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BOARD CERTIFICATION
Following didactic and experiential training, many clinical
pharmacists seek Board of Pharmacy Specialties (BPS)
certification (13). There are more than 21,000 pharmacists
worldwide who are BPS board certified in eight pharmacy
specialties: ambulatory care, critical care, nuclear, nutri-
tion support, oncology, pediatric, pharmacotherapy, and
psychiatric pharmacy. Future specialty certifications may
include infectious disease and cardiology among others.
Board certified pharmacists must pass a rigorous examina-
tion and then maintain accreditation through continuing
education or additional testing every 7 years. Board certi-
fication is a typical requirement to achieve privileges for
independent or collaborative practice. Aspects of privi-
leging are similar to those used for other medical providers.
CURRENT ROLES/BENEFITS OF CLINICAL
PHARMACISTS
Clinical pharmacists in the US have established roles in
many healthcare teams. Most are part of a multiprofes-
sional team for acute care or ambulatory care populations,
but some have a private practice upon referral from a broad
population of physicians. There are numerous examples of
the impact made by clinical pharmacists, and this paper
will highlight some recent publications (14).
Since medication management is the primary focus, most
measurements reflect optimal use of medications and
avoidance of adverse events. The broad use of antihyper-
tensive medications may lead to adverse outcomes if doses
are not properly titrated. The benefit of clinical pharmacist
education, monitoring and intervention was demonstrated
in a prospective, randomized study of 800 heart failure
or hypertension patients treated at the clinics of a large
public hospital (15). The patients with clinical pharmacist
interventions had a 34% lower risk of any adverse drug
event (ADE) or medication error (ME) (risk ratio 0.66, 95%
confidence interval [CI], 0.50-0.88) including a signifi-
cantly lower risk of ADE, preventable ADE, potential ADE,
and medication errors compared with control patients
treated at the same clinics. Patients with complicated
cardiovascular histories had the greatest number of medi-
cations and events. Pharmacist interaction, education, and
regular communication with the rest of the team improved
medication adherence, patient satisfaction, and reduced
healthcare utilization and direct costs of care. A system-
atic review of 12 randomized trials of clinical pharmacist
impact on heart failure patients showed similar benefits
with a reduced rate of all-cause hospitalization (Odds ratio
[OR] 0.71, 95%CI (0.54-0.94) and heart failure hospitaliza-
tion rate OR 0.69, 95%CI (0.51-0.94) (16). Other reviews
have described additional benefits of clinical pharma-
cist monitoring and interventions on a variety of treat-
ment endpoints (blood pressure, lipid profile, weight, and
glycemic control) (17). The American College of Cardiology
has endorsed a strategy of team-based care, including
clinical pharmacists (18).
Clinical pharmacists on medical inpatient acute care teams
have been shown to reduce preventable adverse drug
events by 78% (19). A clinical pharmacist who rounded
with a critical care team more effectively identified and
prevented more adverse drug events than pharmacists
involved in order entry and verification, and avoided the
potential expenditure of over $210,000 in 4.5 months.
(20) A review of 36 studies describing the impact of
clinical pharmacists on hospital inpatients suggests that
the addition of a clinical pharmacist to the acute care
team resulted in improved care, with no evidence of harm.
(21) Interacting with the team on rounds, interviewing
patients, reconciling medications from outpatient to
inpatient, patient discharge education, and follow-up all
resulted in improved outcomes. Highest risk patients such
as the very elderly, and the very young have been shown to
benefit from the presence of and contributions of clinical
pharmacists.(22,23)
INTERNATIONAL
Clinical pharmacists have increased in number throughout
the world, and patients have benefited. A survey in 2005
described critical care clinical pharmacist roles in 24
countries outside North America (24). The majority 74.4%
indicated that they attended medical rounds, almost all
(90%) prospectively reviewed drug therapy and intervened
to prevent drug interactions, ADE, and to optimize dosing
and frequency of administration. Pharmacists in Australia
have described medication therapy interventions for
hospitalized inpatients and demonstrated their ability to
reduce length of stay and over $4 million dollars of annu-
alized hospital cost savings in 8 hospitals (25). Over 25% of
the interventions were major or life-saving.
Pharmacists in the Netherlands have significantly reduced
prescribing errors and related patient harm by their pres-
ence on the ward compared with the baseline central
pharmacy services (26). Pediatric pharmacists in China
demonstrated a significant reduction in adverse drug
reactions, length of stay, and drug costs compared with a
control group of similar patients without a rounding phar-
macist (27). While these illustrate only a few examples,
there are pharmacists providing patient focused inter-
ventions throughout the world, including Chile. Clinical
[REV. MED. CLIN. CONDES - 2016; 27(5) 571-577]