Abstract:
A clinical pharmacologist in India is a
medically qualified professional who has received formal training in
clinical pharmacology. The curricular training helps in building
critical knowledge and honing relevant expertise in areas revolving
around medicines and their clinical use. A clinical pharmacologist is
traditionally engaged in drug development research, in medicines access
and utilization research, in developing policies and procedures for
appropriate and safer use of medicines, and in professional and patient
education for rational use of medicines.1 Beyond the
conventional role of a clinical pharmacologist, we propose an
additional, presumably a more direct role in optimization of patient
care. In the last one decade or so, this role is being explored and
cultivated by some trained professionals. And the experience so far has
been quite encouraging. Here we describe a scheme of ten key strategies
or activities regarding how clinical pharmacologists can apply their
skills and can pro-actively ensure patient safety.
A research reports approximately 5.2 million medical errors to occur
annually in India.2 Recent studies estimate that
medical errors in the United States are responsible for up to 251,000
fatalities annually, making them the third leading cause of
mortality.3 To minimize adverse outcomes related to
medicine use, and to maximize benefits, a ready-to-use intervention
bundle of clinical pharmacological reconciliation, review and feedback
(CPRRF) is proposed.
CPRRF consists of following strategies as:
- Evaluating if the duly prescribed medicine is unnecessary or
redundant, or no or a wrong medicine is prescribed for a given
indication;
- De-prescribing of medicines that are unnecessary or redundant or
contraindicated or not well tolerated;
- Identifying omissions and commissions during transition of care;
- Tailoring the dose adjusting to the individual need and perspectives
- Preventing, minimizing and managing adverse drug reactions (ADRs);
- Improving treatment adherence;
- Considering affordability and availability of medicines vis-Ă -vis
adherence
- Individualization of treatment accommodating patient factors;
- Rationalising polypharmacy especially in the elderly;
- Enhancing quality of life.
Clinical pharmacologists can play the above role in two ways: one,
responding to drug-related-problem cases and extending referral services
to other specialist practitioners; and second, allowing patients with
suspected drug-related problems to directly reach out to them seeking
relevant care. Further, some clinical pharmacologists may have interest
in a specific clinical area, namely, hypertension, asthma, or diabetes.
They can extend professional support in collaboration with clinical
experts in the corresponding areas. Further, some of them with
particular interest in toxicology, deal with drug overdose poisoning and
their emergency management. De-addiction measures for habitual use of
illicit drugs may be the interest area of others.
In outpatient clinics, clinical pharmacologists pre-emptively may
monitor and supervise patients at higher risk of drug-related problems.
Application of CPRRF principles by clinical pharmacologists can deliver
optimum patient care and promote both safety as well as effectiveness of
ongoing therapy. In elderly population polypharmacy, anticholinergic
burden and cardiac autonomic neuropathy are important areas and we in
our clinics, paid special attention to these areas and achieved better
patient outcomes. 4,5 We acknowledge that in reference
to treatment success, patient reported outcomes matter more than
physicians’ global judgment about treatment benefit. Evaluating a
prescription beyond its snapshot image and looking forward to capture
the bigger picture of prescribing continuum are crucial. judicious
de-prescribing is often beneficial and ensures prevention of prescribing
cascades. 6,7
It is generally held that clinical pharmacologists should play a
significant role in promoting prudent use of medicines. The World Health
Organization has emphasized the need to integrating clinical
pharmacology with the health service system. 8 It
seems we still have a long way to go to make this a reality.9 Application of CPRRF principles in different
sub-specialty domains is a need of the hour and clinical pharmacologists
can play a significant role.