Conventionally, pharmacists are perceived as drug experts who dispense medicine in front of a counter. However, this traditional image of a pharmacist is no longer applicable to the profession's diversified role today. In addition to dispensing medicine, pharmacists have found a niche role in providing clinical care side-by-side with doctors in the hospital.

Pharmacy, as a learned profession, has its history stretched long before the country gained its independence. Pharmacy service in Malaysia was established after the enactment of three cornerstone legislations, namely the Registration of Pharmacist Act 1951, Poison Act 1952 and the Dangerous Drug Act 1952. However, the nature of pharmaceutical work at that time leaned towards providing product-oriented services.

The focus of pharmacy then progressively shifted towards patient-oriented service. This was also when the concept of clinical pharmacy was introduced. As mentioned by the Malaysian Pharmaceutical Services Division, there were four elements to the new concept of clinical pharmacy at that time: total parenteral nutrition, drug information services, therapeutic drug monitoring, and cytotoxic drug reconstitution.

In 2004, the clinical pharmacy services evolved yet again by expanding into more areas. Some of these areas included ward pharmacy, medication therapy adherence clinic (MTAC) and methadone maintenance therapy. Among these clinical services, ward and MTAC pharmacists are the ones who work most closely with doctors in delivering patient care.

The role of ward pharmacists


Ward pharmacists are frequently, and rather misleadingly, identified as the only clinical pharmacists. However, unlike other pharmacists that are involved in the clinical management of patients, ward pharmacists have distinct responsibilities due to their unique position in the ward.

Ward pharmacists are part of the medical team and act as an authoritative source for pharmacotherapy decision making. These pharmacists will participate in daily ward rounds and provide drug-related information to doctors.

In addition, ward pharmacists are also involved in patient assessment, such as in patients' likely compliance level and past medical history. Moreover, if the patient has difficulty adhering to pharmacotherapy, ward pharmacists will need to suggest an alternative delivery route for vital medicine.

Medication compliance & MTAC


Another integral part of a pharmacist's work is to ensure that patients are fully compliant with their medications. In fact, local studies have suggested that, when pharmacists are actively involved in evaluating patients’ compliance, the intervention will result in significantly improved clinical outcomes for the patients.

The MTAC performs exactly this function. Frequently, a team of dedicated pharmacists will take the helm of MTAC to ensure a continuous, undisrupted service to the patients. In certain pharmacies that are hard-pressed on manpower, other pharmacists may take over the responsibilities.

The first of such service, a post-renal transplant MTAC, was initiated in 2004 under an ambulatory setting. It focuses on optimising pharmacotherapy, improving patient adherence to the complex medication regimen and preventing or reducing the occurrence of side effects from treatment. Since then, the number of public health facilities offering the MTAC service has ballooned to 660 in less than 10 years.

Currently, there are over a dozen different MTAC protocols covering distinct clinical areas such as diabetes, stroke, warfarin use and hepatitis.

Albeit clinical pharmacists are not formally recognised as specialists in their own field, these remarkable people have provided indispensable services to the patients. It is hoped that, in due time, clinical pharmacists will receive their well-deserved specialist status, and be recognised as an asset to the healthcare team. MIMS

Read more:
Wound care can be a successful niche for a community pharmacy
The role of pharmacists in palliative care
3 medication needs of elderly patients that a pharmacist should know

Sources:
Hassan Y. Challenge to Clinical Pharmacy Practice in Malaysia. Ann Pharmacother. 1993 Sep;27(9):1134–8.
Mohamad N. Clinical Pharmacy in Malaysia: Past, Present and Future. 2014.
Lim PC, Lim K, Embee ZC, Hassali MA, Thiagarajan A, Khan TM. Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia. Pak J Pharm Sci. 2016 Mar;29(2):595–601.
http://www.pharmacy.gov.my/v2/ms/dokumen/protocol-medication-therapy-adherence-clinic-hepatitis.html