IMPORTANCE OF CLINICAL PHARMACIST IN THE MANAGEMENT OF CHRONIC MEDICAL CONDITIONS.

 IMPORTANCE OF CLINICAL PHARMACIST IN THE MANAGEMENT OF CHRONIC MEDICAL CONDITIONS.

What are chronic medical conditions?

               The term chronic is used when the disease lasts for more than 3 months and requires a long term treatment.

Common chronic medical conditions includes Asthma, Cancer, Diabetes, Hypertension, Arthritis, Epilepsy, HIV/AIDS etc..,

Who is clinical pharmacist?

Clinical pharmacist is a healthcare professional who is specialized in clinical pharmacy where he/she provides direct patient care by individualizing the medication therapy, promoting health and helps in disease management.

What happens when people are on long term treatment?

Many people have to take medications for a very long period of time (tuberculosis, chronic kidney diseases, chronic liver diseases etc..,) or on permanent basis (hypertension, diabetes, epilepsy, asthma etc..,), but some characteristics of drugs makes it difficult for the patient to take them over long period of time and its becomes very difficult when taking several different drugs.

Some people don’t want to take medications ( Antiepileptics, Antineoplastics etc.,) for long periods because of fear of side effects.

Some adults as they become older they find it difficult to take solid dosage forms (Tablets, Capsules etc.,) so they might discontinue to take those medications.

Some medications (Antidepressants, Antipsychotics) will not show their effect immediately or patient could not feel the effect of the medication, then they think that the medication is not working and stops taking them.

Some of the medications ( Refampicin, Chloroquine, Metronidazole, Nitrofurantoin etc.,) changes the color of body secretions, then people may feel unsafe and worried and avoids taking them.

Some of the medications (Pantoprazole, Paracetamol etc.,) may interact with foods and leads to impaired efficacy of the drugs.

When people using medications (Theophylline, Phenytoin, Digoxin etc.,)  for long term use, the serum levels of those medications should be monitored regularly, otherwise continuous use of medications with no proper dose adjustment may leads to drug toxicity.

People who are taking medications on long term basis may also take medications for temporary medical problems like headaches, vomiting, diarrhea, constipation, fever, skin diseases, infectious diseases, injuries etc.., in such cases the number of drugs increases which leads to increased chances of drug interactions.

Examples:

Warfarin + paracetamol = increased risk of bleeding.

 Phenytoin + paracetamol = increased risk of hepatotoxicity

               Carbamazepine + antipsychotics = decreased plasma concentrations of antipsychotics.                   

If these drug interactions are not identified, they may leads to several serious consequences and sometimes leads to death also.

What is the need of clinical pharmacist in the management of chronic health conditions?

Anyone managing patients with chronic medical conditions understands the importance of medication management and adherence.

Physicians however have little time & knowledge on these issues and a possible solution is working with a clinical pharmacist.

The clinical pharmacists perform such tasks like medication management and adherence very effectively and are trained on best pharmaceutical practices.

Clinical pharmacists help manage chronic patients because they look at medications in a different way than any other health professionals.

Some of the important functions of clinical pharmacists are

                                      i.            Medication therapy management.

                                    ii.            Therapeutic drug monitoring.

                                  iii.            ADR monitoring and management.

                                   iv.            Drug interaction monitoring.

                                     v.            Selection of appropriate dosage forms & formulations.

                                   vi.            Medication adherence.

                                 vii.            Dose  adjustments & calculations ( mainly in multiple disease conditions)

                               viii.            Patient counseling.

Whenever all these activities are going on there are very less chances or no chances of getting drug interactions, ADR’s, drug toxicity, patient non compliance.

Through patient counseling and recommending appropriate dosage forms and formulations, clinical pharmacist can promote medication adherence, increases patient compliance, reduces the fear of side effects and avoids drug- food interactions.

So it is necessary for the health system to include clinical pharmacist for the management of chronic medical conditions.

In fact, clinical pharmacist is the major health professional to be considered as far as the drug therapy is concerned.

                                                           Dr, Sunil Paul Guttula  PharMD