not applied in the community setting.  For example, I haven’t had to dose Vancomycin or aminoglycosides since finishing my pharmacy rotations. Nor do I monitor renal function in patients on Lovenox or other renally-adjusted medications.  But I do daily contact local physicians regarding patient drug allergies, therapeutic duplications, therapeutic substitutions, drug-drug interactions, and more.  It is quite remarkable the number of interventions a pharmacist makes on a day to day basis.  With or without Doctorate-level training, that is what I call clinical pharmacy!

Pharmaceutical Care was the buzz word during my four years of pharmacy school.  Similar to the definition of Clinical Pharmacy, Pharmaceutical Care is defined as “the responsible provision of drug therapy and other patient care services for the purpose of achieving outcomes related to the prevention or cure of disease, the elimination or reduction of a patient’s symptoms, or the prevention, arrest, or slowing of a disease process.”  There are several ways in which a community pharmacist performs pharmaceutical care every day, including administering drugs, documenting professional services, prospective drug utilization review, patient counseling, and medication therapy management.

Here at D-REX Pharmacy, we have taken several steps to provide better pharmaceutical care to our patients.  All four of our pharmacists are certified by the APhA in “Pharmacy-Based Immunization Delivery.” Last year was our first year of being able to personally provide vaccinations to our patients.  The state of North Carolina allows pharmacists to administer the influenza, zoster, and pneumococcal vaccines.

In November 2009, we held a Diabetes Day event with the purpose of launching our “Sweet Spot” classes.  The Diabetes Day event consisted of free blood glucose and blood pressure screenings, insulin pen demonstrations, personal question-and-answer sessions with a dietician, free diabetic shoe fittings, and more! Following the day’s activities, we held our first Sweet Spot class which covered “An Overview to Diabetes.”  The Sweet Spot curriculum, provide by creativepharmacist.com, follows guidelines set by the American Diabetes Association and uses a format that is easy to follow and understand by all patients.  We have continued to have success in December and January, and look forward to the class continuing to grow in the future.  We are particularly excited about February’s topic, “Foot Care,” since a local podiatrist has agreed to come and share his expertise!

Pharmaceutical Care is also provided to our patients by our compounding services.  Not only do we flavor medications and compound basic creams and ointments, but we also make medicated veterinary treats, various pediatric suspensions, and bio-identical hormone products.

D-REX constantly looks for ways to offer programs and services for our patients to achieve better health outcomes. Pharmacy students on fourth year rotations have offered Bone Marrow Density screenings, Asthma classes, and Smoking Cessation seminars.  The Patchwork of Hope Network provided us with curriculum to hold a Shingles Seminar on National Postherpatic Neuralgia (PHN) Day. (FYI…the first National PHN day was September 15, 2009).  We gladly jump on opportunities like these to educate our community on health issues and disease states.

My hope is that the future of pharmacy in the community setting will become more and more clinically focused.  The days of lick and stick, count and pour pharmacy are gone!  With the emergence of Clinical Pharmacist Practitioner (CPP) status, more pharmacists are able to make a direct impact in patient care.  A CPP is a licensed pharmacist approved to provide drug therapy management, including controlled substances, under the direction of, or under the supervision of a licensed physician.  Maybe one day we will have easy access to patient labs such as INR values or lipid panel results so that we can assist physicians in monitoring and optimizing patient care.  The possibilities are endless and I look forward to new advances in Clinical Pharmacy in the community setting.

One thought on ““Clinical Pharmacy” in the Community Setting

  1. Hello, I am a pharmacist in India working in a pharmaceutical company. I am very keen to open my own pharmacy in India. However, in India, runing a pharmacy means only and only filling the prescriptions. While clinical pharmacy as a branch of pharmacy, as a matter of fact, is in infancy when compared to the US, but the problems that we have now in terms of serious resistance from the physicians is not very different than what the pharmacists in the US had about 40 years back. Do you face resistance issues from the physicians when you practice clinical pharmacy in the clinical setting? I don’t want to run merely a prescription filling shop, but I actually want to add value to my prescription filling by giving medical advices to the patients pertaining to drug usage. Do you have any advices to offer?

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