Challenges facing Clinical Pharmacy practice

'Clinical Pharmacy' needs no further introduction to pharmacists as it is the heart of pharmaceutical care. It has many peripheral specialised pharmacy knowledge that are equally vital to optimise the quality of health care. During the recent 2012 UK Renal Pharmacy Conference [1], this topic was well elaborated by Dr Chris Green [2]. Even though the discussion focused on the challenges facing clinical pharmacy in the UK National Health Service (NHS), I believe this is a global issue in the pharmacy world.

In the introduction of his talk, Dr Chris Green mentioned what pharmacists can learn from the Olympics. If we are the losing team, be a Challenger and ask ourselves ‘What can we do to close the gap?’ If we are the Record Holder, ask ourselves ‘What can we do to improve?’ If we are the Team Manager ask ourselves ‘How can we aggregate the marginal achievements?’ The cumulative answers will determine our current scale and what we should be aiming for and how long are we are willing to wait to achieve it. The following paragraphs may be using examples relevant to the practice in Malaysia, therefore I would like to apologise to my non-Malaysian readers. Neverthelss, we may share some basic principles.  

It is important for us to first accept the fact that the task in facing the challenges is the responsibility of the individual professionals forming the profession. This simply means it is OUR responsibility. Many of us, for many reasons, regard the responsibility entirely to the MPS, PSD, MoH [3] or the individuals holding certain posts and positions in the managerial level - an irresponsible dogma that should be eliminated as it brings more harm than good to us all. If this is not to your agreement, I doubt the content of this article would be an interest to you. You may want to stop reading at this point or carry on with an open mind. This article is written with the intention of sharing information and hopefully to inspire more pharmacists to move out from their current comfortable cocoon.

Dr Chris laid out five challenges or potential opportunities (depending to our individual perspective) that the profession or precisely WE need to tackle in order to place clinical pharmacy in the ground of our health care system, namely:

1. Leadership
2. Innovations

3. Clinical developments
4. Patient safety
5. Education & Training

Leadership

There is a reason for Leadership being first in the list - clearly stated realistic vision. Leadership is also important to initiate and sustain the wind of progressive changes. I have a simple analogy to share, carefully read these next three sentences: Strong leadership is the foundation of any successful organisation. A successful organisation has leadership qualities at all levels. All levels must be willing to be lead to achieve the clearly stated realistic vision.

If we draw a figure out of the above sentences, it will turn out to be a circular process. The better we are, the bigger our Leadership Cycle will be. There will be less turbulence and more positive energy when every unit of the cycle flow in uniformity. However, there are three factors that can potentially introduce gaps within this cycle. The gaps are contributed to either unrealistic vision which may put the cycle on pause or poorly communicated vision which may result in diversion of many peripheral stand-alone cycles. Both circumstances are equally destructive to the organisation. Perhaps it is time for our professional bodies to explore the potential of current technology as a mean of communication to ensure visions are clearly delivered and understood. The third factor is lack of leadership qualities in the individuals within the cycle.

Each one of us is a leader and should work in unity to build our professional Leadership Cycle. We must know how can we fit in. This is easily said than done because we do (at some point of our career) come across situations that can be frustrating; and when nothing much can be done about it (mostly due to unnecessary red tapes and lousy policies) it can be demotivating! Whether we like it or not...face it, do no turn our back and hide! Sharpen our leadership skills by analysing the root of the problem and find the most appropriate solution within the limitation.

Innovations

When is the last time we initiated something new? When is the last time we challenged ourselves to do something out of the norm?

Clinical developments

Are we joining the front line of the growing clinical developments? In the scientific world where evidence based is the only communicable langguage, we must be more than just a commentator. Pharmacists should be looking across the boundries and grab the opportunities to be hands-on in research. It is high time for us to be loud professionally otherwise we will always be the profession that has a history of rewarding clinical experience with management that does not reach any extraordinary potentials.

Patient safety

Data Rich but Information Poor : we have mega databases that are nicely kept but poorly utilised to generate information.  

Education & Training

Professional training and education is a vital investment. Many efforts has been put forward and is still taking place in our local system. The latest development is the BPS examination. A lot of ground work has taken place over the years before the recent BPS comes to reality. It would best for us to embrace the changes and look forward for the potential opportunities it may bring rather than bragging on the disadvantages. Other education and training that  we should aim to achieve in the near future are:

·         Career path (credentialing, consultant post)

·         Antibiotic stewardship

·         Medicine optimisation

·         Medication safety

·         Pharmacist prescriber

In conclusion, changing a gigantic system is difficult and almost impossible within days. It is best to stop wasting our energy pushing the wall. A more promising result is likely to be achieved by changing ourselves and the people within our reach.  Lead others to be a better leader than ourselves because change is a long term investment. There is obviously a lot of work to do in nailing clinical pharmacy practice into the health care system and there are many more challenges awaiting us. I would like to end this entry with a quote from President Barrack Obama:

 ‘Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek’ [4].

 
References:
1. UK Renal Pharmacy Conference 2012, 28-29 September 2012, Manchester
2. Dr Chris Green - ^{Clinical Director Pharmacy & Medicines Management, Countess of Chester NHS Foundation Chair UK Clinical Pharmacy Association}
3. MPS (Malaysian Pharmaceutical Society), PSD (Pharmacy Service Division MoH), MOH (Ministry of Health, Malaysia)
4.  http://www.brainyquote.com/quotes/authors/b/barack_obama.html#F2hvA2ldPzqCwZRd.99