Saudi Pharmaceutical Journal (2014) 22, 600602

King Saud University

Saudi Pharmaceutical Journal

www.ksu.edu.sa
www.sciencedirect.com

SHORT COMMUNICATION

Clinical pharmacists: Bridging the gap

between patients and physicians
Jolly Francis, Suja Abraham

Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Viswa vidyapeetham University, AIMS
Healthscience Campus, Kochi, Kerala, India
Received 7 February 2014; accepted 28 February 2014
Available online 12 March 2014

KEYWORDS
Pharmaceutical care;
Clinical pharmacist

Abstract The clinical pharmacy has spread out drastically in terms of its professional services
throughout the past few years. The clinical pharmacist become a crucial element of healthcare team
and promotes patient care by interacting with physician and patient. The aim of this paper is to
highlight the role of clinical pharmacists in various departments. It concludes that the features of
interactions occurring between clinical pharmacists and physicians inuence the teamwork between
pharmacists and physicians and provide better patient care.
2014 King Saud University. Production and hosting by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

The clinical pharmacy has spread out drastically in terms of

its professional services throughout the past few years. Now
the clinical pharmacy profession has been renowned as an
important profession in the multidisciplinary setup of health
care. The clinical pharmacist becomes a crucial element of
healthcare team and promotes patient care by interacting with
physician and patient. As clinical pharmacists have the precise
knowledge about therapeutics and regular interaction with
prescribers, they are ideally placed to bridge the gap between
patients and physicians. Association of clinical pharmacist
and clinician can provide a strong base for quality assured patient care. The presence of a clinical pharmacist on the ward
* Corresponding author. Address: Amrita School of Pharmacy,
AIMS Healthscience Campus, Kochi 682026, Kerala, India. Tel.: +91
9995162188.
E-mail address: suja_srmc@yahoo.co.in (S. Abraham).
Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

was a revolutionary feature of developments in the pharmacy

eld. Clinical pharmacists participate in ward rounds with
physicians and provide their suggestions or recommendations
wherever needed. The physicians prescribe medicines and the
pharmacist checks the prescription to ensure rational use of
drugs. They check whether there is an indication for the drug,
is it the right drug/dose/duration/dosage/time, etc. If there is
any deviation from these, they make appropriate interventions,
inform the prescriber and document the interventions. Complimentary agreement between the physicians concerning the impact of the intervention indicates that the pharmacists
intervention had a conrmed outcome on therapy.
Clinical pharmacists can contribute their efciencies in
medication review, identication of drug related problems,
therapeutic recommendations and promotion of medication
compliance. They obtain medical and medication history,
check medication errors including prescription, dispensing
and administration errors, identify drug interactions, monitor
adverse drug reactions (ADR), suggest individualization of
dosage regimen, provide patient counseling, etc. They also provide information about the use of drugs and medical devices

http://dx.doi.org/10.1016/j.jsps.2014.02.011
1319-0164 2014 King Saud University. Production and hosting by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Clinical pharmacists: Bridging the gap between patients and physicians

like inhaler, insulin pen, eye drops, nasal sprays, etc. Participation of a clinical pharmacist in ward/ICU rounds and clinical
discussions helps to identify, prevent or reduce drug interactions and ADR (Kucukarslan et al., 2003). In addition to this,
a clinical pharmacist can also actively participate in developing
cost-effective patient compliant therapy. They can actively
participate in creating a database for each drug as well as in
clinical trials. Pharmacists have an up-to-date knowledge in
the changing world of medicine and they can contribute effectively for clinical research project and other ongoing research
programs. In addition to this, clinical pharmacists do drug
dilutions, extemporaneous preparations, dose calculations, etc.
Clinical pharmacy services develop and maintain a clinical
practice with a patient care service, cooperating with medical
and nursing personnel to optimize the pharmacotherapeutic
aspects of patient care (Makowsky et al., 2009). This provides
optimal selection of pharmacologic agents, and design of a regimen to maximize therapeutics benet and minimize toxicity.
Clinical pharmacists provide daily follow-up on the clinical
effects of the regimen with adjustments as necessary to achieve
desired outcomes.
Need of clinical pharmacists in various departments
Clinical pharmacists are responsible to conduct a complete patient interview on medical history, social and family history,
history of allergy, use of OTC drugs, dietary supplements
and alternative systems of medicine. Clinical pharmacists perform review of drug therapy which helps to recognize and utilize relevant clinical and lab data to identify and resolve drug
related problems such as duplication of therapy, drugdrug
and drugfood interactions, contraindications, inappropriate
dosage [frequency, strength], lack of basic lab monitoring
requirements, potential ADRs, inappropriate drug selection,
drug therapy without indication or no drug order for an indication, non-adherence to medications and availability of cost
effective alternatives. They can assist in therapeutic decision
making and the preparation of guidelines for antibiotic usage
by assessing cost effectiveness.
Provision of unbiased, up-to-date information on any aspect of drug use is another major responsibility of a clinical
pharmacist. They are capable of providing information on
strength, availability of drug formulations, brand and cost.
They provide information regarding empirical dosing of drugs
in patients with impairment of renal or hepatic function. Since
the clinical pharmacists have a thorough knowledge about the
drugs they can easily identify and notify look-alike and soundalike drugs. They can actively participate in therapeutic drug
monitoring, medical camps and patient awareness programes
on medication usage.
Clinical pharmacists ensure that reconstitution, dilution,
stability, storage, compatibility and administration of drugs
are carried out appropriately. They facilitate conversion of
parenterals to oral dosage forms when indicated. Provision
of alert cards for selected patients who suffer from ADR or
taking medications that require special warning/caution
(epilepsy, cardiac problem, drug allergy or taking insulin,
warfarin, aspirin, etc) is another major task.
They have an active participation in physician rounds in
general and specialty departments. They provide patient counseling on medication usage, use of devices and life style

601

changes needed. The clinical pharmacist education sessions

and medication adherence programmes (pill box, use of diary
logs and follow up calls) proved benecial in reducing mean
FBS and HbA1c signicantly (Farsaei et al., 2011). Clinical
pharmacist in the endocrinology department gave counseling
regarding the proper usage of insulin pens, administration of
insulin injection, dietary restrictions, lifestyle modications,
importance of regular check up, etc.
Clinical pharmacists in pediatrics and neonatology help in
dose calculation and dosage form modication. The increased
need for calculations and dilutions of pediatric medicines, and
a requirement to adjust dose of an individual patient based on
age, gestational age, weight and surface area, provide a greater
opportunity for a clinical pharmacist in medication management process. They can help to prepare pediatric/neonatal formulary. They provide counseling to parents regarding
medication and immunization.
Clinical pharmacists in the stroke unit can identify risk
group of patients (bleeding), potential drug interactions and
reduce adverse effects. They monitor the INR range of patients
taking warfarin, and give proper advice to adjust the dose of
warfarin after consulting with the doctor. They provide counseling regarding the diet, need for INR monitoring, adverse
effects, its management, etc. Clinical pharmacist in oncology
department calculates the body surface area (BSA) for the
patients who are due for the next chemotherapy based on their
height and weight.
In patients with renal impairment, clinical pharmacist
should emphasize on drug dosing adjustments. An increase
in morbidity and mortality as well as therapeutic costs will
be the consequences of failure in doing dosage adjustment.
In these contexts it is highly recommended to estimate creatinine clearance prior to drug ordering and use reliable dosing
guideline. The adjustment of dose can be done by interval
extension or dose reduction. Estimates of renal function are
helpful in identifying patients who may need shorter dose
intervals (high clearance) or may be adequately treated with
smaller dose amounts or longer dose intervals (low clearance).
Patients who have undergone organ transplantation are also
necessitated to take a multitude of drugs and adherence to
these medications is important to get around graft rejection
and medical costs. A clinical pharmacist can be really helpful
to prevent the progression of ESRD by providing patient
counseling about lifestyle modication and educating and
motivating the risk group patients for regular check up and
adhering to therapy.
Clinical pharmacy services are not limited to the above
mentioned activities. Clinical pharmacists can implement
ever-expanding roles like therapeutic drug monitoring and
managing of patients pharmacotherapy which signicantly
improve patient care. The features of interactions occurring
between clinical pharmacists and physicians inuence the
teamwork between pharmacists and physicians and provide
better patient care. Clinical pharmacist could nd a solution
for a number of queries which included information of drug
prole, indication or dosage, adverse drug events, patient management, drug interactions, drug use in pregnancy and lactation, poisons and information regarding storage of drugs,
etc. They work with patients and other health professionals,
to support and assist patients to make lifestyle changes to
improve health outcomes. Improvements in the care of

602
patients, level of attention and disease management result in
control of risk factors and decline in health care costs.
References
Kucukarslan, S.N., Peters, M., Mlynarek, M., Nafziger, D.A., 2003.
Pharmacists on rounding teams reduce preventable adverse drug
events in hospital general medicine units. Arch. Intern. Med. 163
(17), 20142018.

J. Francis, S. Abraham
Makowsky, M.J., Schindel, T.J., Rosenthal, M., Campbell, K.,
Tsuyuki, R.T., Madill, H.M., 2009. Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. J.
Interprof. Care 23 (2), 169184.
Farsaei, S., Sabzghabaee, A.M., Zargarzadeh, A.H., Amini, M., 2011.
Effect of pharmacist-led patient education on glycemic control of
type 2 diabetics: a randomized controlled trial. J. Res. Med. Sci. 16
(1), 4349.