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the goal for clinical pharmacists is a broader approach

or comprehensive medication management (CMM). The

definition of CMM is the standard of care that ensures

each patient’s medications (prescription, non-prescrip-

tion, supplements, or herbals) are individually assessed to

determine if appropriate for the patient, effective for the

condition, safe for use with concurrent comorbidities and

therapies, and that the patient is able to take them. An

individualized care plan defines the goals, monitoring, and

intended outcome. The patient is an active participant in

the development of a CMM plan, along with other members

of the care team. Key elements of CMM will be described

in the Standards of Practice Section. The impact of CMM

provided by clinical pharmacists in ambulatory settings

is under investigation with a goal to determine effective

processes and to measure overall patient outcomes. The

disease-state specific medication therapy management

programs have shown a reduction in frequency of some

medication-related problems, including nonadherence,

and have lowered some healthcare costs (2).

CLINICAL TEAMS DEFINED

The American College of Physicians has described the clin-

ical care team in the United States as the health profes-

sionals-

physicians, advanced practice registered nurses,

other registered nurses, physician assistants, clinical phar-

macists, and other health care professionals-with the training

and skills needed to provide high-quality, coordinated care

specific to the patient’s clinical needs and circumstances

(3). Support for team-based practice is also provided by

the American College of Obstetricians and Gynecologists,

the Society of Critical Care Medicine, and other organiza-

tions (4). While the composition of teams may vary, the

responsibility and authority for specific aspects of care

are optimally assigned to the person most appropriate for

the task. Optimal team effectiveness relies on a culture of

trust, shared goals, effective communication and mutual

respect. The best interests of the patient should be the

driving force for team activities. All team members need

not be in a single location and as such the broad group

of health professionals certainly includes general practice

pharmacists in hospitals, clinics, and retail settings.

While just a single example, patients benefit from team-

based care through improved control of BP, and a higher

proportion of patients achieved controlled BP when a

pharmacist was part of the team (5).

The composition of dynamic clinical teams is reflected in

the multi-professional nature of large professional orga-

nizations such as the Society of Critical Care Medicine,

the Society of Hospital Medicine, the American Society

of Parenteral and Enteral Nutrition, and the Neurocritical

Care Society. Most of these organizations include clinical

pharmacists in governance roles, including the presidency.

PHARMACIST PROCESS OF CARE

Pharmacists in the United States are expected to practice

in a uniform manner according to the Pharmacist Process

of Care published in 2015. This process includes multiple

steps in the medication therapy sequence. The steps are

illustrated in Figure 1, and include collection of pertinent

patient care data, assessment of data relative to patient

goals, development of a patient-centered plan, implemen-

tation of the care plan for therapy and monitoring, and

reassessment and revision of the plan- all in collaboration

with the care team (6). However, it is realistic to assume that

practitioners who were trained many decades ago, and who

remain in practice are likely to have a different approach to

direct patient care than the younger pharmacists who have

been trained this way. However, the POC allows training and

job descriptions to be focused on a consistent endpoint and

defines the minimal expected activity for all pharmacists in

all settings. In medicine, the POC is much more standardized

and serves as the model for pharmacy.

CLINICAL PHARMACIST STANDARDS OF PRACTICE

Clinical pharmacists are pharmacy the practitioners who

specialize in direct patient care. While they are expected

to follow the steps described in the Pharmacist POC, the

Standards of Practice (SOP) guide the clinical pharmacist

to comprehensively assess medication related needs, and

frequently, to manage complex and specialized regimens.

(7) The documentation requirements are more detailed,

and when applicable must be compatible with billing

requirements. The clinical pharmacist may practice more

independently in some settings, especially as defined by

organizational privileges. Clinical pharmacists who have

achieved the proper credentials and certification now must

obtain hospital privileges like physicians and advanced prac-

tice providers. They are required to maintain a valid license,

but have additional maintenance of certification require-

ments. The clinical pharmacist SOP also includes educational

activities, scholarly pursuits, and quality improvement.

TRAINING CLINICAL PHARMACISTS

Pharmacy training varies throughout the world. In the

United States (US), a pharmacist is eligible for licensure

after 6 years of education and attainment of a Doctor

of Pharmacy degree. While not required, many of these

[REV. MED. CLIN. CONDES - 2016; 27(5) 571-577]