Research on the Development of Clinical Pharmacy in Secondary Medical Institutions

LI Xue-jiao1,2, TIAN Li-juan1
(1.School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016, China; 2. Liaoning Electric Power Central Hospital, Shenyang 110002, China)

Objective To discuss the development of clinical pharmacy in secondary medical institutions. Methods Literature review was conducted to analyze the situation of clinical pharmacy in secondary medical institutions and some suggestions were raised to promote clinical pharmacy practices in secondary medical institutions. Results and Conclusion The development of pharmacy in secondary medical institutions should be based on the development of clinical pharmacy. A suitable clinical pharmacy education system should be established, and relevant laws and regulations must be improved to promote the development of clinical pharmacy in secondary medical institutions.

secondary medical institution; clinical pharmacy; rational drug use

The development of clinical pharmacy, a new discipline of hospital pharmacy, is uneven in China’s medical institutions at all levels. In 2011, the Ministry of Health issued Management Regulations of Medical Pharmacy which clearly put out that there should be at least five clinical pharmacists in three grade hospitals, and at least three clinical pharmacists in secondary hospitals. It provided a legal guarantee to the development of clinical pharmacy. At present, a relatively complete system of clinical pharmacy service has been established in the three grade hospitals in China[1]. But in most of the secondary hospitals, although the number of clinical pharmacists meets the standards, the specific clinical pharmacy service practice is not good.

1 Clinical pharmacy’s development in China

Clinical pharmacy originated in the US in 1960s[3]. Due to the damage of adverse drug reactions and druginduced illness, great pain and burden have been brought to patients and their families as well as the society, and under this background clinical pharmacy emerged.

In China, clinical pharmacy which was based on therapeutic drug monitoring began at the end of the 1970s. In the 1990s, clinical pharmacists started to participate in the medication[3]. With the rapid development of China’s medical and health sector, hospital pharmacy changed from the traditional model of supply to providing high quality service to the patients. China’s clinical pharmacy grows gradually from nothing. Though some achievements have been made, compared with the United States, Japan and other countries, China’s clinical pharmacy is still at the initial stage. With the development of society, improved living standards and health care system in China, pharmacists are prompted to transfer from “ensuring drug supply” to “providing drug knowledge aids and technical service”, and clinical pharmacists will play a more important role in rational drug use.

2 Status of clinical pharmacy in secondary hospitals

Compared with tertiary hospitals, the devices and medical standards in secondary hospitals are backward. Drug safety issues in these hospitals have become more prominent. Therefore, the demand for clinical pharmacists is more urgent. In order to better understand the practice of clinical pharmacy in China’s secondary hospitals, this study took a total of thirty pharmacists as the research object fromfive secondary hospitals, and we did some research on status of their clinical pharmacy practice. Results are shown in Table 1 and Table 2.

Table 1 Basic status of researched pharmacists

Table 2 Status of clinical pharmacy practice in hospitals

Meanwhile, three questions were asked including the main work of clinical pharmacy in the hospital, the reasons that hindered the development of clinical pharmacy in secondary medical institutions, and suggestions on promoting the development of clinical pharmacy. According to the results of the questionnaire, combined with the review of literature, we made the following conclusions. Firstly, there were not enough pharmacists in secondary hospitals, resulting in the lack of full-time clinical pharmacists, and they did not have the professional quality for clinical pharmacists’ work. Hospitals should focus on providing strong support to the development of pharmacy department and introducing talents. Secondly, when clinical pharmacists participated in checking the patients and giving advice on the doctor’s medication, they might have different views with the doctors at times. When such situation occurs, doctors, nursing staff and even patients could have skeptical comments on clinical pharmacists. It meant clinical pharmacists should continuously improve their professional quality by acquiring clinical knowledge and mater communication skills to communicate with doctors, nursing staff and patients. Finally, the responsibility of clinical pharmacist is not clear and there is no standard to assess their workload. Hospitals should introduce relevant policies to clarify clinical pharmacists’ responsibility and to ensure the smooth progress of their clinical practice. Meanwhile, hospitals should develop an assessment standard for clinical pharmacists to motivate their work interest.

3 Problems of clinical pharmacy in secondary medical institutions

The analysis of the status of clinical pharmacy in secondary hospitals showed us that clinical pharmacy hadthe following problems.

3.1 Imperfection of relevant laws and regulations

In terms of the development of clinical pharmacy in medical institutions, the government just made some policies for it without appropriate regulations and laws. “Medical Institutions Pharmacy Administration Regulations” only stated that medical institutions must be equipped with a corresponding number of clinical pharmacists and their job responsibilities. However, there were no clear definition of clinical pharmacists’ duties, and there were no legal regulations regarding clinical pharmacists’ responsibilities and management requirements.

3.2 Insufficient personnel training and the shortage of professionals

Firstly, the curriculum of colleges and universities can not meet the actual needs, emphasizing more on pharmacy, less on medical courses. To solve this problem, in recent years, many colleges and universities have set up clinical pharmacy major to meet the need of hospitals. However, students who major in clinical pharmacy in colleges and universities had little professional practice which caused most of pharmacists could not be qualified as professional clinical pharmacists. Secondly, the small number of clinical pharmacists is confined to ensuring drug supply and drugs dispense in secondary hospitals, and most of them are part-time pharmacists. Due to the lack of professionals who can understand pharmacy and clinical medicine, the development of clinical pharmacy in secondary hospitals is restricted.

3.3 The neglect of hospitals

As administrators in secondary hospitals lack a good understanding of the development of clinical pharmacy, they merely require pharmacy department to ensuring drug supply. Most pharmacy practice in secondary hospitals is still stuck in the “window-type” model and its service for patient is to dispense drugs by prescription, reviewing drug name, quantity and usage, etc. Review of prescription is limited to the incompatibility of medicines or whether a penicillin-sensitive test should be done. The work model of pharmacists is supplying drug and ensuring patients to get timely and accurate drugs in the prescription, rather than ensuring patients to get the most appropriate drugs. On one hand, secondary medical institutions are in extreme shortage of clinical pharmacy talents. On the other hand, pharmacists have few opportunities to participate in the study and training because administrators invest less on pharmaceutical development. Undergraduates, graduates and higher educated people are only involved in the drug dispense and storage. Most of the part-time clinical pharmacists’ work is merely to report prescription review and other unimportant things instead of the real sense of clinical pharmacy.

3.4 Shortage of medicine information

This is mainly reflected in the access to literature, medical information and so on. Because clinical pharmacists have not systematically learnt medical courses, they acquired medical knowledge primarily by self-taught and practical experience. They have to get access to relevant books and information in their daily work. However, secondary hospitals rarely purchase professional medicine software for clinical pharmacists. Then, the share of patient medical information is not enough. Therefore, it is difficult for clinical pharmacists to get the patients’ medical information, such as medical history, progress notes and treatment records.

3.5 The quality of clinical pharmacists should be improved

Clinical pharmacists do not adapt to the transition from “supplying drugs” to “patients’ medication”. At present, physicians are responsible for patients’ drug treatment program, and pharmacists are merely in charge of drug supply. With the development of clinical pharmacy, clinical pharmacists should participate in decision making in patients’ medication, tracking and monitoring patients’drug use as well. However, clinical pharmacists dare not to participate in clinical practice or communicate with doctors, nurses and patients due to the lack of self-confidence. Meanwhile, hospitals do not have the corresponding incentive systems which inevitably discourage pharmacists’enthusiasm. Therefore, most of the clinical pharmacy in secondary hospitals is merely on the surface.

3.6 doctors, nurses and patients have insufficient trust in clinical pharmacists

In the clinical departments, doctors, nursing staff and patients have a limited understanding of clinical pharmacists. They believe that pharmacists are responsiblefor distributing drugs, telling patient drug instruction and drug adverse reactions. Clinical pharmacists can not play a role in guidance and intervention on doctors’ medication due to the lack of trust from doctors.

4 Suggestions for promoting clinical pharmacy practice in secondary medical institutions

We made the following suggestions for the development of clinical pharmacy in secondary medical institutions faced with the status and problems of clinical pharmacy practice.

4.1 Improving the legal protection

The rights and obligations of clinical pharmacists were not clearly stated in the “Medical Institutions Pharmacy Management Regulations” implemented in March 2011 and other relevant laws and regulations. Health administrative departments should carry out researches and determine the clinical pharmacist examinations and access system so that the clinical practice of pharmacists can become professional. Government should continuously improve the law and promote the development of clinical pharmacists system[4].

4.2 Focusing on personnel training and increasing full-time staff

Medical courses should be added to the curriculum of clinical pharmacy in colleges and universities. Clinical pharmacists should have more job training, and the size and number of clinical pharmacist training bases must be expanded so that opportunities can be provided for pharmacists who want to participate in learning clinical pharmacy. Secondary medical institutions should increase the proportion of full-time clinical pharmacy staff, selecting and sending pharmacists to clinical training bases for further study.

4.3 Strengthening the support from the administrators of hospitals

Clinical pharmacy is an effective measure of hospital service and it is the basis for the development of hospitals. Hospital administrators should strengthen the awareness of clinical pharmacy practice, and pay attention to it. They should also actively promote pharmacists’ researches and create more opportunities for clinical pharmacists to learn, such as sending them to tertiary hospitals to further study or go to clinical training bases. Pharmacists should be encouraged to do clinical practice and to discuss clinical pharmacy treatment. Their views should be respected, and the cooperation between doctors and pharmacists should be strengthened. Hospitals should have enough positions for clinical pharmacists, and position promotion, title examination and review methods should be introduced so that people can realize the importance of clinical pharmacists.

4.4 Making full use of modern information to carry out clinical pharmacy practice

Hospitals should increase support for clinical pharmacy practice and introduce software to monitor rational drug use. The departments should be equipped with computers connected to the internet so that pharmacists can take advantage of abundant internet resources, such as the relevant medicine literature information query databases and professional electronic patients’ database. Clinical pharmacists can work better when they have strong technical support.

4.5 Strengthening self-improvement and clinical practice for clinical pharmacists

Pharmacy staff in hospitals should change their views from providing drug supply to participating in clinical rounds, consultation and emergency. Then they can continuously improve their pharmaceutical expertise like clinical diagnosis and treatment. Clinical pharmacists should also strengthen their self-learning. Determining their longterm goals, they can learn from the clinicians, and they must strengthen communications with doctors, nurses, patients and their families so that they can make progress together with doctors and pharmacists. Meanwhile, due to the poor conditions in secondary hospitals, clinical doctors should take advantage of the internet resource or going out to acquire new knowledge and enhance their self-improvement[4,5].

4.6 Developing professional clinical pharmacists

Because of the diversity of clinical diseases, clinical pharmacy should have professional development as clinical medicine. Specialization allows clinical pharmacists to perfect their professional expertise and become more convincing in their clinical practice, enhancing trust between medical staff and patients. Specialization cansmooth clinical pharmacy service in-depth[4].

5 Self-positioning of clinical pharmacists in secondary medical institutions

With the improvement of people’s awareness of health care and the promotion of national policies, clinical pharmacists must become the complex talents who not only understand drugs but also medicine. Nowadays, since secondary medical institutions have the medical service concept that patients are the center and rational drug use is the core, it has become a priority for clinical pharmacists to grow rapidly and play their role. In terms of this issue, clinical pharmacists should clarify their responsibilities, namely, they should provide a full range of service for patients, such as guaranteeing drug safety, monitoring patients’ health care and assisting medical staff. Firstly, they should change the existing mode from part-time to fulltime, and engaging in clinical pharmacy related practice. It includes participation in rounds and drug prescription, monitoring therapeutic drugs, writing medication history, collecting and reporting drug adverse reactions, compiling drug information and guiding medication for patients and so on. Secondly, clinical pharmacists should focus on improving their own quality. Clinical pharmacists in secondary medical institutions should continuously improve their professional skills, acquiring more clinical knowledge and enhancing their self-confidence to ensure patients’medication safety and receive more respect and attention when involved in patients’ clinical diagnosis and drug treatment. Thirdly, clinical pharmacists should learn some communication skills. When clinical pharmacists want to participate in doctors’ diagnosis and medication, it is bound to cause doctors’ doubt. In this case, good communication skills play a key role. They should communicate more with medical staff at times to avoid misunderstanding, making doctors feel being respected.

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[3] QU Hua-qiang, WANG Yan-ping. Current Situation and Future of Clinical Pharmacists in China [J]. Chinese Medicine Magazine, 2013, 2 (38): 459-460.

[4] CHENG Gang, ZHANG Jian. Exploration of Clinical Pharmacy Service Practice in Secondary Hospitals [J]. Chinese Medicine Guide Newspaper, 2010, 7 (23): 128-129.

[5] GUAN Zhen-shui. Methods and Importance of Clinical Pharmacy Service Practice in Secondary Hospitals [J]. Chinese Medicine Guide Newspaper, 2008, 10 (8): 1298-1301.

Author’s information: TIAN Li-juan, Associate professor. Major research area: Rational drug use. Tel: 024-23986543, E-mail: tianlijuan_8@126.com