Since the early introduction of clinical pharmacy into the Malaysian healthcare system, the profession has developed extensively into various sub-specialties. The focus in pharmacy has also shifted from product-oriented to patient-oriented. In fact, there has been greater emphasis on collaborative care with other healthcare professionals and greater emphasis on interactions with patients.
Clinical pharmacy services are beneficial to healthcare
To the author’s best knowledge, there is a lack of systematic review in the country to analyse if the integration of clinical pharmacy into routine medical care is truly beneficial. To a large extent, such analysis may be deemed unnecessary, as evident by the global progression in pharmacy to become more clinically relevant.
However, it is still interesting to look into just how much, and to what extent, clinical pharmacy has benefitted patients and the healthcare system as a whole.
A quick look into existing literature reveals that international research in this field has a dual-focused approach: clinical benefits to patients and cost benefits to the local healthcare system. A systematic review that looked at 36 different studies on the benefits of clinical pharmacy, including pharmacist's participation in ward rounds, medication reconciliation and drug-specific services, discovered that pharmacist's involvement in direct or indirect patient care generally results in improved efficacy with no evidence of harm.
Specifically, more than half of the studies that evaluated adverse drug reactions and medication errors found that the pharmacist's participation had a positive impact on the outcome. Moreover, the introduction of clinical pharmacists into the medical care team also brought improvement over medication history taking, better adherence to discharge medications by patients, and more appropriate use of medication in complex treatment regimens.
Clinical pharmacy has economic benefits
On the other hand, there are also numerous studies that looked at the cost-to-benefit ratio of introducing the clinical pharmacy service into healthcare.
A systematic review conducted in the early 2000s analysed 59 published papers, which collectively studied the economic impact of various clinical pharmacy practices. These included pharmacotherapeutic monitoring, target drug programmes, disease management programmes and patient education or cognitive services.
The majority of the studies (85%) reported a positive economic impact. However, most of the studies were conducted in the United States, and hence may not be representative of the situation in Asian countries as the healthcare system in Malaysia is significantly different from that of the US. Caution should hence be exercised when interpreting these results.
The human factor
While the data may suggest that clinical pharmacy has positive impacts on healthcare, there is still the human factor that comes into play. To work efficiently, clinical pharmacists must first earn the trust of their doctor counterparts, as these pharmacists have a direct influence on the doctors' patient.
The competency of the clinical pharmacist and his ability to work in an interdisciplinary team will determine the nature of the interactions. Subsequently, it will also impact how much the pharmacist can contribute to the team.
Clinical competency is likely to become the focus of many pharmacists in the future. Unfortunately, there are no clear pathways for clinical pharmacists in Malaysia to pursue the specialisations in their respective field.
There are many short-term training opportunities, but a nationally recognised specialisation scheme is still lacking. The relevant authority has revealed that there are plans to formally recognise pharmacists as specialists in the country. Such plans should be expedited for the benefit of all. MIMS
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Mohamad N. Clinical Pharmacy in Malaysia: Past, Present and Future. 2014.
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical Pharmacists and Inpatient Medical Care. Arch Intern Med. 2006 May 8;166(9):955.
Schumock GT, Butler MG, Meek PD, Vermeulen LC, Arondekar B V, Bauman JL, 2002 Task Force on Economic Evaluation of Clinical Pharmacy Services of the American College of Clinical Pharmacy. Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy. 2003 Jan;23(1):113–32.