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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]