Clinical Pharmacy and Pharmaceutical Care: A Need to Homogenize the Concepts

To the Editor. Over the last 4 decades, the pharmacy profession has witnessed tremendous practice changes, especially after the introduction of clinical pharmacy concepts in the late 1960s, followed by the philosophy of pharmaceutical care in the early 1990s^1-9. The introduction of these concepts and philosophy in modern day pharmacy practice has transformed the pharmacist's role to focus more on patient-oriented services rather than the traditional focus on product and dispensing services. Over the years, after the successful introduction of clinical pharmacy concepts and services in the United States and Europe, the rest of the world has followed suit in transforming pharmaceutical services. Along with adopting these concepts and philosophy, these countries also need to change the existing pharmacy curriculum to provide the necessary training so that future pharmacy practitioners are equipped with the necessary knowledge and clinical skills. The impact of these changes was strong enough that even countries lacking in appropriate health infrastructure and education facilities were eager to produce future pharmacists trained in these concepts. This is evidenced by the variety of undergraduate pharmacy degrees such as doctor of pharmacy (PharmD) and master of pharmacy (MPharm) being offered to pharmacy undergraduates in developing countries. The programs in developing countries vary significantly from similar programs offered in countries such as the United States, Canada, and the United Kingdom. The main reasons for the differences in developing countries are differences in need, professional standards, and pharmacy practice. Both clinical pharmacy and pharmaceutical care are closely related concepts, although there are differences among the professional bodies that define them. For example, the United Kingdom Clinical Pharmacy Association describes clinical pharmacy as encompassing the knowledge, skills, and attitudes required by pharmacists to contribute to patient care. The European Society of Clinical Pharmacy defines it as a health specialty that describes the activities and services of the clinical pharmacist in developing and promoting the rational and appropriate use of medicinal products and devices.⁵

However, the American College of Clinical Pharmacy, in an abridged definition, describes clinical pharmacy as that area of pharmacy concerned with the science and practice of rational medication use. The practice of clinical pharmacy embraces the philosophy of pharmaceutical care; it blends a caring orientation with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes.¹ Whatever definition we choose, the basic essence of clinical pharmacy is the provision of pharmaceutical care to the patient, which is a different and more evolved form of hospital pharmacy services. Because many developing countries are adopting this concept by providing specialized positions for their hospital pharmacists, a strong need exists to standardize this specialized pharmacy service both in terms of education as well as practice. Pharmaceutical care is defined clearly by the professional bodies mentioned, and a clinical pharmacist is the one who possesses specialized clinical pharmacy education that enables him or her to deliver pharmaceutical care. The idea must be disseminated globally so that clinical pharmacy and pharmaceutical care are understood clearly, not only by the pharmacist but also by other health care professionals, as a distinct pharmacy practice. This is necessary because the whole concept has not been understood clearly among pharmacists, and if left unchecked numerous degrees with differences in standards and concepts about clinical pharmacy will result, as witnessed with the profession of pharmacy itself over the past few decades.

Syed Imran Ahmed
Syed Shahzad Hasan
International Medical University Kuala Lumpur, Malaysia
Mohammad Azmi Hassali
University Sains Malaysia Penang, Malaysia